Hohenaufenthalt und endogener kortisolspiegel bei psoriasis

As the adaptational response to a high altitude climate can be accompanied by an increased adrenal activity, and patients with psoriasis are supposed to have an impaired balance in the hypothalamus-pituitary-adrenal axis, the plasma cortisol levels of 76 patients suffering from psoriasis were measured once a week during a four weeks dermatological high mountain climatotherapy in the Swiss alps (Alexanderhaus Clinic Davos, 1560 m above sea level). Further 15 patients with psoriasis were examined for plasma cortisol under lowland conditions at home immediately before as well as after arrival in the altitude of Davos. The results showed no increase of plasma cortisol during the 4 weeks of high altitude stay compared to the measured values at home, except for a slight increase around the arrival and departure days. No correlation was found between plasma cortisol levels and individual cumulative UVB doses by solar phototherapy (heliotherapy). It is concluded that the efficacy of the high mountain climatotherapy in psoriasis is not the consequence of an altitude related increase in plasma cortisol. The results support the concept that the beneficial effect of high mountain climate in psoriasis rather is due to a normalization of the dysbalanced hypothalamic- pituitary-adrenal axis together with reduction of stress response and not due to a general increase in plasma cortisol levels.