Uric acid in the etiology of psoriasis.

Abstract

The potential etiologic relationship between uric acid in its microcrystalline monosodium urate form and psoriasis was examined by 1) substantiating the reported correlation between hyperuricemia and psoriasis using the phosphotungstate method; 2) examining psoriatic tissue samples for the presence of urates under a microscope using polarized light and a compensator; 3) attempting to induce psoriasis-like symptoms in laboratory animals with purine-to-uric acid metabolism by increasing serum uric acid level; and 4) observing psoriasis-hyperuricemic patients following treatment for their hyperuricemia with Allopurinol. As expected, both men and women psoriatics had higher uric acid levels than did their counterparts in a control group. Monosodium urate crystals were found in samples from psoriatic plaques by both methods used. They were clustered particularly around sweat pores and Munro abscesses, but were found only occasionally in epidermal tissue taken from nonpsoriatics. Psoriasis-like symptoms were induced in laboratory animals (the South American boa, Constrictor constrictor) when they were fed doses of uric acid. Patients with psoriasis and hyperuricemia showed marked improvement in psoriasis when treated for their hyperuricemia. Psoriasis, like gout, may be, at least partly, a result of disorder of purine metabolism and monosodium urate crystals may be responsible for the cell proliferation that is characteristic of psoriatic plaques. Monosodium urate crystals were found by the author to be strikingly segmented. This structure may result in ease of fragmentation, thus increasing the difficulty in identifying urates in any tissue.