الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Psoriasis is a chronic immune-mediated inflammatory disease that affects skin, nails, and joints.
It affects both sexes equally, with an incidence of 2 - 3% of the world̓̓̕ s population. It appears in a bimodal pattern, with a first peak at 16 - 22 years (type 1 psoriasis) and a second peak at 57 - 60 years (type 2 psoriasis).
Incidence of psoriasis is higher in first and second degree relatives than in general population. At least nine chromosomic loci associated to psoriasis (known as PSORS 1 to 9) have been recognized. Between 35 and 50 percent of patients with a familial disease have PSORS 1 alteration; it appears clinically as psoriasis vulgaris in 90 percent of patients.
The increased inflammatory mediators, secreted by various immune cells, in psoriasis such as TNF-α, INF-γ, and IL-1 and IL-6, have pleiotropic effects on different processes like angiogenesis, adipogenesis, lipid metabolism, immune cell traffic, and epidermal proliferation.
The deep impact of psoriasis on the quality of life has been acknowledged, and it has been considered one of the most psychologically and socially disabling skin diseases.
In recent years, particular importance has been given to co morbidities frequently associated to psoriasis, such as various degrees of insulin resistance, obesity, blood hypertension, dyslipidemias, and cardiovascular diseases, as well as a higher incidence of neoplasias and autoimmune diseases.
Traditional options for psoriasis include topical therapies as topical corticosteroids; vitamin D analogues; and topical retinoids; for mild degree psoriasis, phototherapeutic modalities including; UVA; PUVA; BB-UVB; and NB-UVB for moderately severe psoriasis or psoriasis that has not responded to topical treatment alone, and systemic therapies as cyclosporine; methotrexate; and acitretin for more severe and generalized psoriasis. The biologic agents as infliximab and etanrecept represent a newer treatment option for moderate and severe psoriasis.
Folic acid is an essential vitamin for cell division and cell growth. Patients with psoriasis exhibit a low serum folate level due to increased utilization of folate by the hyper proliferating epidermal cells in psoriatic plaques. Insufficient folate levels predispose to folic acid deficiency anemia, pregnancy complications such as spontaneous abortion, congenital malformations like neural tube defect and severe language delay in the offspring. In addition folate deficiency may increase the risk of colorectal carcinoma and cause hyperhomocysteinemia which is thought to be a risk factor for cardiovascular disease and associated with depression and dementia.
Chronic inflammation related to psoriasis, as well as its systemic treatment are associated with elevated levels of serum total cholesterol, LDL cholesterol and /or triglycerides, and decreased HDL cholesterol. These lipid abnormalities are correlated with increased mortality due to myocardial infarction and stroke.
Narrowband ultraviolet B (NB-UVB) phototherapy is a widely used modality in the treatment of psoriasis and is generally accepted as safe method of treatment during pregnancy. NB-UVB phototherapy causes folate photolysis, which will greatly increase the incidence of complications associated with folate deficiency. Also NB-UVB phototherapy changes cell membrane permeability leading to increased lipid perioxidation, affecting lipid indices; which in turn lead to atherogenesis.
The goal of our study was to evaluate the effect of NB-UVB phototherapy on serum levels of folic acid and total cholesterol in patients with psoriasis aiming for proper selection of the safest modality of treatment for these patients who exhibit low serum folate level and have many cardiovascular risk factors.
This study included 30 patients with psoriasis vulgaris involved ≥ 20% of their total body surface area and undergoing NB-UVB treatment. All studied patients were subjected to; history taking (personal history, present history, past history, and family history), general examination and dermatological examination for identification the clinical type of psoriasis and PASI score calculation; NB-UVB phototherapy up to 36 sessions; and laboratory investigations including; serum sample collections ( 2 samples were collected from each patient: one at the first visit and the other after 36 sessions of NB-UVB) and storage of samples at -20 C°. After that, samples were analyzed for estimation of serum folate levels using Human Folic Acid Enzyme Linked Immunosorbent Assay (ELISA) Kit and estimation of serum total cholesterol levels using enzymatic colorimetric method.
Results were reported as mean ± SD for quantitative data and frequency and distribution for qualitative data. Data was analyzed statistically by student̕ s t-test and Chi square test. A P value < 0.05 was considered statistically significant (S) while > 0.05 statistically non significant (NS) and a P value < 0.01 was considered highly significant (HS) in all analysis.
The results of this work showed the following:
1. There was statistically significant DROP of serum folate after 36 sessions of NB-UVB.
2. There was statistically non significant difference in serum level of total cholesterol after 36 sessions of NB-UVB.
3. There was highly statistically significant difference of PASI score before and after NB-UVB phototherapy, indicating significant improvement in the clinical state of psoriasis.
4. There was statistically significant negative correlation between PASI score and serum folate before NB-UVB phototherapy.
5. There was statistically significant negative correlation between PASI score and serum folate after 36 sessions of NB-UVB phototherapy.
6. There was statistically significant negative correlation between PASI score and serum TC before NB-UVB phototherapy.
7. There was statistically significant positive correlation between PASI score and serum TC after NB-UVB phototherapy.
8. There was highly statistically significant difference between serum FA before and after NB-UVB phototherapy in patients with BMI > 25 kg/m².
9. There was statistically non significant difference between serum FA levels before and after NB-UVB in patients with BMI ≤ 25 kg/m².
10. There was statistically non significant difference between levels of serum TC before and after NB-UVB treatment regarding BMI of patients.
11. There was statistically significant DROP of serum FA levels after NB-UVB phototherapy in patients with duration ≤ 77 months and in patients with duration > 77 months.
12. There was statistically significant difference of TC levels before and after NB-UVB in patients with psoriasis duration ≤ 77 months.
13. There was no statistically significant difference of serum TC levels before and after NB-UVB in patients with psoriasis duration > 77 months.