Epidemiology and Pathophysiology

Epidemiology^1-6

• 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.

Pathophysiology^7-9

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

 

 

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

 

 

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.