Family history of psoriasis and recent infectious disease are risk factors for the first episode of acute guttate psoriasis
DOI:
https://doi.org/10.66344/jpad.v14i3.798Keywords:
Guttate psoriasis, streptococcal pharyngitis, ASO titerAbstract
Background Psoriasis is a heterogeneous disease in its clinical expression. Both genetic
and environmental factors are thought to contribute to the pathogenesis. The association of
guttate psoriasis with streptococcal pharyngitis is well accepted. The association of other
risk factors is less well-defined.
Objectives The aim of this study was to estimate the risk for guttate psoriasis with recent
infections and to explore other potential risk factors like family history of psoriasis.
Patients and methods This was a case-control study. Cases were patients with the first
diagnosis ever of acute guttate psoriasis. Controls were patients newly diagnosed as having
dermatologic conditions other than psoriasis and seen in the same outpatient services as the
cases. Inclusion of cases and controls was restricted to patients up to 18 years of age. A
total 35 cases (median age, 8 years) and 150 controls (median age, 12½ years) were
included in the analysis.
Results A significant difference was observed for a family history of psoriasis. 45.7% of
patients with guttate psoriasis gave a family history of psoriasis in their first-degree
relatives. The risk of psoriasis was also increased in subjects who reported a history of a
recent infectious episode. The analysis by individual diagnosis pointed to acute pharyngitis
as the disease with the strongest association. Twenty-seven patients (77.1%) gave a history
of sore throat preceding the onset of guttate psoriasis. All of them had a throat swab
performed, of these 20 had normal flora cultured. Only 6 had a positive culture and in these
cases Lancefield group C ß-hemolytic streptococci were isolated. ASO titer was raised in
21 (60%) patients of guttate psoriasis .
Conclusion The study confirmed that recent pharyngeal infection is a risk factor for guttate
psoriasis. It also documented the strong association between guttate psoriasis and a family
history of psoriasis
References
Van de Kerkhof PCM. Boss JP, eds.
Pathogenesis aspects of psoriasis.
Clin Dermatol 1995; 13: 97-8.
Telfer NR, Chalmers RJ, Whale K,
Colman G. The role of streptococcal
infection in the initiation of guttate
psoriasis. Arch Dermatol 1992; 128:
-42.
Martin BA, Chalmers RJC, Telfer
NR. How great is the risk of further
psoriasis following a single episode of
acute guttate psoriasis? Arch
Dermatol 1996; 132: 717 -8.
Valdimarsson H, Baker BS, Jonsdottir
I et al. Psoriasis: a T-cell mediated
autoimmune disease induced by
streptococcal superantigens? Immunol
Today 1995; 16: 145-9.
Banno T, Fujisawa H, Stomi Het al.
Psoriasis vulgaris and acute guttate
psoriasis in a family. Int J Dermatol
; 40: 285-7.
Luigi N, Lorenzo P, Fabio P, Claude
FC, and the psoriasis study group of
the Italian Group for Epidemiological
Research in Dermatology. Family
history of psoriasis, stressful life
events, and recent infectious disease
are risk factors for a first episode of
acute guttate psoriasis: Results of a
case-control study. J Am Acad
Dermatol 2001; 44: 433-8.
Bolton GG, Daniel CR. A family
outbreak of acute guttate psoriasis .
Arch Dermatol 1990; 126: 1523-4.
Williams RC, Mckenzie AW, Roger
JH, Joysey VC. HLA -A antigens in
patients with guttate psoriasis. Br J
Dermatol 1976; 95: 163-7.
Krain LS, Newcomer VD, Terasaki
PI. HLA antigen in psoriasis [letter].
N Engl J Med 1973; 288: 1245.
Wilson AG, Clark I, Heard SR et al.
Immuno-blotting of streptococcal
antigens in guttate psoriasis. Br J
Dermatol 1993; 128: 151-8.
Leung DY, Travers JB Giorno Ret al.
Evidence for a streptococcal
superantigen-driven process in acute
guttate psoriasis. J Clin Invest 1995;
: 2106-12.
Tervaert WC, Esseveld H. A study of
the incidence of haemolytic
streptococci in the throat in patients
with psoriasis vulgaris with reference
to their role in the pathogenesis of this
disease. Dermatologica 1970; 140:
-90.
Stjernquist-Desatnik A, Prellner K,
Christensen P. Clinical and laboratory
findings in patients with acute
tonsillitis. Acta Otolaryngol (Stockh)
; 104: 351-9.
Johnson DR, Kaplan EL, Stramek J et
al., eds. Laboratory diagnosis of
group A streptococcal infections.
Geneva: World Health Organization;
Mallon E, Bunce M, Savoie H et al.
HLA-C and guttate psoriasis. Br J
Dermatol 2000; 143: 1177-82.
Leung DY, Walsh P, Giorno R,
Norris DA. A potential role for
superantigens in the pathogenesis of
psoriasis. J Invest Dermatol 1993;
: 225-8.
Lewis HM, Baker BS, Bokth S et al.
Restricted T cell receptor V-beta gene
usage in the skin of patients with
guttate and chronic plaque psoriasis.
Br J Dermatol 1993; 129: 514-20.
Horiuchi N, Aiba S, Ozawa H et al.
Peripheral blood lymphocytes from
psoriatic patients are hyporesponsive
to beta-streptococcal superantigens.
Br J Dermatol 1998; 138: 229-35.
Skov L, Baadsgaard O.
Superantigens. Do they have a role in
skin diseases? Arch Dermatol 1995;
: 829-32.
Aiba S, Tagami H. Proliferative
responses of peripheral blood
mononuclear cells from psoriatic
patients to T lymphocyte-stimulating
cytokines (IL -2, IL-3, IL-4 and
granulocyte-macrophage colonystimulating
factor) and OK-432. Arch
Dermatol Res 1989; 281: 310-5
Baker BS, Powel AV, Malkani AK et
al. Altered cell-mediated immunity to
group A haemolytic streptococcal
antigens in chronic plaque psoriasis.
Br J Dermatol 1991; 125: 38-42.
Baker BS, Powles A, Garioch JJ et al.
Group A streptococcal antigenspecific
T lymphocytes in guttate
psoriatic lesions. Br J Dermatol 1993;
: 493-9.
Villeda GG, Santamaria CLC, Perez
LR et al. Recognition of
Streptococcus pyogenes and skin
autoantigens in guttate psoriasis. Arch
Med Res 1998; 29: 143-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2016 Shahzana Naqqash, Dr. Tameez-ud-deen, Shahid Naqqash, Abdul Quddus Butt
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
