Stress-Induced Endocrine and Immunological Changes in Psoriasis Patients and Healthy Controls

Abstract

Background: Clinical observations suggest that psychological stress can induce exacerbation of psoriasis. It is hypothesized that these stress effects on the course and outcome of psoriasis are caused by neuroendocrine modulation of immune functions. Therefore we investigated the cardiovascular, endocrine and immunological response to a laboratory stressor in psoriasis patients and healthy controls. Methods: Untreated (n = 7) and PUVA-treated (n = 4) psoriatics and healthy controls (n = 7) were exposed to a brief laboratory stressor (public speaking and mental arithmetic). Heart rate and blood pressure, catecholamine, cortisol, and DHEA plasma concentration, as well as distribution of T and NK lymphocytes were analyzed before, immediately after and 1 h after stress exposure. Results: Heart rate and blood pressure increased in all three groups during stress exposure with the most pronounced changes in PUVA-treated patients. Psoriasis patients displayed higher adrenaline values but diminished cortisol and DHEA plasma concentrations compared to controls. NK cell numbers (CD16⁺, CD56⁺), but not T lymphocyte subsets, increased immediately after stress exposure in untreated patients and controls. This effect was significantly diminished in PUVA-treated patients. Conclusions: The data of this pilot study indicate an enhanced stress-induced autonomic response and diminished pituitary-adrenal activity in psoriasis patients. PUVA treatment seems to interfere with the cardiovascular and NK cell response to acute psychological stress. Future studies will analyze the stress-induced neuroimmunological mechanisms in psoriatics in more detail.

Beta Adrenergic Receptors in Keratinocytes

“…Interestingly, in a recent study of 50 subjects, it was found that the Arg16 allele frequency was significantly higher in the sporadic psoriasis group as compared to controls [82]. Since increased circulating levels of catecholamines have been observed in psoriatic patients [84], and a 10-fold increase in the expression of the epinephrine sythetic enzyme PNMT is also found in basal keratinocytes in involved psoriatic epidermis [85], it is tempting to propose that long-term exposure to increased levels of catecholamines, in the circulation or locally derived by the keratinocytes themselves, in combination with increased desensitization of beta 2AR in individuals with the Arg16 allele, may predispose to psoriasis.…”

Psychosomatic Medicine: Emerging Trends and Perspectives

“…In Graves’ disease, the evidence that ensues is pretty solid, since it is based on independent studies which obtained comparable results by using similar and reliable methods in different countries. Stressful life events may affect the regulatory mechanisms of neuroendocrine-immune functions in a number of ways [32, 33, 34]. Within a multifactorial frame of reference, stressful life events have been consistently associated with several medical disorders.…”

“…Within a multifactorial frame of reference, stressful life events have been consistently associated with several medical disorders. Table 1 outlines the medical disorders for which controlled studies have pointed to a relationship [11, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40]. …”

Psychological and biological background of the interaction between psoriasis and stress

“…A kísérletes vagy valós stresszorokra adott kortizolvá-laszt eddig hat tanulmány vizsgálta, amelyek közül négy alulműködő HPA-tengelyről számolt be [16,54,55,57,60,63]. A bevezetőben említett, a betegségüket saját bevallásuk szerint stresszérzékenynek, illetve a nem stresszérzékenynek tartó pikkelysömörös betegek közöt-ti klinikai különbségek ismeretében érdekes megvizsgál-ni, hogy a két csoport közötti különbség a hormonok szintjén is megjelenik-e. Richards és mtsai azt találták, hogy a betegségüket stresszérzékenynek vallók stresszor előtti bazális kortizolszintjei alacsonyabbak voltak, és a stresszre is csökkent kortizoltermeléssel reagáltak [56].…”

“…Schmid-Ott és mtsai [63] A rövidítésjegyzékben nem szereplő rövidítések: TSST = Trier Social Stress Test.…”