Between 250.000 and  300.000 people live with psoriasis in Sweden today. 50% develop psoriasis before they are 25 years old. When living with psoriasis, one have an increased risk of developing comorbidities, which include overweight, joint problems, high blood pressure, cardiovascular diseases and depression, among others. Based on recent findings, people living with psoriasis can achieve health benefits and improve the symptoms of the condition through living and good life style. I have developed a lifestyle system named "núna", which will empower the patient, encourage a good lifestyle, prevent comorbidities and improve the healthcare personnel and patient communication. The system includes an application which consists of five different main categories (Activity, diet, quit smoking, photography documentation and administrating issues related to ones healthcare providers), and an activity tracker with two different portable docks and a charging station.

The present study was designed to determine the effect of skin-temperature-biofeedback training on cellular proliferation in three psoriasis patients. It was hypothesized that (a) psoriasis patients would be able to consciously decrease skin temperature of psoriatic tissue, and (b) there would be a positive correlation between rate of cellular proliferation and temperature change. Results obtained indicated biofeedback training to be effective in decreasing the surface temperature of psoriatic tissue. A 2 X 7 analysis of variance for two repeated measures indicated the change in skin temperatures as a function of sample period to be significant, F (6,26) = 3.29, p < .02. Generalization of temperature-training effects from the biofeedback to the no-feedback condition were observed. Rate of proliferation decreased from pretraining to posttraining biopsies.

Further mechanistic studies demonstrated that both Radix Rubiae and realgar were capable of inducing cellular apoptosis on HaCaT cells in a dose- and time-dependent manner as shown by morphological inspection, DNA fragmentation, TUNEL assay, cell cycle analysis, annexin V---PI staining and Western blot analysis. HPLC fingerprintings were constructed for quality control of the Radix Rubiae extract using mollugin as the chemical marker. Further phytochemical study found that ethyl acetate fraction of this herb possessed potent growth inhibition on HaCaT cells, with IC50 of 0.9 microg/ml. However, the chemical compounds obtained from commercial sources including mollugin, alizarin, purpurin, and quinizarin failed to induce growth inhibition. Meanwhile, arsenic trioxide, arsenic pentoxide and arsenic iodide, three arsenic salts presented in realgar, had significant anti-proliferative effect on HaCaT cells, with IC50 values of 2.4, 16 and 6.8 microM, respectively; and cellular apoptosis was found to be the underlying mechanism for the observed growth inhibitory activity. Furthermore, Radix Rubiae, realgar and arsenic compounds were also revealed to possess growth inhibition when evaluated in a PHA-activated PBMC model, and all of the substances except arsenic pentoxide significantly attenuated the release of inflammatory cytokines such as IFN-y, TNF-alpha and IL-2 in PBMC, indicating an anti-inflammatory effect. The in vivo mouse tail model experiments demonstrated that arsenic trioxide, arsenic pentoxide and arsenic iodide were able to markedly induce mouse tail keratinocyte differentiation, while such differentiation-modulating effect observed in the fraction of Radix Rubiae was only marginal. / In summary, Radix Rubiae and realgar extracts and three arsenic compounds have been identified and characterized as potential anti-psoriatic agents. The discoveries from the present PhD project not only help put the traditional use of these medicinal substances for psoriasis treatment on a scientific footing, but also open up new opportunities for their development into novel anti-psoriatic therapies. / Psoriasis, a chronic inflammatory skin disorder affecting approximately 2-3% of the population worldwide, is characterized histologically by hyperproliferation and aberrant differentiation of epidermal keratinocytes. Many conventional therapies are offered for psoriasis treatment but there exist problems such as unsatisfactory efficacy, side effects and drug resistance. Many patients therefore turn to alternative and complementary medicines for help. Traditionally, Chinese herbal medicine has been extensively used to treat psoriasis and produced promising clinical results. The present PhD study was conducted to investigate psoriasis-treating Chinese herbal medicines with an aim to identify effective anti-psoriatic agents. Sixty Chinese medicinal materials were selected for the screening project based on their ethnomedical use in psoriasis. The ethanolic extracts of these medicinal substances were evaluated for their anti-proliferative action on cultured HaCaT human keratinocytes using microplate SRB and MTT assays. Among them, the root of Rubia cordifolia L. (Radix Rubiae) and realgar were found to have significant anti-proliferative effects, with IC50 values of 1.4 and 6.6 microg/ml, respectively as measured by MTT assay, while they exerted mild significant cytotoxicity on the human fibroblast Hs-68 cell line. / Tse, Wai Pui. / Advisers: C. T. Che; Z. X. Lin. / Source: Dissertation Abstracts International, Volume: 70-09, Section: B, page: . / Thesis submitted in: October 2008. