Cytokine alterations in psoriasis: an updated review

ABSTRACT

Introduction

Psoriasis is a chronic immune-mediated disease affecting 125 million people globally. It is characterized by erythematous plaques in the skin, covered by silvery scales. However, non-cutaneous manifestations (e.g., joint symptoms in psoriatic arthritis) and a high prevalence of other immune-mediated diseases such as inflammatory bowel diseases reflect its systemic nature. So far, research on psoriasis pathogenesis has improved our knowledge of the roles of the immune system, and cytokines play significant roles in immune responses.

Areas Covered

Herein, we review cytokine changes in psoriasis patients. Moreover, we will investigate the possible relationships between disease severity and cytokines alongside describing cytokine alterations in psoriasis patients with other comorbidities. Lastly, we will discuss the biologics and their effects on cytokines in psoriasis patients.

Expert Opinion

Psoriasis could develop various clinical types and clinical manifestations in people. It is an immune-mediated disease, and these manifestations are associated with different impaired cytokines. Imbalanced cytokines could lead to abnormal keratinocytes, neovascularization, and inflammation in psoriasis patients. So, a better understanding of the cytokine roles can help one choose a specific cytokine-targeting biologic to treat psoriasis. Moreover, these cytokines may be used as a severity marker for following up with these patients.

Graphical Abstract

KEYWORDS:

• Psoriasis
• psoriatic arthritis
• cytokines
• inflammation
• biological products

Article highlights

• Psoriasis is a chronic inflammatory disease affecting 125 million people worldwide.

• As skin manifestations are the prominent features of this disease, it used to be categorized as a cutaneous disorder. However, recent data on its systemic inflammatory effects and immune-mediated comorbidities suggest the systemic nature of psoriasis.

• The distribution and differentiation of various cutaneous cells are impaired in psoriasis patients, and these manifestations are associated with disturbed immune cells and cytokines.

• According to a significant number of studies, various families of cytokines are systemically and locally impaired in psoriasis patients. Moreover, some of these studies have introduced using cytokines as biomarkers for severity assessments in these patients.

• Biologic products such as inhibitors of tumor necrosis factor-alpha, interleukin 12/23, interleukin 17, and interleukin 23 have revolutionized the treatment of psoriasis, especially in cases of moderate-to-severe. Moreover, a considerable number of studies have reported the effects of these agents on cytokines other than their primary target.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.