Psoriasis is an immune-mediated inflammatory skin disease in conjunction with the systemic inflammatory process. It appears to be related to increased risks ofcardiovascular disease events, especially in severe cases. Thehemostatic balance is disrupted due to the prothromboticbias in psoriasis, which might be mainly preserved by platelet hyperactivity. Platelets are also immune cells that initiateand regulate immune and inflammatory processes, exceptas the principal mediator of hemostasis and thrombosis, andplatelet dysfunction is deeply involved in the pathogenesisof psoriasis.

The abnormal immune system in psoriasis may lead to the release of various inflammatory mediators to induce concomitant platelet activation, and in turn platelet activation could further aggravate the inflammatory response, thus triggering a vicious circle to worsen the condition. Much more systematic research that could identify how psoriasis interacts with platelet dysfunction will be extremely important.

Platelet activation indexes as described above generally suggest abnormal platelet function and are given an additional role in the diagnosis of psoriasis. Taking into account the diverse effects of biological markers, their combination could help to predict psoriasis severity and characterize the subgroup of patients who are at high risk to develop long-term vascular complications. Furthermore, these biomarkers could also be used to monitor the effect of antipsoriatic therapeutic strategies. Of note, they could be readily measured and are widely available in clinical practice.

Antipsoriasis treatment needs to be improved in order to decrease the incidence of complications. Whether existing drugs could fight platelet activation will have to attract more attention. Despite the notably increased risk of cardiovascular diseases, there are currently no antiplatelet guidelines for primary prevention in psoriasis patients. The significance of antipsoriasis drugs in combination with antiplatelet medications for reducing both psoriasis activity and the occurrence of comorbidities is worthy of further investigation. Further clinical trials are still required to explore an integrated treatment of psoriasis.

Source: Dermatology 2021;237:56–65