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 298-340). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Psoriasis är en hudsjukdom som syns på grund av dess röda och fjällande hudflagor på huden. Sjukdomen beror på både miljö- och genetiska faktorer. Det kan vara både psykiskt och fysiskt påfrestande att leva med diagnosen eftersom sjukdomen innebär en livslång behandling men går inte att bota. Vårt syfte är att undersöka hur personer med psoriasis accepterar sin livssituation. Metoden som användes var en allmän litteraturstudie. Resultatet visade på att personer med psoriasis kan acceptera sin livssituation med hjälp av familj och vänner, social samhörighet och genom anpassningar i deras liv. Detta genom att de drabbade fick stöd från närstående och kunde prata ut med andra personer som befann sig i samma situation, då var det enklare att acceptera sin livssituation. Förmågan att kunna koppla bort negativa kommentarer och fokusera på sin inre krets istället var till hjälp. Genom att belysa hur personer med psoriasis upplever sin livssituation kan det underlätta till acceptans hos den drabbade. / Psoriasis is a skin disease that is visible due to its red and scaly skin flakes on the skin. The disease is due to both environmental and genetic factors. It can be both mentally and physically stressful to live with the diagnosis because the disease involves a lifelong treatment but can not be cured. Our purpose is to investigate how people with psoriasis accept their disease. The method used was a general literature study. The result showed that people with psoriasis can accept their life situation with family and friends, social cohesion and through adjustments in their lives. This because the victims were given support from related people and were able to communicate with other people who were in the same situation, it was easier to accept their life situation. The ability to disconnect negative comments and focus on their inner circle instead was helpful. By highlighting how people with psoriasis experience their life situation, it can facilitate acceptance of the victim.

Un réseau de cytokine complexe a été décrit dans le psoriasis mettant en évidence le rôle central des cytokines proinflammatoires dans la physiopathologie de cette maladie. Notre tentative de modéliser l'inflammation cutanée a montré que la combinaison de l'IL-17A, IL-22, IL-1α, oncostatine M (OSM) et le TNFα, augmente de manière synergique l'expression de chimiokines et de peptides antimicrobiens, reflétant certaines caractéristiques du psoriasis. D'autres caractéristiques de cette maladie sont l'acanthose et le blocage de la différenciation des kératinocytes. Notre premier objectif était d'étudier le rôle respectif de ces cytokines sur la différenciation des kératinocytes en comparaison avec les lésions de patients psoriasiques. Toutes ces cytokines inhibent l'expression des marqueurs de différentiation des kératinocytes, parmi lesquelles l’IL-22 et l’OSM sont les plus puissantes et le mélange M5 présente des effets synergiques. Si l'IL-22 et l'OSM déclenchent plus spécifiquement l'hyperplasie épidermique et le blocage de la différenciation, l’IL-1α, IL-17A et le TNFα sont plutôt impliqués dans l'activation de l'immunité innée. Le rôle fonctionnel de chacune de ces cytokines in vivo a été étudié dans un modèle d'inflammation cutanée de type psoriasique induit par l'imiquimod (IMQ), un agoniste TLR7, en utilisant des souris déficientes en cytokines. L'absence de l'OSM ou de l'OSMRβ n'a pas modifié le développement des lésions inflammatoires induites par l’IMQ. Une hypothèse est que d'autres cytokines peuvent avoir des effets redondants avec l'OSM. L'absence de l'IL-22 chez la souris diminue partiellement les lésions cutanées induites par l'IMQ, démontrant que son retrait du réseau cytokinique rompt une partie des effets synergiques des cytokines in vivo comme présenté dans le modèle M5. L'absence de l'IL-1α ou de l'IL-1β ne modifie pas l'inflammation cutanée induite par l'IMQ, ce qui n'est pas surprenant au vu des activités redondantes de ces deux cytokines. La diminution partielle de l'inflammation en absence d'IL-1α ET d'IL-1β OU de la chaine réceptrice commune IL-1RI confirme ces observations. A long terme ces études devraient permettre de proposer des stratégies anti-cytokine ciblées et combinées pour tenter de rompre la