Dermatology: Practical and Conceptual Original Article | Dermatol Pract Concept. 2025;15(2):5014 1 Evaluation of Nasal Mucociliary Activity in Patients with Psoriasis Vulgaris Mehmet Akif Dündar¹, Selami Aykut Temiz², İsmail Hakkı Tunçez3, Elif Emre4, Sadettin Emre5, Recep Dursun² 1 Necmettin Erbakan University Medical Faculty, Department of Ear Nose Throat 2 Necmettin Erbakan University Medical Faculty, Department of Dermatology 3 Konya Provincial Health Directorate, Department of Public Health 4 Fırat University Medical Faculty, Department of Anatomy 5 Fırat University Medical Faculty, Department of Ear Nose Throat Key words: Psoriasis, Nasal Mucociliary Clearance, Inflammation, Respiratory Infection, Comorbidity Citation: Dündar MA, Temiz SA, Tunçez İH, Emre E, Emre S, Dursun R. Evaluation of Nasal Mucociliary Activity in Patients with Psoriasis Vulgaris. Dermatol Pract Concept. 2025;15(2):5014. DOI:https://doi.org/10.5826/dpc.1502a5014 Accepted: November 28, 2024; Published:April2025 Copyright: ©2025 Dündar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Selami Aykut Temiz. Clinic of Dermatology, Necmettin Erbakan University Medical Faculty, Konya — Turkey. E-mail: aykutmd42@gmail.com Introduction: Psoriasis, a chronic inflammatory dermatological condition, is marked by recurring periods of activity and quiescence. This persistent inflammation contributes to a range of associated health issues. The respiratory system relies on nasal mucociliary clearance as a fundamental defense mechanism. Mucociliary transport dysfunction is frequently observed in chronic inflammatory states. Objective: We aimed to determine the relationship between psoriasis and concomitant clinical condi- tions and nasal mucociliary clearance time (NMCT). Method: We conducted a study to evaluate NMCTin 34 individuals diagnosed with psoriasis and a control group of 35 healthy individuals. Results: Our results revealed a statistically significant prolongation of NMCT in the psoriasis group (11.26 ± 2 minutes) compared to the control group (9.2 ± 1.85 minutes, P<0.001). Moreover, a pos- itive correlation was identified between NMCT and both the duration of psoriasis and the Psoriasis Area and Severity Index (PASI). This suggests that impaired nasal mucociliary clearance in individuals with psoriasis, especially those with more severe disease, may elevate their vulnerability to infections of the sinuses and nasal passages. Conclusion: This highlights the need to consider strategies for enhancing mucociliary function in this patient population. ABSTRACT 2 Original Article | Dermatol Pract Concept. 2025;15(2):5014 Introduction Psoriasis is a chronic inflammatory skin disease with remis- sion and relapses [1]. Immunological, autoimmune, genetic, and environmental factors play a role in the etiopathogenesis of the disease. Psoriasis is characterized by chronic inflamma- tion accompanying the disease. Chronic inflammation in the course of the disease causes many co-morbidities associated with psoriasis. Cardiovascular disease, obesity, diabetes, hy- pertension, dyslipidemia, metabolic syndrome, non-alcoholic fatty liver disease, cancer, anxiety, depression, and inflamma- tory bowel diseases are co-morbidities associated with chronic inflammation in the disease course [2]. Nasal mucociliary clearance activity is determined by nasal mucociliary clearance time (NMCT) [3]. Nasal mucociliary clearance is the primary defense mechanism of the respiratory system. The mucosa be- gins in the nose and extends into the upper and lower airways. Inhaled particles adhere to the nasal mucosa, which covers the nasal cavity in a single layer, and efficient and coordinated cil- iary activity transports mucus towards the oropharynx, thus protecting the respiratory system against inhaled particles and microorganisms. Ineffective ciliary activity may lead to acute or chronic infections in the upper and lower respiratory tract, even sepsis [4]. In the literature, NMCT has been found to be impaired in many chronic inflammatory diseases. Objective In our study, we aimed to determine the relationship between psoriasis and concomitant clinical conditions and NMCT. Methods Individuals with psoriasis and a comparison group without chronic