TISSUE EXPRESSION OF INTERLEUKIN-17 SIGNIFICANTLY AND INDEPENDENTLY AFFECTS PRURITUS IN PSORIATIC PATIENTS: A CLINICOPATHOLOGICAL CORRELATION
Keywords:Interleukin-17, Pruritus, Psoriasis
Objective: This study aimed at the evaluation of pruritus and its intensity and aggravating factors in psoriatic patients with the assessment of its relation to interleukin-17 (IL-17) expression in psoriatic lesions.
Methods: The study included 50 patients with psoriasis vulgaris. A questionnaire was used for the evaluation of pruritus and its effect on the quality of life. Severity of pruritus was assessed by the visual analog scale (VAS) while clinical severity of psoriasis was assessed using psoriasis area severity index (PASI) score. Tissue immunohistochemical expression of IL-17 was assessed in psoriatic lesions and in 20 normal skin biopsies included as control.
Results: Pruritus was encountered in 92% of psoriatic patients studied, 45.5% of them considered emotional stress as the main pruritus aggravating factor. Pruritus had influenced the daily activity and sleep in 91.3% of the studied patients. Mean VAS in studied cases was 5.70 ± 2.76. VAS grades were significantly associated with PASI scores and IL-17 tissue expression on univariate analysis. On multilogistic regression analysis, both IL-17 and PASI scores emerged as independent influencers of pruritus.
Conclusion: Pruritus is a common symptom that affects the quality of life in psoriatic patients. IL-17 is an independent aggravating factor of pruritus in those patients. To the best of our knowledge, this is the first study evaluating the tissue expression of IL-17 in relation to pruritus. Pruritus treatment should be one of our goals while managing the psoriatic patients and anti-IL-17 may play a pivotal role in this field.
Christophers E. Psoriasis-epidemiology and clinical spectrum. Clin Exp Dermatol 2001;26:314-20.
Mak RK, Hundhausen C, Nestle FO. Progress in understanding the immunopathogenesis of psoriasis. Actas Dermosifiliogr 2009;100:2-13.
Nestlé FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med 2009;361:496-509.
di Cesare, A, di Meglio P, Nestle FO. The IL-23/Th17 axis in the immunopathogenesis of psoriasis. J Invest Dermatol 2009;129:1339-50.
Stander S, Weisshaar E, Mettang T. Clinical classification of itch: A position paper of the international forum for the study of itch. Acta Derm Venereol 2007;87:291-4.
Lavery MJ, Stull C, Kinney MO, Yosipovitch G. Nocturnal pruritus: The battle for a peaceful night’s sleep. Int J Mol Sci 2016;17:425.
Saraceno R, Kleyn CE, Terenghi, G, Griffiths CE. The role of neuropeptides in psoriasis. Br J Dermatol 2006;155:876-82.
Reich A, Szepietowski JC. Mediators of pruritus in psoriasis. Mediators Inflamm 2007;2007:64727.
Johansen C, Usher PA, Kjellerup RB, Lundsgaard D, Iversen L, Kragballe K. Characterization of the interleukin-17 isoforms and receptors in lesional psoriatic skin. Br J Dermatol 2009;160:319-24.
Hisakata Y. Current perspectives on the role of IL-17 in autoimmune disease. J Inflamm Res 2010;3:33-44.
Sun C, Zhang J, Chen L, Liu T, Xu G, Li C, et al. Il-17 contributed to the neuropathic pain following peripheral nerve injury by promoting astrocyte proliferation and secretion of proinflammatory cytokines. Mol Med Rep 2017;15:89-96.
Psoriatic Areas and Severity Index Worksheet; 2009. Available from: http://www.bad.org.uk/html.
Reich A, Heisig M, Phan NQ, Taneda K, Takamori K, Takeuchi S, et al. Visual analogue scale: Evaluation of the instrument for the assessment of pruritus. Acta Derm Venereol 2012;92:497-501.
