This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Pathogenesis of psoriasis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hyperproliferation of keratinocytes in response to cytokines released by inflammatory cells produce characteristic changes in the epidermis and dermis, including:

  • reduced epidermal cell transit time - from 30 days to 2-3 days - causing:
    • acanthosis - epidermal thickening - 3-5 times normal
    • arrowheads - elongated epidermal rete ridges
    • hyperkeratosis - thickening of the cornified layer
    • parakeratosis - nuclei retained in stratum corneum (1)

  • increased expression of intercellular adhesion molecule 1 (ICAM-1) in the epidermis (1)

  • granular layer - thinned or absent (1)

  • infiltration of neutrophils and activated lymphocytes, extending from the dermis into the epidermis (1) (presence of neutrophils in the stratum corneum and mononuclear leucocytes in the papillary dermis are defining histopathological features of psoriasis) (2)

  • Munro's microabscesses - small aggregates of neutrophils transmigrate through the epidermis and forms microabscesse below the parakeratotic stratum corneum. Later these are moved towards the upper layers and sloughed off as the lesion progresses (1)

  • dilated, tortuous capillaries within outer dermal - papillary dermis; create minute bleeding points when scale removed - the Auspitz sign

Current thinking is that endogenous or exogenous damage unmasks antigens in the corneum which fix complement and activate neutrophils. Neutrophils then release proteases which unmasks more antigen so repeating the cycle. Most likely, activation is assisted by arachidonic acid metabolites and leukotrienes, particularly B4.

Reference:

1. Schön M.P, Boehncke W.H. Psoriasis. NEJM 2005;352:1899-1912

2. Krueger J.G, Bowcock A. Psoriasis pathophysiology: current concepts of pathogenesis. Annals of the Rheumatic Diseases 2005;64(2)


Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.