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Abnormal epidermal barrier recovery in uninvolved skin supports the notion of an epidermal pathogenesis of psoriasis.

Ye L, Lv C, Man G, Song S, Elias PM, Man MQ - J. Invest. Dermatol. (2014)

View Article: PubMed Central - PubMed

Affiliation: Dalian Skin Disease Hospital, Liaoning, People's Republic of China.

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Yet, both clinical experience and recent molecular studies support an emerging concept that psoriasis could be ‘driven’ by a primary defect in epidermal permeability barrier function... Since psoriasis often flares during late autumn and winter through early spring, all studies were performed during February and March, 2012, and during October, 2013, representing early spring and autumn seasons in northern China Consistent with prior findings, our results showed that both stable and progressive psoriatic lesions displayed significantly higher basal levels of TEWL than the uninvolved skin and skin sites of normal control subjects (Fig. 1a)... SC hydration markedly declined in involved skin of both progressive and stable psoriasis, but hydration levels were normal in uninvolved skin sites of both psoriatic cohorts (Figure 1d)... Recently, the central role of epidermal permeability barrier abnormalities in the pathogenesis of inflammatory dermatoses has attracted increased attention... Previous studies have shown that sustained defect in permeability barrier function predisposes skin to the development of epidermal hyperplasia and inflammation, resulting in part from the stimulation of a cytokine cascade that recruits a downstream inflammatory cell infiltration... Because not only involved, but also the uninvolved skin sites of patients with progressive disease display altered epidermal function, the results presented here are consistent with an emerging concept that an underlying abnormality in epidermal function initiates, triggers or exacerbates psoriasis, together supporting an ‘outside-to-inside’ concept of psoriasis pathogenesis... The fact that stable uninvolved psoriatic skin sites does not display demonstrable defect in epidermal function, can be explained by the reestablishment of a steady-state, where epidermal function has largely been normalized, coupled with reduced exposure to external stressors that otherwise place additional stress on the barrier... Nonetheless, it should be noted that the uninvolved skin of psoriasis could still display subtle abnormalities that are not detectable by the biophysical technique utilized here... For example, we have shown accelerated movement of the water-soluble, electron-dense tracer, lanthanum nitrate, in some situations where TEWL levels otherwise appeared normal (e.g., )... A defective permeability barrier not only stimulates epidermal proliferation, but it also increases pro-inflammatory cytokine expression, as well as increasing Langerhans cell and mast cell infiltration... Moreover, the abnormalities in surface pH in the uninvolved skin of progressive psoriasis could further predispose to disease expression in psoriasis as follows (Supplemental Figure 1): An elevation in pH inevitably activates serine proteases (kallikreins) in the outer epidermis, which in turn degrade lipid processing enzymes leading to abnormal permeability barrier homeostasis, and catalyze pro-IL-1 beta to active IL-1 beta, initiating the cytokine cascade... Finally, reduced SC hydration, which often parallels abnormalities in barrier function, alone places further stress on the barrier, evidenced by the development of epidermal proliferation and the initiation of cutaneous inflammation in experimental animals exposed to low ambient humidity.

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Comparison of SC Biophysical Properties among Normal, Involved and Uninvolved Psoriatic Skin Sitesa & b depicts basal TEWL and barrier recovery rates, respectively. c & d presents skin surface pH and SC hydration, respectively. Results are expressed as mean ± SEM in comparison with normal skin, as shown by the horizontal dotted lines. GraphPad Prism 4 software (GraphPad Software, Inc., La Jolla, CA, USA) was used for all statistical analysis. Dunnett’s Multiple Comparison Test was used to determine the difference between normal, and psoriasis involved and uninvolved skin, except in figure 1b where the differences between normal and progressive uninvolved skin were determined with unpaired T test. P<0.05 was considered to a statistically significant difference. Significant differences are shown in the figures and numbers of subjects are detailed in Table 1.
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Figure 1: Comparison of SC Biophysical Properties among Normal, Involved and Uninvolved Psoriatic Skin Sitesa & b depicts basal TEWL and barrier recovery rates, respectively. c & d presents skin surface pH and SC hydration, respectively. Results are expressed as mean ± SEM in comparison with normal skin, as shown by the horizontal dotted lines. GraphPad Prism 4 software (GraphPad Software, Inc., La Jolla, CA, USA) was used for all statistical analysis. Dunnett’s Multiple Comparison Test was used to determine the difference between normal, and psoriasis involved and uninvolved skin, except in figure 1b where the differences between normal and progressive uninvolved skin were determined with unpaired T test. P<0.05 was considered to a statistically significant difference. Significant differences are shown in the figures and numbers of subjects are detailed in Table 1.

Mentions: Consistent with prior findings Ghadially et al., 1996, our results showed that both stable and progressive psoriatic lesions displayed significantly higher basal levels of TEWL than the uninvolved skin and skin sites of normal control subjects (Fig. 1a). Barrier recovery was also delayed in the involved skin of both progressive and stable psoriasis (Fig. 1b). Although basal TEWL readings in uninvolved sites of both stable and progressive disease were comparable to those in normal skin, barrier recovery kinetics were significantly delayed in the uninvolved skin sites of patients with progressive psoriasis (Fig. 1b).