inflammatory conditions were enrolled from a der- matology clinic. The study population comprised 34 patients diagnosed with psoriasis and 35 individuals serving as healthy controls. The control group had no reported history of chronic inflammatory diseases. Demographic information, the time elapsed since psoriasis diagnosis, and the current PASI score were documented for each psoriasis patient. Participants in both groups were excluded if they had a history of upper respi- ratory tract problems, infections, allergic rhinitis, substantial septal deviations, prior nasal surgery, any smoking history, any other chronic inflammatory disease, or nasal trauma. Ethical approval was granted by the Fırat University Medical Faculty Hospital Ethics Committee, and informed consent was secured from all study participants (APPROVAL No: 2020/12-20). Measurement of Nasal Mucociliary Clearance Several techniques, both in vivo and in vitro, are avail- able for evaluating nasal mucociliary clearance. In vitro methods, such as stroboscopy, photon-electron techniques, and phase-contrast microscopy, offer the ability to measure ciliary beat frequency but are often expensive and imprac- tical for routine clinical application. The saccharin transit test (STT) is commonly preferred for NMCT assessment due to its affordability, simple administration, and reliability [2]. A normal STT result typically falls within the range of 7 to 15 minutes, with values exceeding this range suggesting impaired mucociliary function. Our study adopted the STT method as described by Greenstone and Cole [3]. A small saccharin particle (1 x 1 x 1 mm³) was carefully positioned on the nasal mucosa approximately 1 cm posterior to the anterior edge of the inferior turbinate, ensuring avoidance of the squamous epithelium. Participants were instructed to abstain from food or drink for six hours before the test. To mitigate the influence of circadian rhythms on mucociliary clearance, all measurements were conducted between 13:00 and 15:00. The testing environment was controlled for tem- perature (20–23°C) and humidity (40%–60%). The nasal passage offering the least resistance to airflow and reported as most comfortable for breathing by the participant was se- lected for testing. Participants signaled the initial perception of a sweet taste on their tongue, indicating saccharin transit. STT values were recorded using a stopwatch. Throughout the STT procedure, participants were instructed to main- tain their usual breathing pattern and allowed to swallow normally. However, actions that might influence mucocili- ary clearance, such as forced breathing, coughing, sneezing, sniffing, talking, and excessive movement, were discouraged. Statistical Analysis Statistical analyses were carried out using IBM SPSS Statistics version 23.0 (IBM Corp., Armonk, NY). Descriptive statistics are reported as means ± standard deviations and percentages. The Kolmogorov-Smirnov test was employed to assess the normality of data distribution. Intergroup comparisons of continuous variables were performed using independent sam- ples t-tests. Pearson correlation coefficients were calculated to examine relationships between numerical data. Categorical variables were analyzed using the chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results Our study cohort included 34 participants with psoriasis (18 men [52.9%] and 16 women [47.1%], with a mean age of 40.7 ± 12 years) and 35 healthy control participants (17 men [48.6%] and 18 women [51.4%], with a mean age of 35.5 ± 14.2 years). No statistically significant difference in age or sex was found between the psoriasis and control groups. For the psoriasis group, the mean PASI score was 9.3 ± 8.3, and the average disease duration was 11.3 ± 11 years. The mean Original Article | Dermatol Pract Concept. 