الفهرس 
PSORIASISOnly 14 pages are availabe for public view
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Abstract
P
soriasis is a chronic inflammatory skin disease with an estimated prevalence of 2%. The disease has a strong genetic background, may appear as various clinical manifestations, and is associated with several co-morbidities such as psoriatic arthritis and metabolic syndrome or components of the syndrome. Psoriasis may be triggered by several factors such as drugs, infections or mechanical stimuli.
There is also a link between inflammation and metabolic syndrome and thus psoriasis as well. The metabolic syndrome is associated with overweight or obesity. Adipose tissue is an active endocrine organ which produces adipokines and proinflammatory cytokines that attract immune system cells, mainly monocytes, and support differentiation of infiltrating macrophages into M1 proinflammatory subset; therefore, the presence of the metabolic syndrome might negatively regulate the course of psoriasis and vice versa.
The role of sex hormones in the pathobiology of psoriasis remains unclear and understudied. Recent in vivo and in vitro studies suggest that sex steroid hormones including estrogen, progesterone or androgen may regulate a variety of pathophysiological conditions in the skin.
In this study, we aimed to assess serum free testosterone level in psoriatic male patients with and without metabolic syndrome. The secondary objective is to correlate hormone levels with Psoriasis severity index (PASI).
This cross-sectional study was conducted at tertiary care hospital at the out-patient clinic in the Department of Dermatology and Andrology, at Ain Shams University hospital from October 2021 till April 2022 and performed on a total of 96 male patients who divided into four Psoriatic patients with metabolic syndrome, Psoriatic patients without metabolic syndrome, metabolic syndrome only patients, control group.
During this study, 120 patients were assessed for eligibility and 96 patients were included in the study (24 in each group). Of all eligible patients, 14 patients were excluded from the study based on the inclusion criteria and 10 patients refused to participate in the study.
Ultimately, the analysis was based on the data of 96 male patients who divided into four Psoriatic patients with metabolic syndrome, Psoriatic patients without metabolic syndrome, metabolic syndrome only patients, control group.
The current study revealed that there was no significant difference between the studied groups regarding age, smoking, PASI score and psoriasis duration while waist circumference and body mass index statistically were significantly higher in Psoriasis& metabolic and Control& metabolic (metabolic groups) (with no significant difference between them) than in Psoriasis& non-metabolic and Control& non-metabolic (with no significant difference between them).
our study results revealed that Hyperlipidemia statistically were significantly more frequent in Psoriasis& metabolic and Control& metabolic (with no significant difference between them) than in Psoriasis& non-metabolic and Control& non-metabolic (with no significant difference between them) while Hypertension and Diabetes mellitus statistically were non-significantly more frequent in Psoriasis& metabolic and Control& metabolic than in Psoriasis& non-metabolic and Control& non-metabolic (with no significant difference between them).
Consequently, Serum cholesterol, triglycerides, LDL and Fasting blood glucose statistically were significantly higher in Psoriasis& metabolic and Control& metabolic (with no significant difference between them) than in Psoriasis& non-metabolic and Control& non-metabolic (with no significant difference between them). Serum HDL statistically were significantly lower in Psoriasis& metabolic and Control& metabolic (with no significant difference between them) than in Psoriasis& non-metabolic and Control& non-metabolic (with no significant difference between them).
The current study results revealed that there was negative correlation between serum free testosterone and each of serum cholesterol, triglycerides and LDL, the correlations statistically were significant only in metabolic groups. No statistically significant correlations between serum free testosterone and HDL in all the studied groups.
As regards serum free testosterone, the current study results revealed that Serum free testosterone statistically were significantly lower in Psoriasis& metabolic and Control& metabolic (with no significant difference between them) than in Psoriasis& non-metabolic and Control& non-metabolic (with no significant difference between them) and lower in smokers in Control& non-metabolic group and lower in high PASI cases in all the studied psoriasis groups.
Serum free testosterone was significantly lower in hypertensive cases only in Control& metabolic group.
The current study results revealed that there was significant negative correlation between serum free testosterone and age only in Control groups and significant negative correlation between serum free testosterone and PASI score in all psoriasis groups with significant negative correlation between serum free testosterone and Waist circumference in all the studied groups and significant negative correlation between serum free testosterone and BMI in non-metabolic groups.
We concluded that Serum free testosterone statistically were significantly lower in Psoriasis& metabolic syndrome patients and associated high PASI. Hyperlipidemia statistically were significantly more frequent in Psoriasis & metabolic syndrome.
It is recommended for all psoriasis patients early screening and treatment of hyperlipidemia to prevent atherosclerosis and its complications.
CONCLUSION
• Serum free testosterone statistically were significantly lower in Psoriasis& metabolic syndrome patients and associated high PASI.
• Hyperlipidemia statistically were significantly more frequent in Psoriasis & metabolic syndrome.
• Consequently, Serum cholesterol, triglycerides and LDL statistically were significantly higher in Psoriasis& metabolic syndrome patients.
RECOMMENDATIONS
• It is recommended for all psoriasis patients early screening and treatment of hyperlipidemia to prevent atherosclerosis and its complications.
• The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes demonstrating the long-term outcomes of low testosterone on male hypogonadism and the benefit from testosterone substitution.
• Future investigations need to focus on other hormones of the gonad axis in order to distinguish between different forms of hypogonadism in psoriasis, as well as the role of systemic inflammation agents such as cytokines, as these topics were not addressed in this study