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more than a skin disease
Uveitis
Uveitis is a condition characterized by intra-ocular inflammation affecting the uvea, or the middle layer of the eye, which includes the iris, ciliary body, choroid tissue, and adjacent structures.1-4 Symptoms can vary depending on the part of the uveal tract involved, but they typically include pain, redness, and blurred or decreased vision.1 Around 2 million people worldwide are estimated to suffer from uveitis, with severe uveitis possibly being responsible for 10% of all cases of blindness.2,5,6
Patients with psoriasis (PsO), especially those with concomitant psoriatic arthritis (PsA), are at higher risk of developing uveitis than controls without PsO or PsA, and the reverse relationship has also been reported: patients with uveitis are at increased risk for developing PsO.3,7,8 Ocular involvement is being increasingly recognized as a serious complication of PsO and is reported to affect approximately 7%-20% of patients suffering from uveitis.1-3,9-11 Psoriatic uveitis is usually chronic and severe, and its incidence increases with PsO severity.2,7
Uveitis
IL, interleukin; TGFß, transforming growth factor beta; Th, T helper; TNF-α, tumor necrosis factor-alpha; Treg, regulatory T cell.
Lin P et al. Ophthalmology. 2014;121:365-376. Priluck AA et al. J Drugs Dermatol. 2020;19:1192-1198.
Uveitis
PsO and uveitis share certain pathogenic etiologies that may provide a mechanistic explanation of the association. Both diseases are linked by helper T (Th)17- and Th1-dependent immune responses.1,2,9,12 Cytokines known for their important roles in PsO, such as interleukin (IL)-6, IL-17, IL-23, and tumor necrosis factor (TNF) have been found in increased concentrations in the aqueous humor of patients with uveitis.2,9,12 Furthermore, the sub-clinical inflammation from PsO may break down the blood−aqueous humor barrier, allowing activated neutrophils from peripheral blood to exacerbate anterior uveitis.1,2
It is important for dermatologists to be aware of the increased incidence of uveitis in patients with PsO in case ocular symptoms arise.7,13 In case of eye redness, decreased visual acuity, photosensitivity, or blurred vision, urgent referral to an ophthalmologist may be warranted.7,13 Early detection and initiation of treatment for uveitis may prevent ocular damage.7
Uveitis
IL, interleukin; TGFß, transforming growth factor beta; Th, T helper; TNF-α, tumor necrosis factor-alpha; Treg, regulatory T cell.
Lin P et al. Ophthalmology. 2014;121:365-376. Priluck AA et al. J Drugs Dermatol. 2020;19:1192-1198.
Uveitis
IL, interleukin; TGFß, transforming growth factor beta; Th, T helper; TNF-α, tumor necrosis factor-alpha; Treg, regulatory T cell.
Lin P et al. Ophthalmology. 2014;121:365-376. Priluck AA et al. J Drugs Dermatol. 2020;19:1192-1198.
Uveitis is a condition characterized by intra-ocular inflammation affecting the uvea, or the middle layer of the eye, which includes the iris, ciliary body, choroid tissue, and adjacent structures.1-4 Symptoms can vary depending on the part of the uveal tract involved, but they typically include pain, redness, and blurred or decreased vision.1 Around 2 million people worldwide are estimated to suffer from uveitis, with severe uveitis possibly being responsible for 10% of all cases of blindness.2,5,6
Patients with psoriasis (PsO), especially those with concomitant psoriatic arthritis (PsA), are at higher risk of developing uveitis than controls without PsO or PsA, and the reverse relationship has also been reported: patients with uveitis are at increased risk for developing PsO.3,7,8 Ocular involvement is being increasingly recognized as a serious complication of PsO and is reported to affect approximately 7%-20% of patients suffering from uveitis.1-3,9-11 Psoriatic uveitis is usually chronic and severe, and its incidence increases with PsO severity.2,7
Uveitis
IL, interleukin; TGFß, transforming growth factor beta; Th, T helper; TNF-α, tumor necrosis factor-alpha; Treg, regulatory T cell.
Lin P et al. Ophthalmology. 2014;121:365-376. Priluck AA et al. J Drugs Dermatol. 2020;19:1192-1198.
PsO and uveitis share certain pathogenic etiologies that may provide a mechanistic explanation of the association. Both diseases are linked by helper T (Th)17- and Th1-dependent immune responses.1,2,9,12 Cytokines known for their important roles in PsO, such as interleukin (IL)-6, IL-17, IL-23, and tumor necrosis factor (TNF) have been found in increased concentrations in the aqueous humor of patients with uveitis.2,9,12 Furthermore, the sub-clinical inflammation from PsO may break down the blood−aqueous humor barrier, allowing activated neutrophils from peripheral blood to exacerbate anterior uveitis.1,2
It is important for dermatologists to be aware of the increased incidence of uveitis in patients with PsO in case ocular symptoms arise.7,13 In case of eye redness, decreased visual acuity, photosensitivity, or blurred vision, urgent referral to an ophthalmologist may be warranted.7,13 Early detection and initiation of treatment for uveitis may prevent ocular damage.7
References
- Fraga NA et al. An Bras Dermatol. 2012;87:877−883.
- Fotiadou C, Lazaridou E. Psoriasis (Auckl). 2019;9:91−96.
- Chaiyabutr C et al. Biomed Res Int. 2020;2020:9308341.
- Barisani-Asenbauer T et al. Orphanet J Rare Dis. 2012;7:57.
- Gritz DC, Wong IG. Ophthalmology. 2004;111:491−500.
- Foster CS et al. Surv Ophthalmol. 2016;61:1−17.
- Elmets CA et al. J Am Acad Dermatol. 2019;80:1073−1113.
- Egeberg A et al. JAMA Dermatol. 2015;151:1200−1205.
- Perez-Chada LM, Merola JF. Clin Immunol. 2020;214:108397.
- Chandran NS et al. J Dermatol. 2007;34:805−810.
- Ghalamkarpour F et al. J Dermatolog Treat. 2020;31:27−32.
- El-Asrar AM et al. Clin Immunol. 2011;139:177−184.
- Bilal J et al. Am J Med. 2018;131:1146−1154.