The expression of serotonin transporter protein correlates with the severity of psoriasis and chronic stress.

Psoriasis may be worsened by stress and mood disorders. There is an increased expression of the serotonin transporter protein (SERT) in involved psoriatic skin as compared to non-involved psoriatic skin and normal skin. The aim of this study was to investigate if the increased expression of SERT in psoriasis correlates with the severity of disease, chronic stress, and depression. Biopsies from involved and non-involved skin from the back of 20 patients with chronic plaque psoriasis were immunohistochemically analysed, using a monoclonal antibody to SERT. The severity of psoriasis was assessed for each patient using the Psoriasis area and severity index (PASI). Levels of depression and chronic stress were measured using Beck's Depression Inventory (BDI) and the salivary cortisol test, respectively. A positive correlation (r = 0.53; p < 0.05) between PASI and the numbers of SERT-positive dendritic cells in the epidermis of involved psoriatic skin was determined. We also observed a negative correlation (r = -0.46; p < 0.05) between salivary cortisol ratio levels and the numbers of SERT-positive cells in the epidermis of involved psoriatic skin, indicating a correlation between SERT expression and chronic stress. The serotonergic system may be involved in the chronic inflammation evident in psoriatic skin. Through modulating the levels of SERT, there might be a therapeutic possibility for reducing chronic inflammation in psoriasis.

GABA and GABA(A) receptor expression on immune cells in psoriasis: a pathophysiological role.

Psoriasis is a chronic inflammatory disease in which pruritus is a common symptom. Pruritus may be associated with the gamma-aminobutyric acid (GABA) system. The distribution of GABA and its GABA(A) receptor (R) was studied in involved and non-involved psoriatic skin, as well as normal healthy control skin, using an immunohistochemistry technique. Pruritus was determined using a visual analog scale. Inflammatory cells immunoreactive for the GABA ligand and the GABA(A) R were increased (P < 0.01, respectively) in the involved skin. Cells stained for GABA ligand were mostly macrophages with some lymphocytes, while cells stained for GABA(A) R were macrophages, neutrophils or lymphocytes. There was a positive correlation when comparing GABA ligand (P = 0.05) and GABA(A) R (P < 0.05) expressing inflammatory cells, with pruritus. The GABA ligand and its GABA(A) R may play a role for the pathogenesis of psoriasis as well as for pruritus in this disease.

Pattern of skin and nail changes in chronic renal failure in Nepal: a hospital-based study.

Chronic renal failure, regardless of its cause, often produces specific dermatological abnormalities, which can develop long before failure manifests clinically. Our aim was to study the clinical pattern of skin and nail changes in chronic renal failure and also study the associations of these changes with age, sex, etiology and duration of the chronic renal failure. A total of 104 diagnosed cases of chronic renal failure were included in the study over a period of 1 year. Equal numbers of age- and sex-matched individuals were taken as controls. The male : female ratio was 1.4:1. The mean duration of chronic renal failure was 19 +/- 20 months. Among cases and controls, 72% and 16% had skin changes, respectively. Xerosis was the most common of the skin changes (28%), followed by hyperpigmentation (20%), pruritus (15%), infectious diseases (5%) and other skin changes (33%) in chronic renal failure patients. Abnormal nail changes were seen in 82% of the cases compared to only 8% of the controls. In the cases, white nail was most common followed by brown and half-and-half nail. Pruritus was significantly higher in the dialysis group whereas the nail changes were significantly higher in the non-dialysis group. The skin and nail changes were common in chronic renal failure and manifested in various forms. Thus, thorough inspection of the integument might reveal markers of occult renal disease.

Focus groups in Swedish psoriatic patients with pruritus.

Pruritus is a common complaint among patients of psoriasis vulgaris of the chronic plaque type. Despite a high prevalence of pruritus in psoriasis, limited information is available on this subject. The aim was to assess patients' perspective of pruritus in psoriasis vulgaris of plaque type, by using focus groups. A total of 20 patients with chronic plaque psoriasis participated in focus group discussions and were divided into five groups, on different occasions. Themes for the discussion were introduced and moderated by the investigators. The focus groups created a proper atmosphere for discussion on different aspects of pruritus in psoriasis. The patients regarded themselves able to discriminate between pruritus and pain. Pruritus was most common on the lower back and legs. Stress, cold weather and skin dryness were seen as the most common worsening factors for pruritus. Sunbathing and application of emollients with or without steroids and calcipotriol cream were suggested as factors that relieved pruritus. Quality of life was affected in some patients, for instance they were reluctant to participate in social activities. Patients' perspectives on pruritus in psoriasis were important for a better understanding of this sensation. The information collected from the focus group discussions might be useful for further study in this area.