Psoriasis comes with an unknown outlook and increased risk of other health issues. Researchers hope immune cell mapping will help predict disease course and guide treatment.

Psoriasis is an immune-mediated skin disease that affects 0.1–11.4% of people worldwide. In a person with psoriasis, the body produces excess new skin cells. The cells accumulate and form plaques of discolored, rough skin. Symptoms tend to flare up in cycles followed by periods of remission.

There are several phenotypes, including plaque psoriasis and guttate psoriasis. From mild to severe, psoriasis can involve a single plaque of rough skin or cover most of the body. It also raises the risk of developing psoriatic arthritis (PsA) and other related disorders.

“Immune cell neighborhoods” refers to where certain cells are in relation to each other. Knowing where immune cells are and how these neighborhoods change may offer clues about overall health.

This article examines disease progression and comorbidities — and how immune cell mapping may advance psoriasis research.

For a 2023 study, researchers used spatial transcriptomics to analyze skin samples from 14 volunteers. This is a technology that helps measure and map out gene activity in tissue samples.

Researchers compared immune cell distribution in people with active psoriasis, those with psoriasis but no active lesions, and some who do not have psoriasis.

The key findings included:

  • B cells, which likely play a role in psoriasis, move to the upper layers of skin during active disease.
  • Inflammatory areas appear in healthy-looking skin, as well as actively inflamed skin. This shows that inflammation may affect the body in ways that are difficult to identify.
  • Increased gene activity occurs in molecular pathways linked to metabolism and lipids. Both factors are associated with diabetes and heart disease. People with psoriasis develop these conditions more often than people without psoriasis, which points to a possible link.

According to the research team’s findings, mild and severe forms of psoriasis have distinct molecular features. They also found that severe psoriasis may change the cellular and metabolic composition of unaffected skin.

The hope is that future research will provide insights into issues such as:

  • predicting disease progression
  • the differences between mild and severe psoriasis and how to treat them
  • how psoriasis relates to other health issues and how to prevent them

To help advance these goals, the researchers have created maps and data from their study available to other scientists.

“We cannot predict psoriasis course at this time,” Dr. Jessica Kaffenberger told Medical News Today. Kaffenberger is a board certified dermatologist specializing in psoriasis at The Ohio State University Wexner Medical Center.

There is a link between severe disease and increased risk of comorbidities, such as PsA and cardiovascular disease, she explained.

“Immune cell mapping would be very helpful, as it would give patients a better roadmap for disease prognosis,” added Kaffenberger.

A cohort study published in 2021 investigated factors that may play a role in long-term outcomes. Participants included 721 people with recent-onset psoriasis. Findings from a 10-year follow-up include:

  • 48% who had severe plaque psoriasis at onset had severe disease
  • only 14% with mild or moderate disease at onset had severe disease
  • 20% with plaque psoriasis had minimal disease activity without treatment
  • 48% with guttate psoriasis had minimal disease
  • the prevalence of PsA rose from 18% to 26% in people with plaque psoriasis
  • the prevalence of PsA went from 4% to 14% for those with guttate psoriasis

The study also suggests that certain groups may be at higher risk of severe disease or PsA. People with plaque psoriasis, whose symptoms are more than mild, and who have scalp lesions may be almost five times more likely to develop severe psoriasis than those with mild symptoms.

Individuals with peripheral enthesitis (inflammation where ligaments or tendons connect to bones) may be more than four times more likely to have PsA at 10 years than those with no joint pain. The reasons why are not clear.

People who started on systemic therapy before or at the beginning of the study were less likely to have severe disease at 10 years than those who started later. The study authors wrote that they could not determine causality and that more research is necessary.

Psoriasis involves systemic inflammation, which is associated with many other conditions. Recent research suggests that more than half of individuals with psoriasis develop a comorbidity.

About 30% of people with psoriasis develop PsA. Other conditions associated with psoriasis include:

  • anxiety, depression
  • cardiovascular disease, stroke
  • certain cancers
  • dyslipidemia (imbalance of cholesterol and triglycerides)
  • diabetes
  • inflammatory bowel disease, such as Crohn’s disease
  • liver and kidney disease
  • metabolic syndrome (a group of conditions that raise the risk of heart disease, diabetes, stroke, and other serious health problems)
  • obesity
  • uveitis (inflammation inside the eye)

There is no cure for psoriasis. However, systemic treatment may help lower the risk of complications and comorbidities.

Kaffenberger said there are now many “outstanding medications” approved for the treatment of psoriasis.

“Hopefully, in the future genetic analysis will help us in choosing different medications for different people,” she continued.

Psoriasis is more than a skin condition. It is a chronic inflammatory disease with an unpredictable outcome. In addition, a person with psoriasis is at increased risk of developing other serious health conditions. Early systemic therapy may help lower the risks of severe disease and comorbidities.

Immune cells likely play a key role in psoriasis. Scientists are mapping immune cell “neighborhoods” to identify where certain immune cells are in relation to each other. They are also studying how they move when the disease is active.

Research is ongoing. The hope is that it will become easier to predict disease progression and choose the most effective treatments as scientists and doctors continue this course of study.