Psoriasis is a common cutaneous disease with multifactorial etiology including genetic and non-genetic factors, such as drugs, smoking, drinking, diet, infection and mental stress. Now, the role of the interaction between environmental factors and genetics are considered to be a main factor in the pathogenesis of psoriasis. However, it is a challenge to explore the mechanisms how the environmental factors break the body balance to affect the onset and development of psoriasis. In this article, we review the pathogenesis of psoriasis and summarize numerous clinical data to reveal the association between environmental factors and psoriasis. In addition, we focus on the mechanisms of environmental risk factors impact on psoriasis and provide a series of potential treatments against environmental risk factors.

Critical role of environmental factors in the pathogenesis of psoriasis.

Psoriasis is a common, chronic, inflammatory skin disease that affects 2%-4% of the global population. Recent studies have shown that increased oxidative stress (OS) and T-cell abnormalities are central to the pathogenesis of this disease. The resulting reactive oxygen species (ROS) induces proliferation and differentiation of Th17/Th1/Th22 cells and inhibits the anti-inflammatory activities of regulatory T lymphocytes (Treg). Subsequent secretions of inflammatory cytokines, such as interleukin (IL)-17, IL-22, tumor necrosis factor alpha (TNF-α), and interferon-gamma (IFN-γ), and vascular endothelial growth factor (VEGF), stimulate keratinocyte proliferation and angiogenesis. Proanthocyanidins are a class of flavonoids from plants and fruits, and have various antioxidant, anti-inflammatory, and anti-angiogenic properties. Numerous reports have demonstrated therapeutic effects of proanthocyanidins for various diseases. Among clinical activities, proanthocyanidins suppress cell proliferation, prevent OS, and regulate Th17/Treg cells. Because the pathogenesis of psoriasis involves OS and T cells dysregulation, we reviewed the effects of proanthocyanidins on OS, Th17 and Treg cell activities, and keratinocyte proliferation and angiogenesis. Data from multiple previous studies warrant consideration of proanthocyanidins as a promising strategy for the treatment of psoriasis.

https://www.tandfonline.com/doi/pdf/10.1080/13510002.2018.1462027

Proanthocyanidins: novel treatment for psoriasis that reduces oxidative stress and modulates Th17 and Treg cells.

Objectives: This study aimed to determine the prevalence of depression, anxiety and stress among Saudi Arabian dermatology patients and to assess associations with sociodemographic and clinical characteristics. Methods: This cross-sectional study was conducted among 300 consecutive dermatology patients visiting King Abdulaziz Medical City in Riyadh, Saudi Arabia, in August 2015. The Arabic version of the Depression, Anxiety and Stress Scale was used to screen for symptoms of depression, anxiety and stress. Quality of life (QOL) was assessed using the Dermatology Life Quality Index. Results: A total of 254 dermatology patients participated in the study (response rate: 84.7%). The prevalence of depression, anxiety and stress was 12.6%, 22.1% and 7.5%, respectively. The presence of at least one of these negative emotional states was noted among 24.4% of the cohort (95% confidence interval: 19.3–30.2%). Depression was significantly higher among subjects who lacked family support (26.5% versus 10.7%; P = 0.006) while anxiety was less common among patients who engaged in physical exercise (14.5% versus 29.4%; P = 0.005). According to the multivariate logistic regression analysis, poor QOL and a lack of family support were significant predictors of a negative emotional state. Conclusion: Almost a quarter of the studied Saudi Arabian dermatology patients were found to suffer from at least one negative emotional state. A lack of family support and poor QOL were the primary factors associated with a negative emotional state. Interventional studies are needed to examine the effects of social and family support on psychological conditions among Saudi Arabian dermatology patients. Keywords: Depression; Anxiety; Psychological Stress; Quality of Life; Social Support; Dermatology; Saudi Arabia.

/pdf/depression-anxiety-and-stress-among-saudi-arabian-cc0znsk7on.pdf

Depression, Anxiety and Stress among Saudi Arabian Dermatology Patients: Cross-sectional study.

Psoriasis is associated with several comorbidities ranging from cardiovascular comorbidity and mental disorders to other immune mediated inflammatory diseases. However, most of these co-morbidities are often overlooked or diagnosed late. Furthermore, evidence suggests that comorbidities are undertreated. Here, we provide an overview of comorbidities in psoriasis and present a simple rundown of considerations of relevance to the clinician. We hope that this review may raise clinicians' awareness of comorbidities in psoriasis and provide simple guidance regarding screening tools and treatment decisions in psoriasis with comorbidities. 

Comorbidity in Adult Psoriasis: Considerations for the Clinician

To evaluate the therapeutic efficacy and safety of anti-IL-17 agents in the treatment of psoriasis, we performed a systemic review and meta-analysis of the relevant published clinical trials, collectively referred to as secukinumab, ixekizumab and brodalumab. 2668 patients in eight eligible trials with psoriasis were selected for the present meta-analysis. The estimated pooled PASI75, PSAI90, physician's global assessment (PGA; clear) showed significant improvements for psoriasis patients who received biotherapy compared with placebo. The results of headache, upper respiratory tract infection and infections demonstrated that there was no significant difference between the biotherapy and placebo groups. But the results of nasopharyngitis demonstrated that there was a significant difference for biotherapy group. The results showed that anti-IL-17 agents were effective and safe for psoriasis patients.

Clinical efficacy and safety of anti-IL-17 agents for the treatment of patients with psoriasis

Psoriasis is a common inflammatory disease affecting 2%-5% of the population of industrialized countries. Although the association between psychiatric pathologies and dermato- logical conditions is well known, the dermato- logist fails to indentify the psychological distress and when he identifies it, he doesn't take care of this suffering. The biological links between psoriasis and depression are now well-established. The impact on the quality of life (QoL) is studied for several years. In this vast domain of the QoL, the first problem revealed by the patients is the feeling of stigmatization. In psoriasis, the psychiatric comorbidity is estimated approximately at 30 %. The psychiatric troubles the most associated with dermatological conditions in general are depression, anxiety and suicidal ideations. The prevalence of depression in patients with psoriasis is estimated between 10 % and 62 % according to different studies. The patient's psychological distress is not correlated to the intensity of the clinical symptoms and the treatment does not modify either this distress, the coping mechanism, or the patient's opinion about his skin condition. Furthermore, it is necessary to know that the dermatological diseases affecting the patients during their childhood or adolescence will have a significant effect on the formation of their personality. However, personality will have an influence on the psychological morbidity. Therefore, it is important to take care of young people. To help the physician to recognize these difficulties, we propose a review of the literature and a method for a better management of the psychological suffering often experienced by the patients with psoriasis.

http://www.amub.be/revue-medicale-bruxelles/download/1066

Psoriasis and depression

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Psoriasis and depression