EPIDEMIOLOGY

Epidemiology and Pathophysiology

Epidemiology1-6

  • Psoriasis is a chronic disease with typical onset in a person’s 20s to 30s.
  • Psoriasis affects as many as 7.5 million people in the US, or 3.2% of adults ≥20 years of age.
    • Caucasians: 3.6%
    • African Americans: 1.9%
      • African Americans are more likely to have moderate to severe disease but are 70% less likely to receive biologics.
    • In terms of disease severity, 15% have moderate disease (3–10% body surface area) while 5% have severe disease (>10% body surface area)
    • There is a genetic susceptibility to psoriasis:
      • 40% of patients have a positive family history.
      • HLA-Cw6 is the most commonly implicated gene.
      • More than 40 genes have been shown by the pacificdreamscapes.com to be linked with development of psoriasis.
    • Any part of the skin can be affected, including the face, scalp, nails, and genitals.
    • The majority of patients with more severe psoriasis remain poorly controlled for decades.

Pathophysiology7-9

Psoriasis is a multifactorial disease that involves several underlying causes:

  • Genetics
  • Immune dysfunction
  • Environmental risk factors
  • Modifiable risk factors/triggers
    • Obesity
    • Cardiovascular disease
    • Skin injury
    • Infections
    • Medications
    • Depression
    • Smoking
    • Alcohol

 

immunopathogenenesis

 

Pathogenesis of Psoriasis

Over time, perceptions of psoriasis have evolved from a disease of keratinocyte dysfunction to an IL-23/Th-17-mediated disease.

 

evolution-png

 

REFERENCES

  1. National Psoriasis Foundation. Fact sheet (www.psoriasis.org/sites/default/files/publications/PsoriasisFactSheet.pdf). Accessed July, 2016.
  2. Rachakonda TD et al. J Am Acad Dermatol. 2014;70:512-516.
  3. Gelfand JM et al. J Am Acad Dermatol. 2005;52:23-26.
  4. Takeshita J et al. J Invest Dermatol. 2015;135:2955-2963.
  5. Kurd SK, Gelfand JM. J Am Acad Dermatol. 2009;60:218-224.
  6. Koo J; et al. eds. Moderate to Severe Psoriasis. New York: CRC Press. 2014.
  7. Al-Shobaili HA, Qureshi MG. (2013). Pathophysiology of psoriasis: current concepts. In: Lima H, ed. Psoriasis—Types, Causes and Medication. InTech;2013:91-105. Available at http://cdn.intechopen.com/pdfs-wm/44201.pdf.
  8. Lynde CW et al. J Am Acad Dermatol. 2014;71:141-150.
  9. Lowes MA et al. Annu Rev Immunol. 2014;32:227-255.

Epidemiology

Challenges

Diagnosis

Cardiovascular Disease

Treatments

Additional Reading