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Severely Photosensitive Psoriasis: A Phenotypically Defined Patient Subset
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Journal Article
Severely Photosensitive Psoriasis: A Phenotypically Defined Patient Subset
2009
Overview
A subset of patients with chronic plaque psoriasis exhibits severely photosensitive psoriasis (PP) with a pronounced seasonal pattern, but the pathomechanism is not understood. We performed two related studies; first, a detailed clinical characterization of PP, and second, a controlled investigation exploring the underlying pathomechanisms through the assessment of disease onset after photoprovocation. Patients with PP (n=20) showed striking female predominance (19F:1M), very low mean age of psoriasis onset (11 years, range 2–24), family history of psoriasis (13/20), a strong HLA–Cw*0602 association (16/17), and a rapid abnormal clinical response to broadband UVA, comprising erythema±scaling plaques (17/20). Subsequently, patients with PP (n=10), non-PP (n=9), and healthy volunteers (n=11) were challenged with low-dose broadband UVA on 3 consecutive days, and serial biopsies were taken after 6hours to 7 days and from unchallenged skin. Histological changes consistent with early psoriasis occurred in 4 of 10 PP patients, but in neither of the control groups, with significant dermal infiltration by neutrophils, CD4+, CD8+, and CD45RO+ cells at 24h, accompanied by acanthosis. Thus, a phenotypically distinct subset of psoriasis has been characterized. In contrast with earlier assumptions, UV can provoke psoriasiform features rapidly de novo; a role for memory effector T cells is supported in the early phase.
Publisher
Elsevier Inc,Nature Publishing Group,Elsevier Limited
Subject
/ Biological and medical sciences
/ CD4-Positive T-Lymphocytes - pathology
/ CD8-Positive T-Lymphocytes - pathology
/ Female
/ Humans
/ Leukocyte Common Antigens - metabolism
/ Male
/ Photosensitivity Disorders - immunology
/ Photosensitivity Disorders - pathology
/ Psoriasis. Parapsoriasis. Lichen
/ Seasons
