CAN KELOID LESIONS BE ASCRIBED?

ABSTRACT

Background: The relationship between the mind and skin has long been hypothesized to exist as the brain and skin share an embryologic ectodermal origin and are affected by similar neuro-hormonal factors. Neuropeptide Y (NPY) is often regarded as a stress-mediated “resilience” peptide. As a pleiotropic factor, NPY exerts diverse effects across many systems. Exogenous and endogenous stress may induce NPY release, which may lead to enhanced immune response via lymphocytic proliferation. In turn, both lymphocytes and macrophages produce NPY once activated. Scar formation is regulated by macrophages; specifically, the M2 phenotype regulates the repair process and scar outcome through the secretion of growth factors, which encourages proliferation, angiogenesis, and fibroblast differentiation into collagen secreting myofibroblast cells. However, excess collagen may lead to fibrosis. In this study, we focus on three of NPY’s roles: the mediation of stress, the promotion of angiogenesis, and its impact on the skin.

Objective: To investigate the relationship between keloid disorder, psychosocial distress associated with ascribed status (social status assigned at birth), and NPY, specifically its role in stress mediation, angiogenesis, and wound repair.

Method: A total of 37 (15 men, 22 women) Black, Hispanic, Asian, and White volunteers with and without keloids participated in this current study. The risk group consisted of keloid formers (8 males, 12 females) and the control group consisted of non-keloid formers (7 males, 10 females). During intake, participants were asked to provide information about their current health, income, and experience with trauma/ discrimination as well as complete a 22-item Psychological General Well-Being Index (PGWBI) and a 10-item Dermatology Life Quality Index (DLQI). Following this, participants had 2 ml of blood drawn via venipuncture before and after watching a stress-inducing video. NPY levels pre/post video were analyzed using commercially available sandwich ELISA kits.

Results: Preliminary results show a potential interaction between gender, race, and keloid status, in which Black men with keloid disorder showed a more exaggerated response (increased NPY levels) to acute stress (stereotype threat video) compared to Black women with keloid disorder. Moreover, there was a positive correlation between quality of life/stress and keloid status such that subjects with keloids have a higher DLQI than subjects without keloids (means of 4.40 vs. 2.65, p =. 040). Further analysis indicated a near significant difference between all four groups (male/no keloid, male/keloid, female/no keloid, female/keloid) and self-reported overall health and PGWBI.

Conclusion: As anticipated, Black men with keloid disorder showed a more robust response to acute stress, and overall, participants with keloid disorder reported more distress and lower quality of life associated with having keloid lesions. To our knowledge, no research has been done on the possible relationship between NPY, stress, and keloid disorder. Future research should use stricter inclusion criteria to control for confounds in order to determine true significance of preliminary results.

Key Points: NPY has been shown to modulate cutaneous and/or immune function. Preliminary results show a potential interaction between keloid disorder and gender that is mediated by NPY levels. This project aims to raise awareness on the impact of psychosocial conditions on symptomology as well as highlight the importance of coordinating psychological services within dermatological care for keloids.


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