synergie et diminuer ainsi toutes les composantes de la réponse inflammatoire cutanée. / A complex cytokine network has been described in psoriasis and highlighted a central role of proinflammatory cytokines produced by infiltrated immune cells. Our attempt to model skin inflammation showed that the combination of IL-17A, IL-22, IL-1α, OSM and TNFα (Mix M5) synergistically increases chemokines and antimicrobial-peptides expression, recapitulating some features of psoriasis. Other characteristics of psoriasis are acanthosis and down-regulation of keratinocyte differentiation markers. Our aim was to characterize the specific roles of these cytokines on keratinocyte differentiation, and to compare with psoriatic lesion features. All cytokines decrease keratinocytes differentiation markers expression, but IL-22 and OSM were the most powerful, and the M5 strongly synergized the effects. If IL-22 and OSM more specifically drive epidermal hyperplasia and differentiation loss, IL-1α, IL-17A and TNFα were more involved in the activation of innate immunity. Functional role of these cytokines in vivo was studied in imiquimod-induced psoriasis-like skin inflammation by using knockout mice. Imiquimod (IMQ) is a TLR7 ligand. The absence of OSM or OSMRβ did not affect skin lesions after IMQ treatment. We supposed that other cytokines might be redundant with the OSM effects. The absence of IL-22 in mice partially reduced skin lesions induced by IMQ, demonstrating that removal of IL-22 in cytokine network break synergistic effects of cytokines in vivo as observed in in vitro with M5. The absence of IL-1α or IL-1β did not affect skin lesions after IMQ treatment, supporting the potential redundant activity of these cytokines, since the response is attenuated in mice deficient for both IL-1α and IL-1β or for IL-1RI. In the long term these studies should propose strategies targeted and combined anti-cytokine in order to break the synergy and thus reduce all components of the inflammatory skin response.

Le psoriasis et la dermatite atopique sont des pathologies inflammatoires cutanées chroniques, fréquentes et invalidantes. Dans la peau des patients souffrant de ces pathologies, un dérèglement de la réponse immunitaire aboutissant à une inflammation chronique est toujours observé. Le réseau cytokinique joue un rôle essentiel dans la physiopathologie cutanée en permettant la communication entre les cellules cutanées et les cellules immunitaires. Dans le psoriasis et la dermatite atopique, ce réseau est largement perturbé. En effet, un grand nombre de cytokines proinflammatoires sont surexprimées au détriment des cytokines anti-inflammatoires. Cette inflammation chronique est directement responsable de l'apparition des lésions cutanées. Parmi les cytokines surexprimées dans ces pathologies, des études antérieures du LITEC ont montré in vitro que l'Oncostatine M (OSM) est impliquée dans la production de peptides antimicrobiens et de médiateurs de l'inflammation, ainsi que dans l'inhibition de la différenciation des kératinocytes. Notre objectif était de poursuivre ces travaux en étudiant le rôle de l'OSM dans l'inflammation cutanée in vitro et in vivo chez la souris. Nous avons pour cela, comparé le rôle de l'OSM à celui d'autres cytokines de la famille de l'IL-6, l'IL-6 et l'IL-31, qui présentent également une activité sur le kératinocyte. L'activité de ces cytokines a été étudiée in vitro sur des cultures primaires de kératinocytes murins en monocouche, sur des épidermes reconstruits murins ainsi qu'in vivo dans différents modèles d'inflammation cutanée. Nous montrons que l'OSM est plus active que l'IL-6 et l'IL-31 sur les kératinocytes en culture et que la surexpression de cette cytokine in vivo dans la peau de souris à l'aide d'adénovirus recombinants induit une inflammation cutanée forte, présentant des caractéristiques communes avec le psoriasis et la dermatite atopique. Néanmoins, les souris déficientes pour le gène codant l'OSM ne présente aucune diminution du phénotype inflammatoire cutané dans le modèle de psoriasis induit par application d'Imiquimod et dans un modèle de dermatite atopique induit par application de Calcipotriol, suggérant l'existence de mécanismes de compensation par d'autres cytokines proinflammatoires. En parallèle de cette étude, nous avons mis au point un nouveau modèle d'épidermes reconstruits murins permettant l'étude de l'activité des cytokines sur les kératinocytes. Ce modèle présente l'avantage de reproduire plus finement la physiologie d'un épiderme normal par rapport aux autres modèles préalablement décrits et ouvre la perspective de développer des épidermes reconstruits à partir de kératinocytes de souris transgéniques. En conclusion, ces travaux démontrent le rôle pro-inflammatoire de l’OSM dans l'inflammation cutanée et son activité majeure sur les kératinocytes en comparaison à celles décrites pour l'IL-6 et