Serum level of endothelial markers in patients with psoriasis vulgaris with or without arteriogenic erectile dysfunction

INTRODUCTION

Psoriasis has been a systemic, chronic, cell-mediated inflammatory disorder which impacts the nails, skin, and joints in different age groups.¹

Psoriasis-related vascular changes are caused by elevated expression of vascular endothelial growth factor (VEGF).²

Upon stimulation of cytokines, adhesion molecules (ICAM-1 and VCAM-1) are upregulated over the vascular endothelium, allowing transmigration of leukocytes into tissues. ³

Erectile dysfunction (ED) is described as the failure to achieve and/or sustain a firm enough erection to engage in sexual intercourse satisfactorily. ⁴

Endothelial dysfunction is considered the main pathophysiologic event of arteriogenic ED particularly in men with penile vascular dysfunction. ⁵

Men who have ED but no cardiovascular disease have significantly high sICAM-1 and sVCAM-1 levels. ⁶

PATIENTS AND METHODS

The research was carried out at Al-Azhar University's Dermatology Department. The Ethical Committee of the Al-Azhar Faculty of Medicine gave its approval to the research.

The study included 90 patients as 3 main groups. Patients have been selected from university hospitals' dermatology outpatient clinics. Informed written consents were signed by all participants of this study after explaining the nature of the study to them.

Inclusion criterion: 30 patients with psoriasis and arteriogenic ED, 30 patients with arteriogenic ED and 30 healthy donors as control ranged from 20 to 60 years with stable marital status

Exclusion criteria: age 60 years, Psychogenic, venogenic and neurogenic erectile dysfunction, Penile abnormalities, Penile prosthesis, Primary and secondary hypogonadism, Severe Systemic sclerosis, Severe chronic medical illness (liver and kidney diseases), Patients who have had a history of coronary heart disease or under treatment of IHD, Drugs as biological therapy, MTX and Acitretin and Phototherapy.

The following procedures were carried out on all of the patients: collection of general informations and history taking, consent from the patient, complete physical, dermatological and andrological examination, radiological diagnosis: Penile Dopplex ultrasound was performed, and serological diagnosis: for measuring serum ICAM-1 and VCAM-1 levels in peripheral and penile blood samples.

RESULTS

This study comprised 90 patients: 30 with psoriasis and arteriogenic ED, 30 with arteriogenic ED, and 30 healthy donors as controls.

Concerning age; Group 1 included 30 patients aged 29 to 59, with a mean of 45; Group 2 included 30 patients aged 29 to 59, with a mean of 47; and Group 3 included 30 patients aged 25 to 56, with a mean of 41 (Table 1).

Concerning age, there were no statistically significant differences (P > 0.05) between the three groups (Table 2).

Table 1: Comparison between the three groups according to age (Kruskal Wallis Test; NS= Non-Significant P>0.05).

Table 2: Comparison between the three groups according to peripheral ICAM-1. (Kruskal Wallis Test; S= Significant (P<0.05).

There were statistically significant differences in the mean of peripheral ICAM-1 between the three groups (P < 0.05) (Figure 1; Table 3).

Fig 1: Comparison between the three groups according to   Peripheral ICAM-1.

There were statistically significant differences in the mean of penile ICAM-1 between the three groups (P < 0.05) (Figure 2; Table 4).

Fig 2: Comparison between the three groups according to Penile ICAM-1.

There were statistically significant differences in the mean of peripheral VCAM-1 between the three groups (P < 0.05) (Figure 3; Table 5).

There were statistically significant differences in the mean of penile VCAM-1 between the three groups (P < 0.05) (Figure 4; Table 6).

There were statistically significant differences in the mean of PSV between the three groups (P< 0.05) (Figure 5; Table 7).

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Fig 3: Comparison between the three groups according to   Peripheral VCAM-1.

Fig 4: Comparison between the three groups according to Penile VCAM-1

Fig 5: Comparison between the three groups according to Penile VCAM-1

DISCUSSION

Psoriasis is a widespread systemic chronic immune-mediated inflammatory disease which affects both children's and adults' skin, nails, joints, and other organs.⁷

Genetics play a significant part in psoriasis pathogenesis, and it is affected by other factors as well. It is characterized by altered differentiation and hyperproliferation of keratinocytes, infiltration by T-lymphocyte, and changes in dermal blood vessels.⁸

Pathological findings in psoriasis are not confined only to the skin, but also affect other sites.⁹

Table 3: Comparison between the three groups according to Penile ICAM-1. (Kruskal Wallis Test; S= Significant (P<0.05).

Table 4: Comparison between the three groups according to   Peripheral VCAM-1. (Kruskal Wallis Test; S= Significant (P<0.05).

Table 5: Comparison between the three groups according to   Peripheral VCAM-1. (Kruskal Wallis Test; S= Significant (P<0.05).

Table 6: Comparison between the three groups according to PSV. (Kruskal Wallis Test; S= Significant (P<0.05).

Table 7: Correlation between different parameters among group A (Psoriasis with Arteriogenic ED). (X2: Chi-square test; NS: p-value > 0.05 is considered non-significant; S: p-value < 0.05 is considered significant; HS: p-value < 0.001 is considered highly significant).

Table 8: Correlation between different parameters among group B (Arteriogenic ED). (X2: Chi-square test; NS: p-value > 0.05 is considered non-significant; S: p-value < 0.05 is considered significant; HS: p-value < 0.001 is considered highly significant).