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Kaczmarska A, Kwiatkowska D, Skrzypek KK, Kowalewski ZT, Jaworecka K, Reich A. Pathomechanism of Pruritus in Psoriasis and Atopic Dermatitis: Novel Approaches, Similarities and Differences. Int J Mol Sci 2023; 24:14734. [PMID: 37834183 PMCID: PMC10573181 DOI: 10.3390/ijms241914734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Pruritus is defined as an unpleasant sensation that elicits a desire to scratch. Nearly a third of the world's population may suffer from pruritus during their lifetime. This symptom is widely observed in numerous inflammatory skin diseases-e.g., approximately 70-90% of patients with psoriasis and almost every patient with atopic dermatitis suffer from pruritus. Although the pathogenesis of atopic dermatitis and psoriasis is different, the complex intricacies between several biochemical mediators, enzymes, and pathways seem to play a crucial role in both conditions. Despite the high prevalence of pruritus in the general population, the pathogenesis of this symptom in various conditions remains elusive. This review aims to summarize current knowledge about the pathogenesis of pruritus in psoriasis and atopic dermatitis. Each molecule involved in the pruritic pathway would merit a separate chapter or even an entire book, however, in the current review we have concentrated on some reports which we found crucial in the understanding of pruritus. However, the pathomechanism of pruritus is an extremely complex and intricate process. Moreover, many of these signaling pathways are currently undergoing detailed analysis or are still unexplained. As a result, it is currently difficult to take an objective view of how far we have come in elucidating the pathogenesis of pruritus in the described diseases. Nevertheless, considerable progress has been made in recent years.
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Affiliation(s)
- Agnieszka Kaczmarska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | - Dominika Kwiatkowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | | | | | - Kamila Jaworecka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
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Jaworecka K, Rzepko M, Marek-Józefowicz L, Tamer F, Stefaniak AA, Szczegielniak M, Chojnacka-Purpurowicz J, Gulekon A, Szepietowski JC, Narbutt J, Owczarczyk-Saczonek A, Reich A. The Impact of Pruritus on the Quality of Life and Sleep Disturbances in Patients Suffering from Different Clinical Variants of Psoriasis. J Clin Med 2022; 11:jcm11195553. [PMID: 36233422 PMCID: PMC9572740 DOI: 10.3390/jcm11195553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Quality of life (QoL) and sleep, which are essential for well-being in the mental, physical, and socioeconomic domains, are impaired in psoriatic patients. However, the exact role of the clinical subtype of psoriasis in this aspect remains poorly studied. Objectives: The aim of this study was to investigate differences in QoL impairment and sleeping problems in patients suffering from various clinical subtypes of psoriasis and to evaluate the effects of pruritus on QoL. Methods: This cross-sectional, multicenter study included 295 eligible subjects with diagnosed psoriasis. Each patient was examined with the use of the same questionnaire. Measures included predominant subtype of psoriasis, disease severity, pruritus scores, patients’ health-related QoL and the incidence of sleep disturbance. Results: The QoL of most patients was decreased irrespectively of clinical psoriasis subtype, however, the most impaired QoL was in patients with erythrodermic psoriasis. The majority of patients reported sleep disturbances caused by pruritus, albeit there was no relevant differences between analyzed subgroups in this aspect of patients’ well-being. Pruritus was an important factor determining QoL and sleeping problems in the studied population. Conclusions: Identifying the most disturbing area of life and recognizing the most bothersome subjective symptoms of psoriasis are pivotal to focusing on the most relevant treatment goal and achieving therapeutic success.
