Proliferative function of endothelium in local scleroderma, gender and age characteristics of the disease

Abstract

Objective — to investigate the variability of vascular endothelial growth factor (VEGF) in localized scleroderma (LS), characteristics of the disease in different age groups. Materials and methods. The study included the clinical evaluation of 78 patients (27 men, 51 women) with localized scleroderma aged (43.2 ± 7.28) years. All patients underwent clinical, laboratory, and enzyme immunoassay investigation of VEGF. The criteria for inclusion in the study were: the presence of localized scleroderma and the absence of signs of a systemic process. Results and discussion. It has been proven that localized scleroderma is gender­related, more often recorded in women (65.4 %, p < 0.05), with an attributive risk of 50.0 % compared to men. Late diagnosis of the disease was proven in 78.2 % of patients. The age and gender characteristics of this pathology were determined — men are more likely to get sick at a young age (up to 20 years; 22.2 % of the surveyed), however, women over the age of 55 prevail (p < 0.05). Women sought dermatological help earlier compared to men (29.4 %; p < 0.05), but had a higher risk of early progression (p < 0.05). Among the clinical forms of localized scleroderma, most of the cases (70.5 %) were of the plaque form. In 15.4% of cases, a linear form was diagnosed, in 9.0% ­ lichen sclerosus, in 5.1 % — Pasini—Pierini idiopathic atrophoderma. The plaque form of LS was significantly more often detected in women (80.3 %), and the linear form and lichen sclerosus — in men (22.2 % each). The average number of lesions was 2.8 ± 1.12. Three lesions were found in almost half (43.6 %) of the patients, one lesion – in 23.1%, two lesions – in 16.7%, four lesions – in 11.5%. Five or more lesions were present in 4 (5.1 %) patients. It has been found that the highest content of VEGF was observed in classic plaque form (p < 0.05), the lowest — in Pasini—Pierini idiopathic atrophoderma (p < 0.05). U­shaped age dependence of the disease was determined: high content of VEGF­A in patients under the age of 20 (p < 0.05), with a significant decrease of VEGF­A in patients aged 20—35 years (p < 0.05) and further increase in those aged 35 to 55 years (p < 0.05). It was established that VEGF­A level increased at patients with early progression of the disease — in the first 2 years after the start of clinical manifestations against the group of patients with slow progression — more than 6 years (p < 0.05). In assessment of gender dependence, we found a higher content of VEGF­A in female patients compared to male patients (p < 0.05). Conclusions. Localized scleroderma has gender and age­related characteristics and is 50.0 % more often recorded in women. Among men, young patients predominate. Studying the pathogenesis of LS and assessing the proliferative function of the endothelium of the disease will make it possible to predict the course of the disease, improve the diagnosis and treatment.