INTRODUCTION

Psoriasis is a chronic, immune-mediated polygenic skin disorder characterized by epidermal hyperplasia. Cardinal histopathological features are as follows: hyperkeratosis, parakeratosis, neutrophils in the stratum corneum and spinous layer, hypogranulosis with suprapapillary thinning, acanthosis, clubbed rete ridges, dilated capillaries, and perivascular lymphocytes. As histopathology may be more definitive compared to clinical manifestations, being able to diagnose psoriasis accurately through histopathology may enable early diagnosis and treatment. This could ideally mean a decrease in its progression, prevention of complications, and improvement of quality of life for psoriatic persons.

To examine, grade, and compare histopathologic f indings of psoriatic lesions with established parameters from previous literature.

This is a retrospective descriptive study that will examine, grade, and compare all histopathologic findings of psoriatic lesions of patients who have accessed care at Ospital ng Manila Medical Center from 2010-2015 with established parameters from previous literature.

All 41 cases (100%) showed parakeratosis, followed in decreasing order by 19 cases (46.34%) with Munro's microabscesses, 15 cases (36.59%) with pustules of Koga, 15 cases (36.59%) with hypogranulosis, and 11 cases (26.83%) with spongiosis. Using the visual analogue scale of Moorchung Net al (2013), 28 cases (68.29%) showed mild inflammatory infiltrates, followed in decreasing order by 19 cases (46.34%) with mild epidermal hyperplasia, 12 cases (29.27%) with mild capillary proliferation, and 4 cases (9.77%) with mild suprapapillary thinning.

Findings of the current study showed histopathologic features of both early and fully developed lesions based on established psoriasis histopathological parameters. Recognized histopathological features were not consistently found in well-developed lesions.

Köebner phenomenon, also known as isomorphic response, originally refers to the erythemas and scales resulted from skin traumas. The similar phenomenon later was observed in many other diseases. This article reviews classification, etiopathogenisis, pathogenesis, clinical manifestation, and application of KP.
Humans ; Psoriasis ; pathology ; physiopathology ; Risk Factors ; Skin ; injuries ; pathology ; physiopathology ; Skin Diseases ; pathology ; physiopathology

Adult ; Diagnosis, Differential ; Female ; Humans ; Nevus, Sebaceous of Jadassohn ; diagnosis ; pathology ; Psoriasis ; diagnosis ; pathology

BACKGROUND: The assessment of the severity of psoriasis is often subjective because of the lack of quantitative laboratory diagnostic tools. Histopathological examination is the most commonly performed procedure for psoriasis diagnosis; however, it is usually descriptive. Thus, there is currently no quantitative method of determining psoriasis severity. The clinical types of psoriasis are correlated with the severity of the disease, and a lesional severity index, such as the psoriasis severity index (PSI), could be used as a quantitative tool for assessing gross severity. OBJECTIVE: To correlate the histopathological findings of psoriasis with the PSI. METHODS: Psoriatic lesions in 98 patients were evaluated. The lesions were classified into the guttate, papular, small plaque, and large plaque types according to morphology, and were scored according to the PSI. Ten common histopathological features of psoriasis were evaluated for correlation with gross severity. RESULTS: The clinical types of psoriasis showed significant correlations with the histopathological severity. However, the PSI score showed no correlation with histopathological severity. CONCLUSION: In the future, subjective gross assessment should be modified by using objective measuring devices with detailed scales, in order to correlate the findings with the histological severity.
Adult ; Classification ; Diagnosis ; Evidence-Based Practice ; Humans ; Pathology ; Psoriasis* ; Weights and Measures

As one of the most serious types of psoriasis, pathogenesis of erythrodermic psoriasis (EP) is unclear so far. In this study, we aimed to detect the levels of Th1/Th2 cytokine-associated transcription factors and T-lymphocyte clone in peripheral blood mononuclear cells (PBMCs) derived from EP patients, and gene expression level of T-bet/GATA-3 in skin lesion. The potential role of Th1/Th2 reaction pattern played in the pathogenesis of EP was also discussed. Serum levels of IFN-γ, IL-2, IL-4 and IL-10 were quantified by ELISA among 16 EP patients, 20 psoriasis vulgaris (PV) patients and 15 healthy controls. The expression levels of T-bet/GATA-3 in the skin lesion and PBMCs were examined by real-time qPCR. The ratio of Th1/Th2 was measured by flow cytometry. The levels of IFN-γ, IL-2, IL-4 and IL-10 were higher in EP patients than in the healthy controls. The levels of IL-4 and IL-10 were 69.44±11.45 and 12.62±4.57 pg/mL, respectively, in EP patients, significantly higher than those in PV patients and healthy controls (P<0.05). Flow cytometry revealed the levels of both Th1 and Th2 in PBMCs from EP patients were higher than those in healthy controls, and the Th1/Th2 ratio was dramatically lower than in PV patients (P<0.01). The ratios of IFN-γ/IL-4 and T-bet/GATA-3 in EP patients were both less than 1.0, suggesting a reversal when compared with the other two groups. Our study indicated that the EP patients exerted a Th1/Th2 bidirectional response pattern, and the balance of Th cell subsets inclines to Th2, which might be one of the important mechanisms of EP pathogenesis.
Adult ; Cytokines ; immunology ; Dermatitis, Exfoliative ; immunology ; pathology ; Female ; Gene Expression Regulation ; immunology ; Humans ; Male ; Psoriasis ; immunology ; pathology ; Skin ; immunology ; pathology ; Th1 Cells ; immunology ; pathology ; Th2 Cells ; immunology ; pathology

Adult ; Aged ; Baths ; Child ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Psoriasis ; pathology ; therapy ; Tacrolimus ; therapeutic use

