Oxidative Stress Involved in the Development of Psoriasis

Elena Codruta Dobrică, MD, PhD

A new systematic review from Romania found that oxidative stress appeared to be involved in the development and evolution of psoriasis and its associated comorbidities, with specific affects being observed regarding cardiometabolic health.

Though the pathogenesis of psoriasis remains vague, recent studies hypothesized that oxidative stress could be involved in the development and perpetuation of psoriasis.

Investigators led by Elena Codruta Dobrică, MD, PhD, Department of Dermatology at Elias University Emergency Hospital, Bucharest, evaluated the involvement of oxidative stress in psoriasis as well as the associations between different genetic polymorphisms in enzymes involved in the redox valance and the influence of topical or systemic treatments.

The Methods

An advanced search was conducted in PubMed/Medline, Web of Science and SCOPUS with keywords and word combinations from the inception of the databases to July 23, 2021.

Inclusion criteria considered were original studies evaluating the relationship between different parameters of oxidative status and psoriasis severity, original studies evaluating different polymorphisms in genes encoding enzymes involved in the oxidative status in psoriasis, and original studies which assessed the oxidative status of patients with psoriasis before and after the use of approved topical or systemic antipsoretic therapies.

The selected original studies were also required to be conducted in the adult population, written in a language spoken by the authors (English, French, Italian or Romanian), available for retrieval and published on or after 1 January 2000.

From there, the team evaluated the methodological quality and the risk of bias of the analyzed studies using the methodological index for non-randomized observational studies (MINORS) and the Mixed Methods Appraisal Tool (MMAT), respectively.

A total of 1293 potentially eligible articles were detected.

The Findings

After applying the inclusion and exclusion criteria, a total of 53 studies were chosen to be included in the study.

These studies evaluated markers or parameters of oxidative stress in patients with psoriasis including (CAT), myeloperoxidase (MPO), ferroxidase (FOX), ischemia modified albumin (IMA), paraoxonase-1 (PON-1), total oxidant status (TOS), total antioxidant status (TAS), and more.

In 1 selected study, 87 patients with psoriasis were compared with 60 healthy subjects with the former group showing a significant increase in oxidative stress markers, namely catalase (p = 0.04), ferroxidase, myeloperoxidase, and ischemia-modified albumin (p < 0.001 for all).

Ischemia-modified albumin was considered a new marker of oxidative stress for psoriasis with another study observing elevated levels of the molecule (p = 0.001) in patients with psoriasis versus controls.

Dobrică and colleagues believed this confirmed the theory that oxidative stress plays a key role in the development of this dermatosis and its complications such as cardiovascular disease.

Despite patients with psoriasis have higher levels of total reactive oxygen species and superoxide ion levels in CD4+ T lymphocytes (p = 0.04), no significant differences were recorded in terms of psoriasis severity.

“The utility of the assessment of circulating serum, plasma, urinary and/or skin biomarkers of oxidative stress and of the study of polymorphisms in genes regulating the redox balance remains to be explored in future prospective cohort studies,” the team wrote. “However, the role that oxidative stress plays in the pathophysiology of psoriasis is indisputable and understanding the mechanisms by which it contributes to the initiation and maintenance of this chronic condition can aid the management of this dermatosis in the near future.”