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CORRESPONDENCE
Year : 2017  |  Volume : 145  |  Issue : 2  |  Page : 250-252

Serum prolactin levels in patients with psoriasis: Results of a pilot study


1 Department of Dermatology, Venereology & Leprosy, Dr. R. P. Government Medical College, Kangra (Tanda) 176 002, Himachal Pradesh, India
2 Department of Biochemistry, Dr. R. P. Government Medical College, Kangra (Tanda) 176 002, Himachal Pradesh, India

Date of Submission26-May-2015
Date of Web Publication19-Jun-2017

Correspondence Address:
Vikram K Mahajan
Department of Dermatology, Venereology & Leprosy, Dr. R. P. Government Medical College, Kangra (Tanda) 176 002, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_814_15

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How to cite this article:
Khatri G, Mahajan VK, Mehta KS, Sharma KK, Bhushan S, Chauhan PS. Serum prolactin levels in patients with psoriasis: Results of a pilot study. Indian J Med Res 2017;145:250-2

How to cite this URL:
Khatri G, Mahajan VK, Mehta KS, Sharma KK, Bhushan S, Chauhan PS. Serum prolactin levels in patients with psoriasis: Results of a pilot study. Indian J Med Res [serial online] 2017 [cited 2021 Sep 16];145:250-2. Available from: https://www.ijmr.org.in/text.asp?2017/145/2/250/208368

Sir,

Prolactin possibly plays a pathogenetic role in psoriasis by stimulating keratinocyte proliferation, T-lymphocyte interferon gamma production and promoting angiogenesis [1]. The inhibition of the T-suppressor cell functions by prolactin may serve to promote psoriatic plaque development [2]. It has been postulated that retinoids decrease the prolactin secretion from pituitary gland and add to their antipsoriatic effect [3]. Bromocriptine, an antiprolactin drug has been found useful in the treatment of psoriasis and psoriatic arthritis [4],[5]. There are studies demonstrating serum prolactin levels varying with severity, duration and treatment of psoriasis [5],[6],[7],[8]. However, not many studies are available from India.

Fifty five male patients aged 22-66 years (mean ± SD 42.30±12.72 yr) having chronic plaque psoriasis for at least six months and presenting at the Dermatology, Venereology and Leprosy outpatient department, of Dr R.P. Government Medical College, Kangra (Tanda), Himachal Pradesh, India, during January to December 2012, were included in this study. Only those patients who gave written informed consent were included. Except for topical emollients and oral anti-histaminics, all topical and systemic treatments were stopped for two and four wk respectively before blood sampling. Patients with palmoplantar psoriasis, psoriatic arthritis, on medications or who had consumed foods (during the last one week) affecting prolactin levels (phenothiazines, metoclopramide, calcium channel blockers, methyldopa, cimetidine, alcohol, coffee and animal proteins) were excluded from the study. Patients with cardiovascular disease, peripheral vascular disease, systemic lupus erythematosus or having abnormal haemogram, fasting blood glucose, hepatorenal function tests or thyroid functions tests were also excluded. The study was approved by the institutional ethics committee.

Demographic profile, clinical details and baseline body surface area (BSA) involvement and psoriasis area-and-severity index (PASI) score [9] were recorded and severity of psoriasis was graded as mild, moderate or severe [Table 1]. The 55 age-matched male patients (45.52 ±11.77 yr, range 20-65 yr) with or without minor dermatoses (dermatophytosis, scabies) and having no personal or family history of psoriasis, were included as controls. Blood samples (5 ml) were collected after overnight fasting between 0800 and 1000 h by antecubital venepuncture. Quantitative estimation for serum prolactin was performed by standard chemiluminescent immunoassay method and as per manufacturer protocol using Immulite ® ready to use in vitro kits (Siemens Healthcare, Diagnostic Products Ltd., UK). Magnetic resonance imaging (MRI) of brain was performed to exclude prolactinoma in case serum prolactin levels exceeded 100 ng/dl.
Table 1: Psoriasis severity score

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Of the 55 patients, 25 (45.5%) were aged between 22 and 40 yr, 23 (41.8%) were between 41 and 60 yr and seven (12.7%) patients were >60 yr of age. The duration of psoriasis varied between six months and 20 yr. Thirty five (63.6%) patients had the disease for less than five years while in 20 (36.4%) patients it was present for more than five years. BSA involvement was <10 per cent in 38 (69%), 10-20 per cent in 10 (18.2%) and >20 per cent in 7 (12.8%) patients, respectively. PASI score of <6 was seen in 41 (74.5%), 10 (18.2%) patients had PASI score of 6-12 and it was >12 in four (7.3%) patients. Serum prolactin levels [Table 2] in 53 (96.4%) patients were though within normal range (1.9-25 ng/ml) but on higher side and varied between 4.1 and 24.68 ng/ml (14.37±6.74 ng/ml). The remaining two (3.6%) patients had serum prolactin levels above normal (26.50 ng/ml and 32.54 ng/ml). The controls had serum prolactin levels within normal range (8.40±4.50 ng/ml).
Table 2: Serum prolactin levels of patients and controls

