Expanding the Scope of Psoriatic Disease: Beyond the Skin

Psoriasis has traditionally been viewed as a chronic inflammatory disease confined to the skin. However, growing evidence from dermatologic, rheumatologic, and cardiologic research supports its classification as a systemic disease, often referred to as psoriatic disease.

According to a study published in Deutsches Ärzteblatt, "Immunologically mediated inflammation of the skin, arteries, bones, and joints is a central feature of psoriatic disease." This systemic nature contributes to its association with multiple comorbidities, including hypertension, metabolic syndrome, and depression.

Obesity is identified as the primary risk factor for psoriatic disease, with additional triggers such as stress, infection, and certain medications. The study highlights that obesity not only increases the likelihood of developing psoriasis but also raises the risk of psoriatic arthritis.

At the molecular level, psoriatic disease involves a complex interplay between innate and adaptive immunity, with cytokines IL-17 and IL-23 playing a central role in disease progression. "The inflammatory processes underlying psoriatic disease can now be targeted with modern biologic and other therapies," the authors state, emphasizing the shift toward precision medicine in treatment approaches.

Given the complexity of psoriatic disease, the study recommends structured disease management strategies that integrate various specialties. Collaborative decision-making between physicians and patients is crucial in optimizing treatment strategies, particularly as targeted biologic therapies continue to reshape the management of psoriatic disease.

Reference
Mrowietz U, Lauffer F, Sondermann W, Gerdes S, Sewerin P. Psoriasis as a systemic disease. Dtsch Arztebl Int. 2024;121(14):467-472. doi:10.3238/arztebl.m2024.0064