Abnormal epidermal barrier recovery in uninvolved skin supports the notion of an epidermal pathogenesis of psoriasis.

Ye L, Lv C, Man G, Song S, Elias PM, Man MQ - J. Invest. Dermatol. (2014)

Comparison of SC Biophysical Properties among Normal, Involved and Uninvolved Psoriatic Skin Sitesa & b depicts basal TEWL and barrier recovery rates, respectively. c & d presents skin surface pH and SC hydration, respectively. Results are expressed as mean ± SEM in comparison with normal skin, as shown by the horizontal dotted lines. GraphPad Prism 4 software (GraphPad Software, Inc., La Jolla, CA, USA) was used for all statistical analysis. Dunnett’s Multiple Comparison Test was used to determine the difference between normal, and psoriasis involved and uninvolved skin, except in figure 1b where the differences between normal and progressive uninvolved skin were determined with unpaired T test. P<0.05 was considered to a statistically significant difference. Significant differences are shown in the figures and numbers of subjects are detailed in Table 1.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4199879&req=5

Figure 1: Comparison of SC Biophysical Properties among Normal, Involved and Uninvolved Psoriatic Skin Sitesa & b depicts basal TEWL and barrier recovery rates, respectively. c & d presents skin surface pH and SC hydration, respectively. Results are expressed as mean ± SEM in comparison with normal skin, as shown by the horizontal dotted lines. GraphPad Prism 4 software (GraphPad Software, Inc., La Jolla, CA, USA) was used for all statistical analysis. Dunnett’s Multiple Comparison Test was used to determine the difference between normal, and psoriasis involved and uninvolved skin, except in figure 1b where the differences between normal and progressive uninvolved skin were determined with unpaired T test. P<0.05 was considered to a statistically significant difference. Significant differences are shown in the figures and numbers of subjects are detailed in Table 1.
Mentions: Consistent with prior findings Ghadially et al., 1996, our results showed that both stable and progressive psoriatic lesions displayed significantly higher basal levels of TEWL than the uninvolved skin and skin sites of normal control subjects (Fig. 1a). Barrier recovery was also delayed in the involved skin of both progressive and stable psoriasis (Fig. 1b). Although basal TEWL readings in uninvolved sites of both stable and progressive disease were comparable to those in normal skin, barrier recovery kinetics were significantly delayed in the uninvolved skin sites of patients with progressive psoriasis (Fig. 1b).

View Article: PubMed Central - PubMed

Affiliation: Dalian Skin Disease Hospital, Liaoning, People's Republic of China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Yet, both clinical experience and recent molecular studies support an emerging concept that psoriasis could be ‘driven’ by a primary defect in epidermal permeability barrier function... Since psoriasis often flares during late autumn and winter through early spring, all studies were performed during February and March, 2012, and during October, 2013, representing early spring and autumn seasons in northern China Consistent with prior findings, our results showed that both stable and progressive psoriatic lesions displayed significantly higher basal levels of TEWL than the uninvolved skin and skin sites of normal control subjects (Fig. 1a)... SC hydration markedly declined in involved skin of both progressive and stable psoriasis, but hydration levels were normal in uninvolved skin sites of both psoriatic cohorts (Figure 1d)... Recently, the central role of epidermal permeability barrier abnormalities in the pathogenesis of inflammatory dermatoses has attracted increased attention... Previous studies have shown that sustained defect in permeability barrier function predisposes skin to the development of epidermal hyperplasia and inflammation, resulting in part from the stimulation of a cytokine cascade that recruits a downstream inflammatory cell infiltration... Because not only involved, but also the uninvolved skin sites of patients with progressive disease display altered epidermal function, the results presented here are consistent with an emerging concept that an underlying abnormality in epidermal function initiates, triggers or exacerbates psoriasis, together supporting an ‘outside-to-inside’ concept of psoriasis pathogenesis... The fact that stable uninvolved psoriatic skin sites does not display demonstrable defect in epidermal function, can be explained by the reestablishment of a steady-state, where epidermal function has largely been normalized, coupled with reduced exposure to external stressors that otherwise place additional stress on the barrier... Nonetheless, it should be noted that the uninvolved skin of psoriasis could still display subtle abnormalities that are not detectable by the biophysical technique utilized here... For example, we have shown accelerated movement of the water-soluble, electron-dense tracer, lanthanum nitrate, in some situations where TEWL levels otherwise appeared normal (e.g., )... A defective permeability barrier not only stimulates epidermal proliferation, but it also increases pro-inflammatory cytokine expression, as well as increasing Langerhans cell and mast cell infiltration... Moreover, the abnormalities in surface pH in the uninvolved skin of progressive psoriasis could further predispose to disease expression in psoriasis as follows (Supplemental Figure 1): An elevation in pH inevitably activates serine proteases (kallikreins) in the outer epidermis, which in turn degrade lipid processing enzymes leading to abnormal permeability barrier homeostasis, and catalyze pro-IL-1 beta to active IL-1 beta, initiating the cytokine cascade... Finally, reduced SC hydration, which often parallels abnormalities in barrier function, alone places further stress on the barrier, evidenced by the development of epidermal proliferation and the initiation of cutaneous inflammation in experimental animals exposed to low ambient humidity.

Show MeSH
Related in: MedlinePlus