(P11) correlation between serum tumor necrosis factor alpha and the severity of psoriasis in patients with vasculogenic erectile dysfunction: a case–controlled study

Background Erectile dysfunction (ED) is a common disorder leading to a serious, negative impact on the quality of the patient’s life and self-esteem. Its occurrence rate increases with psoriatic patients, as it is a systemic disease that interferes with endothelial dysfunction. A link is described between systemic inflammation and endothelial dysfunction (Psoriasis), and ED. It is noticeable that diseases associated with high levels of TNF-α, such as psoriasis, psoriatic arthritis, are associated with erectile dysfunction. Endothelial dysfunction is a key event in the pathophysiology of erectile dysfunction, and endothelial function is impaired in the presence of increased oxidative stress and inflammatory conditions such as psoriasis. TNF-α plays a key role in inducing endothelial dysfunction. Many studies indicated that TNF-α may be the causal agent of endothelial dysfunction, such as in erectile dysfunction and psoriasis. The study aims to estimate of the serum level of tumor necrosis factor-α (TNF-α) in erectile dysfunction patients with psoriasis and patients with erectile dysfunction without psoriasis. Methods This study was conducted over a period of one year, starting from February 2018 until February 2019. The study was approved by the Ethics Committee of Al-Azhar Faculty of Medicine. Written informed consent was obtained from all of the patients and healthy controls. The study included 90 individuals who were divided into 3 groups: Group I: 30 patients with erectile dysfunction and psoriasis. Group II: 30 patients with erectile dysfunction only. Group III: 30 normal individuals (control). The patients were collected from the Dermatology and Andrology Outpatient Clinics at Al-Hussein University Hospital. Inclusion Criteria Patients with erectile dysfunction and psoriatic patients with erectile dysfunction. Ages ranged from 20 to 50 years old. Sexually active (married). Patients had to break off the systemic therapy for psoriasis at least one month before the study. Exclusion criteria Patients with other autoimmune diseases, as Graves ‘disease, rheumatoid arthritis, thyroid dysfunction, etc. Patients with former skin cancer or premalignant skin lesions or those taking immunosuppressive drugs such as methotrexate. All patients were subjected to: Detailed personal, medical, sexual, and sexual history as well as general and local dermatological and genital examination. ED presence and severity were tested by the five-item version of the International Index of Erectile Function questionnaire (IIEF-5). Psoriatic patients were evaluated by the PASI score. The serum level of TNF-α was measured for all cases and healthy controls using a specific enzyme-linked immunosorbent assay (ELISA) technique. All men who volunteered to partake in this study were married and had only one sexual partner. Results Thirty psoriatic patients with ED, their ages ranged between 20 and 50 years old (Mean = 31.77 ± 7.04) and PASI score (Mean 7.40 ± 3.64). Thirty patients with ED, their ages ranged between 20 and 50 years old (Mean = 30.60 ± 6.50). Thirty normal individuals (control), their ages ranged between 20 and 50 years old (Mean = 32.53 ± 7.98). Our study shows no statistically significant difference (p-value >0.05) between the studied groups with regard to age. In addition, our study showed a highly statistically significant difference (p-value <0.001) between group I and group II with regard to duration of ED. (23.83 ± 8.47 vs. 11.70 ± 5.23) (Table 2). Table (6) showed the description of PASI in group I. The mean PASI was 7.4 ± 3.64 with a minimum PASI of 3.3 and a maximum PASI of 15. Our study also showed no statistically significant difference (p-value >0.05) between group I and group II as regard penile duplex for ED. In our study, serum TNF-α levels were elevated in group 1 (psoriatic patients with ED), Serum TNF-α levels were elevated too in group 2 (ED patients only), and were normal in group 3 (control group). TNF-α was significantly elevated in psoriatic patients with ED compared to ED patients only. And the difference reached a highly statistically significant level between psoriatic patients with ED and healthy controls. In this study, serum TNF levels were significantly elevated in psoriatic patients with ED compared to ED patients only. In addition, the difference was highly statistically significant between psoriatic patients with ED and healthy controls. The elevation correlates with the duration of the disease and family history. Levels of TNF-α were further increased when ED was associated with psoriasis, advocating a more severe course of ED in these patients. Conclusion The results of this study showed that TNF-α plays a detrimental role in erectile function, indicating that it could be implicated in the pathogenic process of ED, and could be used as a marker for screening the disease severity and progress. The coexistence of ED and psoriasis is associated with higher levels of this marker on top of ED alone. These findings support that this factor could be a general inflammatory marker of endothelial damage, and emphasize the pathophysiological involvement of TNFα and endothelial dysfunction in the pathogenesis of ED.