32.3.40 Association of Prolactin with Psoriasis in Out-Patients at a Tertiary Care Hospital

Original Article

 

Prolactin with Psoriasis in Patients

Association of Prolactin with Psoriasis in Out-Patients at a Tertiary Care Hospital

Nadia Rajper1, Muhammad Suleman Pirzado2, Hafiz Bashir Ahmed Kalhoro1,Tanweer Ahmed Shaikh3, Muhammad Yaqoob Shahani4 and Sanam Pirzado1

ABSTRACT

Objective: Psoriasis is a serious, persistent, disfiguring, inflammatory, and proliferative skin disorder. Prolactin (PRL), an anterior pituitary gland secreted neuropeptide, has a number of physiological and biochemical actions. It has been suggested that Prolactin may be involved in psoriasis development. Therefore, the study could help to look for hyperprolactinemia in psoriasis patients and thus take appropriate treatment measures to address the issue. The study's basic objective is to determine the mean amount of serum prolactin in psoriasis patients.

Study Design: Observational / cross sectional study

Place and Duration of Study: This study was conducted at the outpatient’s department (OPD) of Department of Dermatology, LUMHS Jamshoro & LMU hospital Sindh Pakistan from October 2015 to March, 2016.

Materials and Methods: This research included 42 confirmed cases of psoriasis. All these patients were tested by the ELISA technique of taking 3cc venous blood sample in a disposable syringe for serum prolactin level and sent it for analysis to the laboratory. On pre-designed pro forma, the patient data are collected.

Results: The average age was 37.71± 10.68 years. There were 40.48% male and 59.52% female. Mean serum prolactin level in patients of psoriasis was 44.21± 14.73 ng/ml (95%CI: 39.61 to 48.80).

Conclusion: The above findings indicate that the amount of serum prolactin may play a significant role in pathophysiology of psoriasis. In patients with psoriasis, we experienced a significant rise in serum PRL. We therefore could say that PRL can be used as a useful psoriatic behavioral biological marker.

Key Words: Psoriasis, Serum prolactin level, Hyperprolactinemia

Citation of article: Rajper N, Pirzado MS, Kalhoro HBA, Shaikh TA, Shahani MY, Pirzado S. Association of Prolactin with Psoriasis in Out-Patients at a Tertiary Care Hospital. Med Forum 2021;32(3):159-162.

 

 

INTRODUCTION

Psoriasis is a severe persistent, incapacitating, aggressive, and proliferative skin disorder. It is medically characterized by plaques that are dark, scaly, clearly defined, indurated, present especially on extender surfaces and scalp.1It is also characterized by keratinocyte hyperproliferation and T cell aggregation in the psoriatic lesions involving epidermis and dermis.2The mean worldwide prevalence of psoriasis is considered to be around 2%.3Psoriasis is a serious, long-lasting (chronic) condition, there is no cure, although therapies for psoriasis can provide some relief.4

 

 

1. Department of Dermatology / Molecular Biology and Genetics2 / Pathology3 / Anatomy4, Liaquat University of Medical & Health Sciences Jamshoro, Sindh.

 

 

Correspondence: Dr. Muhammad Yaqoob Shahani, Department of Anatomy, Liaquat University of Medical & Health Sciences Jamshoro, Sindh.

Contact No: 0336-8506956

Email: doctor_shahani@hotmail.com

 

 

Received:  September, 2020

Accepted:  November, 2020

Printed:      March, 2021

 

 

 

A neuropeptide secreted by the anterior pituitary gland, prolactin (PRL), has a number of physiological and biochemical activities. It was involved as an active immunomodulator and through various receptors this exerts a proliferative effect on cultivated human keratinocytes.2Hyperprolactinemia has been reported to occur frequently in psoriasis patients and it has been suggested that PRL may promote psoriasis development.5 The presence of PRL receptors on epidermal keratinocytes supports the hypothesis that PRL may play a role in the etiopathogenesis of psoriasis.6Elevated serum prolactin levels can play a rolein in-vivo keratinocyte hyperproliferation, the hallmark of the cycle of psoriasis disease.7There are three recent studies on this basis reporting an independent correlation of increased serum PRL levels with psoriasis.8The interest in investigating the ''psoriasis-PRL link'' should be reinvigorated. El-Chateeb and so on.9noted that blister fluid PRL levels obtained from skin-active psoriasis patients are significantly higher than those obtained from uninvolved or healthy skin in blister fluid.

