The Relevance of Acute Phase Reactants in Dermatology
Main Article Content
Abstract
Liver proteins called “Acute Phase Reactants (APRs)” respond to inflammation, infection, and tissue injury. APRs are biomarkers for psoriasis, systemic lupus erythematosus, hidradenitis suppurativa, vitiligo, rosacea, and autoimmune bullous disorders like pemphigus vulgaris and bullous pemphigoid.
CRP is a well-studied APR. Psoriasis and lupus erythematosus have high CRP values. Serum CRP levels correlate with psoriasis severity and may be a treatment target. CRP also indicates disease activity in lupus.
Hidradenitis suppurativa, a chronic skin condition, causes painful nodules, abscesses, and sinus tracts in the axillary, inguinal, and anogenital areas. Hidradenitis suppurativa patients exhibit high APRs, particularly CRP, which correspond with disease severity.
Vitiligo, an autoimmune disorder, causes skin regions to lose colour. Vitiligo patients had higher haptoglobin and ceruloplasmin levels.
Rosacea causes facial flushing, erythema, papules, and pustules. APRs including serum amyloid A, alpha-1-antitrypsin, and haptoglobin may be rosacea biomarkers.
Autoantibodies targeting skin structure proteins cause blistering and erosion in autoimmune bullous disorders. Pemphigus vulgaris and bullous pemphigoid patients had increased CRP and haptoglobin.
In conclusion, APRs have emerged as important biomarkers in dermatology, providing valuable information about disease activity, severity, and response to therapy. While more research is needed to fully understand the role of APRs in skin diseases, their potential as diagnostic and therapeutic targets is promising.
Article Details
References
Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805-1812.
Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448-454.
Jain S, Gautam V, Naseem S. Acute-phase proteins: As diagnostic tool. J Pharm Bioallied Sci. 2011;3(1):118-127. doi:10.4103/0975-7406.76489.
Jishna P, Dominic S. Acute Phase Reactants: Relevance in Dermatology. Indian Dermatol Online J. 2022;14(1):1-8. Published 2022 Dec 29. doi:10.4103/idoj.idoj_174_21
Dinarello CA. Proinflammatory cytokines. Chest. 2000;118(2):503-508.
Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J. 1990;265(3):621-636.
Zipfel PF, Skerka C. Complement regulators and inhibitory proteins. Nat Rev Immunol. 2009;9(10):729-740.
Nimmerjahn F, Ravetch JV. Fcγ receptors as regulators of immune responses. Nat Rev Immunol. 2008;8(1):34-47.
Pickering MC, Walport MJ. Links between complement abnormalities and systemic lupus erythematosus. Rheumatology (Oxford). 2000;39(2):133-141. 9. Rittirsch D, Flierl MA, Ward PA. Harmful molecular mechanisms in sepsis. Nat Rev Immunol. 2008;8(10):776-787.
Nielsen OH, Vainer B, Madsen SM, Seidelin JB, Heegaard NH. Established and emerging biological activity markers of inflammatory bowel disease. Am J Gastroenterol. 2000;95(12):359-367.
Gulhar R, Ashraf MA, Jialal I. Physiology, Acute Phase Reactants. [Updated 2022 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519570/.
Gilliam AE. Skin signs of systemic disease in childhood. Advances in Dermatology. 2006;22:1..
Biljan D, Situm M, Kostović K, Batinac T, Matisić D. Acute phase proteins in psoriasis. Coll Antropol. 2009;33(1):83-86..
Laurent MR, Panayi GS, Shepherd P. Circulating immune complexes, serum immunoglobulins, and acute phase proteins in psoriasis and psoriatic arthritis. Ann Rheum Dis. 1981;40(1):66-69. doi:10.1136/ard.40.1.66.
Patel P, Werth V. Cutaneous lupus erythematosus: a review. Dermatol Clin. 2002;20(3):373-v. doi:10.1016/s0733-8635(02)00016-5.
von Laffert M, Stadie V, Wohlrab J, Marsch WC. Hidradenitis suppurativa/acne inversa: bilocated epithelial hyperplasia with very different sequelae. Br J Dermatol. 2011;164(2):367-371. doi:10.1111/j.1365-2133.2010.10034.x.
Sanad EM, El-Fallah AA, Al-Doori AR, Salem RM. Serum Zinc and Inflammatory Cytokines in Vitiligo. J Clin Aesthet Dermatol. 2020;13(12 Suppl 1):S29-S33..
Beygi S, Lajevardi V, Abedini R. C‐reactive protein in psoriasis: a review of the literature. Journal of the European Academy of Dermatology and Venereology. 2014 Jun;28(6):700-11..
Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182(5):1269-1276. doi:10.1111/bjd.18420.
Amber KT, Murrell DF, Schmidt E, Joly P, Borradori L. Autoimmune Subepidermal Bullous Diseases of the Skin and Mucosae: Clinical Features, Diagnosis, and Management. Clin Rev Allergy Immunol. 2018;54(1):26-51. doi:10.1007/s12016-017-8633-4.
Lee SH, Hong WJ, Kim SC. Analysis of Serum Cytokine Profile in Pemphigus. Ann Dermatol. 2017;29(4):438-445. doi:10.5021/ad.2017.29.4.438.
Gottlieb A, Narang K. Ustekinumab in the treatment of psoriatic arthritis: latest findings and clinical potential. Ther Adv Musculoskelet Dis. 2013;5(5):277-285. doi:10.1177/1759720X13501021
Tan M, Luo Y, Hu J, Hu K, Li X, Yang J, Chen J, Zhu W, Kuang Y. Elevated C-Reactive Protein and Erythrocyte Sedimentation Rate Correlates with Depression in Psoriasis: A Chinese Cross-Sectional Study. Clinical, Cosmetic and Investigational Dermatology. 2023 Dec 31:397-405.