• BRIJESH G SHIHORA C G Bhakta Institute of Biotechnology,UKA TARSADIA UNIVERSITY,Gopal Vidyanagar, Bardoli Mahua Road,Tarsadi, 394350
  • SHWETA D PATEL C G Bhakta Institute of Biotechnology,UKA TARSADIA UNIVERSITY,Gopal Vidyanagar, Bardoli Mahua Road,Tarsadi, 394350
  • MEONIS A PITHAWALA Assistant Professor C G Bhakta Institute of Biotechnology, Uka Tarsadia University, Gopal Vidyanagar, Bardoli Mahua Road, Tarsadi, 394350, Dist Surat, (Gujarat) India,


Pathogenicity, Immune perspectives, Differential Diagnosis, Therapy


The current review article focuses on “Psoriasis”, a form of over-active wound healing response, relatively common, chronic, inflammatory and hypersensitive disease of unsolved pathogenesis affecting skin and joints in 2-3% of the general population. Psoriasis is a skin disease driven by immune system which starts below the skin's surface and cause severe pain and adverse mental health effects. Genetic susceptibility as well as environmental factors plays an important role in determining the development and prognosis of psoriasis. Natural Killer (NK) cells are lymphocytes that are best known for killing virally infected and cancer cells. However, evidence is emerging to support a role for NK cells in psoriasis. NK cells are found in the inflammatory infiltrate in psoriatic skin lesions. They can produce a range of inflammatory cytokines, many of which are important in the pathogenesis of psoriasis. Elucidation of the Immunopathogenesis of psoriasis has led to the discovery of novel biologic agents for the treatment of moderate to-severe plaque psoriasis. There are countless therapies currently in the research pipeline, with mechanisms ranging from receptor antagonism to signal transduction pathway inhibition.

Author Biographies

BRIJESH G SHIHORA, C G Bhakta Institute of Biotechnology,UKA TARSADIA UNIVERSITY,Gopal Vidyanagar, Bardoli Mahua Road,Tarsadi, 394350


SHWETA D PATEL, C G Bhakta Institute of Biotechnology,UKA TARSADIA UNIVERSITY,Gopal Vidyanagar, Bardoli Mahua Road,Tarsadi, 394350


MEONIS A PITHAWALA, Assistant Professor C G Bhakta Institute of Biotechnology, Uka Tarsadia University, Gopal Vidyanagar, Bardoli Mahua Road, Tarsadi, 394350, Dist Surat, (Gujarat) India,



Nestle FO, Kaplan DH, and Barker J. Mechanisms of disease: psoriasis, The New England Journal of Medicine.2009; 361(5):496-509. (http://www.ncbi.nlm.nih.gov/pubmed/19641206)

Mehta V, Malhotra SK. Psychiatric Evaluation of Patients with Psoriasis Vulgaris and Chronic Urticaria. German J Psychiatry 2007; 10:104-110. (http://www.gjpsy.uni-goettingen.de/gjp-article-mehta.pdf)

James TE, Rajan PD, Sun WG, Tilo H, Christophers E, Voorhees JJ. The Genetics of Psoriasis. Arch Dermatol 1994; 130(2):216-224. (http://www.ncbi.nlm.nih.gov/pubmed/8304761)

Friberg C. Genetic studies of psoriasis and psoriatic arthritis, Goteborg University, Sweden; 2007 (https://gupea.ub.gu.se/bitstream/2077/9534/2/Spiktitelblad%20final.pdf)

Questions and answers about psoriasis. NIH Publication 2003. (http://www.natural-skin-care-info.com/psoriasis-fcic.html)

Singri P, West DP, Gordon KB. Biologic therapy for psoriasis: the new therapeutic frontier. Arch Dermatol. 2002; 138:657-663. (http://www.ncbi.nlm.nih.gov/pubmed/12020229)

Ellis CN, Krueger GG, for the Alefacept Clinical Study Group. Treatment of chronic plaque psoriasis by selective targeting of memory effector T lymphocytes. N Engl J Med. 2001; 345:248-255. (http://www.ncbi.nlm.nih.gov/pubmed/11474662)

Lebwohl M. Psoriasis. The Lancet. 2003; 361 no. 9364:1197-1204. (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)12954-6/fulltext)

Walter LF, Gundula S. Histopathology of the skin. 3rd Edn., Boston, Massachusetts: Lippincott; 1981. P.156-164. (http://www.amazon.com/Histopathology-Skin-Walter-F-Lever/dp/0397508689/ref=pd_rhf_se_p_img_1_K1FJ)

Seaton T. Psoriasis. In: Young LY, Koda-Kimbal MA, ed. Applied Therapeutics: The Clinical Use of Drugs. Vancouver, WA: Applied Therapeutics; 1995:37-1–37-7. http://books.google.co.in/books?id=R-lsAAAAMAAJ&q=seaton)

