Jun 12, 2026 · 29 min · 10 segments
In this episode of the DIGA Podcast, we continue our *Dermatology Crash Course* mini series with a high-yield discussion on Psoriasis led by Dr. Nikki Trupiano. We hope you enjoy! About the…
Nikki TrupianoGuest
George PapadeusHost
I think sometimes it can be helpful to start a little bit with thinking about the epidemiology and then go a little bit more into the pathophysiology just to think about how common it is.
But psoriasis is actually present in 2% of the world's population, and in the United States, the prevalence is closer to 4% to 5%.
The majority of cases are mild, but most have nail changes, and about 20% to 30% will get psoriatic arthritis.
In one study, 90% of patients with early onset psoriasis showed expression of this gene, as opposed to 50% in late onset psoriasis patients, and only 7% of a control population showed Because of this distinction, some people have proposed a type 1 and type 2 psoriasis, differentiating between gene association and age of onset.
There are also some other HLA associations to be aware of, but I think those are more advanced than what we have time for.
But I think the real thing when thinking about the pathophysiology is thinking about triggers of psoriasis.
So we can see the Kevner phenomenon, which is, you know, if you have friction from a watch or a sunburn and then they get psoriasis, it's usually a site of injury in which there's a two to six week lag time from the injury to the flare, right? And in some of these other triggers, we, you know, talked about genetic predisposition and then the Kevner phenomenon, but we also have a few more.
There's also a lot of systemic triggers, including infections, strep pharyngitis is usually number one, HIV, hypocalcemia and pustular psoriasis and pregnancy.
There's also a variety of drugs, including lithium, beta blockers, TNF inhibitors, which can lead to paradoxical psoriasis and steroid tapers.
And then smoking, alcohol use, and obesity have all been associated with psoriasis.
And it's more thought that smoking and alcohol are triggers while obesity can be a consequence in some studies.
But overall, it impacts a wide variety of patients and is something that you'll commonly see in dermatology clinic.
I think sometimes it can be helpful to start a little bit with thinking about the epidemiology and then go a little bit more into the pathophysiology just to think about how common it is.
But psoriasis is actually present in 2% of the world's population, and in the United States, the prevalence is closer to 4% to 5%.
The majority of cases are mild, but most have nail changes, and about 20% to 30% will get psoriatic arthritis.
In one study, 90% of patients with early onset psoriasis showed expression of this gene, as opposed to 50% in late onset psoriasis patients, and only 7% of a control population showed Because of this distinction, some people have proposed a type 1 and type 2 psoriasis, differentiating between gene association and age of onset.
There are also some other HLA associations to be aware of, but I think those are more advanced than what we have time for.
But I think the real thing when thinking about the pathophysiology is thinking about triggers of psoriasis.
So we can see the Kevner phenomenon, which is, you know, if you have friction from a watch or a sunburn and then they get psoriasis, it's usually a site of injury in which there's a two to six week lag time from the injury to the flare, right? And in some of these other triggers, we, you know, talked about genetic predisposition and then the Kevner phenomenon, but we also have a few more.
There's also a lot of systemic triggers, including infections, strep pharyngitis is usually number one, HIV, hypocalcemia and pustular psoriasis and pregnancy.
There's also a variety of drugs, including lithium, beta blockers, TNF inhibitors, which can lead to paradoxical psoriasis and steroid tapers.
And then smoking, alcohol use, and obesity have all been associated with psoriasis.
And it's more thought that smoking and alcohol are triggers while obesity can be a consequence in some studies.
But overall, it impacts a wide variety of patients and is something that you'll commonly see in dermatology clinic.
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