Comorbilidades en pacientes psoriásicosestudio retrospectivo y comparativo de cohortes

Resumo

Psoriasis is a chronic and inflammatory skin disease that causes redness, inflammation, and peeling of the skin. The aims of this Thesis were the study of comorbidities associated with psoriasis and their influence on the response to phototherapy treatment of patients, as well as the study of the effect of blood glucose and antidiabetic drugs on chronic inflammation on the skin in zebrafish models and human epidermis organoids. For this, a study was carried out that included 300 subjects, 200 belonged to the group of patients with psoriasis and 100 to the control group. All subjects met the requirements of being over 18 years of age, having signed the informed consent, and having an analysis of fewer than 12 months from the start of the study. In psoriasis group, they must have been diagnosed with psoriasis plaque or generalized psoriasis and have received treatment with phototherapy in the last 10 years. Likewise, in the control group, patients had to not suffer from psoriasis. Comorbidities presented in all patients were studied through reports from the primary care physician, specialist reports, and chronic medication information available. For the study of phototherapy in patients with psoriasis, the type of phototherapy administered, the number of cycles, the initial and final PASI, and the improvement in psoriasis during treatment were considered. In addition, the zebrafish of the spint1a mutant line was used as an animal model and 3D organotypic models of human epidermis. The results showed a higher incidence of psychiatric disease, liver disease, kidney disease, hypertension, heart disease, vascular disease, diabetes, gastrointestinal disease, autoimmune and infectious diseases, dyslipidemia, and psoriatic arthritis in patients with psoriasis compared to the control group. However, there was no statistically significant difference in the incidence of osteoporosis, dermatological diseases, hyperuricemia, arthritis and, anemia between the two groups. The incidence of comorbidities showed a significant difference from 40 years of age in patients with psoriasis, which could be indicative of premature aging. Phototherapy turned out to be an effective treatment in moderate-severe psoriasis, achieving total whitening in more than 3 out of 10 patients, showing women a better response to treatment compared to men. UVBBE was the most effective type of phototherapy. Liver disease, hypertension, heart disease, vascular disease, and diabetes showed a worse prognosis to achieve a PASI100 in treatment with phototherapy. Patients who suffered from anemia or liver disease had an increased risk of treatment failure. Finally, zebrafish and 3D organotypic models of human psoriasis demonstrated the influence of diabetic comorbidity on psoriasis. Specifically, they demonstrated the influence of both blood glucose levels and transport through its GLUT1 receptor on skin inflammation. Furthermore, a direct anti-inflammatory effect of DPP-4 inhibition was observed in keratinocytes.