University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco, San Francisco, CA, USA.
Am J Clin Dermatol. 2016 Jun;17(3):257-63. doi: 10.1007/s40257-016-0183-7.
As most efforts in the last decade have focused on the immunologic basis of inflammatory skin disease, there has been less emphasis on the role of the nervous system in the disease process of psoriasis. Evidence in support of the neurocutaneous pathway has come from observations of patients experiencing unilateral improvement and even complete remission following nerve damage in the affected dermatomal region. The aim of this review was to investigate the role of neuropeptides in the intricate pathophysiology of psoriasis. The PubMed database was searched for individual case reports or case series that reported clearance or significant improvement in psoriatic disease in patients following documented nerve injury. A total of 11 cases were found that reported improvement of psoriatic lesions in areas afflicted by central or peripheral nerve injury. The most common causes of denervation were inadvertent surgical interruption, cerebrovascular accident, and poliomyelitis. In four cases the patients eventually regained neurologic function, which was associated with a recurrence of skin lesions. In cases of permanent nerve damage, there was remission of psoriasis. The cases reported in the literature to date provide clinical evidence that absence of neural input leads to psoriasis improvement, suggesting a crucial role of the nervous system in the pathophysiology of psoriatic disease. In fact, neuropeptides such as nerve growth factor, substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide may be important contributors of psoriatic disease and potential targets for future therapies.
由于过去十年中的大多数研究都集中在炎症性皮肤病的免疫学基础上，因此对神经系统在银屑病发病机制中的作用的重视程度较低。支持神经皮肤途径的证据来自于观察到的患者在受累皮节区域的神经损伤后出现单侧改善甚至完全缓解的情况。本综述的目的是探讨神经肽在银屑病复杂病理生理学中的作用。在 PubMed 数据库中搜索了单独的病例报告或病例系列，这些报告表明在有记录的神经损伤后，患者的银屑病得到了清除或显著改善。共发现 11 例报告称，在中枢或周围神经损伤部位的银屑病病变得到改善。去神经支配最常见的原因是意外的手术中断、脑血管意外和脊髓灰质炎。在 4 例中，患者最终恢复了神经功能，这与皮肤病变的复发有关。在永久性神经损伤的情况下，银屑病得到缓解。迄今为止，文献中报道的病例为缺乏神经输入会导致银屑病改善提供了临床证据，这表明神经系统在银屑病发病机制中起着关键作用。事实上，神经生长因子、P 物质、降钙素基因相关肽和血管活性肠肽等神经肽可能是银屑病发病的重要因素，也是未来治疗的潜在靶点。
