Keratinocytes in psoriasis: Key players in the disease process

Inas Helwa, Meg Gullotto, Wendy B Bollag

Research output: Chapter in Book/Report/Conference proceedingChapter

3 Scopus citations

Abstract

Psoriasis is a common chronic hyperproliferative inflammatory disease that affectsskin, nails and joints. This disorder affects about 1%-3% of the general population andprevalence varies among countries and races. Although psoriasis can occur at any age,two peaks of disease incidence are observed: one between 15 and 30 years and the secondbetween 50 and 60 years. Psoriasis has been described for many years as an autoimmunedisorder; however, due to lack of convincing evidence regarding autoantibodies in thedisease, it has recently been more precisely described as an "immune-mediated disorder".The pathogenesis of psoriasis involves a strong crosstalk between immune cells (mainlyT cells and dendritic cells) and lesional keratinocytes. However, the exact etiologyregarding which cell initiates the disease is still an unresolved issue. The lack of a widelyaccepted animal model is one obstacle towards an exact understanding of the diseasemechanism, although it is known that genetic and environmental factors are involved.Since skin is the primary barrier against environmental insults and keratinocytes aremajor contributors to the innate immune response, there is an evolving hypothesis that thekeratinocyte is a key player and may be, in some cases, the initiator of the disease processrather than simply a bystander in an active T cell-mediated immune response. This evolving hypothesis may provide a new avenue for establishing promising treatmentoptions that have negligible adverse effects. Such treatments are critical since long-termmanagement of psoriasis is required in most cases and a complete cure of the disease israre. Thus, safer treatment options with minimal side effects are in increasing demand.Options that directly target keratinocytes may have fewer adverse effects than the newerbiologic agents that reduce immunity, thereby putting patients at risk of fatal infections aswell as lymphomas. In this chapter, we will discuss types of psoriasis as well as theevidence supporting the developing theory of the keratinocyte being a major player. Wewill also be summarizing possible treatment options including those that may be directlytargeting keratinocytes. Understanding what is known and unknown concerning the exactetiology of the disease may lead to new perspectives and novel insights regardingpotential research directions and treatment options for this chronic and debilitating disorder.

Original languageEnglish (US)
Title of host publicationPsoriasis
Subtitle of host publicationTypes, Triggers and Treatment Strategies
PublisherNova Science Publishers, Inc.
Pages1-54
Number of pages54
ISBN (Print)9781626185845
StatePublished - Mar 1 2013

ASJC Scopus subject areas

  • Medicine(all)

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    Helwa, I., Gullotto, M., & Bollag, W. B. (2013). Keratinocytes in psoriasis: Key players in the disease process. In Psoriasis: Types, Triggers and Treatment Strategies (pp. 1-54). Nova Science Publishers, Inc..