Psoriasis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Psoriatic lesions are red, inflamed, silvery-white scaly, and circumscribed papules and plaques; often affecting elbows, knees, extensor limbs, and scalp, and, less commonly, nails, ear, and umbilical region.
Psoriasis is a multifactorial disease with a genetic basis. Exacerbations of disease may be related to infection, alcohol, medications, stress, and intercurrent illness.
Diagnosis is usually clinical.
Mild or limited psoriasis is treated with topical corticosteroids and/or vitamin D analogs.
Moderate to severe and/or extensive psoriasis may require phototherapy, and systemic agents such as methotrexate, cyclosporine, acitretin, or biologic agents.

Plaque psoriasis on legs

From the collection of Professor Tsu-Yi Chuang, MD, MPH, FAAD; used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Smith CH, Yiu ZZN, Bale T, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update. Br J Dermatol. 2020 Oct;183(4):628-37.[Abstract][Full Text]
Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology - National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019 Sep;81(3):775-804.[Abstract][Full Text]
Menter A, Gelfand JM, Connor C, et al. Joint American Academy of Dermatology - National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020 Jun;82(6):1445-86.[Abstract][Full Text]
National Institute for Health and Care Excellence. Psoriasis: assessment and management. September 2017 [internet publication].[Abstract][Full Text]

Other Online Resources

National Psoriasis Foundation
Psoriasis Association (UK)

Referenced Articles

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28. Arakawa A, Siewert K, Stöhr J, et al. Melanocyte antigen triggers autoimmunity in human psoriasis. J Exp Med. 2015 Dec 14;212(13):2203-12.[Abstract]
29. Boyd AS, Neldner KH. The isomorphic response of Koebner. Int J Dermatol. 1990 Jul-Aug;29(6):401-10.[Abstract]
30. Song G, Yoon HY, Yee J, et al. Antihypertensive drug use and psoriasis: a systematic review, meta- and network meta-analysis. Br J Clin Pharmacol. 2021 Oct 5 [Epub ahead of print].[Abstract]
31. Armstrong AW. Psoriasis provoked or exacerbated by medications: identifying culprit drugs. JAMA Dermatol. 2014 Sep;150(9):963.[Abstract]
32. Wu S, Han J, Li WQ, et al. Hypertension, antihypertensive medication use, and risk of psoriasis. JAMA Dermatol. 2014 Sep;150(9):957-63.[Abstract][Full Text]
33. Russo PA, Ilchef R, Cooper AJ. Psychiatric morbidity in psoriasis: a review. Australas J Dermatol. 2004 Aug;45(3):155-9.[Abstract]
34. Naldi L, Chatenoud L, Linder D, et al. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol.2005 Jul;125(1):61-7.[Abstract]
35. Armstrong AW, Harskamp CT, Dhillon JS, et al. Psoriasis and smoking: a systematic review and meta-analysis. Br J Dermatol. 2014 Feb;170(2):304-14.[Abstract]
36. Richer V, Roubille C, Fleming P, et al. Psoriasis and smoking: a systematic literature review and meta-analysis with qualitative analysis of effect of smoking on psoriasis severity. J Cutan Med Surg. 2016 May;20(3):221-7.[Abstract]
37. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014 Mar;70(3):512-6.[Abstract]
38. Zhu KJ, Zhu CY, Fan YM. Alcohol consumption and psoriatic risk: a meta-analysis of case-control studies. J Dermatol. 2012 Sep;39(9):770-3.[Abstract]
39. Brenaut E, Horreau C, Pouplard C, et al. Alcohol consumption and psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol. 2013 Aug;27 (Suppl 3):30-5.[Abstract][Full Text]
40. Cassano N, Vestita M, Apruzzi D, et al. Alcohol, psoriasis, liver disease, and anti-psoriasis drugs. Int J Dermatol. 2011 Nov;50(11):1323-31.[Abstract]
41. Parisi R, Webb RT, Carr MJ, et al. Alcohol-related mortality in patients with psoriasis: a population-based cohort study. JAMA Dermatol. 2017 Dec 1;153(12):1256-62.[Abstract][Full Text]
