Molecular Phenotyping Small (Asian) versus Large (Western) Plaque Psoriasis Shows Common Activation of IL-17 Pathway Genes, but Different Regulatory Gene Sets

Kim, Jaehwan,Oh, Chil-Hwan,Jeon, Jiehyun,Baek, Yoosang,Ahn, Jaewoo,Kim, Dong Joo,Lee, Hyun-Soo,da Rosa, Joel Correa,Suá,rez-Fariñ,as, Mayte,Lowes, Michelle A.,Krueger, James G. Nature Publishing Group 2016 The Journal of investigative dermatology Vol.136 No.1

<P>Psoriasis is present in all racial groups, but in varying frequencies and severity. Considering that small plaque psoriasis is specific to the Asian population and severe psoriasis is more predominant in the Western population, we defined Asian <I>small</I> and <I>intermediate</I> plaque psoriasis as psoriasis subtypes, and compared their molecular signatures with classic subtype of Western <I>large</I> plaque psoriasis. Two different characteristics of psoriatic spreading—vertical growth and radial expansion—were contrasted between subtypes, and genomic data were correlated to histologic and clinical measurements. Compared to Western <I>large</I> plaque psoriasis, Asian <I>small</I> plaque psoriasis revealed limited psoriasis spreading, but IL-17A and IL-17-regulated pro-inflammatory cytokines were highly expressed. Paradoxically, IL-17A and IL-17-regulated pro-inflammatory cytokines were lower in Western <I>large</I> plaque psoriasis, while T cells and dendritic cells in total psoriatic skin area were exponentially increased. Negative immune regulators, such as CD69 and FAS, were decreased in both Western <I>large</I> plaque psoriasis and psoriasis with accompanying arthritis or obesity, and their expression was correlated with psoriasis severity index. Based on the disease subtype comparisons, we propose that dysregulation of T cell expansion enabled by downregulation of immune negative regulators is the main mechanism for development of large plaque psoriasis subtypes.</P>

P247 : A study of screening behavior for cardiovascular risk factors in patients with psoriaisis and awareness of cardiovascular disease and risk factors among psoriasis patients and dermatologists

( Min Kyung Lee ),( Han Su Kim ),( Eun Byul Cho ),( Eun Joo Park ),( Kwang Ho Kim ),( Kwang Jwoong Kim ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: Psoriasis is chronic immune-mediated inflammatory disorder, affecting nearly 1.5~3% of the world``s population. A number of literatures have suggested that frequency of cardiovascular diseases increases in the patients with psoriasis. Objectives: We tried to assess awareness of increased cardiovascular disease and risk factors among patients with psoriasis and dermatologists, and assess screening behavior for cardiovascular risk factors in patients with psoriasis. Methods: We conducted 52 questionnaires to out-patients who had visited Hallym University Sacred Heart Hospital and treated for psoriasis between January 1, 2013, and March 31,2014. We also distributed 100 questionnaires to dermatologists who practice in Seoul and Gyeonggi-do by e-mail. Results: Among 52 patients, 14(27%) answered that they knew increased risk of cardiovascular disease in psoriasis. Among 50 dermatologists, 36(72%) were aware that patients with psoriasis have greater cardiovascular risk than normal population. However, the number of dermatologists who screened for cardiovascular risk factors in patients with psoriasis was far less.5 of 36 screened for dyslipidemia, 17 for obesity, 11 for hypertension and 10 for diabets. Conclusion: We found that less than half of all dermatologists screened for cardiovascular risk factors in patients with psoriasis. Educating not only patients with psoriasis, but also dermatologists regarding increased cardiovascular risk in psoriasis is needed for leading to improved patient outcomes.

