A Preliminary Study Of Fever Mechanism In Patients With Generalized Pustular Or Erythrodermic Psoriasis

Background:The pathogenesis of generalized pustular psoriasis (GPP) or erythrodermic psoriasis (EP) might be concerned with immunization, environment and inheritance. The clinical features of GPP or EP were wide and recurrent dermal lesions, high medical expenses and more drug side effects. So the physical and mental health of patients would be serious challenges. In clinical, fever is a symptoms of GPP or EP, and treatment is very difficult. Some research showed that miscellaneous cytokines were associated with the immunopathogenesis of psoriasis and fever, and IL-1, IL-6and TNF-a were very important and reliable cytokines between psoriasis and fever. IL-1, IL-6and TNF-a might play important roles in the fever mechanism of GPP or EP.Objective:To investigate the fever mechanism of GPP or EP.Methods:The clinical information of GPP, EP and vulgaris psoriasis (VP) was analyzed. GPP or EP were divided into fever group and apyretic group according to fever, VP group, and normal group were set to the control group. Serum levels of IL-1, IL-6and TNF-α of each group were detected by sandwich ABC-ELISA. Related experiments data had been analyed by SPSS17.0software.Results:The body temperatures of GPP patients were positively associated with pathogenesis severity scores, white blood cell counts, neutrophil counts, and serum levels of IL-1, IL-6and TNF-a (P<0.05or P＜0.01). Serum levels of IL-1, IL-6and TNF-a during fever period in GPP fever group were higher than those during body temperature stable period and while the patients being discharged in GPP fever group, and than those w-hile patients being admitted and discharged in GPP apyretic group, and than those while patients being admitted in VP group, and than those in normal group as well (P<0.05or P<0.01). There were positive correlations among serum levels of IL-1, IL-6and TNF-α of each group in GPP (P0＜.01). The body temperature of EP was positively associated with psoriasis area and severity index, lesion area percentage, and serum levels of IL-1, IL-6and TNF-a (P＜0.05or P＜0.01), but no associated with white blood cell counts and neutrophil counts(P>0.05). There were positive correlations among serum levels of IL-1, IL-6and TNF-a of each group in EP(P＜0.01). In EP fever group, and serum levels of IL-1, IL-6and TNF-a during fever period were higher than those while the patients being discharged (P<0.05or P＜0.01), and serum levels of IL-1and IL-6were higher than those during body temperature stable period (P<0.05), but serum levels of TNF-a had no difference between fever period and body temperature stable period (P>0.05). Serum levels of IL-1, IL-6and TNF-a in EP fever group were higher than those in EP apyretic group and VP group(P<0.05or P＜0.01).Conclusion:IL-1, IL-6and TNF-a, and their interaction might be a key fever mechanism of GPP or EP. The neutrophil maybe plays an important role in fever mechanism of GPP.