الفهرس 
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Abstract
Psoriasis is a chronic, relapsing, immune- mediated inflammatory skin disease affecting 1-3% of the world population. Clinical manifestations of psoriasis are heterogeneous, ranges from limited to extensive disease. The majority of patients approximately (80%) have limited disease while, approximately (20%) have extensive disease. The most characteristic lesions consist of red, scaly sharply demarcated, erythematous papules and plaques present particularly over extensor surfaces and the scalp. The disease is variable in extent, duration and periodicity of flares.
The etiology of psoriasis is unknown, but evolving evidence suggests that it is a complex disorder caused by interaction of multiple factors includes immunological, environmental and genetic factors.
Epidemiological data demonstrate that psoriasis patients suffer from a spectrum of comorbidities which may be roughly divided into two types:
1. Comorbidities due to common pathogenetic mechanisms such as psoriatic arthritis and Crohn’s disease.
2. Comorbidities following chronic severe inflammation characteristic for psoriasis such as cardiovascular disorders and metabolic syndrome (MS).
Cardiovascular disease is an important cause of morbidity and mortality in patients with psoriasis.
The risk factors for cardiovascular disease (eg. Obesity, hypertension, diabetes mellitus, smoking, hyperlipidemia, oxidative stress,…..) occur with higher incidence in patients with psoriasis and appear to be highest for those with more severe disease.
With the introduction of recent developments in understanding the role of inflammation in the pathogenesis of psoriasis, it is widely believed that psoriasis is not just a skin disease but a systemic inflammatory process. This inflammatory process plays a major role in the formation of atherosclerosis which is a hallmark of cardiovascular disease.
Psoriasis and atherosclerosis share many similar underlying inflammatory mechanisms. In psoriasis, local elaboration of tumor necrosis factor-alpha (TNF-α) initiates a cascade of adaptive and innate immune cell differentiation, keratinocyte proliferation and development of psoriatic plaques. In atherosclerosis, increased circulating TNF- α lead to endothelial dysfunction and T-cell extravasation from the vascular compartment to sites of atherosclerotic plaque, that contributes to atherosclerotic plaque formation and mediate plaque instability and eventual myocardial infarction.
Endocan, previously called endothelial cell specific molecule-1 is expressed by endothelial cells, in the lung, liver and kidney, it may play an important role in regulating cell adhesion and raised plasma levels that reflect endothelial dysfunction
The aim of this study is to investigate the mean endocan serum level values in patients with psoriasis compared to healthy subjects and to study the correlation between this evaluated serum endocan level and the clinical aspects (severity, duration and age of onset) of psoriasis, in addition to evaluate the association between endocan serum level in psoriatic patients and possible risk of early stage of atherosclerosis in those patients.
This prospective case-control study was conducted on 35 patients with variable degrees of psoriasis severity and 30 age, gender, and BMI matched healthy volunteers as a control group. Cases were selected from Dermatology outpatient clinic, Faculty of Medicine, Menoufia University Hospital during the period from October 2015 to January 2016. Control subjects were selected from persons attending Plastic Surgery Department.
A written consent form, approved by Committee of Human Rights of research in Menoufia University, was obtained from every participant prior to study initiation. The patients included in this study were selected according to inclusion and exclusion criteria. All patients were not on any topical (two weeks) or systemic (one month) therapy for psoriasis before samples taking.
All studied cases were subjected to complete history taking, clinical, general and dermatological examination including assessment of PASI score and BMI determination. Measurement of endocan serum level and assessment of carotid intima media thickness were done for all subjects in this study.
In the present study, the mean value of endocan serum level in psoriatic patients was significantly higher (p<0.001) than that of the control group, That was significantly positively correlated with PASI score (r=0.88, p=0.000) denoting that severe form of psoriasis is associated with more increased endocan level.
In studying the association between endocan and other evaluated different variables in psoriatic patients, there were significant positive correlations between endocan serum level with age of psoriatic patients (r=0.43 , p=0.010), duration of psoriasis (r=0.56, p=0.000) and severity of psoriasis (r=0.88, p=0.000 ).
A comparison of CIMT in psoriatic patients and controls revealed highly significant difference (p<0.001) confirming that psoriasis was associated with subclinical atherosclerosis. There were positive correlations between CIMT mean value and age of psoriatic patients (r=0.66, p=0.002), duration of psoriasis (r=0.65, p=0.000), PASI score (r=0.67, p=0.000) and BMI (r=0.50, p=0.002).
Moreover, we divided our psoriatic patients into two groups according to CIMT; atherosclerotic psoriatic group (23 patients whose CIMT > 0.8) mm and non atherosclerotic psoriatic group (12 patients whose CIMT was ≤ 0.8 mm). The comparison between both groups revealed that atherosclerotic psoriatic patients were significantly of longer disease duration, and having severe and progressive form of psoriasis than non atherosclerotic ones.
In the current study, endocan serum concentration mean value was elevated in atherosclerotic than non atherosclerotic psoriatic patients, and was significantly and positively correlated with age, duration and severity of psoriasis and CIMT in atherosclerotic psoriatic patients, and was significant negatively correlated with age of psoriasis onset, however in non atherosclerotic psoriatic cases the endocan was only significantly correlated with PASI score indicating that the endocan is a good indicator of psoriasis severity in general (atherosclerosis and non atherosclerosis).
The ROC curve analysis of endocan for early diagnosis of atherosclerosis in psoriatic patients showed that endocan is a faire positive test for early detection of atherosclerosis in psoriatic patients.