| Background and purposeErythrodermic psoriasis(EP) is a relatively rare and serious clinical subtype of psoriasis.Its etiology and pathogenesis are unknown.The clinical features of this disease are severe pruritus with edema and a lot of desquamation.The patients may have serious disorder of water and electrolyte regulation,abnormal thermoregulation and metabolic imbalance.Because of its low incidence rate and lack of clinical data,standardized clinical guidelines have not yet been obtained.Toll like receptors(TLRs)play the role of pattern recognition receptors in innate immunity,recognize tissue damage and activate downstream signal pathways.A large number of in vitro and animal experiments have found that TLRs are abnormally activated in the occurrence and maintenance of psoriasis.However,whether TLR subtypes are expressed in psoriasis and whether they play a role in psoriasis has not reached a consensus.In this study,EP patients in Peking Union Medical College Hospital were studied retrospectively to explore the therapeutic effect and possible related clinical factors;through immunohistochemistry,TLRs expression in EP lesions was explored to provide direction for the future to clarify EP mechanism and find the next treatment target.MethodIn this study,we analyzed the medical records of EP patients who were diagnosed and treated in our dermatology ward from October 1,2015 to May 1,2020.The basic clinical characteristics of patients,clinical risk factors related to psoriasis,treatment and efficacy information were summarized.The efficacy was divided into three categories:significant,effective and ineffective.SPSS 23.0 statistical software was used for difference analysis,chi square test was used for counting data,and independent sample t-test or rank sum test was used for measuring data according to whether they conform to normality.P<0.05 indicates that it has statistical significance.Whether clinical factors are related to efficacy and whether factors are related to treatment drugs were analyzed.Kappa consistency test was used to evaluate the efficacy of the two methods.Fifteen cases of EP with definite diagnosis were selected to carry out tissue sections and immunohistochemical staining of TLR2 and TLR3.The staining degree and the proportion of positive cells in total visual field cells were observed under the microscope.The sections were evaluated quantitatively.Finally,the staining results were divided into four grades:negative,weak positive,positive and strong positive.Result(1)Retrospective analysis1.Basic information:a total of 77 EP patients were included,the ratio of male to female was 3.05:1,the age was 50.62 ±17.13 years old;in the past psoriasis types,the main types were common type(77.9%),arthrosis type(11.7%)and pustular type(10.4%);in the past treatment history,traditional Chinese medicine(63.6%),tretinoin(50.6%)and glucocorticoid(39.0%)were the most;62.3%patients with metabolic syndrome and hypertension(29.9%)And hyperlipidemia(28.6%),77.9%of the EP had definite inducing factors,mainly including hormone reduction or improper discontinuation(31.2%),stimulant strong external drug use(24.7%),infection(10.4%)and stress(9.1%);2.Sixty-five cases received systematic treatment,3 biological treatment and 9 combined treatment.Thirty-two cases(41.5%)were effective,45 cases(58.4%)were effective,no invalid or aggravating;3.Twenty-four cases reported complications,including 21 cases of infection,including skin,lung,urinary tract infection,6 cases reported treatment-related side effects,including drug-induced liver damage,dyslipidemia after treatment;4.There was a significant correlation between the course of psoriasis and the therapeutic effect(P=0.031).The shorter the course of psoriasis,the better the therapeutic effect;there was no statistical difference between the rest and the therapeutic effect(P>0.05);5.All 77 patients were divided into three groups:systematic treatment,biological preparation and combination.There was no significant difference between the clinical factors and the types of drugs(P>0.05);6.Sixty-two patients who only received systemic treatment were divided into three groups:tretinoin alone,tretinoin+hormone,tretinoin+immunosuppressant.There was a significant correlation between gender and systemic drugs(P=0.038),male patients were more inclined to use retinoids alone,and there was no significant difference between other factors and systemic drugs(P>0.05);7.Two methods of efficacy evaluation based on symptoms and signs and PASI score were analyzed,and their consistency was general(kappa=0.460).(2)Expression of TLRsTLR2 was expressed in one case of EP lesions,the staining depth was light brown,the proportion of positive cells was 5-25%,the expression intensity was positive(++),the expression position was basal layer,in the other 14 cases,the staining was colorless,the proportion of positive cells was less than 5%,the comprehensive staining was negative(-);TLR3 was colorless,the ratio of positive cells in 15 cases of EP lesions All cases were less than 5%,the comprehensive staining result was negative(-).Conclusion1.Retrospective analysis showed that there were no significant differences in gender,age of onset,type of psoriasis,severity of systemic symptoms,metabolic syndrome,treatment plan and efficacy,but not in patients’ choice of treatment mode,gender and choice of systemic treatment drugs;2.The expression of TLRs was not found in the lesions of 15 patients with erythroderma type psoriasis.TLR2 and TLR3 were not expressed in the lesions of EP. |
