ASSESSMENT OF SERUM HOMOCYSTEINE LEVELS IN PATIENTS WITH PSORIASIS VULGARIS

Abstract

Psoriasis is a chronic relapsing inflammatory skin disease mostly characterized by red, scaly, sharply demarcated, indurated plaques, present particularly over extensor surfaces and the scalp.

The pathogenesis of psoriasis involves an interaction between genetic, environmental and immunologic factors. Advances in the understanding of the role of inflammatory cells and mediators in the pathogenesis of psoriasis have shifted the clinical perspective on psoriasis from that of skin disorder to that of systemic inflammatory process that may increase the prevalence of other co-morbid conditions. Recognition of the systemic inflammatory effects of this common skin disease, as well as the overrepresentation of cardiovascular risk factors in patients with psoriasis, such as smoking, hyperlipidaemia and obesity, as well as systemic treatments for psoriasis, has led investigators to study the association between psoriasis and ischemic heart disease. Patients with psoriasis experience a higher prevalence not only of ischemic heart disease but also of peripheral arterial disease and cerebrovascular disease.

Epidemiological studies have shown that hyperhomocysteinaemia is a risk factor for atherosclerotic cardiovascular diseases, stroke, peripheral arterial occlusive disease and venous thrombosis. Raised levels of homocysteine are an independent risk factor for the development of cardiovascular diseases.

The aim of the present study was to assess serum homocysteine levels in patients with psoriasis vulgaris without known risk factors for acquired hyperhomocysteinaemia in comparison to age and sex matched healthy controls.

The present study represents a case-control study which was carried out on 40 patients with psoriasis vulgaris and 40 age and sex matched healthy volunteers as controls.

Each participant was subjected to a detailed history taking and careful clinical examination. Blood samples were taken from all subjects to assess serum level of homocysteine by ELISA technique.

Results of the present study revealed: higher levels of serum total homocysteine in patients with psoriasis when compared with controls and higher levels of serum total homocysteine in psoriatic patients with higher PASI scores.

The present study also assessed family history of different diseases, disease duration of psoriasis, disease characteristics and their relation to homocysteine levels in psoriatic patients. Results revealed that family history of cardiovascular diseases, longer disease duration of psoriasis and the presence of Koëbner phenomenon were independent variables affecting serum total homocysteine levels. Accordingly, the presence of these factors may be helpful in identifying psoriatic patients that may be at risk of developing cardiovascular diseases to early detect and treat modifiable risk factors and improve morbidity and mortality.

In conclusion, the results obtained in the present study revealed that measuring serum total homocysteine levels in psoriatic patients especially those with positive family history of cardiovascular diseases, long duration of psoriasis, presence of Koëbner phenomenon and/or increased disease severity assessed by PASI score may help in identifying psoriatic patients at risk of cardiovascular diseases.