The Relationship Between Seborrheic Dermatitis And Psoriasis

Objective:①To explore the characteristics of head and facial rash in patients withpsoriasis and seborrheic dermatitis,and to study the psoriasis patients with a history ofseborrheic dermatitis.②To investigate the psoriasis incidence in relatives of patients withpsoriasis and seborrheic dermatitis.③To study the pathological changes inpatients withpsoriasis and seborrheic dermatitis.④To investigate the expression of ERα,ERβ and ARin the scalp seborrheic dermatitis and scalp psoriasis vulgaris.⑤To study the estradiol andtestosterone levels in patients with psoriasis and seborrheic dermatitis.Methods:(1)Clinical observation and history taking of349cases of patients withpsoriasis vulgaris and191cases of patients with seborrheic dermatitis.(2) Drawing thegenealogy of262cases of psoriasis,122cases of seborrheic dermatitis,264cases of thenormal group.To estimate the heritability with Falconer method.(3)The specimens of scalppsoriasis and scalp seborrheic dermatitis were fixed in buffered formalin and embedded inparaffin.(4) To detect the expression of ERα,ERβ and AR and the estradiol andtestosterone levels in the scalp seborrheic dermatitis,scalp psoriasis vulgaris and normalgroup(in progress).Result:(1)257cases (73.64%) had auricle rash(mainly small piece of erythemascales)and166cases (47.56%) of nasolabial fold site had greasy erythema in349cases ofpsoriasis vulgaris.130cases(68.06%)had auricle rash and98cases(51.31%)of nasolabialfold site had greasy erythema in191cases of seborrheic dermatitis.There was no differencebetween them(P>0.05).②29.51%of patients with psoriasis have a history of scalpseborrheic dermatitis.5.24%of patients with seborrheic dermatitis appeared typical psoriatic lesions during treatment.③The winter was more serious than summer in43.27%patients with psoriasis vulgaris and34.03%patients with seborrheic dermatitis.In2.58%patients with psoriasis vulgaris and3.14%patients with seborrheic dermatitis,summer wasmore serious than winter.There was no difference between them(P>0.05).(2)①Drawing a family pedigree648pieces(262cases of psoriasis,122cases of seborrheicdermatitis,264cases of the normal group),of which74cases (28.24%) in patients withpsoriasis have a family history and21cases(17.21%) in patients with seborrheic dermatitishave a family history of psoriasis.There was no statistically significant difference betweenpsoriasis and seborrheic dermatitis(P>0.05),but both higher than normal group(P<0.05).②The first-degree relatives and second-degree relatives’ standardized prevalence rate of thepatients in seborrheic dermatitis and psoriasis were5.60%,5.53%and2.24%,2.94%respectively.There was no significant difference(P>0.05) between them,but both higherthan normal group(0.43%and0(no incidence of patients))(P<0.05).③Heritability ofpsoriasis in first-degree relatives of psoraiastic patients and seborrheic dermatitis patientswere70.40%±4.28%and68.4%±7.62%,respectively.④The psoriasis prevalence ofcompatriots in psoriasis,seborrheic dermatitis and normal group was2.65%,2.96%and0.086%respectively.The s/q value of psoriasis and seborrheic dermatitis was30.84and34.42.They were so close to34.10(1/q).(3)①The main pathological manifestations of scalp psoriasis were epidermishyperkeratosis,diffuse parakeratosis,a decreased or absent granularlayer,acanthosis,downward extension of epidermal protrusion,thin suprapapillaryplates,munro microabscesses(10pieces)or Kogoj sponginess pustules(3pieces),intercellular(14pieces)and intracellular edema(9pieces),extended upward ofdermal papilla,proliferation and dilatation of capillaries in dermal papilla,inflammatory cellinfiltration in superficial dermis,and so on.The main pathological manifestations of scalpseborrheic dermatitis were similar to psoriasis,but were more ease.In seborrheicdermatitis,2(11.76%) had the the munro microabscess and kogoj sponginess pustules,compared with the psoriasis group were no significant differences (bothP>0.05).In decreased or absent granular layer,thin suprapapillary plates and extended upward ofdermal papilla,seborrheic dermatitis were lighter than psoriasis but than normal group weresignificantly(P<0.05or P<0.01).②At the lips of openings and infundibular of hairfollicles,scalp seborrheic dermatitis had parakeratosis and decreased or absent granularlayer,but psoriasis was more significantly(P<0.05).