What are the characteristics of Psoriasis (Soriasis is a chronic autoimmune skin condition)?

From the Guidelines

Psoriasis is a chronic autoimmune skin condition characterized by thickened, scaly plaques and erythema, resulting from hyperproliferation of epidermal keratinocytes and a dysregulated interplay among the epidermis and dermis, the cutaneous microvasculature, and the immune system 1.

Key Characteristics

• Genetic and environmental factors contribute to the development of psoriasis 1
• Immune-mediated condition involving cutaneous T-cells, dendritic cells, and keratinocytes with subsequent release of a variety of cytokines and other soluble mediators 1
• Associated with considerable morbidity and comorbid conditions, including psoriatic arthritis, Crohn’s disease, multiple sclerosis, lymphoma, heart disease, obesity, type 2 diabetes, and the metabolic syndrome 1
• Psychosocial issues and depression are also common in patients with psoriasis 1

Severity Measures

• Total body surface area (BSA) involved, with less than 3% BSA considered mild, 3% to 10% BSA considered moderate, and greater than 10% considered severe disease 1
• Psoriasis Area Severity Index (PASI), a more specific means of quantifying the extent and severity of psoriasis, taking into account BSA, redness, scaling, and plaque thickness 1 Some of the key points to consider when managing psoriasis include the use of topical treatments, such as corticosteroids and vitamin D analogs, as well as systemic agents, like methotrexate and biologic therapies, including etanercept and adalimumab 1.

From the FDA Drug Label

The safety and efficacy of HUMIRA were assessed in randomized, double-blind, placebo-controlled studies in 1696 adult subjects with moderate to severe chronic plaque psoriasis (Ps) who were candidates for systemic therapy or phototherapy Study Ps-I evaluated 1212 subjects with chronic Ps with ≥10% body surface area (BSA) involvement, Physician’s Global Assessment (PGA) of at least moderate disease severity, and Psoriasis Area and Severity Index (PASI) ≥12 within three treatment periods Across all treatment groups the mean baseline PASI score was 19 and the baseline Physician’s Global Assessment score ranged from “moderate” (53%) to “severe” (41%) to “very severe” (6%) Study Ps-II evaluated 99 subjects randomized to HUMIRA and 48 subjects randomized to placebo with chronic plaque psoriasis with ≥10% BSA involvement and PASI ≥12 Across all treatment groups the mean baseline PASI score was 21 and the baseline PGA score ranged from “moderate” (41%) to “severe” (51%) to “very severe” (8%)

The characteristics of Psoriasis include:

• Moderate to severe chronic plaque psoriasis 2
• ≥10% body surface area (BSA) involvement
• Physician’s Global Assessment (PGA) of at least moderate disease severity
• Psoriasis Area and Severity Index (PASI) ≥12
• Disease severity ranging from “moderate” to “severe” to “very severe” Key features of psoriasis include:
• Plaque elevation
• Scale
• Hyperpigmentation or diffuse pink or red coloration
• Surface dryness with some white coloration
• Red coloration

From the Research

Characteristics of Psoriasis

Psoriasis is a chronic autoimmune skin condition characterized by:

• Immune-mediated disease with skin or joints manifestations, or both 3, 4
• Inflammatory effects on the skin or joints, or both, with a major impact on quality of life 3, 4
• Hyperproliferation and aberrant differentiation of epidermal keratinocytes 5
• IL-17-dominant abnormal innate and acquired immunity 5

Clinical Manifestations

Psoriasis can present in various forms, including:

• Chronic plaque psoriasis, characterized by redness, thickness, and scaling 6
• Guttate psoriasis, with small, round lesions commonly over the upper trunk and extremities 7
• Inverse psoriasis, with smooth plaques of inflamed skin within skin folds 7
• Pustular psoriasis, with white painful pustules within red inflamed blotches widespread over the body 7
• Erythrodermic psoriasis, with a red rash present over most of the body 7

Comorbidities and Risk Factors

Psoriasis is associated with various comorbidities and risk factors, including:

• Genetics 5, 7
• Obesity 5, 7
• Metabolic syndrome 5, 7
• Infection 5, 7
• Cardiovascular disease 5, 7
• Stress 5, 7
• Type 2 diabetes mellitus (T2DM) 7
• Ultraviolet (UV) light 7
• Air pollution 7
• Various pharmacological treatments 7

Diagnosis and Treatment

Psoriasis is diagnosed clinically, with no definitive test, and treatment options include:

• Topical treatments, such as vitamin D analogues, topical corticosteroids, and tar-based preparations 6
• Systemic treatments, such as biologics, small molecules, and conventional systemic agents 3, 4
• New treatment options, such as retinoic-acid-receptor-related orphan nuclear receptor γt inhibitors, IL-36 receptor antagonist, or aryl hydrocarbon receptor agonist 5