Peters BP, Weissman FG, Gill MA. Pathophysiology and treatment of psoriasis. Am J Health Syst Pharm. 2000; 57:645-659. (http://www.ncbi.nlm.nih.gov/pubmed/10768819)

Fleischer AB Jr., Feldman SR, Rapp SR, et al. Disease severity measures in a population of psoriasis patients: the symptoms of psoriasis correlate with self-administered psoriasis area severity index scores. J Invest Dermatol 1996; 107: 26-29. (http://www.ncbi.nlm.nih.gov/pubmed/8752834)

Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr., Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999; 41:401-407. (http://www.ncbi.nlm.nih.gov/pubmed/10459113)

Rapp SR, Exum ML, Reboussin DM, Feldman SR, Fleischer A, Clark A. The physical, psychological and social impact of psoriasis. J Health Psychol. 1997; 2:525-537. (http://hpq.sagepub.com/content/2/4/525)

Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005; 64 suppl 2: ii 14-17. (http://ard.bmj.com/content/64/suppl_2/ii14.full?sid=f5824cee-5d0e-4dfc-b258-cc219f1a4643)

Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis. 2005; 64 suppl 2: ii 18-23. (http://ard.bmj.com/content/64/suppl_2/ii18.full?sid=f5824cee-5d0e-4dfc-b258-cc219f1a4643)

Cohen MR, Reda DJ, Clegg DO. Baseline relationships between psoriasis and psoriatic arthritis: analysis of 221 patients with active psoriatic arthritis. Department of Veterans Affairs Cooperative Study Group on Seronegative Spondyloarthropathies. J Rheumatol. 1999; 26:1752-1756. (http://www.ncbi.nlm.nih.gov/pubmed/10451073)

Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J. 2010; 31(8):1000-1006. (http://www.ncbi.nlm.nih.gov/pubmed/20037179)

Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006; 296(14):1735-1741. (http://www.ncbi.nlm.nih.gov/pubmed/17032986)

Gisondi P, Tessari G, Conti A, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. Br J Dermatol. 2007; 157(1):68-73. (http://www.ncbi.nlm.nih.gov/pubmed/17553036)

Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depres¬sion, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010; 146(8):891-895. (http://www.ncbi.nlm.nih.gov/pubmed/20713823)

Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T. The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol. 2001; 137(3): 280-284. (http://www.ncbi.nlm.nih.gov/pubmed/11255325)

Sinead D and Clair MG. NK Cells and Psoriasis. NK Cell Research Group, School of Biochemistry and Immunology, Trinity College, Dublin 2, Ireland: Hindawi Publishing Corporation. Journal of biomedicine and biotechnology, 2011; 248317:1-10. (http://www.hindawi.com/journals/bmri/2011/248317/)

Yawalkar N, Schmid S, Braathen LR, and Pichler WJ. Perforin and granzyme B may contribute to skin inflammation in atopic dermatitis and psoriasis. British Journal of Dermatology. 2001; 144(6):1133-1139. (http://www.ncbi.nlm.nih.gov/pubmed/11422032)

Prpic L, Strbo N, Soto sek V, Gruber F, Podack ER, and Rukavina D. Assessment of perforin expression in peripheral blood lymphocytes in psoriatic patients during exacerbation of disease. Acta Dermato-Venereologica. 2000; suppl 211:14-16. (http://www.ncbi.nlm.nih.gov/pubmed/11234556)

Prpic LM, Kastelan M, Laskarin G, Zamolo G, Massari D, and Rukavina D. Analysis of perforin expression in peripheral blood and lesions in severe and mild psoriasis. Journal of Dermatological Science. 2007; 47 suppl 1:29-36. (http://www.ncbi.nlm.nih.gov/pubmed/17412565)

Lowes MA, Bowcock AM, and Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007; 445 suppl 7130:866-873. (http://www.ncbi.nlm.nih.gov/pubmed/17314973)

Schon MP and Boehncke WH. Psoriasis. The New England Journal of Medicine. 2005; 352 suppl 18:1899-1912. (http://www.ncbi.nlm.nih.gov/pubmed/15872205)

Liu Y, Krueger JG and Bowcock AM. Psoriasis: genetic associations and immune system changes. Genes and Immunity. 2007; 8 suppl 1:1-12. (http://www.ncbi.nlm.nih.gov/pubmed/17093502)

Bowcock AM and Krueger JG. Getting under the skin: the immunogenetics of psoriasis. Nature Reviews Immunology. 2005; 5 suppl 9:699-711. (http://www.ncbi.nlm.nih.gov/pubmed/16138103)

Cameron L, Kirby B, Fei W and Griffiths C. Natural killer and natural killer-T cells in psoriasis. Archives of Dermatological Research. 2002; 294 suppl 8:363-369. (http://www.ncbi.nlm.nih.gov/pubmed/12420105)

Cameron L, Kirby B and Griffiths CEM. Circulating natural killer cells in psoriasis. British Journal of Dermatology. 2003; 149 suppl 1:160-164. (http://www.ncbi.nlm.nih.gov/pubmed/12890211)

Bachelez H. Immunopathogenesis of psoriasis: recent insights on the role of adaptive and innate immunity. Journal of Autoimmunity. 2005; 25 suppl:69-73.