P171 : Clinical study on psoriasis patients in NMC psoriasis clinic

( Jae Wook Jeon ),( Kyung Ho Kim ),( Hye Jung Jeong ),( Min Soo Kim ),( Ji Young Ahn ),( Mi Youn Park ),( Jai Il Youn ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Psoriasis is a common chronic inflammatory skin disease whose prevalence and clinical feature vary among different populations worldwide. The prevalence rate of psoriasis in Korea shows increasing tendency compare to the past. Objectives: The clinical study with many patients is important to clarify the epidermiological characteristics and clinical features of psoriasis. Methods: The questionnaire-based study was carried out from patients who have been enrolled in National Medical Center psoriasis clinic during 1 year. We surveyed epidermiologic data, clinical features including extent of involvement and disease activity of psoriasis from 338 patients. The collected data were analyzed by statistical variables Results: The gender ratio of psoriasis patients was 1.1:1 (male 52.4%, female 45.4%). The peak age of onset in male was twenties, while it was teenage in female. Total 51.1% of patients developed psoriasis before 30 years of age. Family history of psoriasis was observed in 23.7% of patient. Mild to moderate extent of imvolvement was frequently observed in both male and female patients. Mild to moderate disease activity was also frequently presented without relation to gender and age. The most common morphologic type was nummular type(57.6%), followed by large plaque(33.8%) and PPP(4.4%). Conclusion: This study was investigated with second-largest number of patient in Korea, which also demonstrate epidermiological characteristics of psoriasis

Comorbidities in patients with psoriasis in Korea: a population-based prospective cohort study

( Jae Won Lee ),( Keum Ji Jung ),( Tae-gyun Kim ),( Jongwook Oh ),( Sun Ha Jee ),( Min-geol Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Psoriasis is increasingly being recognized as a systemic inflammatory disorder. Recent studies support associations between psoriasis and various systemic comorbidities. However, the association among Asians has yet to be established. Objectives: To analyze the risk of depression, inflammatory bowel disease (IBD), and malignancies in patients with psoriasis compared to subjects without psoriasis in Korea. Methods: This prospective cohort study included 1,733,620 Koreans with 19 years of study period. (National Health Insurance System data) Results: The risk of depression was higher in patients with psoriasis with the adjusted hazard ratio (aHR) of 1.12 compared to controls, which was mainly driven by female patients, whereas that of ulcerative colitis was higher only in male patients (aHR=1.32). Crohn’s disease showed higher risk in moderate-to-severe psoriasis (aHR=1.68). The risk of malignancy was higher in psoriasis patients compared to controls (aHR=1.08). Specifically, gastric cancer showed higher risk in patients with psoriasis (aHR=1.31). The risk of non-Hodgkin lymphoma and Non-melanoma skin cancer were increased in patients with moderate-to-severe psoriasis (aHR=2.86 and aHR=3.93, respectively). Conclusion: The positive association of psoriasis with depression, IBD, and malignancy was present in our cohort of patients with psoriasis. Perception of specific diseases with significant relations is essential to provide comprehensive medical care for patients with psoriasis.

Pathological and immunohistochemical changes on psoriasis: comparison between biologics and oral medication treatment

( Yulhee Kim ),( Jisun Yoon ),( Eun-so Lee ),( You Chan Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Psoriasis is a chronic inflammatory skin disorder primarily affecting the epidermis. Patients with moderate-to-severe psoriasis have been treated with oral medications including methotrexate and cyclosporine. Nowadays, targeted monoclonal antibodies showed evident effect on psoriasis, but little is known about pathological and immunohistochemical alterations in psoriasis treated with biologics. Objectives: We compared the pathologic and immunohistochemical changes between patients with psoriasis, treated with biologics and oral medications. Methods: Skin samples from 10 patients with psoriasis treated with biologics and 10 patients with psoriasis treated with oral medication were obtained before and after treatment. We analyzed histological and immunohistochemical changes of skin samples after treatment. Results: The histological changes between baseline and after treatment showed that most of classic histological features of psoriasis such as parakeratosis or regular acanthosis were almost cleared in both groups, particularly in biologics group. The results of qualitative and quantitative analysis of immunohistochemical stains showed significant reduction of cytokines, especially for IL-23, IL-36r, and IL-10 cytokines in biologics group. Conclusion: In psoriasis, biologics could improve pathological and immunohistological features in psoriasis in addition to improvement of severity and symptoms of psoriasis than oral medication.

