الفهرس 
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Abstract
Psoriasis is a disease of multifactorial origin where certain environmental factors acting on individuals with specific genetic predisposition lead to an immune dysregulation and abnormal keratinization which results in the appearance of typical cutaneous lesions( Ghosh and Panda, 2017). Psoriasis is a common immune mediated and chronic inflammatory skin disorder described as hyperproliferation and maturation impairment of keratinocytes, increased immune cells infiltration and blood vessel formation, and accumulation in proinflammatory cytokines (Rapalli et al., 2018) with an estimated worldwide prevalence of 0.5–11.4% in adults, and 0–1.4% in children (Michalek et al., 2017). Acitretin is a retinoid (vitamin A derivative) that can be used for moderate-to-severe psoriasis vulgaris, as well as local or generalized pustular or erythrodermic psoriasis. In contrast to other systemic therapies, it is not considered cytotoxic or immunosuppressive. This is considered an advantage for patients with malignant tumors. Also, it has an antiproliferative effect that is partially preventive for epithelial tumors of the skin (Carretero et al., 2013). Acitretin acts by modulating the proliferation of epidermal keratinocytes. In hyperproliferative tissue, such as psoriasic plaques, acitretin has an antiproliferative effect, whereas in healthy tissues it induces proliferation. In psoriasis, this anti-proliferative action reduces desquamation, erythema, and the overall thickness of the lesion. Some authors give retinoids a role in the modulation of the T-cell response, the inhibition of chemotaxis, and the activation of polymorphonuclear leukocytes (Carretero et al., 2013).Aim of the study:In this study we evaluate serum level of adipocyte fatty acid-binding protein (FABP4) in patients with psoriasis vulgaris and compare it with its level in healthy control And also we Compare between serum level of adipocyte fatty acid binding protein (faBP4) before and after 12weeks of treatment with acitretine as antipsoriatic systemic therapy.Patient and Method: Seventy-four person were included in this study.A case study group of 37 patients with psoriasis vulgaris and 37 of healthy people as a control group of similar age and gender was included.The patients were selected based on the following criteria for inclusion Criteria: Patients with chronic plaque psoriasis above 40 years old and exclusion criteria:Systemic disorders (Diabetes, hypothy-roidism or hyperthyroidism),Pregnancy and reastfeeding, Malignancy,Systemic drugs during the last 3 months prior to study,Dietary restrictions during the last 3 months prior to the study, Liver cirrhosis,Cardiac failure.Result: non-statistically significant difference between cases and control group regarding their age, weight, height and body mass index with p value >0.05. Mean (SD) age of the studied cases is (56.59 ± 10.67) years versus (56.59 ± 9.71) years for control group. Mean (SD) body mass index is (28.86± 6.36) kg/m2 for cases and (27.17± 6.62) kg/m2.The median disease duration is 8.0 years ranging from 1.0 to 40 years and median PASI score is 15.4 ranging from 1.9 to 65.4.The mean blood pressure, random glucose and lipid profile illustrate non-statistically significant difference between cases and control group except for cholesterol which show statistic significant higher result in cases than control group (170.49 versus 153.67, respectively) and for ALT which is statistically significant lower in cases than control group (36.62 versus 41.46, respectively).The median FABP4 before acitretin therapy shows a statistically significant higher median value among cases than control group (2.95 versus 2.6). A non-statistically significant difference is detected between cases and control group after acitretin therapy (p=0.751). Median FABP4 is decreased from 2.95 to 2.4 before and after acitretin therapy with statistically significant change (p<0.001).The receiver Operating characteristics Curve validity for detection of FABP4 before acitretin therapy as regards differentiating studied cases illustrates excellent area under curve of 0.728, p<0.001* with the best detected cut off point is 2.7 yielding sensitivity of 75%, specificity 81.1% and total accuracy of 78.1%.There is statistically significant negative correlation between FABP4 and AST (r= -0.370, p=0.024) among control group.There is statistically significant positive correlation between FABP4 and PASI score (r= 0.437, p=0.008). And between FABP4 & cholesterol level (r=0.398, p=0.016) among cases group.
There is statistically significant positive correlation between PASI score and FABP4 (r=0.437, p=0.008).There is statistically significant positive correlation between PASI score and FABP4 (r=0.398, p=0.016).Conclusion: Serum FABP4 levels were significantly increased in patients with psoriasis, indicating that this protein may be a potential marker of psoriasis and an independent predictor for the risk of comorbidities or complications in psoriatic patients. Additionally, it could be sued also as a reliable indicator of acitretin therapy.