Psoriasis The Last Decade

Psoriasis is an infuriating disease. It is an arrogantly trivial disorder placqued on to a systemically unimportant organ. Yet it affects 1-2% of the population,62 some of whom are so badly afflicted that life is reduced to a biological chore. This is the frustration: the psoriatic without his spots is totally fit. So that, in terms of personal happiness and social usefulness, research into psoriasis has more to achieve than many of the spectacular endeavours of contemporary medical science. All of us in dermatology have been heartened in recent years by the beginnings of a real attempt to understand this disease. In this review I do not intend to cover all of the many recent findings; I propose to indicate the more important factual developments which have occurred in the last decade, and certain general concepts and future lines of research which the present suggests. What sort of disease is psoriasis ? All the recent work takes us back again and again to the skin itself. There is absolutely no evidence that psoriasis is an epiphenomenon of a systemic disorder (in particular, the "idea" that psoriasis has a significant psychosomatic component scarcely merits these 15 words). Nor indeed is there convincing evidence that the psoriatic process affects organs other than the skin. There is an associated arthropathy-a "seronegative" rheumatoid type of arthritis with certain territorial predilections-but this is not psoriasis of the joints. Again, there are certain systemic and metabolic disturbances in patients with psoriasis, but these are a consequence of the rash; they are not psoriasis of inner organs. Psoriasis remains therefore a disease of the skin itself* and with this now reasonably well established we can return to the question of what sort of disease it is.