Glucocorticoid receptor expression in the skin of psoriatic patients compared with control skin: correlation with stress and disease activity and severity

Background although the role of topical glucocorticoids treatment in psoriasis is well established, the expression of glucocorticoid receptors (grs) in psoriatics has not yet been studied. objective to study the expression of grs in 20 psoriatics compared with 20 matched controls and correlate the results to disease severity and activity, and life stress. patients and methods in this case–control study, two skin biopsy specimens from each psoriatic patient’s involved and clinically uninvolved skin and one biopsy specimen from each control were evaluated for grs expression using immunohistochemistry. the results were correlated to psoriasis area and severity index, physician’s global assessment for psoriasis activity (pga-ps), and psoriasis life stress inventory (plsi). results a significant increase in gr expression was found in psoriatic involved skin compared with uninvolved and control skin (p = 0.044 and p= 0.033, respectively), with a correlation between expression levels in involved epidermis and both involved dermis and clinically uninvolved epidermis (p= 0.044 and p =0.05, respectively). despite the absence of a significant difference between patients with different grades of psoriasis area and severity index, significantly higher expression was found in psoriatic involved and uninvolved skin of highly stressed patients compared with less stressed patients (p<0.001 and p= 0.01, respectively). expression in both involved and uninvolved skin correlated with plsi and pga-ps scores, and both plsi and pga-ps correlated to each other (p<0.05). conclusion higher gr expression in psoriatic involved skin compared with uninvolved and control skin, with correlation to disease activity, and high life stress indicate the reciprocal relationship between inflammation, stress response, and glucocorticoid signaling pathways. correlation between expression in uninvolved skin and psoriasis activity suggests a prepsoriatic phenotype in psoriatic patients’ clinically uninvolved skin.