42. Mahil SK, McSweeney SM, Kloczko E, et al. Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A critically appraised topic. Br J Dermatol. 2019 Nov;181(5):946-53.[Abstract]
43. Budu-Aggrey A, Brumpton B, Tyrrell J, et al. Evidence of a causal relationship between body mass index and psoriasis: A mendelian randomization study. PLoS Med. 2019 Jan;16(1):e1002739.[Abstract][Full Text]
44. Aune D, Snekvik I, Schlesinger S, et al. Body mass index, abdominal fatness, weight gain and the risk of psoriasis: a systematic review and dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2018 Dec;33(12):1163-78.[Abstract][Full Text]
45. Snekvik I, Nilsen TIL, Romundstad PR, et al. Metabolic syndrome and risk of incident psoriasis: prospective data from the HUNT Study, Norway. Br J Dermatol. 2019 Jan;180(1):94-9.[Abstract]
46. Davidovici BB, Sattar N, Prinz J, et al. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. J Invest Dermatol. 2010 Jul;130(7):1785-96.[Abstract][Full Text]
47. Feldman SR, Krueger GG. Psoriasis assessment tools in clinical trials. Ann Rheum Dis. 2005 Mar;64(suppl 2):ii65-8.[Abstract][Full Text]
48. Cabrera S, Chinniah N, Lock N, et al. Inter-observer reliability of the PASI in a clinical setting. Australas J Dermatol. 2015 May;56(2):100-2.[Abstract]
49. Tillett W, Orbai AM, Ogdie A, et al. GRAPPA-OMERACT initiative to standardise outcomes in psoriatic arthritis clinical trials and longitudinal observational studies. Ann Rheum Dis. 2018 May;77(5):e23.[Abstract]
50. Reich K, Krüger K, Mössner R, et al. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009 May;160(5):1040-7.[Abstract]
51. Strober B, Ryan C, van de Kerkhof P, et al. Recategorization of psoriasis severity: Delphi consensus from the International Psoriasis Council. J Am Acad Dermatol. 2020 Jan;82(1):117-22.[Abstract][Full Text]
52. Bailey JW. Topical treatments for chronic plaque psoriasis. Am Family Physician. 2010 Mar 1;81(5):596.[Abstract][Full Text]
53. Chiricozzi A, Pimpinelli N, Ricceri F, et al. Treatment of psoriasis with topical agents: recommendations from a Tuscany consensus. Dermatol Ther. 2017 Nov;30(6).[Abstract]
54. Schlager JG, Rosumeck S, Werner RN, et al. Topical treatments for scalp psoriasis. Cochrane Database Syst Rev. 2016 Feb 26;(2):CD009687.[Abstract][Full Text]
55. Samarasekera EJ, Sawyer L, Wonderling D, et al. Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses. Br J Dermatol. 2013 May;168(5):954-67.[Abstract][Full Text]
56. Mason AR, Mason J, Cork M, et al. Topical treatments for chronic plaque psoriasis. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD005028.[Abstract][Full Text]
57. Devaux S, Castela A, Archier E, et al. Topical vitamin D analogues alone or in association with topical steroids for psoriasis: a systematic review. J Eur Acad Dermatol Venereol. 2012 May;26 (Suppl 3):52-60.[Abstract]
58. Lebwohl M. A clinician's paradigm in the treatment of psoriasis. J Am Acad Dermatol.2005 Jul;53(1 suppl 1):S59-69.[Abstract]
59. van de Kerkhof P, de Peuter R, Ryttov J, et al. Mixed treatment comparison of a two-compound formulation (TCF) product containing calcipotriol and betamethasone dipropionate with other topical treatments in psoriasis vulgaris. Curr Med Res Opin. 2011 Jan;27(1):225-38.[Abstract]
60. Bottomley JM, Taylor RS, Ryttov J, et al. The effectiveness of two-compound formulation calcipotriol and betamethasone dipropionate gel in the treatment of moderately severe scalp psoriasis: a systematic review of direct and indirect evidence. Curr Med Res Opin. 2011 Jan;27(1):251-68.[Abstract]
61. Guenther L, Lynde C, Poulin Y. Off-label use of topical calcineurin inhibitors in dermatologic disorders. J Cutan Med Surg. 2019 Sep/Oct;23(4 Suppl):27S-34S.[Abstract]