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Affiliation(s)
- Kamila Jaworecka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland
| | - Marian Rzepko
- Institute of Physical Culture Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland
| | - Luiza Marek-Józefowicz
- Department of Dermatology and Venerology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Ludwik Rydygier, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Funda Tamer
- Department of Dermatology, Gazi University School of Medicine, 06570 Ankara, Turkey
| | - Aleksandra A. Stefaniak
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Magdalena Szczegielniak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, 92-215 Lodz, Poland
| | - Joanna Chojnacka-Purpurowicz
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-720 Olsztyn, Poland
| | - Ayla Gulekon
- Department of Dermatology, Gazi University School of Medicine, 06570 Ankara, Turkey
| | - Jacek C. Szepietowski
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, 92-215 Lodz, Poland
| | - Agnieszka Owczarczyk-Saczonek
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-720 Olsztyn, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszow, Poland
- Correspondence: ; Tel.: +48-605-076722
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Lamana A, Castro-Vázquez D, de la Fuente H, Triguero-Martínez A, Martínez-Hernández R, Revenga M, Villanueva-Romero R, Llamas-Velasco M, Chicharro P, Juarranz Y, Marazuela M, Sales-Sanz M, García-Vicuña R, Tomero E, González-Álvaro I, Martínez C, Gomariz RP. VIP/VPAC Axis Expression in Immune-Mediated Inflammatory Disorders: Associated miRNA Signatures. Int J Mol Sci 2022; 23:ijms23158578. [PMID: 35955723 PMCID: PMC9369218 DOI: 10.3390/ijms23158578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Few studies have considered immune-mediated inflammatory disorders (IMID) together, which is necessary to adequately understand them given they share common mechanisms. Our goal was to investigate the expression of vasoactive intestinal peptide (VIP) and its receptors VPAC1 and VPAC2 in selected IMID, analyze the effect of biological therapies on them, and identify miRNA signatures associated with their expression. Serum VIP levels and mRNA of VPAC and miRNA expression in peripheral blood mononuclear cells were analyzed from 52 patients with psoriasis, rheumatoid arthritis, Graves’ disease, or spondyloarthritis and from 38 healthy subjects. IMID patients showed higher levels of VIP and increased expression of VPAC2 compared to controls (p < 0.0001 and p < 0.0192, respectively). Receiver operating characteristic curve analysis showed that the levels of VIP or VPAC2 expression were adequate discriminators capable of identifying IMID. Treatment of IMID patients with anti-TNFα and anti-IL12/23 significantly affected serum VIP levels. We identified miRNA signatures associated with levels of serum VIP and VPAC2 expression, which correlated with IMID diagnosis of the patients. The results indicate that the expression of VIP/VPAC2 is able of identify IMIDs and open up a line of research based on the association between the VIP/VPAC axis and miRNA signatures in immune-mediated diseases.
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Affiliation(s)
- Amalia Lamana
- Department of Cell Biology, Facultad de Biología y Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.); (D.C.-V.); (R.V.-R.); (Y.J.)
| | - David Castro-Vázquez
- Department of Cell Biology, Facultad de Biología y Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.); (D.C.-V.); (R.V.-R.); (Y.J.)
| | - Hortensia de la Fuente
- Department of Immunology, Instituto de Investigación Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain;
| | - Ana Triguero-Martínez
- Department of Rheumatology, Instituto de Investigación Princesa Madrid, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (A.T.-M.); (R.G.-V.); (E.T.); (I.G.-Á.)
| | - Rebeca Martínez-Hernández
- Department of Endocrinology, Instituto de Investigación Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (R.M.-H.); (M.M.)
| | - Marcelino Revenga
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
- Department of Medicine and Medical Specialties, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Raúl Villanueva-Romero
- Department of Cell Biology, Facultad de Biología y Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.); (D.C.-V.); (R.V.-R.); (Y.J.)
| | - Mar Llamas-Velasco
- Department of Dermatology, Instituto de Investigación Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (M.L.-V.); (P.C.)
| | - Pablo Chicharro
- Department of Dermatology, Instituto de Investigación Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (M.L.-V.); (P.C.)
| | - Yasmina Juarranz
- Department of Cell Biology, Facultad de Biología y Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.); (D.C.-V.); (R.V.-R.); (Y.J.)
| | - Mónica Marazuela
- Department of Endocrinology, Instituto de Investigación Princesa, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (R.M.-H.); (M.M.)
| | - Marco Sales-Sanz
- Department of Ophthalmology, Hospital Universitario Ramón y Cajal-IRYCIS, 28034 Madrid, Spain;
| | - Rosario García-Vicuña
- Department of Rheumatology, Instituto de Investigación Princesa Madrid, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (A.T.-M.); (R.G.-V.); (E.T.); (I.G.-Á.)
| | - Eva Tomero
- Department of Rheumatology, Instituto de Investigación Princesa Madrid, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (A.T.-M.); (R.G.-V.); (E.T.); (I.G.-Á.)
| | - Isidoro González-Álvaro
- Department of Rheumatology, Instituto de Investigación Princesa Madrid, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (A.T.-M.); (R.G.-V.); (E.T.); (I.G.-Á.)
| | - Carmen Martínez
- Department of Cell Biology, Facultad de Biología y Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.); (D.C.-V.); (R.V.-R.); (Y.J.)