2025;15(2):5014 3 NMCT was measured as 11.26 ± 2 minutes in the psori- asis group and 9.2 ± 1.85 minutes in the control group. A statistically significant difference in NMCT was observed between the two groups, with a longer NMCT in the pso- riasis group (P<0.001) (Table 1). Furthermore, our analysis revealed positive correlations between NMCT and both the duration of psoriasis (P=0.02, Figure 1) and the PASI score (P<0.001, Figure 2). Figure 1 shows that as the duration of psoriasis disease increased, nasal mucociliary time increased in a positive correlation. Figure 2 shows that as the severity of psoriasis disease (PASI) increased, nasal mucociliary time increased in a positive correlation. Conclusions The nasal mucociliary clearance system provides essen- tial protection to the upper respiratory tract and lungs by removing inhaled foreign matter. This complex process de- pends on the interplay of several factors: the characteristics of the airway surface liquid (including mucus and periciliary fluid), the structure and beating pattern of the cilia, and the dynamic interaction between the mucus and cilia [3]. There are two main reasons for the inhibition of nasal mucocili- ary clearance:either the movement of the cilia can be directly inhibited, or dehydration and changes in consistency of the mucus can lead to increased viscosity, leading to ciliary dys- function. This latter mechanism is the mechanism suggested in many inflammatory diseases [2,3]. Dysfunction of ciliary activity can increase the risk of both acute and chronic respi- ratory infections, potentially leading to serious complications like sepsis [4]. We also observed significant positive correla- tions between NMCT, psoriasis duration, and PASI score. Prior research has produced inconsistent findings con- cerning the effects of age and sex on nasal mucociliary clear- ance [5]. Some studies suggest these demographic factors have minimal impact, while others note age-related mucosal changes that could affect clearance time. In our investigation, we found no significant difference image or sex between the psoriasis and control groups. Smoking is a well-known factor that disrupts nasal mu- cociliary clearance. The harmful compounds in cigarette smoke damage cilia, reducing their numbers and affecting Table 1. Nasal Mucociliary Clearance Times in Psoriasis and Control Groups Nasal Mucociliary Clearance (min) P Psoriasis 11.26 ± 2 <0.001 Control group 9.2 ± 1.85 Figure 1.Correlation between nasal mucociliary time and psoriasis disease duration. 4 Original Article | Dermatol Pract Concept. 2025;15(2):5014 psoriasis [14,15]. Psoriasis is also associated with accelerated atherosclerosis and microvascular disease progression [16], which may further contribute to impaired mucociliary func- tion. Infectious complications pose a significant challenge in the management of psoriasis, especially for patients receiv- ing conventional systemic or biologic therapies [17]. While biologic agents have revolutionized psoriasis treatment, they carry a known risk of lower and upper respiratory tract in- fections [18,19]. Our findings underscore the importance of investigating how impaired nasociliary clearance might in- fluence the effectiveness of respiratory infection treatments in psoriasis patients. Future research should explore whether certain therapies can improve nasociliary function and re- duce infection susceptibility and whether specific treatments might be linked to a higher risk of respiratory complications. A deeper understanding of the factors contributing to infec- tions in psoriasis patients could inform the development of more effective preventative strategies. Prompted by reports of altered NMCT in other chronic inflammatory conditions, we investigated whether psoriasis, a chronic inflammatory skin disease, also impacts NMCT. Our results demonstrate that individuals with psoriasis ex- perience significantly longer NMCT compared to healthy individuals. The nasal mucociliary system appears to be the physical properties of mucus, thereby hindering mucocil- iary transport. A comprehensive review of existing literature has confirmed that smoking is frequently associated with prolonged NMCT [6]. To avoid the confounding effects of smoking, both current and past smokers were excluded from our study population. Infections of the upper respiratory tract, including COVID-19, have been shown to impair NMCT. [7] To con- trol for this, individuals with active respiratory infections were excluded from both study groups. Impaired NMCT has also been documented in various other chronic inflamma- tory diseases, including diabetes, hypertension, celiac