62. Lebwohl M, Freeman AK, Chapman MS, et al. Tacrolimus ointment is effective for facial and intertriginous psoriasis. J Am Acad Dermatol. 2004 Nov;51(5):723-30.[Abstract]
63. Gisondi P, Altomare G, Ayala F, et al. Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2017 May;31(5):774-90.[Abstract][Full Text]
64. Smith CH, Yiu ZZN, Bale T, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update. Br J Dermatol. 2020 Oct;183(4):628-37.[Abstract][Full Text]
65. Lapolla W, Yentzer BA, Bagel J, et al. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. 2011 May;64(5):936-49.[Abstract]
66. Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology - National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019 Sep;81(3):775-804.[Abstract][Full Text]
67. van der Kraaij GE, Balak DMW, Busard CI, et al. Highlights of the updated Dutch evidence- and consensus-based guideline on psoriasis 2017. Br J Dermatol. 2019 Jan;180(1):31-42.[Abstract][Full Text]
68. Prey S, Paul C. Effect of folic or folinic acid supplementation on methotrexate-associated safety and efficacy in inflammatory disease: a systematic review. Br J Dermatol. 2009 Mar;160(3):622-8.[Abstract]
69. Maza A, Montaudie H, Sbidian E, et al. Oral cyclosporin in psoriasis: a systematic review on treatment modalities, risk of kidney toxicity and evidence for use in non-plaque psoriasis. J Euro Acad Dermatol Venereol. 2011;25(suppl 2):19-27.[Abstract]
70. Papp K, Reich K, Leonardi CL, et al. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1). J Am Acad Dermatol. 2015 Jul;73(1):37-49.[Abstract][Full Text]
71. Van Voorhees AS, Stein Gold L, Lebwohl M, et al. Efficacy and safety of apremilast in patients with moderate to severe plaque psoriasis of the scalp: results of a phase 3b, multicenter, randomized, placebo-controlled, double-blind study. J Am Acad Dermatol. 2020 Jul;83(1):96-103.[Abstract][Full Text]
72. Paul C, Cather J, Gooderham M, et al. Efficacy and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in patients with moderate-to-severe plaque psoriasis over 52 weeks: a phase III, randomized controlled trial (ESTEEM 2). Br J Dermatol. 2015 Dec;173(6):1387-99.[Abstract][Full Text]
73. Atwan A, Ingram JR, Abbott R, et al. Oral fumaric acid esters for psoriasis. Cochrane Database Syst Rev. 2015 Aug 10;2015(8):CD010497.[Abstract][Full Text]
74. Nast A, Amelunxen L, Augustin M, et al. S3 guideline for the treatment of psoriasis vulgaris, update: short version part 1 - systemic treatment. J Dtsch Dermatol Ges. 2018 May;16(5):645-69.[Abstract]
75. Menter A, Gelfand JM, Connor C, et al. Joint American Academy of Dermatology - National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020 Jun;82(6):1445-86.[Abstract][Full Text]
76. National Institute for Health and Care Excellence. Dimethyl fumarate for treating relapsing‑remitting multiple sclerosis. August 2014 [internet publication].[Full Text]
77. Griffiths CE, Strober BE, van de Kerkhof P, et al. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med. 2010 Jan 14;362(2):118-28.[Abstract][Full Text]
78. Thaçi D, Blauvelt A, Reich K, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate to severe plaque psoriasis: CLEAR, a randomized controlled trial. J Am Acad Dermatol. 2015 Sep;73(3):400-9.[Abstract][Full Text]
79. Kamata M, Tada Y. Safety of biologics in psoriasis. J Dermatol. 2018 Mar;45(3):279-86.[Abstract]
80. Deodhar A, Mease PJ, McInnes IB, et al. Long-term safety of secukinumab in patients with moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis: integrated pooled clinical trial and post-marketing surveillance data. Arthritis Res Ther. 2019 May 2;21(1):111.[Abstract][Full Text]
81. Menter A, Tyring SK, Gordon K, et al. Adalimumab therapy for moderate to severe psoriasis: a randomized, controlled phase III trial. J Am Acad Dermatol. 2008 Jan;58(1):106-15.[Abstract]
