We searched PubMed using the terms “psoriasis”, “epidemiology”, “pathogenesis”, “genetics”, “psoriasis susceptibility loci”, “therapy”, “guidelines”, and “comorbidity”. Our search covered articles published in English, German, and French published between 1974 and May 13, 2015. We identified additional reports from the reference list of seminal reviews.
SeminarPsoriasis
Section snippets
Disease burden and epidemiology
Psoriasis is a common skin disorder that is associated with both a physical and psychological burden. As with other dermatoses, visible disfiguration can trigger a negative reaction in others, which can cause much of the readily measurable psychological burden of the disease. In a comparison with a selection of other chronic disorders including cancer, myocardial infarction, and congestive heart failure, only depression and chronic lung disease impaired psychological quality of life more than
Clinical manifestations of psoriasis
Psoriasis is a multifarious disease that is equally prevalent in both sexes, although results from a recent study have shown that on average men have more severe forms of the disease than do women.11 Five types of psoriasis have been reported: plaque psoriasis (also known as psoriasis vulgaris); guttate (droplet) or eruptive psoriasis, which is characterised by scaly teardrop-shaped spots; inverse psoriasis, also called intertriginous or flexural psoriasis that is usually found in folds of
Diagnosis and differential diagnosis
Diagnosis is usually made on clinical findings; skin biopsy is rarely used to diagnose psoriasis. The Psoriasis Area and Severity Index (PASI) score has been used to quantify disease severity of erythema, infiltration or thickness, scaling and the extent of lesions in patients with widespread disease.28 More recently, easier-to-use scores, such as the psoriasis global assessment (PGA) or lattice system-physician's global assessment (LS-PGA)have been developed for routine clinical practice.29
Pathogenesis
Involvement of the immune system in psoriasis is now widely accepted.33, 34 Genome-wide scans for psoriasis-associated genes have identified predominantly immune-related genes,35, 36 providing a mechanistic link between genetics and immunity. Psoriatic skin lesions originate as a result of dysregulated interactions of innate and adaptive components of the immune system with resident cutaneous cell types.
Research into the immunopathogenesis of psoriasis has resulted in several highly specific
Genetics and pharmacogenetics
Results from population studies suggest a higher incidence of psoriasis in first-degree and second-degree relatives of patients than in the general population.63 Furthermore, concordance rates in monozygotic twins are up to three times higher than in dizygotic twins.63 Genetic factors are also likely to have an effect on disease severity because, on average, patients with an early onset of the disease (type I psoriasis) have a more severe course and a positive family history, whereas patients
Comorbid disease
Several important diseases occur more often in patients with psoriasis than expected based on their respective prevalence in the general population. Comorbid diseases of psoriasis include psoriatic arthritis, Crohn's disease, cancer, depression, non-alcoholic fatty liver disease, metabolic syndrome (or components of it), and cardiovascular disorders,9, 79 all of which contribute substantially to morbidity and mortality in patients with psoriasis. Comorbid disease needs to be treated, therefore
Management and prevention
In recent years, several high-quality evidence-based guidelines have been developed for the treatment of psoriasis such as the German S3 guidelines,99 North American guidelines,100 and International European guidelines.101 The German S3 guidelines were the first to include topical therapies, phototherapy, and conventional and biological systemic therapies.
Unresolved questions, new developments, and unmet medical needs
Substantial progress has been made to understand the complex pathogenesis of psoriasis and to facilitate the development of more effective, targeted therapies. However, despite these advances more research is needed in several areas.123
Psoriasis has no known cure but many therapies can reduce or nearly stop symptoms. A treatment to which all patients respond adequately, and a reliable test that predicts individual responses before starting treatments, is not yet available.124 The identification
Conclusion
Psoriasis is a systemic inflammatory disorder that involves complex pathogenic interactions between the innate and adaptive immune system that can be targeted by innovative biological therapies. The treatment framework is changing from short-term intervention of acute rashes toward long-term management, taking into consideration both the skin symptoms and comorbid diseases. The quest to reduce medical risks of patients with psoriasis through comprehensive treatment and early identification of
Search strategy and selection criteria
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Innate immunity and antimicrobial defense systems in psoriasis
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Regulatory T cells control VEGF-dependent skin inflammation
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Epidermal vascular endothelial growth factor production is required for permeability barrier homeostasis, dermal angiogenesis, and the development of epidermal hyperplasia: implications for the pathogenesis of psoriasis
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Sequence and haplotype analysis supports HLA-C as the psoriasis susceptibility 1 gene
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A large-scale genetic association study confirms IL12B and leads to the identification of IL23R as psoriasis-risk genes
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Cellular genomic maps help dissect pathology in human skin disease
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Genetic analysis of PSORS1 distinguishes guttate psoriasis and palmoplantar pustulosis
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TNFAIP3 gene polymorphisms are associated with response to TNF blockade in psoriasis
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Disease concomitance in psoriasis
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The risk of lymphoma in patients with psoriasis
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Incidence of cardiovascular disease in individuals with psoriasis: a systematic review and meta-analysis
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Psoriasis is not associated with atherosclerosis and incident cardiovascular events: the Rotterdam Study
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Complexity of the association between psoriasis and comorbidities
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World psoriasis day—document EB133.R2, agenda item 6.2. May 30, 2013
Psoriasis—epidemiology and clinical spectrum
Clin Exp Dermatol
Epidemiology and comorbidity of psoriasis in children
Br J Dermatol
Psoriasis
N Engl J Med
Effect of weather and environmental factors on the clinical course of psoriasis
Occup Environ Med
Psoriasis
N Engl J Med
The higher proportion of men with psoriasis treated with biologics may be explained by more severe disease in men
PLoS One
Scalp psoriasis: European consensus on grading and treatment algorithm
J Eur Acad Dermatol Venereol
Alopecia psoriatica. Charakteristika eines bisher negierten Krankheitsbildes
Hautarzt
Approach to managing patients with nail psoriasis
J Eur Acad Dermatol Venereol
The burden of nail psoriasis: an introduction
Dermatology
Nail psoriasis: a review
Am J Clin Dermatol
Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis
N Engl J Med
Anti-tumour necrosis factor alpha therapy and increased risk of de novo psoriasis: is it really a paradoxical side effect?
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Ezrin, maspin, peroxiredoxin 2, and heat shock protein 27: potential targets of a streptococcal-induced autoimmune response in psoriasis
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How great is the risk of further psoriasis following a single episode of acute guttate psoriasis?
Arch Dermatol
Management of psoriasis in adolescence
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Juvenile psoriasis and its clinical management: a European expert group consensus
J Dtsch Dermatol Ges
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