Exosomes in Psoriasis: From Pathogenic Mechanisms to Therapeutic Innovations.

Psoriasis is a chronic recurrent inflammatory disease driven by keratinocytes and immune cells. Exosomes, as key mediators of intercellular communication, play multidimensional roles in this disease. In terms of pathogenic mechanisms, exosomes released from psoriatic lesions carry non‑coding RNAs and proteins that program T‑cell polarization, drive M1 macrophage activation, and amplify keratinocyte inflammation, thereby sustaining the IL‑23/Th17 immune axis. Translational breakthroughs have repurposed these same vesicles into diagnostic and therapeutic tools. Circulating exosomal fingerprints offer non‑invasive biomarkers for disease activity and psoriatic arthritis differentiation. Leveraging their biocompatibility and low immunogenicity, exosomes from mesenchymal stem cells, plants, and microbes serve as cell‑free platforms achieving immune regulation, antioxidant effects, and microecological repair. Engineering strategies-including cargo loading, membrane surface modification and intelligent microneedle delivery systems-further enhance targeting and efficacy. Despite these advances, clinical translation faces fundamental challenges: lack of production standardization, undefined core active components and insufficient high‑level clinical evidence. Future efforts should prioritize international standards, rational design, and rigorous trials to accelerate exosome‑based precision medicine for psoriasis.