Psoriasis: Behind the scenes

Abstract

Psoriasis is a chronic inflammatory skin disease characterized by a significant deterioration in the quality of life of affected individuals. Notably, psoriasis is significantly associated with cardiovascular and metabolic syndrome and other autoimmune disorders. Recent progress in biologic therapies has revealed the fundamental role of tumor necrosis factor-a, interleukin (IL)-23 and the IL-17A axis together with aberrant overproduction of epidermal IL-36c in the pathogenesis of psoriasis. This review provides an update on the clinical, pathological and therapeutic advancements involving psoriasis.

Cardiovascular and Metabolic Diseases Comorbid with Psoriasis: Beyond the Skin

“…In addition, recent therapeutic success with other biologics seems to have revealed the pivotal role of the TNF-α/interleukin (IL)-23/IL-17 axis in the pathogenesis of psoriasis (Figure). The initial trigger of psoriasis is thought to be the activation of plasmacytoid dendritic cells (DCs) being stimulated by complexes of host DNA and the antimicrobial peptide LL-37 (cathelicidin), which are produced by keratinocytes after minor injuries (8, 13-15). Activated plasmacytoid DCs and damaged keratinocytes produce interferon (IFN)-α and TNF-α, which results in the further production of TNF-α, IL-12 and IL-23 by plasmacytoids and recruited inflammatory DCs (8, 14, 15) (Figure).…”

“…In humans and experimental models of psoriasis, γδT cells (Vγ9Vδ2 T cells in human), innate lymphoid cells type 3 (ILC3) and Th17 cells are detected in blood and lesional skin. These cells readily produce IL-17A and IL-22 (8, 17, 18). IL-17A binds to the IL-17 receptor (IL-17R), which is composed of IL-17RA and IL-17RC (19) (Figure).…”

“…Psoriasis is a common immune-mediated chronic inflammatory skin disease that is characterized by the altered proliferation and differentiation of keratinocytes, vascular remodeling and inflammation in the skin (Figure). Psoriasis shows a diverse prevalence across populations worldwide: 2.5% in Europeans, 0.05-3% in Africans and 0.1-0.5% in Asians (5-8). Psoriasis patients comprise 4.43% of all Japanese dermatological patients (8).…”

“…Psoriasis shows a diverse prevalence across populations worldwide: 2.5% in Europeans, 0.05-3% in Africans and 0.1-0.5% in Asians (5-8). Psoriasis patients comprise 4.43% of all Japanese dermatological patients (8). Men are likely to experience a higher severity of the disease than women are.…”

“…Phenotypic heterogeneity of psoriasis has also been reported among ethnic populations. Small plaque psoriasis is specific to Asian populations, while severe psoriasis is more predominant in Western populations (5-8). Recent genome-wide association studies have identified numerous risk-associated variants within 44 susceptibility loci for psoriasis, including HLA-C*06:02 , LCE3D , IL23R and CARD14 .…”