Novel concepts in psoriasis: histopathology and markers related to modern treatment approaches

Abstract

Psoriasis is a chronic autoimmune disease affecting over 2% of the worldwide population. From an anatomopathological point of view, psoriasis is characterized by immune cells infiltration, epidermal hyperproliferation, and abnormal keratinocyte differentiation. Understanding the pathogenesis of psoriasis will allow clinicians to manage this complex disease. Under these conditions, the application of effective treatments requires a thorough knowledge of all the pathogenetic mechanisms that lead to psoriasis. Numerous immunopathological pathways play crucial roles in the development of new therapies, such as biological therapies, which have been a breakthrough in psoriasis’s treatment. Pharmacogenetics is an essential factor in the patient’s response to treatment. One important pathway targeted by modern treatments is the interleukin (IL)-23/T-helper (Th)17 axis. Like IL-17 inhibitors, IL-23 blockers are a very effective therapy for this autoimmune disease. It is considered that micro-ribonucleic acids (microRNAs) are the starting point for any autoimmune disease. Studying certain microRNA (miR) involved in the inflammatory pathway in psoriasis can find direct targets to future treatments that can even be more specific than actual biological therapies. As such, miR-210 has proven to be up-regulated in psoriasis, also leading to the up-regulation of the Th1/Th17 axis. On the other hand, miR-187 was found to be down-regulated, influencing the outcome of psoriasis by increasing the proliferation of IL-6 stimulated keratinocytes and consecutively generating epidermal thickening. In this review, we are aiming to do an up-to-date briefing of psoriasis histopathology and pharmacogenetic factors that are considered for the accurate evaluation of treatment response.

Psoriasis: What Is New in Markers of Disease Severity?

“…The gold standard for the diagnosis is the histopathological examination. Psoriasis is characterised by acanthosis, parakeratosis, microabscesses of Munro in the stratum corneum, elongated rete ridges, elongated dermal papillae, vasodilatation of dermal vessels and a dense inflammatory infiltrate in the dermis (Figure 1) [10]. In recent years, important progress has been achieved in the treatment of psoriasis.…”

Psoriasis: Clinical Features and Its Impact on Quality of Life

“…The most prevalent form is vulgar psoriasis, which accounts for more than 80% of all psoriasis cases [7,8]. In addition to plaque psoriasis, there are other clinical forms, such as flexural or inverse psoriasis, and these are characterized by red scales with a shiny appearance and can occasionally be mistaken for seborrheic dermatitis due to specific localization and often greasy scales [8,9]. General psoriasis, pustular, inverse, and guttate psoriasis are less common forms of psoriasis with erythroderma, a severe condition that can develop from any type of psoriasis [9].…”

“…The epidermal hyperplastic changes are associated with low expression of keratins K1 and K10, which are keratinocyte differentiation markers. There is also loss of the granular cell layer, hyperkeratosis with para-keratosis (retention of nuclei in stratum corneum cells), elongated rete ridges, the presence of micro-pustules of Kogoj and micro-abscesses of Munro as well as dilated vessels in the dermal papillae; however, the keratinocytes in the hair follicle are unaffected [2,8,[10][11][12]. In the dermis, an inflammatory infiltrate composed of lymphocytes, macrophages, mast cells, and neutrophils is observed.…”

Alteraciones anatomopatológicas de la placenta con preeclampsia: una revisión sistemática

“…Sirve como la conexión esencial entre la madre y el feto (16), desempeñando un papel fundamental en el intercambio de nutrientes y gases, así como en la eliminación de productos de desecho derivados del metabolismo, lo que garantiza una alimentación adecuada en el ambiente intrauterino, esencial para el desarrollo, crecimiento y protección del feto (17).…”

“…La certeza metodológica de los estudios observacionales de diseños transversales y estudios casos y controles, fueron evaluados siguiendo las directrices de Rahmani et al 2020. Los autores utilizaron la lista de verificación ¨Fortalecimiento de los informes de estudios observacionales¨ como herramienta de evaluación que consta de 22 ítems (36), relacionados con el contenido de cada una de las secciones del artículo científico: título y resumen (ítem 1), introducción (ítems 2-3), métodos (ítems 4-12), resultados (13)(14)(15)(16)(17), discusión (ítems 18-21) y financiamiento (ítem 22), 18 ítems son comunes para los dos diseños de estudio y cuatro son específicos para cada una de las dos modalidades. Además, se utilizó el artículo Vandenbroucke et al 2009, en el que detalla el significado y el análisis razonado de cada ítem, aportando con ejemplos publicados en la literatura científica de estudios relevantes y la descripción de la literatura metodológica.…”