82. Paller AS, Siegfried EC, Langley RG, et al; Etanercept Pediatric Psoriasis Study Group. Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med.2008 Jan 17;358(3):241-51.[Abstract][Full Text]
83. Carrascosa JM, Rebollo F, Gómez S, et al. Effects of etanercept on the patient-perceived results (PROs) in patients with moderate-to-severe plaque psoriasis: systematic review of the literature and meta-analysis. J Dermatolog Treat. 2018 Dec;29(8):806-11.[Abstract]
84. Feldman SR, Gottlieb AB, Bala M, et al. Infliximab improves health-related quality of life in the presence of comorbidities among patients with moderate-to-severe psoriasis. Br J Dermatol. 2008 Sep;159(3):704-10.[Abstract]
85. Saurat JH, Stingl G, Dubertret L, et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br J Dermatol. 2008 Mar;158(3):558-66.[Abstract]
86. Lebwohl M, Blauvelt A, Paul C, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: Results through 48 weeks of a phase 3, multicenter, randomized, double-blind, etanercept- and placebo-controlled study (CIMPACT). J Am Acad Dermatol. 2018 Aug;79(2):266-76.[Abstract][Full Text]
87. Gordon KB, Warren RB, Gottlieb AB, et al. Long-term efficacy of certolizumab pegol for the treatment of plaque psoriasis: 3-year results from two randomized phase III trials (CIMPASI-1 and CIMPASI-2). Br J Dermatol. 2021 Apr;184(4):652-62.[Abstract][Full Text]
88. Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet 2008 May 17;371(9625):1665-74.[Abstract]
89. Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet. 2008 May 17;371(9625):1675-84.[Abstract]
90. Zhu X, Zheng M, Song M, et al. Efficacy and safety of ustekinumab in Chinese patients with moderate to severe plaque-type psoriasis: results from a phase 3 clinical trial (LOTUS). J Drugs Dermatol. 2013 Feb;12(2):166-74.[Abstract]
91. Kimball AB, Papp KA, Wasfi Y, et al. Long-term efficacy of ustekinumab in patients with moderate-to-severe psoriasis treated for up to 5 years in the PHOENIX 1 study. J Eur Acad Dermatol Venereol. 2013 Dec;27(12):1535-45.[Abstract]
92. National Institute for Health and Care Excellence. Guselkumab for treating moderate to severe plaque psoriasis. June 2018 [internet publication].[Full Text]
93. Reich K, Armstrong AW, Foley P, et al. Maintenance of response through up to 4 years of continuous guselkumab treatment of psoriasis in the VOYAGE 2 phase 3 study. Am J Clin Dermatol. 2020 Dec;21(6):881-90.[Abstract]
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96. Langley RG, Elewski BE, Lebwohl MN, et al. Secukinumab in plaque psoriasis - results of two phase 3 trials. Engl J Med. 2014 Jul 24;371(4):326-38.[Abstract][Full Text]
97. Ordenes-Cavieres G, Andino-Navarrete R. Secukinumab for plaque psoriasis. Medwave. 2018 Nov 30;18(7):e7364.[Abstract][Full Text]
98. Torres T, Balato A, Conrad C, et al. Secukinumab drug survival in patients with psoriasis: a multicenter, real-world, retrospective study. J Am Acad Dermatol. 2019 Jul;81(1):273-5.[Abstract][Full Text]
99. Gordon KB, Blauvelt A, Papp KA, et al; UNCOVER-1 Study Group; UNCOVER-2 Study Group; UNCOVER-3 Study Group. Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis. N Engl J Med. 2016 Jul 28;375(4):345-56.[Abstract]
100. Papp KA, Reich K, Paul C, et al. A prospective phase III, randomized, double-blind, placebo-controlled study of brodalumab in patients with moderate-to-severe plaque psoriasis. Br J Dermatol. 2016 Aug;175(2):273-86.[Abstract]
101. Lebwohl M, Strober B, Menter A, et al. Phase 3 studies comparing brodalumab with ustekinumab in psoriasis. N Engl J Med. 2015 Oct;373(14):1318-28.[Abstract]
102. Puig L, Lebwohl M, Bachelez H, et al. Long-term efficacy and safety of brodalumab in the treatment of psoriasis: 120-week results from the randomized, double-blind, placebo- and active comparator-controlled phase 3 AMAGINE-2 trial. J Am Acad Dermatol. 2020 Feb;82(2):352-9.[Abstract][Full Text]
103. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019 Apr;80(4):1029-72.[Abstract][Full Text]
104. Cohen AD, Vender R, Naldi L, et al. Biosimilars for the treatment of patients with psoriasis: a consensus statement from the Biosimilar Working Group of the International Psoriasis Council. JAAD Int. 2020 Nov 23;1(2):224-30.[Abstract][Full Text]
105. García-Beloso N, Altabás-González I, Samartín-Ucha M, et al. Switching between reference adalimumab and biosimilars in chronic immune-mediated inflammatory diseases: a systematic literature review. Br J Clin Pharmacol. 2021 Oct 8 [Epub ahead of print].[Abstract]
106. Chen X, Yang M, Cheng Y, et al. Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Syst Rev. 2013 Oct 23;(10):CD009481.[Abstract][Full Text]
107. Montaudie H, Sbidian E, Paul C, et al. Methotrexate in psoriasis: a systematic review of treatment modalities, incidence, risk factors and monitoring of liver toxicity. J Europ Acad Dermatol Venereol. 2011 May;25(suppl 2):12-8.[Abstract]
108. Paul C, Gallini A, Maza A, et al. Evidence-based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol. 2011 May;25 (Suppl 2):2-11.[Abstract]
109. Elmets CA, Leonardi CL, Davis DMR, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019 Apr;80(4):1073-113.[Abstract][Full Text]
110. National Institute for Health and Care Excellence. Psoriasis: assessment and management. September 2017 [internet publication].[Abstract][Full Text]
111. Shah K, Mellars L, Changolkar A, et al. Real-world burden of comorbidities in US patients with psoriasis. J Am Acad Dermatol. 2017 Aug;77(2):287-92.[Abstract][Full Text]
112. Dowlatshahi EA, Wakkee M, Arends LR, et al. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Invest Dermatol. 2014 Jun;134(6):1542-51.[Abstract][Full Text]
113. Phan K, Onggo J, Charlton O, et al. Relationship between psoriasis and non-alcoholic fatty liver disease: updated systematic review and adjusted meta-analysis. Australas J Dermatol. 2019 Nov;60(4):e352-5.[Abstract]
114. International Psoriasis Council. IPC statement on COVID-19 and psoriasis. September 2020 [internet publication].[Full Text]
115. Gelfand JM, Armstrong AW, Bell S, et al. National Psoriasis Foundation COVID-19 task force guidance for management of psoriatic disease during the pandemic: version 1. J Am Acad Dermatol. 2020 Dec;83(6):1704-16.[Abstract][Full Text]
116. National Institute for Health and Care Excellence. COVID-19 rapid guideline: dermatological conditions treated with drugs affecting the immune response. April 2021 [internet publication].[Full Text]
117. Mahil SK, Dand N, Mason KJ, et al. Factors associated with adverse COVID-19 outcomes in patients with psoriasis-insights from a global registry-based study. J Allergy Clin Immunol. 2021 Jan;147(1):60-71.[Abstract][Full Text]
118. Lebwohl MG, Stein Gold L, Strober B, et al. Phase 3 trials of tapinarof cream for plaque psoriasis. N Engl J Med. 2021 Dec 9;385(24):2219-29.[Abstract][Full Text]
119. Strober B, Stein Gold L, Bissonnette R, et al. One-year safety and efficacy of tapinarof cream for the treatment of plaque psoriasis: results from the PSOARING 3 trial. J Am Acad Dermatol. 2022 Oct;87(4):800-6.[Abstract][Full Text]
120. Papp KA, Menter MA, Abe M, et al. Tofacitinib, an oral Janus kinase inhibitor, for the treatment of chronic plaque psoriasis: results from two randomized, placebo-controlled, phase III trials. Br J Dermatol. 2015 Oct;173(4):949-61.[Abstract][Full Text]
121. Bachelez H, van de Kerkhof PC, Strohal R, et al. Tofacitinib versus etanercept or placebo in moderate-to-severe chronic plaque psoriasis: a phase 3 randomised non-inferiority trial. Lancet. 2015 Aug 8;386(9993):552-61.[Abstract]
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