The study was carried out to determine the association between the levels of serum prolactin and psoriasis to investigate the relationship between Prolactin and psoriasis growth. The research will therefore help to check for hyperprolactinemia in patients with psoriasis and thus take appropriate treatment steps and aid with proper diagnosis.

MATERIALS AND METHODS

This is an observational cross sectional study, conducted in outpatient’s department (OPD) of Department of Dermatology, LUMHS Jamshoro & LMU hospital Sindh Pakistan. A non-probability consecutive sampling technique was used for this study. The confidence interval was 95%, the margin of error 3, n=42 patients, according to the observed mean serum prolactin rate= 49.590. This study was carried out on patients with psoriasis who attended the outpatient department (OPD) of the Dermatology Department, Jamshoro & LUMHS Hyderabad after approval by the Ethics Committee. The informed consent from all patients was read and explained to the patient before they were registered for the analysis. All these patients were evaluated by the ELISA technique of taking 3cc venous blood sample in a disposable syringe for their serum prolactin level and sent it for analysis to the laboratory. Patients' serum prolactin level was reported. All patient data was entered and analyzed using version 17.00 of SPSS. For age and serum prolactin, the mean and standard deviation (SD) were calculated. For patients with psoriasis, the incidence and percentage were assessed for gender distribution of elevated prolactin. It has been accredited with regard for age and gender, post-stratification variance analysis and an independent sample t-test has been applied to compare mean increased prolactin in psoriasis patients.

RESULTS

This study included 42 diagnosed cases of psoriasis. Patient age distribution isshown in Figure-1.The average age and duration of disease as shown in Table-2 was 37.71 ± 10.68 years and 5.21 ± 1.80 months. In this study, 40.48% (17/42) of the 42 cases were male and 59.52% (25/42) were female, as shown in Figure 2.

Figure No.1: Distribution of Patients age(n=42)

In patients with psoriasis, the mean serum prolactin rate was 44.21± 14.73 ng / ml (95% CI: 39.61 to 48.80) as shown in Table-1.As shown in Table-3, the mean serum prolactin level in psoriasis patients was high in all age groups and not significant among different age groups (P = 0.359). In patients with psoriasis, the mean serum prolactin rate was 43.38±15.26 ng / ml in male and 44.70 ± 14.66 ng/ml in female patients, which is not important as shown in Table-4. Furthermore, Table-5 gives a comparison of the mean serum prolactin level in psoriasis patients with the length of the disease.

Table No.1: Descriptive Statistics of age and Duration of Disease(n=42)

Statistics

Age (Years)

Duration of disease

(months)

Mean ± SD

37.71± 10.68

5.21 ± 1.80

95% Confidence Interval

34.39 to 41.04

4.65 to 5.78

Mean (IQR)

36.5 (18)

5 (2)

Minimum-Maximum

21-58

2-10

Figure No.2: Distribution of the PatientsGender (n=42)

Table No.2: Mean Serum Prolactin Level in Patients of Psoriasisn=2

Statistics

Raised serum Prolactin Level (ng/ml)

Mean ± SD

44.21± 14.73

95% Confidence Interval

39.61 to 48.80

Mean (IQR)

48.95 (28.8)

Minimum-Maximum

16.8-59

 

 

 

Table No.3: Comparison of mean serum Prolactin level in Patients of Psoriasis among different Age Groups n=42, ANOVA Applied

Age Groups

N

SERUM PROLACTIN LEVEL

P-Value

Mean

SD

21 to 30

12

44.19

16.43

0.359

31 to 40

13

43.95

14.13

41 to 50

11

39.63

16.61

>50

6

53.18

3.43

Table No.4: Comparison of mean serum Prolactin level in Patients of Psoriasis between Genders, n=42, Independent Sample t-Test Applied

Gender

 

n

Serum Prolactin Level

P-Value

Mean

SD

Male

17

43.48

15.26

0.79

Female

25

44.70

14.66

Table No.5: Comparison of mean serum Prolactin level in Patients of Psoriasis with respect to Duration of Disease, n=42, Independent Sample t-test Applied

