The causes of psoriasis are not well understood. There may be multifactorial causes of the disease. Currently there are two hypotheses that are well accepted as the cause of psoriasis, namely genetical cause and immunological cause. The genetical cause of psoriasis hypothesis explains the disease as a fault of epidermis (the outermost dead epithelial cell layer) and keratinocytes (the cells which produce keratin and essential ingredient protein of skin cells). Due to genetic fault in epidermis and keratinocytes there is excessive growth and reproduction of skin cells and as a result the skin cell turnover occurs much faster than normal of approximately 28 days, i.e. less than 28 days e.g. 25 days or lesser.

The second hypothesis of cause of psoriasis sees the disease as an immune mediated disease, which results in excess production of skin cells. The T-cells of immune system become active and migrate to dermis which triggers release inflammatory mediators and there is excess production of skin cells.

Immune mediated cause of psoriasis:

This hypothesis is supported by the fact that use of immunosuppressant medications (such as methotraxate) can clear the plaques of psoriasis. But the role of immune system in causation of psoriasis is not well understood. There are contradictory reports on the role of immune system in psoriasis. For example medications which reduce T-cell count can cause improvement of psoriasis, whereas advanced HIV (Human Immunodeficiency virus) infection (which reduces the number of T-cells) may result in psoriasis.

Psoriasis pathogenesis is not well understood. Majority of psoriasis patients experience remissions/exacerbations of the disease for apparently not reason. Certain factors can trigger psoriasis, such as streptococcal infection, skin injury, mental stress, climate change etc. Certain medications also reported to exacerbate psoriasis such as anti malarial drugs, beta blockers, lithium (used sometimes in epilepsy) etc.

Genetical factors in causation of psoriasis:

The genetic component of the disease is very important and there are several genes which are associated with psoriasis. Most likely the various genes work in association with immunological factors to cause the disease.

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