l'IL-31. Néanmoins, la pertinence du ciblage thérapeutique de cette cytokine dans le psoriasis et la dermatite atopique reste encore à démontrer. / Psoriasis and atopic dermatitis are the most prevalent cutaneous inflammatory disease in worldwide. An imbalance immune response is a characteristic feature of these diseases and through their role in the communication between cutaneous and immune cells; cytokines are key players in these diseases. Indeed, in the psoriatic and atopic lesions, an altered cytokine network is always described and mainly in favor of proinflammatory cytokines. Among them, our laboratory previously described that Oncostatin M, an IL-6 family member is up-regulated in psoriasis and atopic dermatitis lesions. In vitro, we have demonstrated that OSM induces a proinflammatory signature on human keratinocytes including the up-regulation of antimicrobials peptides and proinflammatory mediators as well as inhibiting the epidermal differentiation. The aim of this work was to confirm the role of OSM in cutaneous inflammatory diseases and compare it to others IL-6 family members such as IL-6 and IL-31 also described for their potent activities on keratinocytes. The activity of theses cytokines was study in vitro on normal murine epidermal keratinocytes or in reconstituted murine epidermis and in vivo in inflammatory murine models. Compared to IL-6 and IL-31, OSM is a strong inducer of proinflammatory signature in vitro on keratinocyte and in vivo using recombinant adenovirus overexpressing theses cytokines. The inflammatory phenotype induces by overexpression of OSM in mouse ears mimics key features of psoriatic and atopic skins. However, deficiency mice for the gene encoding OSM dot not demonstrated reduced phenotype in a mouse model of psoriasiform dermatitis induce by imiquimod or in a mouse model of atopic dermatitis induced by calcipotriol suggesting that compensatory cytokines are sufficient to maintain phenotype in the absence of OSM. Concurrent to this study, we also developed a model of reconstituted murine epidermis in order to test the activity of cytokines in a model reproducing more closely the epidermal physiology. The in vitro model could be used to study the function of numerous epidermal proteins of cytokine using transgenic mice and will provide a useful tool in the dermatological research field. Finally this work demonstrated the proinflammatory role of OSM in cutaneous inflammation through its major activities on keratinocytes in comparison to IL-6 and IL-31. However, the relevance of therapeutic strategies to block the activity of this cytokine in inflammatory skin diseases remains to be demonstrated.

El presente estudio tiene la finalidad de conocer los estilos y estrategias de afrontamiento en adultos con psoriasis en Lima Metropolitana. Asimismo se pretende comparar cada estilo de acuerdo al género y la etapa de desarrollo en la que se encuentran. Los participantes fueron 80 personas de ambos sexos, entre 20 y 65 años con el diagnóstico de psoriasis. El instrumento utilizado fue la Escala de Afrontamiento Multidimensional (COPE) de Carver, Scheier y Weintraub (1989), adaptada por Cassuso en 1996 y una ficha sociodemográfica. / The present study aims to know the styles and coping strategies in adults with psoriasis in Metropolitan Lima. It also seeks to compare each style according to gender and the stage of development in which they are located. The participants were 80 persons of both sexes between 20 and 65 years old with the diagnosis of psoriasis. The instrument used was the Multidimensional Coping Scale (COPE) of Carver, Scheier and Weintraub (1989), adapted by Cassuso in 1996 and a sociodemographic tab. / Tesis

Les microparticules (MPs) sont des vésicules dérivées de la membrane plasmique lors de la vésiculation par les cellules stimulées. Les MPs interviennent dans l'inflammation, les communications intercellulaires et la coagulation. Tout d'abord, nous avons standardisé une méthode pour caractériser et quantifier des MPs par cytométrie en flux dans le plasma.L'implication des MPE est suggérée dans le psoriasis notamment par le rôle central du TNF-a qui est un puissant inducteur de vésiculation. Nous avons comparé les valeurs de MPs chez des patients psoriasiques à celles de donneurs sains. Les MPE étaient plus élevées chez les patients notamment les MPs de petite taille. Les MPs diminuaient sous traitements anti-TNF-a.Les MPs agissent sur la progression tumorale des cancers. Les MPs tumorales ou des cellules de l'hôte peuvent modifier les propriétés invasives de la tumeur par des propriétés transférées. Les MPs peuvent aussi interagir avec les cellules du système immunitaire. Dans le mélanome, le risque de thrombose est accru. Or, la libération de MPs conduit à un état d'hypercoagulabilité. Les MPP et les MPE étaient augmentés dans chaque stade de la maladie par rapport à une population témoin. De