Glucocorticoid Receptor Level as an Immunohistochemical Biomarker for Identification and Severity Assessment of Psoriasis and Its Association With Psoriasis Patients Complicated by Obesity and Hyperuricemia

Purpose Psoriasis is a common, chronic epidermal hyperplastic and inflammatory skin disease. Studies have shown that the reduction of skin‐derived glucocorticoids (GC) may be one of the pathogenic factors of psoriasis. However, the clinical significance of the glucocorticoid receptor (GR) in patients with psoriasis remains unclear. This study aims to investigate the immunohistochemical expression of GR in psoriatic lesional tissues and its quantitative correlation with psoriasis severity, as well as to clarify the direction of this association (positive or negative). Methods Skin tissue and corresponding patient information were collected from 15 patients with chronic eczema (CE), 15 patients with lichen planus (LP), 26 patients with psoriasis, and 15 healthy adults. The skin tissue was embedded in paraffin and sectioned, followed by immunohistochemical staining using a GR antibody. The clinicopathological data were then correlated with the staining results. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI), body surface area (BSA), Investigator’s Global Assessment (IGA), and Dermatology Life Quality Index (DLQI) scoring systems. Results We compared GR levels in skin tissues among healthy adults and patients with psoriasis, CE, and LP. Compared with normal skin tissues, GR levels were reduced in lesional skin of both CE and LP, with an even more pronounced decrease observed in psoriasis tissues ( p < 0.01). Among the three psoriasis subtypes (ordinary psoriasis psoriasis, pustular psoriasis PP, and psoriatic arthritis PA), GR expression was the highest in the lesional skin of PA patients, exceeding that found in psoriasis patients, while expression was lower in PP lesions ( p < 0.01). Strong positive correlation was found between PASI and BSA ( r = 0.8). In comorbidity analysis, psoriasis with obesity (PO) showed increased GR levels ( p < 0.01), whereas psoriasis associated with hyperuricemia (PH) did not, confirming GR as a reliable diagnostic marker for psoriasis despite comorbidities. Conclusion GR level shows promise as an immunohistochemical biomarker for identifying psoriasis and assessing its severity. While comorbidities like obesity may affect its utility as a diagnostic marker, in the case of hyperuricemia, GR levels remain a reliable indicator.