الفهرس 
? PsoriasisOnly 14 pages are availabe for public view
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Abstract
P
soriasis is one of the most prevalent chronic inflammatory skin diseases, affecting 1–3% of the Caucasian population and causes significant impairment of quality of life, at least to the same extent as other major medical diseases.
Although the precise pathomechanism of psoriasis remains unknown, various cytokines and growth factors are involved in this disease. TNF-α is a pleiotropic inflammatory cytokine, and studies indicate that TNF-α plays a critical role in the development of psoriasis.
Psoriasis is associated with increased risks of cardiovascular disease, metabolic syndrome, diabetes and obesity compared with non-psoriatic skin diseases.
Adiponectin is an adipocyte-specific secretory protein abundantly present in the circulation. Plasma levels of adiponectin are decreased in obesity, insulin resistance and type 2 diabetes and hypoadiponectinaemia is assumed to be closely associated with the metabolic syndrome.
Considering the fact that adiponectin is related to metabolic syndrome which can coexist with psoriasis, it cannot be excluded that this protein plays a role in pathophysiological processes in psoriasis.
This study included 50 patients with chronic plaque psoriasis with variable extent of lesions, 25 of them are with metabolic syndrome and 25 are without, as well as 50 control subjects, 25 of them are with metabolic syndrome and 25 are without. All cases were subjected to complete history taking, general examination and clinical examination including Psoriasis Area and Severity Index (PASI) score.
Peripheral venous blood samples were withdrawn from patients and controls in the morning after 12 hours overnight fasting. Serum levels of TNFα and adiponectin were measured using (ELISA) methods. Serum triglycerides and HDL were measured also for both patients and controls.
The patients were treated until their initial PASI score decreased to 50 % (PASI 50) using topical treatments like several types of emollients, betamethasone (valerate) 1 mg/gm cream and ointment, calcipotriol ointment and calcipotriol 0.05 mg/gm with betamethasone 0.5 mg/gm ointment, phototherapy and systemic agents like methotrexate, cyclosporine and acitretin were also used according to the disease severity, the general condition and the history of previous medications in different patients.
In the present study serum levels of TNFα and adiponectin are significantly increased in psoriasis patients compared to controls which is in agreement with several studies, the adiponectin levels are significantly lower in psoriatic patients with metabolic syndrome in comparison to those without metabolic syndrome, the levels are also significantly lower in controls with metabolic syndrome in comparison to those without metabolic syndrome, this is in contrast to TNFα levels which are higher in cases and controls with metabolic syndrome in comparison to those without metabolic syndrome.
Our study shows positive correlation of TNFα and adiponectin to PASI score although the correlation was not statistically significant.
The serum levels of TNFα and adiponectin are decreased with treatment of the cases and the difference between pre and post treatment levels is statistically significant.
In the present study, statistically significant positive correlation of serum TNFα level in psoriasis patients in relation to age, waist circumference, fasting blood sugar and body mass index is detected. By comparing among patients, highly significant higher levels of TNFα are detected in smokers in comparison to non-smokers.
As regards adiponectin, there is statistically highly significant positive correlation between its level and the disease duration, also there is statistically significant negative correlation between the adiponectin level and the body mass index.
Also when comparing serum adiponectin levels among patients, highly significant higher levels of serum adiponectin are detected in males in comparison to females, also there is significantly higher levels in smokers in comparison to non-smokers.