الفهرس 
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Abstract
Psoriasis is a common chronic immune mediated skin disorder affecting about 2-3% of world population. The clinical features of psoriasis include erythematous plaques with thick, silvery scales, and sharply defined margins involving the scalp and extensor surfaces of the elbows, knees, and back.
The etiology of psoriasis is still unclear, but it is considered a disease of dysregulated inflammation which is driven and maintained by interaction among multiple components of immune system in genetically predisposed individuals that leads to production of cytokines, chemokines and growth factor which act on epidermal cells, dermal blood vessels and other inflammatory cells.
Psoriasis is characterized by its specific histological changes, including abnormal epidermal proliferation, parakeratosis, loss of the granular cell layer, epidermal acanthosis, dilated and tortuous vasculature and cellular infiltration of neutrophils and T-cells.
Squamous cell carcinoma antigens, members of the ovalbumin serpin family, were originally discovered as tumor-specific antigens and are used as tumor markers for various kinds of squamous cell carcinomas.
Squamous cell carcinoma antigens contain two homologs, SCCA1 and SCCA2, which belong to the high molecular mass serine proteinase inhibitor superfamily. Although they are nearly identical (92% identical in nucleotide level), characteristic features of these molecules are unique inhibition spectra against proteolytic enzymes. SCCA1 is very different from other serpins and inhibits papain-like cysteine proteinases, cathepsins K, L, and S. SCCA2 shows ordinary serpin-like properties and inhibits chymotrypsin-like serine proteinases, cathepsin G and mast cell chymase.
The aim of our study was to assess the expression of squamous cell carcinoma antigen II in skin of psoriatic patients and compare the results with its expression in skin of healthy control cases and to detect its correlation with activity of psoriasis, and possibility of using SCCAII as a marker for psoriasis severity.
The present study included 24 psoriatic patients with chronic plaque phenotype who had not received any topical or systemic therapy in the last 3 months and 24 healthy controls matched for age and sex .The psoriatic patients were evaluated according to their age, sex, duration of the disease, distribution of the lesion and severity of the disease using PASI score. Biopsies from both psoriatic patients and controls were processed for histopathological and immuno-histochemical study to detect the level of SCCA II.
In the current study, there were no significant differences regarding age and sex between psoriatic patients and healthy controls. There was a significant positive correlation between PASI score and age of psoriatic patient (P value=0.001).Also, there was a positive significant correlation between duration of the disease and PASI score (P value =0.001).
In our study, there was no significant difference regarding PASI score, sex and family history. Significant differences were recorded between psoriatic patients and controls regarding density of dermal inflammatory infiltrate.
In this study, there was a significant difference between psoriatic patients and controls regarding SCCA2 expression in the epidermal skin layers. SCCA2 expressed in lower 2/3 of epidermis in moderate cases and expressed in whole thickness of epidermis in severe cases, while was expressed only in the basal cell layer of normal skin.
In our study, IHC score among psoriatic patients was, 41.7% had moderate score, while 58.3% had strong score. We also reported positive relation between PASI score and IHC score.
In the current study, patient group has higher expression of SCCAII in skin than in control group with significant difference, and there was positive correlation (P< 0.05) between IHC score and PASI score. So, the estimation of the SCCAII expression can be used as a tool for monitoring disease activity and as a marker for disease severity.
CONCLUSION
Our study suggests that, SCCAII is involved in the pathophysiology of psoriasis and has a possible association with disease severity. SCCAII significantly decreased with the decrease of PASI scores. SCCAII may be a useful biomarker in psoriasis, reflecting T-helper 17-type inflammation – the main determinant of the severity of psoriasis.
RECOMMENDATIONS
from the results of the current study, we recommend:
1. Further studies on SCCAII expression to be performed on large scale of psoriasis patients to understand more its different contributing mechanisms.
2. Studying serum level of SCCAII and other cytokines in psoriasis to detect role of theses cytokines in SCCAII expression in psoriasis.
3. Moreover, further researches are needed to understand the correlation between level of SCCAII and other types of psoriasis.
4. Using of SCCAII expression level in monitoring disease activity and its use as marker of disease severity in treated psoriatic patients.
5. Studying SCCAII expression before and after treatment, in lesional and non lesional skin and compare the results with its serum level.