Immunologic mechanisms in psoriasis.

The demonstration of activated T lymphocytes, HLA-DR+ I-CAM 1+, gamma IP-10+ keratinocytes, and increased levels of lymphokines in active plaques suggests that immunologic mechanisms may play a role in the pathogenesis of psoriasis. Epidermal hyperplasia and inflammation in psoriasis may be linked by those cytokines many of which are produced by both keratinocytes and leukocytes. Epidermal acanthosis and keratinocyte mitoses have been observed in delayed-type hypersensitivity reactions and after the intradermal injection of gamma interferon. Gamma interferon and its induced proteins have been demonstrated in active psoriatic plaques. Increased levels of the keratinocyte autocrine cytokines, transforming growth factor (TGF)-alpha and interleukin (IL)-6, have been detected in active plaques. The apparent overexpression of IL-6 in hyperplastic psoriatic tissue may explain features of psoriasis that link keratinocyte proliferation with immune activation and tissue inflammation. Both IL-6 and gamma interferon increased TGF-alpha expression in normal cultured keratinocytes. Cytokines produced during immune activation and other inflammatory processes may lead to epidermal hyperplasia.