Comparison of cytokine pattern between childhood and adult psoriatic skin

( So Min Kim ),( Jin Cheol Kim ),( Byung Woo Soh ),( Eun-so Lee ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Many studies of adult psoriasis have shown that the imbalance between regulatory and effector T cells, especially T helper 17-producing T cells, has a key role in the pathogenesis of the disease. However, little is known about the immunologic alteration of psoriasis in children. Objectives: To investigate the tissue cytokine expression of psoriasis in children and compare them with those in adults. Methods: Skin samples from pediatric psoriasis patients and psoriasis-type-matched adult psoriasis patients were analyzed using immunohistochemical staining against antibodies to T cell surface molecules and proinflammatory cytokines. Results: Each of the twenty-two skin sample sets of adult and children patients were reviewed. Lesional skin tissue from pediatric psoriasis patients had significantly increased the level of TNF-α compared with those of adult psoriasis patients. Tissue from pediatric psoriasis patients had significantly less elevation of IL-17 compared with the tissue from adult psoriasis patients. Conclusion: Significant difference in TNF-α and IL-17 expression was observed in pediatric psoriasis patients compared with adult psoriasis patients. Elucidating immunophenotypic differences might help in understanding the clinical differences between children and adults with psoriasis. Also, this findings can be used as a guide to targeted therapy of pediatric psoriasis in near future.

Clinical study on psoriasis patients for past 5 years (2012-2017) in Pusan national university hospital psoriasis clinic

( Sang-hyeon Won ),( Kihyuk Shin ),( Woo-il Kim ),( Min-young Yang ),( Won-ku Lee ),( Tae-wook Kim ),( Sung-min Park ),( Hyun-joo Lee ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum K 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Psoriasis is an chronic inflammatory disease affecting multiple aspects of patients’ lives. The long-term clinical study with large number of patients is important to elucidate the epidemiologic and clinical features of psoriasis. Objectives: To investigate the epidemiologic and clinical characteristics of psoriasis patients from the Psoriasis Clinic of Pusan National University Hospital. Methods: Clinical data were collected and analyzed from the medical records of 541 psoriasis patients, who were newly diagnosed as psoriasis at the Psoriasis Clinic of Pusan National University Hospital between 2012 and 2017. Results: The sex ratio was 1.5:1 (male 60.6%, female 39.4%). The peak age of onset was 20s. The most common morphological type was small plaque (63.6%), followed by large plaque (27.2%) and guttate (6.8%). Nail involvement and psoriatic arthritis accompanied in 20.3% and 9.6% of patients, respectively. Hypertension (14.2%), diabetes mellitus (7.2%), and dyslipidemia (5.2%) were the most frequently observed comorbidities in patients with psoriasis. The most common oral agents as initial treatment was Methotrexate (76.8%), followed by Cyclosporin (19.9%) and Acitretin (3.3%). Conclusion: This study highlighted the epidemiologic and clinical characteristics of psoriasis in Korea.

Relation between the Peripherofacial Psoriasis and Scalp Psoriasis

( Kyung Ho Kim ),( Ji Young Ahn ),( Mi Youn Park ),( Jai Il Youn ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.4

Background: Facial involvement of psoriasis is known to be one of the clinical manifestations that indicate the severity of the psoriasis and thought to be more closely associated with certain distribution. Centrofacial (CF) psoriasis has been suggested to be related with severity of systemic disease while peripherofacial (PF) psoriasis has been thought to have connection with scalp psoriasis. Objective: To analyze the epidemiologic characteristics, clinical features and subjective feelings of patients with facial psoriasis and to find out relationship between scalp psoriasis and facial involvement according to the facial types. Methods: One hundred nineteen facial psoriasis patients were categorized into 3 types according to the distribution: PF type, CF type and mixed facial (MF) type. Onset and duration of facial and scalp psoriasis, and their relationship were questioned. Severity and extent of psoriasis on whole body, face, and scalp were rated by clinicians. Results: There was no significant difference of whole body psoriasis area and severity index (PASI) and body surface area (BSA) score but scalp PASI and BSA was much higher in PF psoriasis compared to CF psoriasis (scalp PASI, 17.9 vs. 10.1; p=0.005) (scalp BSA, 40.9 vs. 22.2; p=0.002). According to the questionnaire, patient’s objective feeling about the spreading of scalp lesion to facial area was markedly more prominent in the patients with peripheral involvement (PF+MF, 90.1%; CF, 54.2%; p<0.0001). Conclusion: Among subtypes of facial psoriasis, PF psoriasis is closely associated with spreading of scalp lesion into the face rather than reflecting the disease severity. (Ann Dermatol 28(4) 422∼426, 2016)

