LIST OF TABLES
Table 2.1. Classification of skin redness levels and treatment 41
Table 2.2. Evaluation of treatment results according to PASI 49 index
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Evaluation of treatment results and changes in some immune factors in patients with common psoriasis treated with narrow band ultraviolet light - 1 -
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Evaluation of treatment results and changes in some immune factors in patients with common psoriasis treated with narrow band ultraviolet light - 22 -
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Table 2.3. Quality of life assessment scorecard 50
Table 3.1. General characteristics of the study group 59
Table 3.2. History of psoriasis treatment before participating in the study 62
Table 3.3. Disease triggering factors 63
Table 3.4. Disease severity according to PASI of study group 64
Table 3.5. Characteristics of functional symptoms 65
Table 3.6. Quality of life scores of patients before treatment 65
Table 3.7. Blood count characteristics before treatment 66
Table 3.8. Characteristics of some blood biochemical indices before treatment 66
Table 3.9. Metabolic syndrome 67
Table 3.10. Body mass index of study subjects 67
Table 3.11. Treatment results according to PASI 75 68 target
Table 3.12. Treatment results according to quality of life index goals 68
Table 3.13. Results of average PASI reduction 69
Table 3.14. General characteristics of patients who achieved and did not achieve PASI 75 71
Table 3.15. History of patients who achieved and did not achieve PASI 75 72
Table 3.16. Changes in functional symptoms of patients achieving and not achieving PASI 75 73
Table 3.17. Changes in itching symptoms of patients in the group that achieved and did not achieve PASI 75 74
Table 3.18. Changes in other clinical lesions of the patient groups achieving and not achieving PASI 75 75
Table 3.19. Initial dose, total dose and number of irradiations 76
Table 3.20. Average number of radiation sessions for the group achieving PASI 75 according to disease severity before treatment 77
Table 3.21. Quality of life scores of the PASI 75-achieving and -nonachieving groups before and after treatment 77
Table 3.22. Treatment outcomes based on quality of life goals for the PASI 75 78 achieving and non-achieving groups
Table 3.23. Comparison of average quality of life scores before and after treatment according to disease severity 78
Table 3.24. Rate of achieving PASI 75 by gender 79
Table 3.25. Rate of achieving PASI 75 by age group 79
Table 3.26. Rate of achieving PASI 75 by age of disease onset 80
Table 3.27. Rate of achieving PASI 75 according to disease duration 81
Table 3.28. Rate of achieving PASI 75 according to initial dose 81
Table 3.29. Rate of achieving PASI 75 according to family history of psoriasis 82
Table 3.30. Treatment effectiveness according to history of systemic drug use 82
Table 3.31. Rate of achieving PASI 75 according to disease severity before treatment 83
Table 3.32. Impact of metabolic syndrome indicators on treatment effectiveness 84
Table 3.33. Side effects in the groups of patients who achieved and did not achieve treatment effectiveness 85
Table 3.34. Laboratory characteristics of the group of patients achieving PASI 75 before and after treatment 86
Table 3.35. Laboratory characteristics of the group of patients who did not achieve PASI 75 before and after treatment 87
Table 3.36. Age and sex characteristics of the cytokine study group 88
Table 3.37. Some other characteristics of the cytokine study group 89
Table 3.38. Cytokine concentrations before treatment 90
Table 3.39. Correlation between cytokine concentrations and PASI 90
Table 3.40. Association between pretreatment cytokine concentrations and disease severity 92
Table 3.41. Association between pretreatment cytokine concentrations and gender 93
Table 3.42. Association between pretreatment cytokine concentrations and age of onset... 93 Table 3.43. Association between pretreatment cytokine concentrations and the above group
under 33 years old 94
Table 3.44. Association between pretreatment cytokine concentrations and time
sick 94
Table 3.45. Association between pretreatment cytokine concentrations and history of systemic drug use 95
Table 3.46. Association between pretreatment cytokine levels and family history of psoriasis 95
Table 3.47. Correlations between cytokine indices 96
Table 3.48. Changes in cytokine concentrations before treatment and when reaching PASI 75 98
Table 3.49. Changes in IL-17 concentrations before treatment and when reaching PASI 75 according to patient characteristics 99
Table 3.50. Changes in IL-23 concentrations before treatment and when reaching PASI 75 according to patient characteristics 100
Table 3.51. Changes in TNF-α concentrations before treatment and when reaching PASI 75 according to patient characteristics 101
Table 3.52. Effect of metabolic syndrome on changes in IL-17 concentrations before treatment and when reaching PASI 75 102
Table 3.53. Effect of metabolic syndrome on changes in IL-23 concentrations before treatment and when reaching PASI 75 103
