Lo Yang, Chiu Hsien-Yi, Tsai Tsen-Fang
Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.
Department of Dermatology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan.
Mol Diagn Ther. 2020 Feb;24(1):85-93. doi: 10.1007/s40291-019-00441-x.
Erythrodermic psoriasis (EP) is a rare variant of psoriasis that involves more complications and poorer biologic drug survival than plaque-type psoriasis vulgaris (PV). No prior study has explored human leukocyte antigen (HLA) or other genetic polymorphisms in patients with EP.
Our objective was to describe the clinical features, comorbidities, and HLA polymorphisms among Chinese patients with EP.
We enrolled consecutive patients with EP from our clinic, with EP defined as generalized confluent erythematous thin plaques covering at least 80% body surface area. Patients were categorized as having primary or secondary EP. Aggravating factors, comorbidities including psoriatic arthritis, family history of psoriasis, age of onset, and treatment history were also identified. Genetic studies were performed for HLA-C and HLA-DRB1, and the results were compared with those from a healthy population and patients with PV.
Of the 63 included patients, the male to female ratio was 2.71:1. Five (7.9%) patients had primary EP, and 58 (92.1%) had secondary EP. Genotyping of HLA-C and HLA-DRB1 was available in 61 and 58 subjects, respectively. HLA-C0102 was the most frequent HLA-C allele (34.4%), followed by HLA-C0702 (18.0%). The frequency of HLA-C0602 allele (4.1%) was lower than in patients with plaque-type psoriasis (4.1 vs. 16.3%, corrected p value [P] = 0.02) and similar to that in the healthy population in Taiwan. The most frequent HLA-DRB1 allele was HLA-DRB10901 (20.7%), followed by HLA-DRB1*0803 (13.8%). An increased prevalence of psoriatic arthritis (61.9%) and higher male predominance were also noted in comparison with PV.
There are HLA differences in Chinese patients with EP compared with patients with PV. The incidence of psoriatic arthritis is also higher. The implications of the above findings await further investigation.
红皮病型银屑病（EP）是银屑病的一种罕见变异型，相较于寻常型斑块状银屑病（PV），其并发症更多，生物制剂疗效维持时间更短。此前尚无研究探讨EP患者的人类白细胞抗原（HLA）或其他基因多态性。
我们的目的是描述中国EP患者的临床特征、合并症及HLA多态性。
我们纳入了门诊连续就诊的EP患者，EP定义为全身性融合性红斑薄斑块，覆盖至少80%的体表面积。患者被分为原发性或继发性EP。还确定了加重因素、包括银屑病关节炎在内的合并症、银屑病家族史、发病年龄及治疗史。对HLA - C和HLA - DRB1进行基因研究，并将结果与健康人群及PV患者的结果进行比较。
63例纳入患者中，男女比例为2.71:1。5例（7.9%）患者为原发性EP，58例（92.1%）为继发性EP。分别有61例和58例受试者获得了HLA - C和HLA - DRB1的基因分型结果。HLA - C0102是最常见的HLA - C等位基因（34.4%），其次是HLA - C0702（18.0%）。HLA - C0602等位基因的频率（4.1%）低于斑块状银屑病患者（4.1%对16.3%，校正P值[P]=0.02），与台湾健康人群相似。最常见的HLA - DRB1等位基因是HLA - DRB10901（20.7%），其次是HLA - DRB1*0803（13.8%）。与PV相比，银屑病关节炎的患病率增加（61.9%），男性优势也更明显。
与PV患者相比，中国EP患者存在HLA差异。银屑病关节炎的发病率也更高。上述发现的意义有待进一步研究。