This study was purposed to investigate the colony formation of high-proliferative potential colony-forming units (CFU-HPP) from bone marrow-derived hematopoietic cells of psoriatic patients and p16 gene promotor methylation in CFU-HPP cells, and to explore the relationship between the colony formation and the methylation status of p16 gene promoter. Bone marrow-derived mononuclear cells from psoriatic patients and normal controls were separated by density gradient centrifugation, and were cultured in methycellulose semi-solid culture medium with SCF, GM-CSF, IL-3 and IL-6 for 14 days to measure the colonies of CFU-HPP. The CFU-HPP colony cells were collected and methylation status of p16 gene promoter of CFU-HPP cell DNA modified with sodium bisulfite was detected by the methylation-specific polymerase chain reaction (MSP). The results showed that in methycellulose semi-solid culture system, the number and the size of CFU-HPP colonies of bone marrow of psoriatic patients were all significantly less than that of normal controls, the positive frequency of p16 gene promoter methylation in CFU-HPP cells was lower than that in CFU-HPP colony cells of normal controls. It is concluded that the colony formation capability of CFU-HPP from bone marrow hematopoietic progenitor cells in psoriatic patients is lower than that in normal controls, and the lower positive frequency of P16 gene promoter methylation in CFU-HPP cells perhaps closely correlated with lower CFU-HPP colony-forming capability.
Cell Proliferation ; Colony-Forming Units Assay ; DNA Methylation ; Genes, p16 ; Hematopoietic Stem Cells ; pathology ; Humans ; Promoter Regions, Genetic ; genetics ; Psoriasis ; genetics ; metabolism ; pathology

Ceramides play major roles in maintaining the epidermal barrier. It has been sus-pected that the depletion of ceramides, associated with disrupted barrier function in the epidermis, leads to the clinical manifestation of dryness and inflammation seen in patients with psoriasis. The aim of the present study was to determine the relation-ship between the level of ceramide synthesis in the epidermis and the clinical severity in patients with psoriasis. Samples from lesional and unlesional epidermis obtained from psoriasis patients were incubated with [14C]serine, an initiator of ceramide syn-thesis. otal ceramide was fractionated using high performance thin layer chromato-graphy, and the radioactivity was measured. The clinical severity of psoriasis was graded according to the psoriasis area and severity index scoring system. The level of ceramide synthesis in the lesional epidermis of patients was significantly lower than that in the unlesional epidermis and bore a negative correlation with the clinical severity of psoriasis. The present results suggest that the decreased level of ceramide synthesis in the epidermis contributes to the clinical severity of psoriasis.
Adolescent ; Adult ; Biological Markers ; Ceramides/*metabolism ; Fatty Acids/*metabolism ; Female ; Humans ; Korea/epidemiology ; Male ; Psoriasis/classification/epidemiology/*metabolism/*pathology ; Severity of Illness Index ; Skin/*metabolism/*pathology ; Statistics

Macrophages acquire distinct phenotypes during tissue stress and inflammatory responses. Macrophages are roughly categorized into two different subsets named inflammatory M1 and anti-inflammatory M2 macrophages. We herein identified a unique pathogenic macrophage subpopulation driven by IL-23 with a distinct gene expression profile including defined types of cytokines. The freshly isolated resting mouse peritoneal macrophages were stimulated with different cytokines in vitro, the expression of cytokines and chemokines were detected by microarray, real-time PCR, ELISA and multiple colors flow cytometry. Adoptive transfer of macrophages and imiquimod-induced psoriasis mice were used. In contrast to M1- and M2-polarized macrophages, IL-23-treated macrophages produce large amounts of IL-17A, IL-22 and IFN-γ. Biochemical and molecular studies showed that IL-23 induces IL-17A expression in macrophages through the signal transducer and activator of transcription 3 (STAT3)-retinoid related orphan receptor-γ T (RORγT) pathway. T-bet mediates the IFN-γ production in IL-23-treated macrophages. Importantly, IL-23-treated macrophages significantly promote the dermatitis pathogenesis in a psoriasis-like mouse model. IL-23-treated resting macrophages express a distinctive gene expression prolife compared with M1 and M2 macrophages. The identification of IL-23-induced macrophage polarization may help us to understand the contribution of macrophage subpopulation in Th17-cytokines-related pathogenesis.
Animals ; Cell Polarity ; Imiquimod ; Interleukin-23 ; metabolism ; Macrophages ; metabolism ; pathology ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Psoriasis ; chemically induced ; metabolism ; pathology

The pathogenesis of psoriasis recently made great advancement due to the introduction of transgenic mouse model. K14-VEGF transgenic mouse showed many of the cellular and molecular features of psoriasis, including angiogenesis in dermis, altered epidermal proliferation and differentiation. Psoriasis of early onset and severe disease showed significantly increased frequency of the +405CC genotype and the C allele. Transgenic mice with keratinocytes expressing active Stat3 (K5. Stat3C mice) developed a skin phenotype closely resembling psoriasis. Stat 3 may link activated keratinocytes and immunocytes required for development of psoriasis. More recently, a novel mouse model with epidermal specific double-knockout of the c-Jun and JunB genes showed developments of psoriasis-like skin phenotype and arthritic lesions. All these data provided more profound understanding in pathogenesis and therapy of psoriasis.
Animals ; Disease Models, Animal ; Humans ; Keratinocytes ; metabolism ; pathology ; Mice ; Mice, Knockout ; Mice, Transgenic ; Psoriasis ; etiology ; genetics ; pathology ; STAT3 Transcription Factor ; genetics ; metabolism ; Vascular Endothelial Growth Factors ; genetics ; metabolism