Spring, the beginning of the year, is also the start of a new round for psoriasis patients to fight the disease. This is inseparable from the large temperature difference between day and night in spring, as well as respiratory infections caused by the quiet growth of pathogens such as bacteria and viruses.
Cough, runny nose and nasal congestion chart
Modern medicine believes that the causes of psoriasis are very complex, among which there is certain evidence that respiratory infection factors can lead to the onset or aggravation of the disease, and the infections are mostly bacterial infections, such as upper respiratory tract infections, including nasal, tonsil and throat infections, which mainly manifest as cough, runny nose, nasal congestion, fever, sore throat and other symptoms.
1. Mechanisms related to psoriasis combined with respiratory system diseases
(1) Immune factors
The reason why upper respiratory tract infection can trigger or aggravate psoriasis may be related to the immune mechanism.
Under normal circumstances, human skin and respiratory system are colonized by numerous symbiotic microorganisms to maintain immune homeostasis without causing clinical symptoms. However, when the body’s immunity is reduced by factors such as temperature changes and exertion, pathogens can launch a “surprise attack” and induce the onset of disease.
Streptococcal infections
Streptococcus, the main causative agent of respiratory infections, can trigger an innate immune response. And related studies have found that respiratory diseases caused by streptococcal infections are closely related to psoriasis. The specific mechanism is that streptococcal peptidoglycan, the main component of streptococcal cell wall, promotes the maturation of monocytes by interacting with immature fever monocytes, which accelerates the proliferation and differentiation of some cells and infiltration of neutrophils, and stimulates the proliferation of keratin-forming cells to trigger psoriasis.
Among them, the virulence factor streptococcal pyrogenic exotoxin C produced by Streptococcus pyogenes and the cell wall component M protein can also be involved in the cellular immunopathogenesis of psoriasis as superantigens.
(2) Genetic factors
In addition, there is a diversity of peptidoglycan recognition proteins PGRP-3 and PGRP-4 genes in Streptococcus, and the PGRP-3 and PGRP-4 genes are co-located with psoriasis susceptibility locus PSORS4 on chromosome 1q21, suggesting that altered peptidoglycan innate recognition may be involved in psoriasis pathogenesis.
Second, psoriasis combined with respiratory disease may also be associated with the HLA-Cw6 gene, the first gene shown to be significantly associated with susceptibility to psoriasis. Genetic studies have confirmed that HLA-Cw6 is a common causative gene for psoriasis and chronic streptococcal tonsillitis, and patients with psoriasis expressing the causative gene HLA-Cw6 with streptococcal tonsillitis are sicker than those without infection.
2.Treatment of psoriasis combined with respiratory system diseases
According to the above pathogenic mechanism, the corresponding treatment options are given clinically.
(1) Tonsillectomy
As a key component of the immune system of the mucous membrane of the oropharynx, tonsils are also a common site of infection of Streptococcus pyogenes, and psoriasis is closely related to streptococcal infection of tonsillitis, so if psoriasis patients have long-term inflammation of the tonsils triggering or aggravating their own conditions, tonsillectomy can be considered as appropriate.
Studies have shown that tonsillectomy can significantly improve the prognosis of patients with psoriasis with recurrent streptococcal tonsillitis. Removal of the tonsils may also block the accumulation of streptococci in the tonsils and significantly reduce immune cells and cytokines in the blood. However, the specific choice needs to be based on the patient’s own situation, and it is recommended that the choice be made under the professional guidance of a physician.
(2) Drug therapy
The chloramphenicol drug, methomycin, is the drug of choice for pediatric pancytopenic psoriasis.
Secondly, penicillin can inhibit streptococcal cell wall synthesis by binding to penicillin-binding protein on the streptococcal cell membrane. And rifampicin can reduce TNF-α and IL-1β secretion, increase IL-10 secretion and inhibit T lymphocyte function.
In addition, macrolide antibiotics inhibit streptococcal protein synthesis by binding to the 50S subunit of the streptococcal ribosome, and also ameliorate psoriasis by inhibiting IL-6, IL-8 and TNF-α secretion, decreasing neutrophil activity, inhibiting IL-1 secretion, major histocompatibility complex-II molecule expression and superantigen presentation, and other immunomodulatory effects.
As a disease that involves multiple systems, psoriasis is never treated and controlled in a single way, requiring multiple measurements and trade-offs. The association between respiratory diseases caused by factors such as streptococcal infections and the pathogenesis of psoriasis is still not well defined, but it has been largely confirmed that anti-streptococcal therapy can significantly improve the prognosis of patients with psoriasis with streptococcal infections. Therefore, in the near future, this may provide new therapeutic ideas and directions for psoriasis combined with respiratory diseases.
References
[1]Gao Xie,Zhang Jiayu,Chen Yi,Li Yongrong,Wu Yifei. Exploration of the correlation between streptococcal infection and psoriasis [J]. Dermatology and Venereal Diseases,2021,43(03):340-341.
[2]Wu Yue,Wang Honglin. Immunological mechanisms and therapeutic targets of psoriasis[J]. Chinese Journal of Immunology,2019,35(11):1281-1288.
[3]Wang Chaoying,Zhang Huimin. New advances in the study of the pathogenesis of psoriasis[J]. World abstract of the latest medical information,2019,19(60):28-31.
[4]JU Xinggang,YAO Ying,CHEN Lin,ZHENG Shuangjin,JIA Xueping,ZHANG Bin. Efficacy of diammonium glycyrrhizate enteric capsule combined with splenamine-freeze dried powder in the treatment of childhood punctate psoriasis[J]. Shanxi Journal of Medicine,2018,47(09):1059-1060.