성별과 중증도에 따른 건선의 임상적, 병리조직학적 및 면역조직화학적인 특성: 에스트로겐의 역할에 대한 연구

양지영 ( Ji Young Yang ),박영준 ( Young Joon Park ),정수은 ( Soo-eun Jung ),박미진 ( Mi Jin Park ),강희영 ( Hee Young Kang ),김유찬 ( You Chan Kim ),이은소 ( Eun-so Lee ) 대한피부과학회 2017 대한피부과학회지 Vol.55 No.9

Background: Psoriasis is a chronic inflammatory skin disorder histopathologically characterized by epidermal hyperplasia, vascular proliferation, and inflammatory infiltrates. It runs a less severe course in women than in men. The role of estrogen in the pathogenesis of psoriasis remains unclear. Objective: We investigated the clinicohistopathological differences between men and women with psoriasis and examined whether serum estrogen levels and immunohistochemical findings correlate with gender and disease severity. Methods: We retrospectively reviewed the medical records of 500 patients with psoriasis. Among these patients, 60 who consented to participate in the study were classified into four groups as follows: 10 men showing psoriasis on <10% of their body surface area (BSA) with psoriasis area severity index (PASI)<10; 20 men showing psoriasis on ≥10% of their BSA with PASI≥10; 10 women showing psoriasis on <10% of their BSA with PASI<10; and 20 women showing psoriasis on ≥10% of their BSA with PASI ≥10. Serum estrogen levels were measured using radioimmunoassay. Immunohistochemical staining of skin biopsy tissues was performed using ERα, ERβ, and CCL5. Results: Men diagnosed with psoriasis showed higher BSA and PASI scores than women. Women aged ≥60 years showed higher BSA and PASI scores than women aged <60 years. There were no histological differences between the four groups. Serum estrogen levels were higher in the patients presenting with mild psoriasis, as well as in women. ERα, ERβ, and CCL5 showed a stronger staining tendency in patients with more severe psoriasis. Conclusion: Gender influences the severity of psoriasis, and estrogen plays an important role. This finding is explained by the fact that estrogen decreases inflammation in psoriasis possibly via its action on estrogen receptors in epidermal keratinocytes. (Korean J Dermatol 2017;55(9):565∼571)

Comparison of Treatment Goals for Moderate-to-Severe Psoriasis between Korean Dermatologists and the European Consensus Report

( Sang Woong Youn ),( Bo Ri Kim ),( Joo Heung Lee ),( Hae Jun Song ),( Yong Beom Choe ),( Ji Ho Choi ),( Nack In Kim ),( Kwang Joong Kim ),( Jai Il Youn ) 대한피부과학회 2015 Annals of Dermatology Vol.27 No.2

Background: The development of therapies for psoriasis has led to the need for a new strategy to the treatment of patients with moderate-to-severe psoriasis. New consensus guidelines for psoriasis treatment have been developed in some countries, some of which have introduced treatment goals to determine the timing of therapeutic regimens for psoriasis. Objective: To investigate the opinions held by Korean dermatologists who specialize in psoriasis about treatment goals, and to compare these with the European consensus. Methods: Korean dermatologists who specialize in psoriasis were asked 11 questions about defining the treatment goals for psoriasis. The questionnaire included questions about the factors used to classify the severity of psoriasis, defining the induction and maintenance phases of psoriasis treatment, defining treatment responses during the induction phase, and defining treatment responses during the maintenance phase. Results: The Korean consensus showed responses that were almost similar to the European consensus, even without using the Delphi technique, which uses repeated rounds of questions to reach a consensus. Only one response that related to psoriasis severity in the context of the quality of patients` lives differed from the European consensus. Conclusion: The concept of using treatment goals in the treatment of moderate-to-severe psoriasis can be applied to Korean psoriasis patients. Since a tool for assessing the quality of patients` lives is not commonly used in Korea, the development of a simple, rapidly completed, and region-specific health-related quality of life assessment tool would enable treatment goals to be used in routine clinical practice.(Ann Dermatol 27(2) 184∼189, 2015)