Etiology

  • Autoimmune

  • Genetic predisposition (HLA-Cw6)

  • Triggered by infections, stress, trauma (Koebner phenomenon), drugs (β-blockers, lithium)

Pathogenesis

  • Hyperproliferation of keratinocytes driven by T-cell–mediated inflammation

  • Shortened epidermal turnover → thickened plaques

Clinical Features

  • Well-demarcated erythematous plaques with silvery scales

  • Extensor surfaces, scalp

  • Auspitz sign (pinpoint bleeding)

  • Nail pitting

  • Possible psoriatic arthritis

Treatment

  • Topical steroids, vitamin D analogs

  • Phototherapy (NB-UVB)

  • Systemic therapy: methotrexate, cyclosporine, biologics (TNF-α, IL-17, IL-23 inhibitors)