Table 3.54. Effect of metabolic syndrome on changes in TNF-α levels before treatment and when reaching PASI 75 104
Figure 3.1. Gender distribution 59
Figure 3.2. Age of onset 60
Figure 3.3. Duration of illness 60
Figure 3.4. Medical history before treatment 61
Figure 3.5. Other injuries of the study group 64
Chart 3.6. PASI 75 achievement rate through 70 screenings
Figure 3.7. PASI 75 achievement rate by age group 80
Figure 3.8: Correlation between IL-17 concentration and PASI 91 score
Figure 3.9: Correlation between IL-23 concentration and PASI 91 score
Figure 3.10: Correlation between TNF-α concentration and PASI 92 score
Figure 3.11: Correlation between IL-17 and TNF-α concentrations 96
Figure 3.12: Correlation between IL-17 and IL-23 concentrations 97
Figure 3.13: Correlation between IL-23 and TNF-α concentrations 97
Figure 1.1: Pathogenesis of psoriasis according to Lynde CW et al. 16
Figure 1.2: Signal transduction pathways of IL-23 and IL-17 20
Figure 2.1: Patient before and after 24 hours of measuring MED dose using Medisun Gigatest 1 UVB 311nm 39 machine
Figure 2.2: NB-UVB 40 protective glasses
Figure 2.3: Medisun Gigatest 1 UVB-311 machine used to measure MED dose in study 47
Figure 2.4: Using the Medisun Gigatest 1 UVB-311 to measure MED 48 dose
Figure 2.5: Medisun@ 2800 Innovation UVB irradiation chamber used for 311nm UVB irradiation in study 48
Figure 2.6: ELISA BIOTEK system used in research 51
Figure 2.7: ELISA KIT in study 51
Figure 1.1: Pathways of IL-12, IL-23 and IL-17 19
Figure 2.1: Research process 43
Figure 2.2: ELISA technical principle 55
Figure 2.3: Patient recruitment process according to research objectives 58
PROBLEM STATEMENT
Psoriasis is a chronic skin disease that progresses erratically, greatly affecting the aesthetics as well as the quality of life of the patient. The disease occurs in all ages, both sexes, on all continents, accounting for 2-3% of the population depending on the country and race [1], [2]. The basic lesions of psoriasis are red patches, with clear boundaries with healthy skin, with many white scales that are easy to peel off, lesions are often localized in pressure areas, often symmetrical [3]. Psoriasis has many clinical forms, but common psoriasis is the most common, accounting for 80-90% [4], [5]. Although the disease is not dangerous to life, it greatly affects the quality of life of the patient, and is a medical burden for the family and society. Severe cases can cause loss of labor, disability, and even death [6].
To date, the exact cause of psoriasis is still unclear. However, most authors have agreed that psoriasis is an immune disorder with genetic factors [7], [8]. The onset and recurrence of the disease are related to many factors such as stress, localized infections, skin trauma, certain drugs, foods, weather, etc. [8], [9]. Today, studies focus on the role of cytokines in the pathogenesis of psoriasis, especially IL-17, IL-23 and TNF-α. These cytokines play a role in maintaining and creating two important characteristics of psoriasis: hyperplasia of epidermal cells and inflammation.
Currently, there is no method to completely cure psoriasis. However, treatment helps to limit damage, maintain stable disease time and improve the quality of life for patients. The main treatment methods today are divided into four groups: topical drugs (salicylic, anti-oxidants, calcipotriol, vitamin A acid, topical corticosteroids, etc.), systemic drugs (methotrexate, ciclosporine, retinoids, etc.), treatment with
light (UVB phototherapy and PUVA photochemotherapy...), and biological drugs/preparations (alefacept, efalizumab, infliximab...) [10], [11]. The use of topical drugs, systemic drugs or biological preparations has been proven and effective in the treatment of psoriasis, however, they also have many side effects when used for a long time or are expensive.
Treatment of moderate and severe psoriasis with narrow band ultraviolet light (NB-UVB) is a modern and effective method in controlling psoriasis [12]. Although there may be some side effects such as sunburn, hyperpigmentation, skin redness or risk of skin cancer later on, NB-UVB is still an effective treatment for psoriasis, making it easier to control the condition.
In Vietnam, NB-UVB has begun to be applied in the treatment of psoriasis, but there is a lack of research to evaluate the effectiveness as well as the changes in some immune factors such as IL-17, IL-23 and TNF-α in the blood of patients after treatment with NB-UVB. Therefore, we conducted the topic: "Evaluation of treatment results and changes in some immune factors in patients with common psoriasis who were irradiated with narrow-band ultraviolet rays" with the following two objectives :
1) Evaluation of the treatment results of moderate and severe psoriasis vulgaris treated with narrow band ultraviolet light (UVB 311nm) at the Central Dermatology Hospital.
2) To investigate the changes in serum concentrations of IL-17, IL-23 and TNF-α before and after treatment of moderate and severe psoriasis vulgaris with narrowband ultraviolet (UVB 311nm) irradiation.