Distinguishing psoriasis from eczema: New diagnostic test

In some patients, the chronic inflammatory skin diseases psoriasis and eczema are similar in appearance. Up to now, dermatologists have therefore had to base their decision on which treatment should be selected on their own experience and an examination of tissue samples. A team of researchers has now analyzed the molecular processes that occur in both diseases and discovered crucial differences. This has enabled them for the first time to gain a detailed understanding of the ways in which the respective disease process occurs.

A better understanding of molecular processes
"Both diseases have a highly complex appearance, which often varies widely from one patient to another," says Dr. Stefanie Eyerich, who heads the Specific Immunology working group at the Institute of Allergy Research (IAF) at the Helmholtz Zentrum München. "This has led previous attempts to compare their molecular signature to fail." In this study, the researchers identified 24 patients who were suffering simultaneously from psoriasis and eczema and in each analyzed at the molecular level the characteristic differences they demonstrated between psoriasis and eczema compared to clinically unremarkable skin.
"We were thus able to drastically reduce random genetic or environmental influences and gain a detailed picture of the development of these two diseases," explains Prof. Fabian Theis of the Institute of Computational Biology (ICB) at the Helmholtz Zentrum München.


Paving the way for personalized medicine
In recent years, many new specific treatments have been developed for psoriasis and eczema. However, in each case, these are only effective for one or other of the two diseases. And they are very expensive: one such treatment generally costs several tens of thousands of euros per year, per patient. The ability to make an exact diagnosis therefore has a considerable economic impact.
If it cannot be clearly determined on presentation which of the two diseases is involved, the newly developed diagnostic tool will help to differentiate them. It involves a test which compares samples of diseased and healthy skin and is concluded within one day. The researchers have now filed a patent application for it.
The procedure, moreover, marks the first step towards the introduction of personalized medicine also for chronic inflammatory skin diseases. "Whereas this is practiced increasingly in oncology, for example in the form of mutation analyses and the subsequent decision in favor of the best individual treatment option, it is not common in the case of inflammatory skin diseases," says Kilian Eyerich of the Clinic and Polyclinic for Dermatology at the Technical University of Munich.
The researchers plan to purse this path with a view to characterizing even more precisely the molecular processes involved in inflammatory skin diseases and combining them with clinical information, such as the choice of certain treatments. In this way, their goal is to determine the best possible treatment option for each individual patient.

Further information
*Psoriasis is a non-contagious, inflammatory skin disease, and it can also be a systemic disease that affects other organs. It generally presents as very flaky patches of skin varying in size from spots to larger areas the size of one's palms (frequently on the knees, the elbows and on the scalp, and also on the anus) -- often with severe itching as well as nail changes. Worldwide about 125 million people suffer from this disease. In Germany it affects about two million people.
**Eczema is a skin disease that presents as a non-infectious inflammatory skin reaction. Eczema can be triggered by different factors. It is characterized by a typical sequence of skin reactions (reddening of the skin, blistering, weeping, scabbing, scaling).
http://www.sciencedaily.com/releases/2014/07/140710081210.htm

Reducing stress may help lead to clearer skin

Anyone who's had a pimple form right before an important event may wonder if stress caused the break out. While commonly linked anecdotally, proving the relationship between stress and inflammatory skin conditions, such as acne, psoriasis and rosacea, is another matter.

"Nearly everyone has some form of stress in their life, so it's difficult to determine whether stress can actually make the skin's appearance worse," said board-certified dermatologist Richard D. Granstein, MD, FAAD, the George W. Hambrick Jr., professor and chairman of the department of dermatology, Weill Cornell Medical College, New York. "However, it's been known for a long time that the nervous system, which processes our stress, has an impact on conditions such as psoriasis."
Dr. Granstein discusses the latest research on the impact stress has on inflammatory skin conditions and his thoughts on how this research could change treatment options.
How does stress play a role in inflammatory skin conditions? Dr. Granstein said research linking the nervous system and the skin has long been understood. "If you interrupt the nerves' path to an area of a patient's skin affected by psoriasis, the psoriasis improves," said Dr. Granstein. "In addition, the condition improves if you inject local anesthetic into psoriasis patches. This information strongly suggests that nerves play a role in how psoriasis operates."
Dr. Granstein notes that animal studies have demonstrated that stress can make inflammatory skin conditions worse. In a Japanese study , mice genetically prone to develop a rash similar to the inflammatory skin condition atopic dermatitis did so when stressed, while mice that were not exposed to stress did not develop the rash.
Dr. Granstein said experimental data support the idea that the nervous system and stress affect inflammatory skin conditions in humans. Many types of cells in the skin, including immune cells and endothelial cells (cells that line blood vessels), can be regulated by neuropeptides and neurotransmitters, which are chemicals released by the skin's nerve endings. Stress can result in the skin's nerve endings releasing an increased level of these chemicals. When this occurs, it can affect how and at what level our body responds to many important functions, such as sensation and control of blood flow, and can contribute to the symptoms of stress that we feel. In addition, the release of these chemicals can lead to inflammation of the skin.
"If we could block specific steps in certain pathways between the nervous system and the skin -- without impacting the whole body -- we would likely have new ways to prevent or treat some skin disorders," said Dr. Granstein. "We're gaining a greater understanding of the mechanisms underlying many skin conditions, which will help us develop new therapies."
Has stress been shown to impact the skin in other ways? While commonly believed, Dr. Granstein said research has not proven that stress causes skin aging.
When combined with exposure to ultraviolet rays, Dr. Granstein noted that animal studies have shown that stress could have an impact on the development of skin cancer. "When exposed to ultraviolet radiation, stressed mice developed skin cancers more quickly than mice that were not exposed to stress," he said.
How does current research impact how people with inflammatory skin conditions are treated? Dr. Granstein said more research needs to be done to further understand the role of the nervous system and stress on inflammatory skin conditions, especially since other factors play a role, including genetics. He encourages people with inflammatory skin conditions to tell their dermatologist if they believe stress is impacting their condition. They can experiment with stress reduction techniques such as meditation, yoga, or tai chi, but they should continue their treatment plan as prescribed by their dermatologist.
http://www.sciencedaily.com/releases/2014/08/140807103642.htm