Montero-Vilchez Trinidad, Martinez-Lopez Antonio, Sierra-Sanchez Alvaro, Soler-Gongora Miguel, Jimenez-Mejias Eladio, Molina-Leyva Alejandro, Buendia-Eisman Agustin, Arias-Santiago Salvador
Dermatology Department, Hospital Universitario Virgen de las Nieves, Avenida de Madrid, 15, 18012 Granada, Spain.
Instituto de Investigación Biosanitaria GRANADA, 18012 Granada, Spain.
J Clin Med. 2021 Aug 30;10(17):3897. doi: 10.3390/jcm10173897.
Psoriasis is a major global health problem. There is a need to develop techniques to help physicians select the most appropriate cost-effective therapy for each patient. The main objectives of this study are (1) to evaluate changes in epidermal barrier function and skin homeostasis after phototherapy and (2) to explore potentially predictive values in epidermal barrier function and skin homeostasis to assess clinical improvement after fifteen sessions of phototherapy. A total of 76 subjects, 38 patients with plaque-type psoriasis and 38 gender- and age-matched healthy volunteers, were included in the study. Erythema, transepidermal water loss (TEWL), temperature, stratum corneum hydration (SCH), pH, sebum, and antioxidant capacity were measured before and after the first and fifteenth phototherapy session. Erythema (401.09 vs. 291.12 vs. 284.52 AU, < 0.001) and TEWL (18.23 vs. 11.44 vs. 11.41 g·m·h, < 0.001) were significantly higher at psoriatic plaques than in uninvolved psoriatic skin and healthy volunteers, respectively, while SCH was lower (9.71 vs. 44.64 vs. 40.00 AU, < 0.001). After fifteen phototherapy sessions, TEWL (-5.19 g·m·h, = 0.016) decreased while SCH (+7.01 AU, = 0.013) and erythema (+30.82 AU, = 0.083) increased at psoriatic plaques. An erythema increase exceeding 53.23 AU after the first phototherapy session, with a sensitivity of 71.4% and specificity of 84.2%, indicates that a patient may improve Psoriasis Area and Severity Index (PASI) by ≥3 points after fifteen phototherapy sessions. In conclusion, phototherapy improves epidermal barrier function in psoriatic patients and the erythema increase after one phototherapy session could help doctors select psoriasis patients who are more likely to respond to phototherapy.
银屑病是一个重大的全球健康问题。有必要开发相关技术，以帮助医生为每位患者选择最合适的性价比高的治疗方法。本研究的主要目的是：（1）评估光疗后表皮屏障功能和皮肤稳态的变化；（2）探索表皮屏障功能和皮肤稳态对评估十五次光疗后临床改善情况的潜在预测价值。本研究共纳入76名受试者，其中38例斑块型银屑病患者和38例性别及年龄匹配的健康志愿者。在第一次和第十五次光疗前后分别测量红斑、经表皮水分流失（TEWL）、温度、角质层水合作用（SCH）、pH值、皮脂和抗氧化能力。银屑病斑块处的红斑（401.09 vs. 291.12 vs. 284.52 AU，P<0.001）和TEWL（18.23 vs. 11.44 vs. 11.41 g·m·h，P<0.001）分别显著高于未受累的银屑病皮肤和健康志愿者，而SCH较低（9.71 vs. 44.64 vs. 40.00 AU，P<0.001）。十五次光疗后，银屑病斑块处的TEWL（-5.19 g·m·h，P = 0.016）下降，而SCH（+7.01 AU，P = 0.013）和红斑（+30.82 AU，P = 0.083）增加。第一次光疗后红斑增加超过53.23 AU，敏感性为71.4%，特异性为84.2%，这表明患者在十五次光疗后银屑病面积和严重程度指数（PASI）可能改善≥3分。总之，光疗可改善银屑病患者的表皮屏障功能，一次光疗后红斑增加有助于医生选择更可能对光疗有反应的银屑病患者。