disease, Behçet disease, chronic renal failure, and obstructive sleep apnea [8-13]. To isolate the impact of psoriasis, individuals with any pre-existing chronic inflammatory condition were excluded from our study. The precise mechanisms by which chronic inflammation disrupts NMCT are not fully under- stood, but it is thought that inflammatory mediators and el- evated cytokine levels may negatively impact ciliary function [11,12]. Our observation of increased NMCT in individuals with psoriasis, a condition characterized by chronic inflam- mation, supports this theory. Studies have shown a higher prevalence of upper respi- ratory tract infections and otitis media in individuals with Figure 2. Correlation between nasal mucociliary time and Psoriasis Area Severity Index (PASI). Original Article | Dermatol Pract Concept. 2025;15(2):5014 5 2021;141(11):989-993. DOI: 10.1080/00016489.2021.1991592. PMID: 34694199 8. Yue WL. Nasal mucociliary clearance in patients with diabetes mellitus. J Laryngol Otol. 1989;103(9):853-855. DOI: 10.1017 /S0022215100110291. PMID: 2584876 9. de Oliveira-Maul JP, de Carvalho HB, Goto DM, et al. Aging, dia- betes, and hypertension are associated with decreased nasal muco- ciliary clearance. Chest. 2013;143(4):1091-1097. DOI: 10.1378 /chest.12-1183. PMID: 23100111 10. Comba A, Atan D. Evaluation of nasal mucociliary clearance time in children with celiac disease. Int J Pediatr Otorhinolar- yngol. 2020;133, 109936. DOI: 10.1016/j.ijporl.2020.109936. PMID: 32088546 11. Ozbay I, Kucur C, Temizturk F, et al. Assessment of nasal muco- ciliary activity in patients with Behçet’s disease. J Laryngol Otol. 2016;130(4):348-351. DOI: 10.1017/S0022215116000207. PMID: 26841706 12. Kucur C, Ozbay I, Gulcan E, et al. Evaluation of nasal muco- ciliary activity in patients with chronic renal failure. Eur Arch Otorhinolaryngol. 2016;273:1167-1171. DOI: 10.1007/s00405 -015-3712-8. PMID: 26162451 13. Deniz M, Gultekin E, Ciftci Z, et al. Nasal Mucociliary Clearance in Obstructive Sleep Apnea Syndrome Patients. Am J Rhinol Al- lergy. 2014;28(5):e178–e180. DOI: 10.2500/ajra.2014.28.4094. PMID: 25198014 14. Joel MZ, Fan R, Damsky W, Cohen JM. Psoriasis associated with asthma and allergic rhinitis: a US-based cross-sectional study using the All of US Research Program. Arch Dermatol Res. 2023;315(6):1823-1826. DOI: 10.1007/s00403-023-02539-z. PMID: 36707438 15. Andersen YMF, Egeberg A, Gislason GH, et al. Burden of respi- ratory comorbidities in patients with atopic dermatitis and pso- riasis. Br J Dermatol. 2017;177(4):e145–e146. DOI: 10.1111 /bjd.15489. PMID: 28334421 16. Branisteanu DE, Nicolescu AC, Branisteanu DC, et al. Cardiovas- cular comorbidities in psoriasis. Exp Ther Med. 2022;23(2):1-5. DOI: 10.3892/etm.2021.11075. PMID: 35069833 17. Rademaker M, Agnew K, Anagnostou N, et al. Psoriasis and infection. A clinical practice narrative. Australas J Dermatol. 2019;60(2):91-98. DOI: 10.1111/ajd.12895. PMID: 30079566 18. Yiu ZZ, Exton LS, Jabbar-Lopez Z, et al. Risk of serious infec- tions in patients with psoriasis on biologic therapies: a system- atic review and meta-analysis. J Invest Dermatol. 2016;136(8): 1584-1591. DOI: 10.1016/j.jid.2016.03.035. PMID: 27085754 19. Kalb RE, Fiorentino DF, Lebwohl MG, et al. Risk of serious infection with biologic and systemic treatment of psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR). JAMA Dermatol. 2015;151(9):961-969. DOI: 10.1001/jamadermatol .2015.0718. PMID: 25970800 significantly compromised in psoriasis patients, particularly those with more severe disease. This finding has implications for the prevention of sinonasal infections and warrants con- sideration of interventions to enhance mucociliary activity in this population. Further investigation into the physiological changes associated with psoriasis will contribute to a more comprehensive understanding of the disease and its related comorbidities, ultimately leading to improved patient care. Limitations A key strength of our study is its novel investigation of NMCT in individuals with psoriasis. However, we ac- knowledge certain limitations, including the relatively small sample size and the preliminary data of our study. 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