PRIMEVIEW

PSORIASIS
For the Primer, visit doi:10.1038/nrdp.2016.82

Psoriasis is a chronic, immune- MANAGEMENT

MECHANISMS
mediated disorder with a strong
Plasmacytoid External
genetic basis. Characteristic cutaneous dendritic cell
damage to Treatment selection depends on the severity
manifestations are red, raised scaly
the skin activates of symptoms, the body areas involved and the
plaques and sometimes pustules. Systemic
Individuals plasmacytoid dendritic presence of comorbidities. Therapeutic options
comorbidities can be rheumatological
predisposed cells, which trigger include topical treatments (for example, with
(psoriatic arthritis) and cardiovascular.
to psoriasis often HLA-A myeloid dendritic cells corticosteroids), systemic agents (for example,
harbour mutations HLA-B and the clonal expansion methotrexate), phototherapy and biologic
in genes involved in and activation agents (which target key mediators of chronic
HLA-C
EPIDEMIOLOGY immune system of T cells. inflammation, such as TNF and IL-17). The
regulation. increasing availability of biosimilars might
INTERFERON
Psoriasis affects >125 million people worldwide reduce treatment costs and improve accessibility.
and its incidence is increasing; the disease is Although remission is possible, flares often occur
more common in adults than in children. Up to Myeloid after withdrawal of treatment.
one-third of individuals affected by psoriasis will IL23R dendritic cell
also develop psoriatic arthritis after the onset of CARD14
cutaneous symptoms.
IL-12

Prevalence of psoriasis ranges IL-23

from 0% in Taiwan to 8.5% in Norway TNF IL-1 TNF

DIAGNOSIS
IL-17
T T
T Myeloid dendritic
Diagnosis of psoriasis includes extensive clinical
examination to differentiate the condition
IL-22 T TNF
IFNγ
cells activate
T helper cell-mediated
from, for example, rheumatoid arthritis or signalling cascades. The
atopic dermatitis. Signs of psoriasis vulgaris release of pro-inflammatory
(the most common type) include erythematous cytokines and chemokines
Infiltration stimulates keratinocyte
scaly plaques, often on the scalp, trunk and of mast cells, proliferation, leading to
extremities. Psoriatic arthritis manifests as macrophages and psoriatic lesions.
inflammatory joint pain that worsens with rest. polymorphonuclear QUALITY OF LIFE
leukocytes to the dermal
vessels also contributes
to chronic Psoriasis can have negative effects on the
OUTLOOK inflammation. quality of life of the patient and the patient’s
family. Furthermore, social stigmatization
Psoriasis is a complex and associated response. Identification of and discomfort often contribute to patient
multifactorial disease comorbidities. differentially expressed genes anxiety and depression. Quantifying
that requires a multidisciplinary Biomarkers are being in psoriatic lesions could lead to the effects of psoriasis on quality of life
approach to understand its sought that can accurately the development of new specific (through questionnaires) is important in
genetic and immunological bases assess prognosis and treatment biologic treatments. patient management.

Written by Lucia Brunello; designed by Laura Marshall Article number: 16083; doi:10.1038/nrdp.2016.83; published online 24 Nov 2016
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