Goldstein I, Simon AJ, Ben Horin S, Matzri S, Koltakov A, et al. Synovial VLA-1+ T cells display an oligoclonal and partly distinct repertoire in rheumatoid and psoriatic arthritis. Clin Immunol. 2008; 128:75-84. (http://www.ncbi.nlm.nih.gov/pubmed/18456562)

Ritchlin C. Newer therapeutic approaches: spondyloarthritis and uveitis. Rheum Dis Clin North Am. 2006; 32:75-90. (http://www.ncbi.nlm.nih.gov/pubmed/16504822)

Krueger, J. G. The immunologic basis for the treatment of psoriasis with new biologic agents. J. Am. Acad. Dermatol. 2002; 46:1-23. (http://ard.bmj.com/content/64/suppl_2/ii30.full)

Pizzorno JE, Murray MT. Textbook of Natural Medicine. 3rd ed. St. Louis, MO: Churchill Livingstone; 2006. p.2080. (http://www.readerviews.com/ReviewPizzornoTextbookNaturalMedicine.html)

Lew W, Lee E and Krueger J G. Psoriasis genomics: analysis of proinflammatory (type 1) gene expression in large plaque (Western) and small plaque (Asian) psoriasis vulgaris. Br. J. Dermatol. 2004; 150:668-676. (http://www.ncbi.nlm.nih.gov/pubmed/15099362)

Elder J T, et al. The genetics of psoriasis. Arch. Dermatol. 1994; 130: 216-224. (http://www.ncbi.nlm.nih.gov/pubmed/8304761)

Tiilikainen A, Lassus A, Karvonen J, Vartiainen P and Julin M. Psoriasis and HLA-Cw6. Br. J. Dermatol. 1980; 102:179-184. (http://www.ncbi.nlm.nih.gov/pubmed/7387872)

Nestle FO and Nickoloff BJ. From classical mouse models of psoriasis to a spontaneous xenograft model featuring use of AGR mice. Ernst Schering Res. Found. Workshop. 2005. p. 203–212 (http://www.ncbi.nlm.nih.gov/pubmed/15526944?dopt=Abstract)

Morar N, Willis-Owen SA, Maurer T, Bunker CB. HIV-associated psoriasis: pathogenesis, clinical features, and management. Lancet Infect Dis. 2010; 10:470-478. (http://www.ncbi.nlm.nih.gov/pubmed/20610329)

Obuch ML, Maurer TA, Becker B, Berger TG. Psoriasis and human immunodeficiency virus infection. J Am Acad Dermatol. 1992; 27:667-673. (http://www.ncbi.nlm.nih.gov/pubmed/1430384)

Sadick NS, McNutt NS, Kaplan MH. Papulosquamous dermatoses of AIDS. J Am Acad Dermatol. 1990; 22:1270-1277. (http://www.ncbi.nlm.nih.gov/pubmed/2141868)

Fife DJ, Waller JM, Jeffes EW, Koo JY. Unraveling the paradoxes of HIV associated psoriasis: a review of T-cell subsets and cytokine profiles. Dermatol Online J. 2007; 13: 4. (http://www.ncbi.nlm.nih.gov/pubmed/17498423)

Roederer M, Dubs JG, Anderson MT, Raju PA, Herzenberg LA. CD8 naive T cell counts decrease progressively in HIV-infected adults. J Clin Invest. 1995; 95:2061-2066. (http://www.ncbi.nlm.nih.gov/pubmed/7738173)

Torres BA, Johnson HM. Identification of an HIV-1 Nef peptide that binds to HLA class II antigens. Biochem Biophys Res Commun. 1994; 200:1059-1065. (http://www.ncbi.nlm.nih.gov/pubmed/8179582)

Mueller W and Herrmann B. Cyclosporin A for psoriasis. N Engl J Med. 1979; 301(10):555. (http://www.ncbi.nlm.nih.gov/pubmed/460314)

Aruffo A and Hollenbaugh D. Therapeutic intervention with inhibitors of co-stimulatory pathways in autoimmune disease. Curr Opin Immunol. 2001; 13(6):683-686. (http://www.ncbi.nlm.nih.gov/pubmed/11677090)

