泛发性脓疱型银屑病并系统器官功能障碍。
Generalized Pustular Psoriasis and Systemic Organ Dysfunctions.
机构信息
Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.
出版信息
Int J Mol Sci. 2024 Jun 6;25(11):6270. doi: 10.3390/ijms25116270.
This review explores the intricate relationship between generalized pustular psoriasis (GPP) and various systemic diseases, shedding light on the broader impacts of this severe skin condition beyond its primary dermatological manifestations. GPP is identified as not only a profound contributor to skin pathology but also a significant risk factor for systemic diseases affecting cardiovascular, hepatic, renal, pulmonary, and skeletal systems, as well as associated with an increased incidence of anemia, depression, anxiety, and arthritis. The research highlights the complex interplay of cytokines, particularly IL-17 and IL-36, which are central to the pathophysiology of GPP and implicated in the exacerbation of systemic conditions. Key findings indicate a higher incidence of cardiovascular events in GPP patients compared to those with other severe forms of psoriasis, notably with a stronger correlation between myocardial infarction history and GPP development. Liver disturbances, frequently reversible upon psoriasis remission, suggest a cytokine-mediated link to hepatic health. Renal dysfunction appears elevated in GPP sufferers, with IL-17 and IL-36 potentially driving renal fibrosis. Similarly, interstitial lung disease and osteoporosis in GPP patients underscore the systemic reach of inflammatory processes initiated in the skin. The associations with anemia, depression, anxiety, and arthritis further complicate the clinical management of GPP, requiring a multidisciplinary approach. The study concludes that managing GPP effectively requires a holistic approach that addresses both the cutaneous and systemic dimensions of the disease, advocating for continued research into the mechanisms that connect GPP with broader health implications to refine therapeutic strategies.
这篇综述探讨了泛发性脓疱型银屑病(GPP)与各种系统性疾病之间错综复杂的关系,揭示了这种严重皮肤疾病除了主要的皮肤表现之外,对全身的广泛影响。GPP 不仅被认为是皮肤病理学的重要因素,也是心血管、肝脏、肾脏、肺部和骨骼系统等多种系统性疾病的重要危险因素,同时还与贫血、抑郁、焦虑和关节炎的发病率增加有关。研究强调了细胞因子,特别是白细胞介素-17(IL-17)和白细胞介素-36(IL-36)的复杂相互作用,这些细胞因子是 GPP 病理生理学的核心,并且与系统性疾病的恶化有关。主要研究结果表明,GPP 患者发生心血管事件的概率高于其他严重形式的银屑病患者,特别是心肌梗死病史与 GPP 发展之间的相关性更强。肝脏紊乱在银屑病缓解后通常是可逆的,这表明细胞因子与肝脏健康之间存在关联。肾功能障碍在 GPP 患者中似乎升高,白细胞介素-17(IL-17)和白细胞介素-36(IL-36)可能导致肾脏纤维化。同样,GPP 患者的间质性肺病和骨质疏松症突出了炎症过程在皮肤中启动后对全身的影响。与贫血、抑郁、焦虑和关节炎的关联进一步增加了 GPP 临床管理的复杂性,需要采用多学科方法。该研究得出结论,有效管理 GPP 需要采取整体方法,既要解决皮肤疾病的局部问题,又要解决全身问题,倡导继续研究将 GPP 与更广泛的健康影响联系起来的机制,以完善治疗策略。
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