الفهرس 
PSORIASIS
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Abstract
Psoriasis is one of the most prevalent chronic inflammatory
skin diseases, affecting 1–3% of the Caucasian population
and causes significant impairment of quality of life, at least to
the same extent as other major medical diseases.
Although the precise pathomechanism of psoriasis
remains unknown, various cytokines and growth factors are
involved in this disease. TNF-α is a pleiotropic inflammatory
cytokine, and studies indicate that TNF-α plays a critical role in
the development of psoriasis.
Psoriasis is associated with increased risks of
cardiovascular disease, metabolic syndrome, diabetes and obesity
compared with non-psoriatic skin diseases.
Adiponectin is an adipocyte-specific secretory protein
abundantly present in the circulation. Plasma levels of
adiponectin are decreased in obesity, insulin resistance and type
2 diabetes and hypoadiponectinaemia is assumed to be closely
associated with the metabolic syndrome.
Considering the fact that adiponectin is related to
metabolic syndrome which can coexist with psoriasis, it cannot
be excluded that this protein plays a role in pathophysiological
processes in psoriasis.
This study included 50 patients with chronic plaque
psoriasis with variable extent of lesions, 25 of them are with
metabolic syndrome and 25 are without, as well as 50 control subjects, 25 of them are with metabolic syndrome and 25 are
without. All cases were subjected to complete history taking,
general examination and clinical examination including
Psoriasis Area and Severity Index (PASI) score.
Peripheral venous blood samples were withdrawn from
patients and controls in the morning after 12 hours overnight
fasting. Serum levels of TNFα and adiponectin were measured
using (ELISA) methods. Serum triglycerides and HDL were
measured also for both patients and controls.
The patients were treated until their initial PASI score
decreased to 50 % (PASI 50) using topical treatments like
several types of emollients, betamethasone (valerate) 1 mg/gm
cream and ointment, calcipotriol ointment and calcipotriol 0.05
mg/gm with betamethasone 0.5 mg/gm ointment, phototherapy
and systemic agents like methotrexate, cyclosporine and
acitretin were also used according to the disease severity, the
general condition and the history of previous medications in
different patients.
In the present study serum levels of TNFα and
adiponectin are significantly increased in psoriasis patients
compared to controls which is in agreement with several
studies, the adiponectin levels are significantly lower in
psoriatic patients with metabolic syndrome in comparison to
those without metabolic syndrome, the levels are also
significantly lower in controls with metabolic syndrome in
comparison to those without metabolic syndrome, this is in contrast to TNFα levels which are higher in cases and controls
with metabolic syndrome in comparison to those without
metabolic syndrome.
Our study shows positive correlation of TNFα and
adiponectin to PASI score although the correlation was not
statistically significant.
The serum levels of TNFα and adiponectin are decreased
with treatment of the cases and the difference between pre and
post treatment levels is statistically significant.
In the present study, statistically significant positive
correlation of serum TNFα level in psoriasis patients in relation
to age, waist circumference, fasting blood sugar and body mass
index is detected. By comparing among patients, highly
significant higher levels of TNFα are detected in smokers in
comparison to non-smokers.
As regards adiponectin, there is statistically highly
significant positive correlation between its level and the disease
duration, also there is statistically significant negative correlation
between the adiponectin level and the body mass index.
Also when comparing serum adiponectin levels among
patients, highly significant higher levels of serum adiponectin
are detected in males in comparison to females, also there is
significantly higher levels in smokers in comparison to nonsmokers.