Psoriasis—recent advances in understanding its pathogenesis and treatment - 21/08/11

Doi : 10.1016/j.jaad.2005.04.035

Gerald Krueger, MD ^a,^⁎ , Charles N. Ellis, MD ^b
^a From the Departments of Dermatology, University of Utah Health Sciences Center
^b University of Michigan Medical School

Reprint requests: Gerald Krueger, MD, University of Utah, 50 N Medical Dr, Salt Lake City, UT 84132.

Salt Lake City, Utah, and Ann Arbor, Michigan

Abstract

Although not completely understood, there is clearly a genetic component in the development of psoriasis. Twin studies show a 67% concordance for monozygotic twins versus 18% for dizygotic twins. This lack of complete concordance in monozygotic twins suggests multifactorial inheritance and interaction between genetic predisposition and the environment. At present, 8 different psoriasis susceptibility loci have been identified in genome-wide linkage scans, including locations on 15 different chromosomes. Genetic connections have been made between psoriasis and other diseases, including atopic dermatitis, rheumatoid arthritis, and Crohn's disease. A variety of approaches are available for the treatment of psoriasis, ranging from topical agents for milder forms of the disease to phototherapy and systemic agents for severe psoriasis. Despite the importance of systemic therapies and recent advances represented by biologic agents, topical treatments will probably remain the mainstay of psoriasis therapy for most patients. The advent of new, cosmetically attractive vehicles may enhance compliance, add to the use of topical agents, and potentially improve patient outcomes.

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Abbreviations used : APC, EGF-R, HEV, IBD, ICAM, IFN-γ, IL, LFA, MHC, PSORS, Re-PUVA, Re-UVB, TGF-⍺, TGF-β, T_H1, T_H2, TNF-⍺, VEGF, VPF

Plan

Pathogenesis

T lymphocytes

Keratinocytes and other cells

Treatment approaches

This article is part of a supplement supported by Connetics Corp, Palo Alto, California.
Disclosure: Dr Krueger is a consultant to Amgen, Biogen/Idec, Centocor, Connetics, Galderma, and Isis. He does not own stock in these companies or in any company that manufactures and promotes corticosteroids for the treatment of skin disease. He has been and continues to be an investigator in clinical trials sponsored by these companies. Dr Ellis has been a consultant for Biogen/Idec, Ferndale Laboratories, Fujisawa, GlaxoSmithKline, and Novartis and has received compensation from Connetics Corp related to this supplement; he has no financial interest in any company that sells therapies for skin disorders.