Psoriasis: a brief overview

Abstract

Psoriasis is a clinically heterogeneous lifelong skin disease that presents in multiple forms such as plaque, flexural, guttate, pustular or erythrodermic. An estimated 60 million people have psoriasis worldwide, with 1.52% of the general population affected in the UK. An immune-mediated inflammatory disease, psoriasis has a major genetic component. Its association with psoriatic arthritis and increased rates of cardiometabolic, hepatic and psychological comorbidity requires a holistic and multidisciplinary care approach. Psoriasis treatments include topical agents (vitamin D analogues and corticosteroids), phototherapy (narrowband ultraviolet B radiation (NB-UVB) and psoralen and ultraviolet A radiation (PUVA)), standard systemic (methotrexate, ciclosporin and acitretin), biologic (tumour necrosis factor (TNF), interleukin (IL)-17 and IL-23 inhibitors) or small molecule inhibitor (dimethyl fumarate and apremilast) therapies. Advances in the understanding of its pathophysiology have led to development of highly effective and targeted treatments.

Keywords: biologic; multimorbidity; plaque; psoriasis; pustular.

Fig 1.

Chronic plaque psoriasis. Widespread, symmetrically distributed and well-demarcated erythematous, scaling plaques. Extensor surfaces such as elbows and knees are typically affected.

Fig 2.

Psoriasis affecting the palms. Psoriasis on the palms, soles, scalp, face, nails and genitalia is difficult to treat and may have a profound impact on activities of daily living.