Causes

The precise causes of psoriasis are unknown. It is generally believed to be due to damage in factors in the immune system, enzymes, and other materials that control skin cell division. This prompts an abnormal immune response, which causes rapid production of immature skin cells and inflammation.

Inflammatory Response and Autoimmunity

The Normal Immune System Response. The inflammatory process is the result of the body's immune response, which fights infection and heals wounds and injuries:

• When an injury or infection occurs, white blood cells are mobilized to rid the body of any foreign invaders, such as bacteria or viruses.
• The masses of blood cells that gather at the injured or infected site produce factors to repair wounds, clot the blood, and fight infections.
• In the process, the surrounding area becomes inflamed (red and swollen), and some healthy tissue is injured.

The Infection Fighters. The primary infection-fighting units are two types of white blood cells: lymphocytes and leukocytes.

Lymphocytes are a type of white blood cell designed to recognize foreign substances (antigens) and launch an offensive or defensive action against them. Lymphocytes include two subtypes known as T cells and B cells:

• B cells produce antibodies, which are designed to attack the antigens. Antibodies can either ride along with a B cell or travel on their own.
• T cells have special receptors attached to their surface that recognize the specific antigen.

A type of T cell called a helper T cell stimulates B cells and other white blood cells to attack a foreign substance. In psoriasis, however, the helper T cell appears to direct the B cells to produce autoantibodies ("self" antibodies), which attack skin cells. In psoriatic arthritis, cells in the joints also come under attack.

In psoriasis, helper T cells also release or stimulate the production of powerful immune factors called cytokines. In small amounts, cytokines are very important for healing. However, the high level of these cytokines that occurs in psoriasis can cause serious damage, including inflammation and injury during the psoriasis disease process.

Genetic Factors

A combination of genes is involved with increasing a person's susceptibility to the conditions leading to psoriasis. However, researchers are still unsure as to exactly how the disease is inherited.

HLA Molecules. The processes leading to all autoimmune diseases involve the human leukocyte antigen (HLA) system. Most immune disorders are associated with problems with this system. However, other genetic and environmental factors are required to actually trigger the disease.

Four key genes (named PSOR 1 - 4) seem to be involved with psoriasis. Seven recently identified DNA variations also may increase the risk of psoriasis. The variations are located in an area that helps the body distinguish its own cells from foreign invaders. These same DNA variations linked to psoriasis and psoriatic arthritis were also associated with four autoimmune diseases: type 1 diabetes, Grave's disease, celiac disease, and rheumatoid arthritis, suggesting that all of these diseases have the same genetic basis.