Journal of Dermatological Science 78 (2015) 239–240
Contents lists available at ScienceDirect
Journal of Dermatological Science journal homepage: www.jdsjournal.com
Letter to the Editor Metabolic abnormalities are absent in patients with generalized pustular psoriasis Generalized pustular psoriasis (GPP) is an uncommon variant of psoriasis. It is characterized by the sudden onset of diffuse erythema, with the scattering of pustules, accompanied by high fever and hyperleukocytosis. Triggered by infection or drug exposure, GPP can occur with other forms of psoriasis or be the only manifestation of disease. GPP has been included within the spectrum of psoriasis, but the clinical and histologic (especially genetic) differences suggest it has a distinct pathogenesis [1]. In recent years, numerous studies have demonstrated that psoriasis is significantly associated with the metabolic syndrome or its components, such as obesity, insulin resistance, hypertension and atherogenic dyslipidemia [2]. A systematic review found that psoriasis was significantly associated with the incidence of dyslipidemia [3]. Also, greater severity of psoriasis appears to be associated with a higher prevalence of dyslipidemia [3]. Laboratory abnormalities (e.g., hyperleukocytosis in the acute stage) of GPP patients are common. Mansur et al. [4] demonstrated that eosinophilia in peripheral blood is associated with GPP. However, a study focusing on the clinical and laboratory features of the metabolic syndrome in GPP patients are lacking. We undertook a case–control study involving 40 patients (age, 40.44 16.87 years) with GPP hospitalized in Anhui Provincial Hospital (Anhui, China) from January 2001 to April 2013 and
86 matched controls (39.4 15.26 years; patients with condyloma acuminatum) (Table 1). GPP patients who had received systemic treatment, phototherapy or photo-chemotherapy within the previous 4 weeks before hospital admission were excluded. Blood samples used for evaluation were taken from all subjects at 8 am to 9 am before initiation of any specific therapy for the disease. Levels of triglycerides (TG), total cholesterol (TC), and fasting blood sugar (FBS) were measured using a 7600-020 Automatic Biochemical Analyzer (Hitachi, Tokyo, Japan). White blood cell count, absolute neutrophil count, and eosinophil count were obtained using a HST-302 Automatic Blood Analyzer (Sysmex, Kobe, Japan) Statistical analyses were carried out using SPSS v13 (IBM, Armonk, NY, USA). In our 40 patients with GPP, comorbidities included chronic infection of the respiratory tract (22.5%), autoimmune disease (5%), and disorders in the hematologic system (2.5%). No patients had a history of diabetes mellitus or diseases of the cardiovascular system. GPP patients had a significantly lower serum level of cholesterol as well as a significantly higher white blood cell count and neutrophil count than controls (all P < 0.01). TG level was lower in GPP patients than in controls, but the difference was not significant. Blood pressure, FBS, and eosinophil cell count were comparable to those of controls (Table 1). Based on differences in disease history, we divided GPP patients into two subgroups: one with a history of psoriasis vulgaris (PsV)
Table 1 The comparison of metabolic index and blood routine index between GPP group and controls. Groups
GPP group (n = 40)
GPP without PsV (n = 16)
GPP with PsV (n = 24)
Control group (n = 86)
GPP group vs controls t
Gender Male 21 39 Female 19 47 Age (year) 40.44 16.87 39.4 15.26 The blood pressure Systolic pressure 122.08 18.59 111.87 17.71 125.92 17.34 120.83 15.41 (mmHg) 72.12 11.89 63.2 9.88 77.71 9.47 75.17 9.97 Diastolic pressure (mmHg) Metabolic index FBS (mmol/L) 4.96 1.13 4.8188 1.14 5.065 1.136 4.76 0.55 TC (mmol/L) 3.74 0.82 3.59 0.93 3.82 0.77 4.31 0.93 TG (mmol/L) 1.17 0.53 1.02 0.43 1.25 0.57 1.41 0.82 Blood routine index White blood cell 10.39 3.77 9.74 4.03 5.7 1.98 10 3.89 count (109) 7.63 3.93 8.52 3.92 3.49 1.60 Absolute neutrophil 8.12 3.88 count (109) 0.159 0.16 0.47 1.31 0.15 0.26 Eosinophils 0.33 0.99 count (109) *
GPP without PsV vs controls P*
P
t
GPP with PsV vs controls P*
P
t
P*
P
0.454
0.568
1.705
0.733
0.814
0.102
0.919
0.919
2.035
0.045
0.072
1.405
0.168
0.336
1.489
0.139
0.278
4.298
0.00004
0.0001 1.351
0.268
0.357
1.334 3.205 1.625
0.3 0.002 0.059
0.5 0.323 0.0067 2.578 0.098 1.662
0.841 0.011 0.1
0.961 0.022 0.13
0.233 0.02 0.286
0.323 0.053 0.286
