Clinical Analysis Of TypeⅠ,Ⅱ Andthe Expression And Significance Of ERβ In Lesions Of Psoriasis Vulgaris

Objective:(1) To study the difference of type I and type II psoriasis vulgaris. (2) To investigate the expression and significance of ERβin psoriasis vulgaris.Methods:(1) 307 patients with psoriasis vulgaris were studied by the questionnaire. (2) The expression of ERP,Ki-67,Cyclin D1 and CD31 in 34 cases of psoriasis vulgaris(include:lesion areas,non-lesional areas and junction areas) and 17 normal controls was detected respectively with immunohistochemistry staining.Result:(1)①Patients of typeⅠwere found to have higher rate of positive family history than typeⅡ,and the age of onset in patients with positive family history were earlier than those without family history (P<0.01).②Onset of typeⅠpatients was mostly taken place in winter and spring,the least in summer; but most patients of typeⅡoccurred in spring, followed by summer and autumn,winter least. There was a significant difference between two types (P<0.05).③The PASI of typeⅠwas higher than typeⅡ(P<0.05),typeⅠwas men less than women,(P<0.05),typeⅠwas no significant difference between men and women(P>0.05),patients with family history were higher than those without family history and the family history of typeⅠwas higher than typeⅡ(P<0.05 or P<0.01).④Location of the primary psoriatic lesions were capitally on scalp, leg, forearm,elbow and external ear. But predilection sites were on the external ear,limbs stretched side,scalp,back, chest and abdomen and so on.⑤Onset sites of hip,ankle and groin, patients of typeⅡwere more than typeⅠ(P<0.01),but the incidence of typeⅠwas higher than typeⅡin elbow (P<0.05),and patients of typeⅠwere more than typeⅡin predilection sites of the external ear, extensor aspect of leg, back, anterior hair line, abdomen, face, neck,nails and tongue(P<0.05 or 0.01),but typeⅡwas higher than type I in dorsum of foot and ankle(P<0.01). (2)①The main pathological manifestations of psoriasis were epidermis hyperkeratosis,parakeratosis,decrease or disappearance of the stratum granulosum,acanthosis,elongation of trochanterellus and dermal papilla,munro's microabscesses or Kogoj sponginess pustules,proliferation and dilatation of capillaries,inflammatory cell infiltration in superficial dermis and around vessels,and so on.②The expression of ERβin lesion and junction areas was so weak,less than in non-lesional areas and normal controls(P<0.01).③The expression of Ki-67 in normal controls was weak,followed by less than the non-lesional areas, lesion areas and junction areas of psoriasis vulgaris(P<0.01),and Ki-67 was negative correlation with ERβ(P=0.0082,rs=-0.4501).④The expression of Cyclin D1 in lesion and junction areas was significantly higher than the non-lesional areas and normal controls(P<0.01).In addition,Cyclin D1 was positive correlation with Ki-67(P=0.0301,rs= 0.3787),but negative correlation with ERβ(P=0.0056, rs=-0.4724).⑤Microvessel density(MVD) was defined by expression of CD31,in lesion areas which was the highest,followed by junction areas, non-lesional areas and normal controls(P<0.01);The MVD was not correlation with ERβ(P=0.1789,rs=0.2374).⑥In lesion and junction areas of dermis,the number of mononuclear cells were more than non-lesional areas and normal controls(P<0.01),and the number of mononuclear cells in dermis was negative correlation with ERβin epidermis(P=0.0197,rs=-0.4002).Conclusion:(1)①The rate of positive family history was typeⅠhigher than typeⅡ,which showed that genetic factors on the impact of typeⅠwere greater than typeⅡ.②Incidence of typeⅠpatients was mainly in winter and spring but lowest in summer;however, typeⅡpatients occurred in spring and summer but winter least.That showed it was different in the seasonal effect on the two types.③The patient's condition of typeⅠwas more serious than typeⅡ,and in typeⅠwoman's condition more serious than men.lt suggested that onset age and sex(sex hormones) relate to the severity of psoriasis.④The most common predilection site of lesions was in the external ear.Erythema and. scale in the external ear were the most characteristic,so they could be an important basis of psoriasis diagnosis and antidiastole. (2)①The expression of ERβin lesion and junction areas keratinocytes was significantly less than in non-lesional areas and normal controls, and the expression of ERP was negative correlation with Ki-67 and Cyclin Dl,which were used to mark up the proliferation of cells.Thereby,one of the reasons for excessive proliferation of keratinocytes was ERβover-reduction.②The number of mononuclear cells in lesion areas of dermis was negative correlation with ERβin epidermis,it showed that excessive proliferation of keratinocytes could secrete some chemotactic factors of mononuclear cells.③The MVD was increased in lesion and junction areas of psoriasis,which indicated that angiogenesis played an important role in the pathogenesis of psoriasis.④Topical application of ERβagonist or ERa antagonist might contribute to the healing of lesions of psoriasis..