الفهرس | Only 14 pages are availabe for public view |
Abstract Psoriasis is a common, chronic, and recurrent inflammatory skin disease of a complex, multifactorial hyperproliferative and T cell- mediated inflammation. It is a polygenic disease and various triggering factors, e.g. trauma, infections or medications, may elicit a psoriatic phenotype in predisposed individuals. The Clinical hallmarks comprise a sharply demarcated erythematous plaques with silvery white scales, these scaly red plaques are a clinical reflection of hyperkeratosis, parakeratosis, acanthosis of the epidermis, tortuous and dilated vessels, and an inflammatory infiltrate composed primarily of lymphocytes. Obesity has long been associated with and considered detrimental for psoriasis. Patients weighing more than their ideal body weight also tend to have worse psoriasis in terms of the proportion of involved skin, and the extent of their psoriasis lesions correlates with body mass index (BMI). Expansion of adipose tissue during weight gain leads to the recruitment of macrophages into the adipose tissue, and this is probably mediated by adipocyte- derived chemokines such as CCL2 (monocyte chemoattractant protein-1).Macrophages are the chief source of adipose tissue-derived tumour necrosis factor (TNF)-a and are an important component of the non-adipocyte fraction of this tissue, which is also the main source of interleukin (IL)-6 and CXCL8. - - Summary & Conclusion These cytokines are abundant in psoriasis skin, their levels in suction blister fluids of involved psoriasis skin correlate with disease severity and both have established roles in psoriasis pathogenesis. The risk of psoriasis is directly related to body mass index BMI, and that patients with obesity are likely to have severe psoriasis. Psoriasis and obesity share similar mediators of inflammation, mainly tumor necrosis factor(TNF) and interleukin (IL)-6, and the effectors of adipocytic and psoriatic inflammation, mainly adipocytes and macrophages, derive from a common mesothelial origin, the high circulating leptin levels in individuals with psoriasis may drive not only from fat tissue but also from inflammation. Body weight loss has been reported to significantly decrease leptin levels and improve insulin sensitivity and may reduce the likelihood of developing metabolic syndrome and adverse cardiovascular diseases so, Body weight loss could potentially become part of the general treatment of psoriasis, especially in patients with obesity. The present study was performed on (38) psoriatic patients attending to dermatology clinic Suez Canal university, and (38) control group. All patients were subjected to clinical history taking, clinical and dermatological examination. PASI score and BMI were calculated and serum leptin levels were measured by ELIZA technique. In our study, patients with psoriasis were found to have elevated serum leptin levels in comparison to normal controls. Moreover, a significant correlation between serum leptin in psoriatic patients and - - Summary & Conclusion their BMI was found, whereas no significant correlation between serum leptin with the disease duration nor severity of psoriasis. Also, there was no significant correlation between severity of psoriasis and the disease duration nor BMI . In conclusion, our study provides further evidence on the importance of leptin in the pathogenesis of psoriasis based on its elevation in the serum of psoriatic patients that probably reflects activation of T cell mediated immuno-pathogenic mechanisms in response to these elevated levels. Also elevated leptin may play a role in psoriatic patients due to elevated BMI in these patients, but it is not contributing to the severity and chronicity of the disease. |