Korean J Dermatol.  2017 Nov;55(9):565-571.

Clinical, Histopathological, and Immunohistochemical Differences between Men and Women with Psoriasis According to Disease Severity: Possible Role of Estrogen

• Yang JY
• Park YJ
• Jung SE
• Park MJ
• Kang HY
• Kim YC
• Lee ES

Abstract

BACKGROUND
Psoriasis is a chronic inflammatory skin disorder histopathologically characterized by epidermal hyperplasia, vascular proliferation, and inflammatory infiltrates. It runs a less severe course in women than in men. The role of estrogen in the pathogenesis of psoriasis remains unclear.
OBJECTIVE
We investigated the clinicohistopathological differences between men and women with psoriasis and examined whether serum estrogen levels and immunohistochemical findings correlate with gender and disease severity.
METHODS
We retrospectively reviewed the medical records of 500 patients with psoriasis. Among these patients, 60 who consented to participate in the study were classified into four groups as follows: 10 men showing psoriasis on < 10% of their body surface area (BSA) with psoriasis area severity index (PASI) < 10; 20 men showing psoriasis on ≥10% of their BSA with PASI≥10; 10 women showing psoriasis on < 10% of their BSA with PASI < 10; and 20 women showing psoriasis on ≥10% of their BSA with PASI ≥10. Serum estrogen levels were measured using radioimmunoassay. Immunohistochemical staining of skin biopsy tissues was performed using ERα, ERβ, and CCL5.
RESULTS
Men diagnosed with psoriasis showed higher BSA and PASI scores than women. Women aged ≥60 years showed higher BSA and PASI scores than women aged < 60 years. There were no histological differences between the four groups. Serum estrogen levels were higher in the patients presenting with mild psoriasis, as well as in women. ERα, ERβ, and CCL5 showed a stronger staining tendency in patients with more severe psoriasis.
CONCLUSION
Gender influences the severity of psoriasis, and estrogen plays an important role. This finding is explained by the fact that estrogen decreases inflammation in psoriasis possibly via its action on estrogen receptors in epidermal keratinocytes.

Keyword

Estrogen; Gender; Immunohistochemistry; Psoriasis

MeSH Terms

Biopsy
Body Surface Area
Estrogens*
Female
Humans
Hyperplasia
Immunohistochemistry
Inflammation
Keratinocytes
Male
Medical Records
Psoriasis*
Radioimmunoassay
Receptors, Estrogen
Retrospective Studies
Skin
Estrogens
Receptors, Estrogen