Eedy DJ, et al. Clearance of severe psoriasis after allogenic bone marrow transplantation. Bmj. 1990; 300(6729):908. (http://www.ncbi.nlm.nih.gov/pubmed/2337714)

Gardembas-Pain M, et al. Psoriasis after allogeneic bone marrow transplantation. Arch Dermatol. 1990; 126 suppl 11:1523. (http://www.ncbi.nlm.nih.gov/pubmed/2241215)

Lew W, Bowcock AM, Krueger JG. Psoriasis vulgaris: cutaneous lymphoid tissue supports T-cell activation and "Type 1" inflammatory gene expression. Trends Immunol. 2004; 25 suppl 6:295-305. (http://www.ncbi.nlm.nih.gov/pubmed/15145319)

Nestle FO, et al. Plasmacytoid predendritic cells initiate psoriasis through interferon-alpha production. J Exp Med. 2005; 202(1):135-143. (http://www.ncbi.nlm.nih.gov/pubmed/15998792)

Krueger JG and Bowcock A. Psoriasis pathophysiology: current concepts of pathogenesis. Ann Rheum Dis. 2005;64 Suppl 2:ii 30-36. (http://www.ncbi.nlm.nih.gov/pubmed/15708932)

Basko-Plluska JL, Petronic-Rosic V. Psoriasis: epidemiology, natural history, and differential diagnosis. Department of Medicine, secton of Dermatology, University of Chicago, IL, USA. Dove medical press Ltd. 2012; 2:67-76. (http://www.dovepress.com/psoriasis-epidemiology-natural-history-and-differential-diagnosis-peer-reviewed-article-PTT)

Perez A, Chen TC, Turner A, et al. Efficacy and safety of topical calcitriol (1, 25 dihydroxyvitamin D3) for the treatment of psoriasis. Br J Dermatol. 1996;134(2):238-246. (http://www.ncbi.nlm.nih.gov/pubmed/8746336)

Mason AR, Mason J, Cork M, Dooley G, Edwards G. Topical treatments for chronic plaque psoriasis. Cochrane Database Syst Rev. 2009; 2:CD005028. (http://www.ncbi.nlm.nih.gov/pubmed/19370616)

Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4.Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009; 61(3):451-485. (http://www.ncbi.nlm.nih.gov/pubmed/19493586?dopt=Abstract)

Kalb RE, Strober B, Weinstein G, Lebwohl M. Methotrexate and pso¬riasis: 2009 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol. 2009; 60(5):824-837. (http://www.jaad.org/article/S0190-9622(08)02482-1/fulltext?refuid=S0377-1237(12)00255-9&refissn=0377-1237)

Rosmarin DM, Lebwohl M, Elewski BE, Gottlieb AB. Cyclosporine and psoriasis: 2008 National Psoriasis Foundation Consensus Conference. J Am Acad Dermatol. 2010; 62(5):838-853. (http://www.ncbi.nlm.nih.gov/pubmed/19932926)

Ghoreschi K, Bruck J, Kellerer C, et al. Fumarates improve psoriasis and multiple sclerosis by inducing type II dendritic cells. J Exp Med. 2011; 208(11):2291-2303. (http://www.ncbi.nlm.nih.gov/pubmed/21987655)

Elias PM. Epidermal effects of retinoids: supramolecular observations and clinical implications. J Am Acad Dermatol. 1986; 15(4 Pt 2):797-809. (http://www.ncbi.nlm.nih.gov/pubmed/2430000)

Jeffes EW 3rd, McCullough JL, Pittelkow MR, et al. Methotrexate therapy of psoriasis: differential sensitivity of proliferating lymphoid and epithelial cells to the cytotoxic and growth-inhibitory effects of methotrexate. J Invest Dermatol. 1995; 104(2):183-188. (http://www.ncbi.nlm.nih.gov/pubmed/7829873)

Nijsten T, Margolis DJ, Feldman SR, Rolstad T, Stern RS. Traditional systemic treatments have not fully met the needs of psoriasis patients: results from a national survey. J Am Acad Dermatol. 2005; 52(3 Pt 1):434-444. (http://www.ncbi.nlm.nih.gov/pubmed/15761421)

Major EO. Progressive multifocal leukoencephalopathy in patients on immunomodulatory therapies. Annu Rev Med. 2010; 61:35-47.( http://www.annualreviews.org/doi/abs/10.1146/annurev.med.080708.082655?journalCode=med)



How to Cite

BRIJESH G SHIHORA, SHWETA D PATEL, & A PITHAWALA, M. (2013). ‘PSORIASIS’ - AN IMMUNE DISEASE IN THE RESEARCH PIPELINE. Innovare Journal of Medical Sciences, 1(1), 1–6. Retrieved from https://journals.innovareacademics.in/index.php/ijms/article/view/28