- Correspondence: (C.M.); (R.P.G.); Tel.: +34-91-3944971 (R.P.G.)
| | - Rosa P. Gomariz
- Department of Cell Biology, Facultad de Biología y Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain; (A.L.); (D.C.-V.); (R.V.-R.); (Y.J.)
- Correspondence: (C.M.); (R.P.G.); Tel.: +34-91-3944971 (R.P.G.)
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Borgia F, Custurone P, Li Pomi F, Cordiano R, Alessandrello C, Gangemi S. IL-31: State of the Art for an Inflammation-Oriented Interleukin. Int J Mol Sci 2022; 23:6507. [PMID: 35742951 DOI: 10.3390/ijms23126507] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 12/23/2022] Open
Abstract
Interleukin 31 belongs to the IL-6 superfamily, and it is an itch mediator already studied in several diseases, comprising atopic dermatitis, allergic pathologies, and onco-hematological conditions. This research aims to assess the role of this cytokine in the pathogenesis of these conditions and its potential therapeutic role. The research has been conducted on articles, excluding reviews and meta-analysis, both on animals and humans. The results showed that IL-31 plays a crucial role in the pathogenesis of systemic skin manifestations, prognosis, and itch severity. Traditional therapies target this interleukin indirectly, but monoclonal antibodies (Mab) directed against it have shown efficacy and safety profiles comparable with biological drugs that are already available. Future perspectives could include the development of new antibodies against IL-31 both for humans and animals, thus adding a new approach to the therapy, which often has proven to be prolonged and specific for each patient.
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Anderson ZT, Dawson AD, Slominski AT, Harris ML. Current Insights Into the Role of Neuropeptide Y in Skin Physiology and Pathology. Front Endocrinol (Lausanne) 2022; 13:838434. [PMID: 35418942 PMCID: PMC8996770 DOI: 10.3389/fendo.2022.838434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Neuropeptide Y is widely distributed within the body and has long been implicated as a contributor to skin disease based on the correlative clinical data. However, until recently, there have been few empirical investigations to determine whether NPY has a pathophysiological role in the skin. Due to appearance-altering phenotypes of atopic dermatitis, psoriasis, and vitiligo, those suffering from these diseases often face multiple forms of negative social attention. This often results in psychological stress, which has been shown to exacerbate inflammatory skin diseases - creating a vicious cycle that perpetuates disease. This has been shown to drive severe depression, which has resulted in suicidal ideation being a comorbidity of these diseases. Herein, we review what is currently known about the associations of NPY with skin diseases and stress. We also review and provide educated guessing what the effects NPY can have in the skin. Inflammatory skin diseases can affect physical appearance to have significant, negative impacts on quality of life. No cure exists for these conditions, highlighting the need for identification of novel proteins/neuropetides, like NPY, that can be targeted therapeutically. This review sets the stage for future investigations into the role of NPY in skin biology and pathology to stimulate research on therapeutic targeting NPY signaling in order to combat inflammatory skin diseases.
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Affiliation(s)
- Zoya T. Anderson
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alex D. Dawson
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrzej T. Slominski
- Department of Dermatology, Comprehensive Cancer Center, Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL, United States
- Veteran Administration Medical Center, Birmingham, AL, United States
| | - Melissa L. Harris
- Department of Biology, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Melissa L. Harris,
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Jaworecka K, Kwiatkowska D, Marek L, Tamer F, Stefaniak A, Szczegielniak M, Chojnacka-Purpurowicz J, Matławska M, Gulekon A, Szepietowski JC, Narbutt J, Owczarczyk-Saczonek A, Reich A. Characteristics of Pruritus in Various Clinical Variants of Psoriasis: Results of the Multinational, Multicenter, Cross-Sectional Study. Life (Basel) 2021; 11:life11070623. [PMID: 34199131 PMCID: PMC8304988 DOI: 10.3390/life11070623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Psoriasis is a chronic, inflammatory skin disease present in about 3% of the world’s population. The clinical symptoms manifest diversely, therefore one can distinguish several subtypes of psoriasis. The majority of patients with psoriasis experience pruritus, which is an unpleasant sensation that decreases patients’ quality of life. The knowledge on pruritus in different subtypes of psoriasis is limited. We have performed a cross-sectional, prospective, and multicenter study to evaluate the relationship between clinical subtypes of psoriasis (large-plaque, nummular, guttate, palmoplantar, inverse, erythrodermic, palmoplantar pustular, generalized pustular psoriasis, and psoriasis of the scalp) and the prevalence, intensity, and clinical manifestation of itch. We introduced a questionnaire assessing various aspects of pruritus to a total of 254 patients. Out of these, 42 were excluded. Pruritus was present in 92.9% of the remaining patients and its prevalence did not depend on the clinical subtype. A correlation between the severity of psoriasis and the intensity of itch was explicitly noticeable in palmoplantar pustular psoriasis and scalp psoriasis (p < 0.05). The itch sensation was individual and differed among subtypes of psoriasis. In conclusion, pruritus is a frequent phenomenon, and its presentation is different in various subtypes of psoriasis.
