Goeckerman Regimen Reduces Alarmin Levels and PASI Score in Paediatric Patients with Psoriasis

Abstract

Background. Psoriasis is a chronic systemic inflammatory disease with (extra-)cutaneous manifestations. Inflammation is associated with cellular stress and tissue damage which lead to the release of alarmins (signals of danger). Goeckerman regimen (GR) is a highly efficacious treatment consisting of the application of pharmaceutical crude tar and UVB light exposure. The reduction of inflammatory processes in the skin is accompanied by changes in the levels of inflammatory markers - alarmins (HMBG-1, S100A7, S1000A8, S100A9, S100A12, IL-17, IL-22, and IL-33). Methods. The alarmin levels in sera of 19 paediatric patients with psoriasis were determined before and after GR using commercial ELISA kits. The Psoriasis area severity index (PASI) was used to determine the disease severity. Results. GR reduced both PASI and the levels of all measured alarmins. The levels of S100A7, S100A9, IL-22, IL-33, and HMGB-1 were significantly decreased. Positive correlations between IL-22 and PASI, between S100A9 and IL-17, S100A9 and IL-22, and a negative correlation between S100A8 and IL-33 were found. Conclusions. Goeckerman regimen is a very effective, safe and low-cost therapy. We confirmed, it modulates the immune system reactivity, ameliorates the severity of the disease and reduces the levels of alarmins reflecting the presence and intensity of inflammation.

The Role of Alarmins in the Pathogenesis of Rheumatoid Arthritis, Osteoarthritis, and Psoriasis

“…The authors revealed that this caused a rapid decrease in S100A7 and S100A12 [182]. In another study, administering the previously mentioned GR regimen resulted in a significant drop in S100A7 and S100A9 [171]. Kruger et al observed that treatment with the anti-IL-17a agent secukinumab decreased the expression of S100 proteins, further confirming the influence of IL-17 on the S100 protein family [172,183].…”

“…One study examined the level of alarmins after anti-psoriatic therapy in pediatric patients who underwent the Goeckerman regimen (GR), which consists of applying pharmaceutical crude tar and UVB light exposure. Administering GR resulted in a significant drop in HMGB1, together with a reduction in the PASI score [171].…”

“…Overexpression of HMGB1 attenuated the inhibitory effect etanercept. Mechanistically, TNF-α causes HMGB1 translocation to the cytoplas which, as mentioned before, is a signal for its secretion, enabling this alarmin to exe immune effects [171]. One study examined the level of alarmins after anti-psoriatic the apy in pediatric patients who underwent the Goeckerman regimen (GR), which consi of applying pharmaceutical crude tar and UVB light exposure.…”