Psoriasis is a common incurable inflammatory skin disease affecting 2-3% of the European population. Psoriatic skin contains large numbers of immune cells which produce many cytokines, chemokines and inflammatory molecules. The epidermis divides much faster than normal and has a defective outer layer or barrier which under normal circumstances protects from infection and dehydration. Psoriatic skin is characterized by a distinct set of inflammation and epidermal proliferation and differentiation markers, and it has not been clear if the genetic basis of psoriasis is due to defects of the immune system or the skin. One genetic determinant lies within the major histocompatibility complex class 1 region. Genome-wide association studies have revealed genetic susceptibility factors that play a role in the formation of immune cells found in psoriasis lesions. Others affect epidermal proliferation and the formation of the skin's barrier. Hence, genetic components of both the immune system and the epidermis predispose to disease.
Psoriasis: a common inflammatory skin disease with a genetic componentPsoriasis affects 2-3% of the European population, is rarer in individuals of Asian descent (0.1% or less), and exceedingly rare in Africa [1]. Initial outbreaks typically affect individuals in their twenties, but can occur at any age [2]. Psoriasis patients have a natural history of outbreaks (flares) followed by temporary remissions. Environmental factors can trigger or exacerbate flares. These factors include HIV infection [3], use of drugs such as lithium, betablockers, or anti-malarials, and the withdrawal of corticosteroids [4]. As many as 10-30% of psoriasis patients develop an inflammatory arthritis termed psoriatic arthritis which is progressive and leads to destruction of the joints if it is not treated aggressively [5]. Although psoriasis often appears sporadically, with patients having no family history of disease, it is a complex disease which includes a familial component. Having a family member with the disease will increase ones risk of being affected. Siblings of an individual with psoriasis are at a 4-6 fold increased risk of developing psoriasis compared to the general population [1].Psoriasis and psoriatic arthritis are serious, poorly understood, diseases. There are no cures and they require sophisticated medical care and treatments. Moreover, having psoriasis increases the risk of heart disease and stroke [6,7]. Recent developments in genetic analysis have been instrumental in highlighting important biological pathways in disease susceptibility. In the case of psoriasis genetic studies such as these are providing a far better understanding of the fundamental biological pathways leading to disease. It is expected that this in turn will lead to the development of better and specific forms of treatment. Here we review recent genetic * Corresponding author: Bowcock, A.M. (bowcock@genetics.wustl.edu).Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for public...