1.353 2.213 1.212
8.154
Contents lists available at ScienceDirect
Journal of Dermatological Science journal homepage: www.jdsjournal.com
Letter to the Editor Metabolic abnormalities are absent in patients with generalized pustular psoriasis Generalized pustular psoriasis (GPP) is an uncommon variant of psoriasis. It is characterized by the sudden onset of diffuse erythema, with the scattering of pustules, accompanied by high fever and hyperleukocytosis. Triggered by infection or drug exposure, GPP can occur with other forms of psoriasis or be the only manifestation of disease. GPP has been included within the spectrum of psoriasis, but the clinical and histologic (especially genetic) differences suggest it has a distinct pathogenesis [1]. In recent years, numerous studies have demonstrated that psoriasis is significantly associated with the metabolic syndrome or its components, such as obesity, insulin resistance, hypertension and atherogenic dyslipidemia [2]. A systematic review found that psoriasis was significantly associated with the incidence of dyslipidemia [3]. Also, greater severity of psoriasis appears to be associated with a higher prevalence of dyslipidemia [3]. Laboratory abnormalities (e.g., hyperleukocytosis in the acute stage) of GPP patients are common. Mansur et al. [4] demonstrated that eosinophilia in peripheral blood is associated with GPP. However, a study focusing on the clinical and laboratory features of the metabolic syndrome in GPP patients are lacking. We undertook a case–control study involving 40 patients (age, 40.44 16.87 years) with GPP hospitalized in Anhui Provincial Hospital (Anhui, China) from January 2001 to April 2013 and
86 matched controls (39.4 15.26 years; patients with condyloma acuminatum) (Table 1). GPP patients who had received systemic treatment, phototherapy or photo-chemotherapy within the previous 4 weeks before hospital admission were excluded. Blood samples used for evaluation were taken from all subjects at 8 am to 9 am before initiation of any specific therapy for the disease. Levels of triglycerides (TG), total cholesterol (TC), and fasting blood sugar (FBS) were measured using a 7600-020 Automatic Biochemical Analyzer (Hitachi, Tokyo, Japan). White blood cell count, absolute neutrophil count, and eosinophil count were obtained using a HST-302 Automatic Blood Analyzer (Sysmex, Kobe, Japan) Statistical analyses were carried out using SPSS v13 (IBM, Armonk, NY, USA). In our 40 patients with GPP, comorbidities included chronic infection of the respiratory tract (22.5%), autoimmune disease (5%), and disorders in the hematologic system (2.5%). No patients had a history of diabetes mellitus or diseases of the cardiovascular system. GPP patients had a significantly lower serum level of cholesterol as well as a significantly higher white blood cell count and neutrophil count than controls (all P < 0.01). TG level was lower in GPP patients than in controls, but the difference was not significant. Blood pressure, FBS, and eosinophil cell count were comparable to those of controls (Table 1). Based on differences in disease history, we divided GPP patients into two subgroups: one with a history of psoriasis vulgaris (PsV)
Table 1 The comparison of metabolic index and blood routine index between GPP group and controls. Groups
GPP group (n = 40)
GPP without PsV (n = 16)
GPP with PsV (n = 24)
Control group (n = 86)
GPP group vs controls t
Gender Male 21 39 Female 19 47 Age (year) 40.44 16.87 39.4 15.26 The blood pressure Systolic pressure 122.08 18.59 111.87 17.71 125.92 17.34 120.83 15.41 (mmHg) 72.12 11.89 63.2 9.88 77.71 9.47 75.17 9.97 Diastolic pressure (mmHg) Metabolic index FBS (mmol/L) 4.96 1.13 4.8188 1.14 5.065 1.136 4.76 0.55 TC (mmol/L) 3.74 0.82 3.59 0.93 3.82 0.77 4.31 0.93 TG (mmol/L) 1.17 0.53 1.02 0.43 1.25 0.57 1.41 0.82 Blood routine index White blood cell 10.39 3.77 9.74 4.03 5.7 1.98 10 3.89 count (109) 7.63 3.93 8.52 3.92 3.49 1.60 Absolute neutrophil 8.12 3.88 count (109) 0.159 0.16 0.47 1.31 0.15 0.26 Eosinophils 0.33 0.99 count (109) *
GPP without PsV vs controls P*
P
t
GPP with PsV vs controls P*
P
t
P*
P
0.454
0.568
1.705
0.733
0.814
0.102
0.919
0.919
2.035
0.045
0.072
1.405
0.168
0.336
1.489
0.139
0.278
4.298
0.00004
0.0001 1.351
0.268
0.357
1.334 3.205 1.625
0.3 0.002 0.059
0.5 0.323 0.0067 2.578 0.098 1.662
0.841 0.011 0.1
0.961 0.022 0.13
0.233 0.02 0.286
0.323 0.053 0.286
1.353 2.213 1.212
8.154
