Psoriasis

Discussion in 'Men's Health Forum' started by Michael Scally MD, Jul 17, 2015.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Saad F, Haider A, Gooren L. Hypogonadal men with psoriasis benefit from long-term testosterone replacement therapy – a series of 15 case reports. Andrologia. http://onlinelibrary.wiley.com/doi/10.1111/and.12452/abstract

    Psoriasis is increasingly recognised as a skin disease with far-reaching systemic effects, associated with a high prevalence of comorbid disease such as cardiometabolic dysfunction, shifting the focus from a single organ disease confined to the skin to a systemic inflammatory condition.

    Chronic and systemic inflammation plays a major role in the development of these diseases, and there are striking similarities between the molecular and inflammatory pathways in psoriasis and atherosclerosis.

    In a single-centre, cumulative, prospective registry study of 347 hypogonadal men (total testosterone ≤12.1 nmol l−1), fifteen men with psoriasis could be studied.

    Upon testosterone administration, the skin disease improved considerably. Scores on the Psoriasis Area and Severity Index and Physician Global Assessment for Psoriasis showed significant improvement for the first 24 months. Thereafter, these improvements were sustained. Upon testosterone treatment, C-reactive protein declined significantly. There were significant improvements of obesity and of lipid profiles. Adipose tissue is now regarded as a source of inflammatory factors.

    These preliminary results deserve to be studied in a specifically designed study to investigate the effects of testosterone on psoriasis and its associated immunopathology.
     
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  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Low Serum testosterone Levels in Male Psoriasis Patients Correlate with Disease Severity

    Psoriasis is a chronic inflammatory skin disease with a genetic and autoimmune background. The involvement of sex hormones as a trigger factor for psoriasis has been suspected. Recently, low serum testosterone has been associated with autoimmune diseases in males, and the role of testosterone in psoriasis is unknown. To investigate serum testosterone levels in male psoriasis patients compared to control individuals with regards to the severity of psoriasis.

    A total of 121 male psoriasis patients and 217 control individuals were enrolled. The severity of psoriasis was documented using the Psoriasis Area Severity Index (PASI). Serum testosterone, sex hormone binding globulin (SHBG), and albumin were analysed. Moreover, psoriasis medication and the incidence of metabolic syndrome were recorded.

    In 52.1% psoriasis patients, low total testosterone values were detected. Compared to the control cohort, total testosterone (tT) and free testosterone (fT) in psoriasis patients were significantly lower. Despite psoriasis-specific medication, there was a significant inverse correlation between tT or fT and PASI, irrespective of age above or below 40 years.

    Low tT levels also correlated with the prevalence of metabolic syndrome. Nevertheless, in psoriasis patients without metabolic syndrome, higher PASI (>/=10) was associated with significantly lower tT values. In addition, low tT was associated with clinical symptoms of testosterone deficiency.

    Severe psoriasis is associated with low serum testosterone. However, further studies are required to investigate whether this observation is an epiphenomenon and whether testosterone substitution might decrease the severity of psoriasis.

    Allam JP, Bunzek C, Schnell L, et al. Low serum testosterone levels in male psoriasis patients correlate with disease severity. European journal of dermatology : EJD 2019;29:375-82. John Libbey Eurotext - European Journal of Dermatology - Low serum testosterone levels in male psoriasis patients correlate with disease severity