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Elevated serum prolactin levels in patients with psoriasis have been considered to play a role in keratinocyte hyperproliferation and inflammation through enhanced production of chemokine CXC ligand (CXCL) 9, CXCL10, CXCL11[6],[10]. Several workers have postulated significance of hyperprolactinaemia in the pathogenesis of psoriasis [5],[6],[7],[10]. El-Khateeb et al[7] after studying elevated prolactin levels in the serum and blister fluid of psoriatic lesional skin of 15 psoriasis patients and healthy controls proposed that it was perhaps locally produced prolactin involved in the pathogenesis of psoriasis. Giasuddin et al[6] observed significantly higher mean serum prolactin levels in psoriasis (25.8±16.1 ng/ml) as compared to that in atopic dermatitis (9.1±4.7 ng/ml) and healthy controls (10.3±5.3 ng/ml). Dilmé-Carreras et al[5] observed significantly increased serum prolactin levels in psoriasis patients (21.4±16.7 ng/ml) as compared to healthy controls (8.4±5.2 ng/ml). The levels reduced significantly six weeks after treatment with tacalcitol ointment suggesting an association of elevated serum prolactin and disease activity [5]. The mean serum prolactin levels in most of our patients (96.4%) were on higher side of the normal as compared to that in controls. However, there was no variation of serum prolactin levels with reference to the PASI score. Gorpelioglu et al[11] also reported similar findings in their study of 39 psoriasis patients and 36 controls. However, they did not consider increased prolactin levels in their nine patients and five controls significant as these were below 100 ng/ml, the minimum limit for the diagnosis of prolactinoma. Azizzadeh et al[12] noted that serum prolactin levels varied with severity of disease in patients but observed no significant difference in mean serum prolactin levels between patients and controls. Keen and Hassan [13] observed serum prolactin levels varying with severity of psoriasis and correlating with duration and treatment. Whether prolactin plays any significant role in the pathogenesis of psoriasis, its high serum levels are biological markers of disease activity or bromocriptine becomes a useful therapeutic option need confirmation after well-designed studies. Small number of patients/controls and no therapeutic follow up were major limitations of our study.

Conflicts of Interest: None.



 
   References Top

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2.
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Dilmé-Carreras E, Martín-Ezquerra G, Sánchez-Regaña M, Umbert-Millet P. Serum prolactin levels in psoriasis and correlation with cutaneous disease activity. Clin Exp Dermatol 2011; 36 : 29-32.  Back to cited text no. 5
    
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Giasuddin ASM, El-Sherif AI, El-Ojali SI. Prolactin: Does it have a role in the pathogenesis of psoriasis? Dermatology 1998; 197 : 119-22.  Back to cited text no. 6
    
7.
El-Khateeb EA, Zuel-Fakkar NM, Eid SM, Abdul-Wahab SE. Prolactin level is significantly elevated in lesional skin of patients with psoriasis. Int J Dermatol 2011; 50 : 693-6.  Back to cited text no. 7
    
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Karimifar M, Tahmasebi A, Bonakdar ZS, Purajam S. Correlation of serum prolactin levels and disease activity in systematic lupus erythematosus. Rheumatol Int 2013; 33 : 511-6.  Back to cited text no. 8
    
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Fredriksson T, Pettersson U. Severe psoriasis-oral therapy with a new retinoid. Dermatologica 1978; 157 : 238-44.  Back to cited text no. 9
    
10.
Kanda N, Watanabe S. Prolactin enhances interferon-gamma-induced production of CXC ligand 9 (CXCL9), CXCL10, and CXCL11 in human keratinocytes. Endocrinology 2007; 148 : 2317-25.  Back to cited text no. 10
    
11.
Gorpelioglu C, Gungor E, Alli N. Is prolactin involved in etiopathogenesis of psoriasis? J Eur Acad Dermatol Venereol 2008; 22 : 1135-6.  Back to cited text no. 11
    
12.
Azizzadeh M, Malek M, Amiri M, Ghorbani R. Does prolactin indicate severity of psoriasis? Iran J Dermatol 2009; 12 : 79-81.  Back to cited text no. 12
    
13.
Keen MA, Hassan I. Serum prolactin levels in psoriasis and its association with disease activity: A case-control study. Indian J Dermatol 2014; 59 : 562-6.  Back to cited text no. 13
    



 
 
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