Severely photosensitive psoriasis: a phenotypically defined patient subset

Kirsty J Rutter, Rachel E B Watson, Lindsey F Cotterell, Thomas Brenn, Christopher E M Griffiths, Lesley E Rhodes

Research output: Contribution to journalArticlepeer-review

Abstract

A subset of patients with chronic plaque psoriasis exhibits severely photosensitive psoriasis (PP) with a pronounced seasonal pattern, but the pathomechanism is not understood. We performed two related studies; first, a detailed clinical characterization of PP, and second, a controlled investigation exploring the underlying pathomechanisms through the assessment of disease onset after photoprovocation. Patients with PP (n=20) showed striking female predominance (19F:1M), very low mean age of psoriasis onset (11 years, range 2-24), family history of psoriasis (13/20), a strong HLA-Cw*0602 association (16/17), and a rapid abnormal clinical response to broadband UVA, comprising erythema+/-scaling plaques (17/20). Subsequently, patients with PP (n=10), non-PP (n=9), and healthy volunteers (n=11) were challenged with low-dose broadband UVA on 3 consecutive days, and serial biopsies were taken after 6 hours to 7 days and from unchallenged skin. Histological changes consistent with early psoriasis occurred in 4 of 10 PP patients, but in neither of the control groups, with significant dermal infiltration by neutrophils, CD4+, CD8+, and CD45RO+ cells at 24 h, accompanied by acanthosis. Thus, a phenotypically distinct subset of psoriasis has been characterized. In contrast with earlier assumptions, UV can provoke psoriasiform features rapidly de novo; a role for memory effector T cells is supported in the early phase.

Original languageEnglish
Pages (from-to)2861-7
Number of pages7
JournalJournal of Investigative Dermatology
Volume129
Issue number12
DOIs
Publication statusPublished - Dec 2009

Keywords

  • Adult
  • Antigens, CD45
  • CD4-Positive T-Lymphocytes
  • CD8-Positive T-Lymphocytes
  • Erythema
  • Female
  • HLA-C Antigens
  • Histocompatibility Testing
  • Humans
  • Immunologic Memory
  • Immunophenotyping
  • Male
  • Middle Aged
  • Neutrophils
  • Photosensitivity Disorders
  • Psoriasis
  • Seasons
  • Severity of Illness Index
  • Skin
  • Ultraviolet Rays
  • Young Adult

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