Abstract
Psoriasis is an immune-mediated dermatosis usually associated with comorbidities. Treatment varies from topicals to systemic drugs and data on susceptibility to viral infections in psoriatic patients are scarce. The objectives of this study were to analyze psoriatic patients on different therapies who were at risk for COVID-19 for seroprevalence of SARS-COV-2, pro-inflammatory cytokine profile, comorbidities and outcomes in order to unveil the immunological mechanisms involved in the anti-viral response in patients with psoriasis. Seventy-five patients with psoriasis were divided according to treatment: immunobiologics, methotrexate, topicals and acitretin. Twenty healthy controls were included. Plasma samples were collected for: IgG SARS-COV-2 (ELISA); IL-27, IL-29 and IL-18 (ELISA); and IL-1β, IL-17A, IL-6 and TNF (cytometric array). Seropositivity for SARS-COV-2 was detected in 24 out of 75 psoriasis patients and did not relate to COVID-19 symptoms and/or hospitalization, despite associated comorbidities. Psoriasis patients who were asymptomatic for SARS-COV-2 exhibited immune imbalance with high levels of IL-18, IL-17A and IL-6, and low levels of IL-27 compared to healthy controls. Psoriasis groups showed significant increased cytokine levels only in the group with immunobiologics. Despite immune deviations and lower IL-27, which has a potential antiviral impact, psoriatic patients did not exhibit complications related to COVID-19. An understanding of this kind of proinflammatory profile of psoriatic patients and of the lack of severe outcomes for COVID-19 is essential to establish novel therapeutic approaches and preventive measures, including with regard to the concomitance of viral infections.
Highlights
Psoriasis is a chronic and inflammatory immune-mediated skin disease featuring genetic predisposition and associated comorbidities, with a worldwide prevalence of around 2% and a high impact on quality of life [1,2,3]
Analysis of Circulating Levels of Proinflammatory Cytokines In our Pso patients, asymptomatic for SARS-COV-2, we detected an immune imbalance with increased levels of IL-18, IL-17A and IL-6 and decreased levels of IL-27 compared to healthy controls
We found that IL-29 was detected in only 9 out of 75 Pso patients and in 1 HC and that IL-1β was detected in 8 out of 75 Pso patients
Summary
Psoriasis is a chronic and inflammatory immune-mediated skin disease featuring genetic predisposition and associated comorbidities (psoriatic arthritis, cardiovascular disease, obesity, hypertension, dyslipidemia, diabetes mellitus, non-alcoholic fatty liver disease, inflammatory bowel disease, depression, and lymphoma, among others), with a worldwide prevalence of around 2% and a high impact on quality of life [1,2,3]. Medication—such as beta-blockers, lithium and anti-malarial and non-steroidal anti-inflammatory drugs—emotional distress, physical trauma, and infections are examples of external factors that may elicit or aggravate psoriasis in a genetically susceptible individual by breaking immunologic tolerance. Histological features of this condition include parakeratosis (due to hyperproliferative keratinocytes in the basal membrane of the epidermis), regular acanthosis, intraepidermal micro-abscesses containing neutrophils, dilatated capillaries on the dermal papillae and a dermal inflammatory infiltrate composed of lymphocytes, histiocytes, neutrophils and dendritic cells [4]. Other pro-inflammatory cytokines—such as IL-23, which is produced by dermal leucocytes from a myeloid lineage —induce the proliferation and differentiation of Th17 lymphocytes and perpetuate the inflammatory cascade in psoriasis [1,7,8,9]
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