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Affiliation(s)
- Kamila Jaworecka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
| | - Dominika Kwiatkowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
| | - Luiza Marek
- Department of Dermatology and Venerology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland;
| | - Funda Tamer
- Department of Dermatology, Gazi University School of Medicine, 06560 Ankara, Turkey; (F.T.); (A.G.)
| | - Aleksandra Stefaniak
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wrocław, Poland; (A.S.); (J.C.S.)
| | - Magdalena Szczegielniak
- Department of Dermatology, Pediatric Dermatology and Oncology, Lodz Medical University, 91-347 Łódź, Poland; (M.S.); (J.N.)
| | - Joanna Chojnacka-Purpurowicz
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Monika Matławska
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Ayla Gulekon
- Department of Dermatology, Gazi University School of Medicine, 06560 Ankara, Turkey; (F.T.); (A.G.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, 50-368 Wrocław, Poland; (A.S.); (J.C.S.)
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Lodz Medical University, 91-347 Łódź, Poland; (M.S.); (J.N.)
| | - Agnieszka Owczarczyk-Saczonek
- Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-959 Olsztyn, Poland; (J.C.-P.); (M.M.); (A.O.-S.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (K.J.); (D.K.)
- Correspondence:
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Bodoor K, Al-Qarqaz F, Heis LA, Alfaqih MA, Oweis AO, Almomani R, Obeidat MA. IL-33/13 Axis and IL-4/31 Axis Play Distinct Roles in Inflammatory Process and Itch in Psoriasis and Atopic Dermatitis. Clin Cosmet Investig Dermatol 2020; 13:419-424. [PMID: 32606880 PMCID: PMC7310969 DOI: 10.2147/ccid.s257647] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pruritus is the most common symptom in patients with skin disease. Psoriasis and atopic dermatitis are clinically distinct inflammatory diseases. Interleukins are cytokines which play key roles in inflammatory signaling pathways. MATERIALS AND METHODS Cross-sectional study was conducted among patients with psoriasis and atopic dermatitis: 59 psoriatic patients, 56 AD patients, and 49 matched healthy controls. Interleukins 4, 13, 31, 33 serum levels were assayed by ELISA and results were compared using SPSS. Itch severity and disease severity were measured and correlation with interleukin levels was determined using SPSS. RESULTS The serum levels of IL-4, -13, -31, -33 were elevated in atopic dermatitis patients compared to controls. Itch and disease severity were not correlated with elevated serum levels of these interleukins. In psoriasis, the levels of IL-4 and -31 were elevated compared to controls, whereas the levels of IL-13 and -33 were lower than controls. The levels of measured interleukins in psoriasis did not correlate with itch and disease severity. CONCLUSION IL-31 is the key mediator for pruritus in both AD and Ps patients. IL-4/31 axis and IL-33/13 axis play distinct roles in the pathogenesis of Atopic dermatitis and Psoriasis. Interleukin serum levels were not correlated with itch and disease severity in both conditions.
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Affiliation(s)
- Khaldon Bodoor
- Department of Applied Biology, Jordan University of Science and Technology, Irbid, Jordan
| | - Firas Al-Qarqaz
- Department of Dermatology, Jordan University of Science and Technology, Irbid, Jordan
| | - Leen Al Heis
- Department of Dermatology, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud A Alfaqih
- Department of Physiology and Biochemistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Ashraf O Oweis
- Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan
| | - Rowida Almomani
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Motaz A Obeidat
- Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan
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