Adrenocorticotropin/cortisol ratio – a marker of psoriasis severity

Abstract

Introduction: The hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role in systemic homeostasis and hormonal regulation of metabolic and immune functions. A similar HPA axis analog exists in the skin, where it regulates inflammation, cell proliferation and differentiation. Data regarding central HPA axis dysregulation in psoriasis are interesting but so far inconclusive. Aim: In the study we attempted to determine whether central HPA axis serum components correlate with psoriasis severity. Material and methods: Forty-two patients (10 women and 32 men) hospitalized at the Department of Dermatology participated in the study. None of our patients received any systemic treatment. Venous blood samples were collected at 6.00 AM. The relationship between quantitative variables and psoriasis severity based on the Psoriasis Area and Severity Index (PASI) was assessed with proc logistic in SAS 9.4. Results: The effect of adrenocorticotropin/cortisol ratio on the PASI group was OR 3.621 (95% confidence limits 1.217-10.775) for a 0.1 change in ratio (p = 0.02), meaning ACTH/cortisol ratio positively correlates with psoriasis severity. The effect of ACTH and cortisol on the PASI group was not statistically significant, with p-values of 0.30 and 0.23 respectively. Other inflammatory markers such as high-sensitivity C-reactive protein, neutrophils level, LDL, and total cholesterol did not show a significant correlation with PASI score. Conclusions: Our results support the role of HPA axis dysfunction in the complex pathogenesis of psoriasis, showing a positive correlation between morning ACTH/cortisol ratio and disease severity. ACTH/cortisol ratio can be regarded as a new biochemical marker of psoriasis severity worth further studies.

Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis

“…These studies suggest that some psoriatic patients may have reduced cortisol response. Such inability to produce an adequate upregulation of cortisol in response to stress is thought to carry important pathogenetic implications given the immunosuppressive action of cortisol [8]. Indeed, glucocorticoids inhibit the differentiation of T helper cells into Th1 and increase the production of Th2 cytokines [27][28][29][30].…”

“…Psychological stress has been for long recognized as a trigger factor in psoriasis, and a systematic review of the literature found that a probable temporal association between psychological stress and onset, recurrence, and severity of psoriasis [2]. The exact mechanisms behind this association have not been fully elucidated, though alterations in hypothalamic-pituitary-adrenal (HPA) axis resulting in an altered response to stress could be demonstrated in psoriasis by serum and salivary cortisol measurements [3][4][5][6][7][8], thus being thought to have pathogenetic implications [9]. Despite the large number of studies on stress in psoriasis, limited data are currently available on salivary cortisol in psoriatic patients.…”

Psoriasis: What Is New in Markers of Disease Severity?

“…The alteration of the hypothalamic-pituitary-adrenal axis may be responsible for the release of pro-inflammatory cytokines involved in the pathogenesis of psoriasis. They found a positive correlation between morning ACTH/cortisol ratio and disease severity evaluated using the PASI score [72]. There is evidence of a correlation between salivary cortisol concentration and psoriasis severity.…”