③The average size of sebaceousglands in scalp psoriasis and scalp seborrheic dermatitiswere(6456.54±3.24)μm2(0~31233.8μm2)and(11748.98±2.14)μm2(515~23374.9μm2),respectively.There was no difference between them(P>0.05),but both were lower thannormal group(24547.09±2.57)(4509.2~250647.8μm2)(bothP<0.05).④The pathologicalmanifestations of hair follicles below the infundibulum in scalp psoriasis and scalpseborrheic dermatitis were not violated and no inflammatory cell infiltration around them.(4)①The positive expression of AR in the epidermal cells of seborrheic dermatitiswas higher than the psoriasis group(P<0.05).while in patients with seborrheic dermatitisand psoriasis compared to normal group,there were no difference(P>0.05).The expressionof AR in sebaceous glands cells of the scalp psoriasis and scalp seborrheic dermatitis wasweak,less than in normal group(P<0.05).②The positive expression rate of ERα in theepidermal cells of seborrheic dermatitis and normal group were42.11%and13.33%.Therewas no expression of ERα in normal group.③The positive expression rate of ERβ in theepidermal cells of psoriasis,seborrheic dermatitis and normal group were63.16%,53.33%and50%(P>0.05).④The ERα/ERβ value(0.62) of psoriasis was higher than normalgroup(0.00)(P<0.05),but seborrheic dermatitis(0.22) was no significant difference withpsoriasis and normal group,but still in between.⑤The expression of AR and ERβ ofhairfollicles(infundibulum and inner hair root sheath and outer hair root sheath)and eccrinegland of scalp psoriasis,seborrheic dermatitisand normal group were so weak(P>0.05).Theexpression of ERα was negative.(5)The estradiol and testosterone levels in patients with psoriasis and seborrheicdermatitis is testing.Conclusion:(1)The small piece of erythema scales in auricle rash and greasy erythema of nasolabial fold site were common rash of seborrheic dermatitis and psoriasis.Psoriasispatients often had a history of scalp seborrheic dermatitis. It was similar seasonal effect onpsoriasis and seborrheic dermatitis.The majority of patients were more serious in winterbut lower in summer.That indicated that the two clinical manifestations of psoriasis andseborrheic dermatitis was very similar.(2)The patients with seborrheic dermatitis and psoriasis both had a higher prevalencerate of psoriatic family history.The first-degree relatives,second-degree relatives’standardized prevalence rate,heritability of psoriasis in first-degree relatives and s/q valuesin patients with seborrheic dermatitis and psoriasis were very close,suggesting that the twodiseases carry almost the same number of psoriasis susceptibility gene.(3)The pathological manifestations of scalp seborrheic dermatitis was similar to scalppsoriasis. In addition to the epidermis and dermis,the two diseases also had sebaceousgland atrophy which was relatively characteristic changes.The histopathologicalmanifestations could not distinguish the two diseases.That showed seborrheic dermatitisand psoriasis were same or similar pathological process.(4)The pathological manifestations of hair follicles infundibular were similar toepidermis in scalp psoriasis and scalp seborrheic dermatitis--hyperkeratosis,parakeratosis,adecreased or absent granular layer, inflammatory cell infiltration around hair folliclesinfundibular.The hair follicles below the infundibulum of scalp psoriasis and scalpseborrheic dermatitis were not violated and no inflammatory cell infiltration aroundthem.That showed hair follicles below the infundibulum of two diseases happened immuneprivilege.(5) AR reduction in sebaceous gland cells led to the atrophy of sebaceous glands inscalp seborrheic dermatitis and psoriasis.The increase of ERα in epidermal cells were theimportant factor of rapid proliferation of epidermal cells in psoriasis and seborrheicdermatitis.(6)The expression of CK17,cyclin D1,cathpsin S and cyclinD1in the epidermal cellsof psoriasis and seborrheic dermatitis were positive.Microvessel density(MVD) which was defined by expression of CD34and proliferation and dilatation of capillaries in dermalpapilla were obvious(See the other master’s thesis).As a result, we have good reason to believe:seborrheic dermatitis may be a light orincomplete psoriasis, which is located the lightest end in the spectral type of psoriasis...