A Comparative Study of the Effect of NB-UVB Phototherapy and PUVA Photochemotherapy on Serum Levels
Journal of Pan-Arab League of Dermatologists
Vol. 19, No. 2, June 2008 Page 33- 42
A Comparative Study of the Effect of NB-UVB Phototherapy and PUVAPhotochemotherapy on Serum Levels of Soluble Interleukin-2 ReceptorsBefore and After Treatment in Psoriatic Patients
Nagwa M Youssef*, Marwa S Zaki*, Hanaa M Emam**, Nagwa Abd EL-Ghaffar*** and Marwa M EL-Feky**
Departments of Dermatology and Venereology*, Faculty of Medicine, Ain-Shams University, Dermatology &
Venereology Research**, and Clinical & Chemical Pathology***, National Research Center, Cairo, Egypt
Abstract
Psoriasis is a common chronic skin conditioncharacterized by thick scaling red plaqueswhich may be localized or widespread. Althoughthe exact etiology is stillunknown, thereis growing evidence that activated T cells, releasingvarious cytokines, are the primarymodulators in the pathogenesis of psoriasis. Interleukin-2(IL-2) plays an important role in theimmunological reactions in psoriasis throughinteracting with cell membrane bound IL-2 receptor(IL-2R) on activated T cells.Cellular receptorsfor IL-2 are shed from the cells andmeasured as a soluble protein (sIL-2R) at a ratethat is proportional to the number of moleculesexpressed onthe cell surface, and thus may beused to monitor disease activity, as well as providebetter understanding of mechanism of actionof different therapeutic modalitiesof psoriasis.The aim of this study was to compare the effectof narrow band ultraviolet B (NB-UVB) phototherapyand psoralen plus ultraviolet A (PUVA)photochemotherapy on soluble IL-2R serumlevel as a marker of T-cell activation in patientswith psoriasis before and after treatment. A correlationbetween theseverity of psoriasis as expressedby PASI score and sIL-2R serum levelswas also done. The study was conducted on 24patients with various degrees ofpsoriasis. Thepatients were divided into two groups: group 1(included 12 patients who received NB-UVB)and group 2 (included 12 patients who receivedPUVA). Twelve apparently healthy subjectswere included as a control group. Patients withpsoriasis had significant elevation of serum sIL-2R levels compared tocontrol group. The posttreatment serum levels of sIL-2R were significantlyreduced in comparison to pretreatmentlevels in both groups of patients. The posttreatment serum sIL-2R levels were lower inPUVA-treated patients (although not statisticallysignificant) in comparison to NB-UVBtreatedpatients. There wasalso a significantpositive correlation between sIL-2R and PASIscores throughout the study. In conclusion, thisstudy provides evidence on the importance ofsIL-R in the pathogenesis of psoriasis and reflectsactivation of T-cell mediated mechanisms,which are suppressed by both PUVA and NBUVB.The sIL-2R appearsto be a useful indexof disease activity and a mean of discerning themode of action of various therapies in this disease.We also support the role of anti-sIL-2R in
the treatment of psoriasis.
Journal of Pan-Arab League of Dermatologists
Vol. 19, No. 2, June 2008 Page 33- 42
A Comparative Study of the Effect of NB-UVB Phototherapy and PUVAPhotochemotherapy on Serum Levels of Soluble Interleukin-2 ReceptorsBefore and After Treatment in Psoriatic Patients
Nagwa M Youssef*, Marwa S Zaki*, Hanaa M Emam**, Nagwa Abd EL-Ghaffar*** and Marwa M EL-Feky**
Departments of Dermatology and Venereology*, Faculty of Medicine, Ain-Shams University, Dermatology &
Venereology Research**, and Clinical & Chemical Pathology***, National Research Center, Cairo, Egypt
Abstract
Psoriasis is a common chronic skin conditioncharacterized by thick scaling red plaqueswhich may be localized or widespread. Althoughthe exact etiology is stillunknown, thereis growing evidence that activated T cells, releasingvarious cytokines, are the primarymodulators in the pathogenesis of psoriasis. Interleukin-2(IL-2) plays an important role in theimmunological reactions in psoriasis throughinteracting with cell membrane bound IL-2 receptor(IL-2R) on activated T cells.Cellular receptorsfor IL-2 are shed from the cells andmeasured as a soluble protein (sIL-2R) at a ratethat is proportional to the number of moleculesexpressed onthe cell surface, and thus may beused to monitor disease activity, as well as providebetter understanding of mechanism of actionof different therapeutic modalitiesof psoriasis.The aim of this study was to compare the effectof narrow band ultraviolet B (NB-UVB) phototherapyand psoralen plus ultraviolet A (PUVA)photochemotherapy on soluble IL-2R serumlevel as a marker of T-cell activation in patientswith psoriasis before and after treatment. A correlationbetween theseverity of psoriasis as expressedby PASI score and sIL-2R serum levelswas also done. The study was conducted on 24patients with various degrees ofpsoriasis. Thepatients were divided into two groups: group 1(included 12 patients who received NB-UVB)and group 2 (included 12 patients who receivedPUVA). Twelve apparently healthy subjectswere included as a control group. Patients withpsoriasis had significant elevation of serum sIL-2R levels compared tocontrol group. The posttreatment serum levels of sIL-2R were significantlyreduced in comparison to pretreatmentlevels in both groups of patients. The posttreatment serum sIL-2R levels were lower inPUVA-treated patients (although not statisticallysignificant) in comparison to NB-UVBtreatedpatients. There wasalso a significantpositive correlation between sIL-2R and PASIscores throughout the study. In conclusion, thisstudy provides evidence on the importance ofsIL-R in the pathogenesis of psoriasis and reflectsactivation of T-cell mediated mechanisms,which are suppressed by both PUVA and NBUVB.The sIL-2R appearsto be a useful indexof disease activity and a mean of discerning themode of action of various therapies in this disease.We also support the role of anti-sIL-2R in
the treatment of psoriasis.