plus, les MPs des patients atteints de mélanome possédaient des propriétés procoagulantes. L'étude des MPs en Dermatologie permet d'appréhender de nouveaux angles de la physiopathologie des maladies inflammatoires ou en carcinogenèse. Le dosage des MPs pourrait devenir un outil intéressant de monitoring des biothérapies dans le psoriasis. Dans le mélanome, des études complémentaires permettront de déterminer si les taux de MPs constituent un facteur pronostique intéressant / Microparticles (MPs) are vesicles derived from the plasma membrane during vesiculation by the stimulated cells. MPsare involved in inflammation, intercellular communications and coagulation. First, we standardised a method tocharacterise and quantify MPs in plasma by flow cytometry.The implication of endothelial microparticles (EMPs) is suggested in psoriasis, in particular by the central role of TNF-a which is a powerful inducer of vesiculation. We compared the values of MPs in psoriatic patients to the values inhealthy donors. EMPs were higher in the patients, especially MPs of small size. MPs were reduced under anti-TNF-atreatments.MPs have an action on the tumoral development of cancers. Tumoral MPs or the host's cells can modify the invasiveproperties of the tumour through transferred properties. MPs can also interact with the cells of the immune System. Inmelanoma, the risk of thrombosis is increased, but the release of MPs leads to a state of hypercoagulability. Plateletsmicroparticles (PMPs) and EMPs were increased at each stage of the disease compared to a control population. Inaddition, MPs of patients with melanoma had procoagulant properties.The study of MPs in Dermatology allows to apprehend new approaches of the physiopathology of inflammatorydiseases or in carcinogenesis. The dosage of MPs could become an interesting tool in the monitoring of biotherapies inpsoriasis. In melanoma, additional studies will show if MPs rates are an interesting prognostic factor.

Dans ce travail de thèse, nous avons préparées des émulsions de Pickering innovantes, stabilisées par des nanoparticules (NP) biocompatibles et biodégradables de poly (acide lactique-co-glycolique) (PLGA), en utilisant du Miglyol comme phase huileuse. Ces systèmes permettent de s’affranchir de l’ajout de tensioactifs synthétiques, utilisés pour stabiliser les émulsions classiques, et qui sont souvent à l’origine d’irritations lors de traitements topiques chroniques. Dans ces émulsions ont été co-encapsulées deux substances actives, la première, un agent immunosuppresseur, dans les NP PLGA, la seconde, un agent anti-inflammatoire, dans les gouttelettes de Miglyol.Dans un premier temps, une étude physicochimique approndie a permis de mieux comprendre les mécanismes de stabilisation de ces émulsions, en fonction du type de NP utilisé. Aussi, l’influence de l’ajout de substances actives a été évaluée sur les structures macroscopique, microscopique et interfaciale des émulsions, mais également sur leur stabilité. Dans un deuxième temps, nous avons démontré que l’ajout de Carbopol, un polymère épaississant, permettait d’améliorer la stabilité, la texture et le pH des émulsions. Enfin, le potentiel thérapeutique d’un tel système à été évalué de manière préliminaire, notamment sa cytotoxicité sur des cultures de kératinocytes, mais aussi son activité immunosuppressive sur des cellules immunitaires activées et leur production de cytokines. Un tel système peut donc s’avérer intéressant pour le traitement de pathologies cutanées chroniques. / In this thesis work, we formulated innovative Pickering emulsions, stabilized by biocompatible and biodegradable poly (lactic-co-glycolic acid) nanoparticles (NP), using Miglyol as the oil phase. These systems could be an alternative to conventional emulsions, often stabilized with synthetic surfactants that can be responsible for irritation in particular during long-term topical treatments. Two active pharmaceutical ingredients (API) were successfully co-encapsulated, the first one, an immunosuppressant agent, entrapped in PLGA NP, the second one, an anti-inflammatory agent, incorporated in Miglyol droplets.Firstly, a thorough physicochemical characterization allowed to better understand the stabilization mechanism of these emulsions, depending on the type of NP used. Moreover, the influence of the addition of API was evaluated on the macroscopic, microscopic and interfacial structures of the emulsions, also on their stability. Secondly, we demonstrated that the addition of Carbopol, a thickening agent, improved the stability, texture and pH of emulsions. Finally, the therapeutic potential of such system was investigated through preliminary evaluation of its cytotoxicity on keratinocyte cells, but also its immunosuppressive activity on activated immune cells and their cytokine production. Such a system could be interesting for the treatment of chronical skin diseases.