Duration of disease

(months)

n

Serum Prolactin Level

P-Value

Mean

SD

2 to 5 months

27

42.63

15.26

0.36

6 to 10 months

15

47.04

13.78

DISCUSSION

Psoriasis is an autoimmune disease described by keratinocyte hyperproliferation and T-cell aggregation in psoriatic lesions of the epidermis and dermis.10There is some evidence that when hormonal changes such as puberty and menopause occur, psoriasis may intensify in ages and may also worsen or strengthen throughout childbirth.11There are several physiological activities of Prolactin (PRL), a neuropeptide secreted by the anterior pituitary gland. As an active immunomodulator, it has been involved and this has a proliferative effect on cultivated human keratinocytes through different receptors. Several research showed an increase in psoriasis serum PRL levels and an increase in psoriasis when a prolactinoma develops.12Prolactin functions in both the epithelial development of the skin and the immune system of the skin as a neuroendocrine modulator. It is thought to be integrated into a multilevel endocrine-immune interaction along the'' brain skin axis'.' Stress has been reported to cause and exacerbate psoriasis, so it could be a connection between prolactin and pathogenesis of the disease.13Prolactin is produced from extrapituitary sources, including the hair, and has been partly traced to the skin for the involvement of keratinocytes, fibroblasts and migratory lymphocytes. Most skin cell populations have shown prolactin and prolactin receptor expression, including keratinocytes, fibroblasts, sweat and sebaceous glands.14,15

This research included 42 confirmed cases of psoriasis. The average age and duration of the disease was 37.71± 10.68 years. 40.48% (17/42) of the 42 cases were male and 59.52% (25/42) were female. Maryam Azizzadeh et al,16 who reported 40% of males and 60% of females in their study, reported similar predominance of female gender. In our sample, mean serum prolactin was 44.21± 14.73 ng / ml (95 percent CI: 39.61 to 48.80) in patients with psoriasis. It is also observed that the mean serum prolactin level was high in all age groups in patients with psoriasis. Regana and Millet, 2000 reported three cases of females with plaque type psoriasis that correlated severity and extent of skin lesions with the development of prolactinoma.17 Bromocriptin was used in all three patients. We also had normalization of the PRL level and regeneration of the psoriatic lesion.In 1981, Weber et al.18–20observed high serum levels of HGH in psoriasis patients20and subsequently confirmed HGH-producing pituitary gland hyperplasia in all 10 post-mortem psoriatic patients.19,20Buskila et al.21described a woman with psoriatic arthritis who had markedly improved skin and joint disease after bromocriptine (a dopamine agonist who blocked bromocriptine). It is notworthy that PRL serum levels in psoriasis are rarely reported.On the other side, Azizzadeh et al.16found that although the serum PRL levels measured by ELISA in 30 psoriatic patients were not significantly higher than the control group having 30 controls using PishtazTeb package. Gorpelioglu et al.22analyzed PRL levels in 39 patients with psoriasis and compared them to 36 controls. Nine patients and five controls raised the PRL levels significantly, but below 100 ng / ml. There was no significant difference in the serum PRL levels between patients and controls.

CONCLUSION

The above findings indicate that the amount of serum prolactin may play a role in psoriasis pathogenesis and its progression. This feature may be a cause and/or result of psoriasis pathology for patients with psoriasis. In this study, where Psoriasis has been found linked to increase in serum PRL levels, we assume that for psoriatic behavior, PRL can be a useful biological marker. To validate our observations and explain the pathogenic role of PRL in psoriasis, further research should be carried out with larger cohort in population with different ethnic groups.

Author’s Contribution:

Concept & Design of Study:

Nadia Rajper

Drafting:

Muhammad Suleman Pirzado, Hafiz Bashir Ahmed Kalhoro

Data Analysis:

Tanweer Ahmed Shaikh, Muhammad Yaqoob Shahani, Sanam Pirzado

Revisiting Critically:

Nadia Rajper, Muhammad Suleman Pirzado

Final Approval of version:

Nadia Rajper

Conflict of Interest: The study has no conflict of interest to declare by any author.

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