Peres LP, Oliveira FB, Cartell A, Mazzotti NG, Cestari TF. Density of mast cells and intensity of pruritus in psoriasis vulgaris: A cross sectional study. An Bras Dermatol 2018;93:368-72.
Stinco G, Trevisan G, Piccirillo F, Pezzetta S, Errichetti E, di Meo N, et al. Pruritus in chronic plaque psoriasis: A questionnaire-based study of 230 Italian patients. Acta Dermatovenerol Croat 2014;22:122-8.
Dickison P, Swain G, Peek JJ, Smith SD. Itching for answers: Prevalence and severity of pruritus in psoriasis. Australas J Dermatol 2018;59:206-9.
Amatya B, Wennersten G, Nordlind K. Patients’ perspective of pruritus in chronic plaque psoriasis: A questionnaire-based study. J Eur Acad Dermatol Venereol 2008;22:822-6.
Yosipovitch G, Goon A, Wee J, Chan YH, Goh CL. The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Br J Dermatol 2000;143:969-73.
Lebwohl MG, Bachelez H, Barker J, Girolomoni G, Kavanaugh A, Langley RG, et al. Patient perspectives in the management of psoriasis: Results from the population-based multinational assessment of psoriasis and psoriatic arthritis survey. J Am Acad Dermatol 2014;70:871-81.e1-30.
Kim TW, Shim WH, Kim JM, Mun JH, Song M, Kim HS, et al. Clinical characteristics of pruritus in patients with scalp psoriasis and their relation with intraepidermal nerve fiber density. Ann Dermatol 2014;26:727-32.
Reich A, Szepietowski JC, Wisnicka B, Pacan P. Does stress influence itching in psoriatic patients? Dermatol Psychosom 2003;4:151-5.
Szepietowski JC, Reich A, Wisnicka B. Itching in patients suffering from psoriasis. Acta Dermatovenerol Croat 2002;10:221-6.
Chang SE, Han SS, Jung HJ, Choi JH. Neuropeptides and their receptors in psoriatic skin in relation to pruritus. Br J Dermatol 2007;156:1272-7.
Nakamura M, Toyoda M, Morohashi M. Pruritogenic mediators in psoriasis vulgaris: Comparative evaluation of itch-associated cutaneous factors. Br J Dermatol 2003;149:718-30.
de Oliveira PS, Cardoso PR, Lima EV, Pereira MC, Duarte AL, Ida RP, et al. IL-17A, IL-22, IL-6, and IL-21 Serum levels in plaque-type psoriasis in Brazilian patients. Mediators Inflamm 2015;2015:819149.
Arican O, Aral M, Sasmaz S, Ciragil P. Serum levels of TNF-alpha, IFN-gamma, IL-6, IL-8, IL-12, IL-17, and IL-18 in patients with active psoriasis and correlation with disease severity. Mediators Inflamm 2005;5:273-9.
Budamakuntla L, Loganathan E, Gundappa P, Sreelakshmi, Kini T, Kavya K. IL 17 cytokine in psoriasis: Before and after methotrexate and NBUVB phototherapy: A longitudinal study. Clin Dermatol Res J 2017;2:1.
Yilmaz SB, Cicek N, Coskun M, Yegin O, Alpsoy E. Serum and tissue levels of IL-17 in different clinical subtypes of psoriasis. Arch Dermatol Res 2012;304:465-9.
Blauvelt A, Reich K, Tsai TF, Tyring S, Vanaclocha F, Kingo K, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: Results from the clear study. J Am Acad Dermatol 2017;76:60-9.e9.
Moynes DM, Vanner SJ, Lomax AE. Participation of interleukin 17A in neuroimmune interactions. Brain Behav Immun 2014;41:1-9.
Czarnecka-Operacz M, Polańska A, Klimańska M, Teresiak- Mikołajczak E, Molińska-Glura M, Adamski Z, et al. Itching sensation in psoriatic patients and its relation to body mass index and IL-17 and IL-31 concentrations. Postepy Dermatol Alergol 2015;6:426-30.
How to Cite
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.