What Is Psoriasis?
Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2–3% of the global population. It is characterized by accelerated skin cell turnover — cells that normally shed over 28 days are replaced in as few as 3–5 days — resulting in the buildup of thick, scaly plaques on the skin surface.
At its core, psoriasis is driven by dysregulation of the immune system, particularly involving T-cells and key inflammatory cytokines including TNF-α, IL-17, and IL-23. This understanding has revolutionized treatment, enabling the development of highly targeted biologic therapies that have transformed outcomes for moderate-to-severe patients.
Psoriasis is not contagious. It is a lifelong condition with periods of remission and flare, influenced by triggers such as stress, infection, certain medications, and environmental factors.
Types of Psoriasis
Psoriasis presents in several distinct clinical forms, each requiring individualized management:
- Plaque Psoriasis (Psoriasis Vulgaris) — The most common form, accounting for ~80–90% of cases. Presents as raised, red plaques covered with silvery-white scales, typically on the elbows, knees, scalp, and lower back.
- Guttate Psoriasis — Small, drop-shaped lesions that often appear suddenly, frequently triggered by streptococcal throat infection. More common in children and young adults.
- Pustular Psoriasis — Characterized by white pustules (non-infectious) surrounded by red skin. Can be localized (palms and soles) or generalized, the latter being a medical emergency.
- Erythrodermic Psoriasis — A severe, potentially life-threatening form involving widespread redness and shedding of the skin over most of the body surface. Requires urgent hospitalization.
- Inverse Psoriasis — Smooth, red lesions in skin folds (armpits, groin, under the breasts), without the typical scaling.
- Psoriatic Arthritis — A distinct but related condition affecting up to 30% of psoriasis patients, causing joint inflammation, pain, and potential permanent joint damage if untreated.
Symptoms & Diagnosis
The clinical presentation of psoriasis varies by type and severity. Common features include:
- Red, raised, inflamed patches of skin
- Silvery-white scales (plaques)
- Dry skin that may crack and bleed
- Itching, burning, or soreness
- Thickened, pitted, or ridged nails
- Swollen and stiff joints (in psoriatic arthritis)
Diagnosis is primarily clinical, based on the characteristic appearance and distribution of lesions. In uncertain cases, a skin biopsy may be performed to confirm the diagnosis histologically.
Disease severity is assessed using validated tools including the Psoriasis Area and Severity Index (PASI), the Body Surface Area (BSA) affected, and the Dermatology Life Quality Index (DLQI). These scores guide treatment decisions and are used to monitor response to therapy.
Treatment Options Available in Shanghai
Shanghai's leading tertiary hospitals offer the full spectrum of psoriasis treatments, including the most advanced biologic therapies approved in China.
Topical Therapies
First-line for mild-to-moderate disease:
- Corticosteroids — Reduce inflammation and slow skin cell turnover
- Vitamin D analogues (calcipotriol) — Normalize skin cell growth
- Calcineurin inhibitors (tacrolimus, pimecrolimus) — Preferred for sensitive areas such as the face and skin folds
- Retinoids (tazarotene) — Normalize skin cell differentiation
- Coal tar and salicylic acid — Reduce scaling and inflammation
Phototherapy
Narrowband UVB (NB-UVB) phototherapy is a well-established, effective treatment for moderate psoriasis, available at major Shanghai dermatology centers. PUVA (psoralen + UVA) is used in selected cases.
Conventional Systemic Therapies
For moderate-to-severe disease not controlled by topicals or phototherapy:
- Methotrexate (MTX) — A cornerstone systemic agent; requires regular liver function monitoring
- Cyclosporine — Rapid-acting immunosuppressant; used for short-term control of severe flares
- Acitretin — An oral retinoid particularly effective for pustular and erythrodermic psoriasis
Biologic Therapies — The Modern Standard of Care
Biologic agents represent the most significant advance in psoriasis treatment in the past two decades. These targeted therapies block specific inflammatory pathways and have demonstrated superior efficacy compared to conventional systemic treatments, with PASI 90 and PASI 100 responses now achievable for many patients.
The following biologics are approved and available in China:
- IL-17A Inhibitors: Secukinumab (司库奇尤单抗 / Cosentyx), Ixekizumab (依奇珠单抗 / Taltz) — Rapid onset, highly effective for plaque psoriasis and psoriatic arthritis
- IL-23 Inhibitors: Guselkumab (古塞奇尤单抗 / Tremfya), Risankizumab (瑞莎珠单抗 / Skyrizi) — Durable remission with infrequent dosing
- IL-12/23 Inhibitor: Ustekinumab (乌司奴单抗 / Stelara) — Established long-term safety profile
- TNF-α Inhibitors: Adalimumab (阿达木单抗 / Humira), Etanercept — Effective for both skin and joint disease
Patient selection for biologic therapy is based on disease severity, prior treatment history, comorbidities, and individual patient factors. Shanghai's top dermatologists are experienced in initiating and monitoring biologic therapy, including managing patients who have previously received biologics abroad.
Small Molecule Therapies
- Apremilast (阿普米司特) — An oral PDE4 inhibitor; a convenient option for patients who prefer oral therapy or are not candidates for biologics
- JAK Inhibitors — Emerging oral targeted therapies under evaluation for psoriasis
Psoriatic Arthritis: Don't Miss the Joint Involvement
Up to 30% of psoriasis patients develop psoriatic arthritis (PsA), a seronegative inflammatory arthropathy that can cause irreversible joint damage if not treated promptly. PsA may affect peripheral joints, the spine (axial disease), entheses (tendon and ligament insertion points), and cause dactylitis (sausage digits).
Early recognition is critical. Patients with psoriasis who develop joint pain, morning stiffness lasting more than 30 minutes, or swollen fingers or toes should be evaluated by a rheumatologist in addition to their dermatologist. Several biologic agents — particularly IL-17 inhibitors and TNF-α inhibitors — are approved for both skin and joint manifestations, enabling coordinated treatment.
Shanghai's leading hospitals offer integrated dermatology-rheumatology multidisciplinary teams (MDT) for complex psoriatic disease. For patients with suspected psoriatic arthritis, Dr. Shen Nan (沈南), Director of Rheumatology at Renji Hospital, is among Shanghai's foremost experts in autoimmune and inflammatory joint disease.
Comorbidities Associated with Psoriasis
Psoriasis is increasingly recognized as a systemic inflammatory disease associated with significant comorbidities beyond the skin:
- Cardiovascular disease — Increased risk of myocardial infarction and stroke, particularly in severe psoriasis
- Metabolic syndrome — Obesity, hypertension, dyslipidemia, and type 2 diabetes are more prevalent in psoriasis patients
- Non-alcoholic fatty liver disease (NAFLD)
- Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
- Depression and anxiety — The psychological burden of psoriasis is substantial; quality of life is significantly impacted
Comprehensive psoriasis management in Shanghai's tertiary centers includes screening and management of these comorbidities alongside skin treatment.
Accessing Dermatology Care in Shanghai as an International Patient
Shanghai is home to some of China's most distinguished dermatology departments, staffed by specialists with international training and extensive experience managing complex inflammatory skin diseases including psoriasis.
Key institutions with leading dermatology programs include:
- Huashan Hospital (华山医院), Fudan University — One of China's premier dermatology centers, led by specialists such as Dr. Xu Jinhua (徐金华), Director of Dermatology and a leading expert in autoimmune skin diseases
- Ruijin Hospital (瑞金医院), Shanghai Jiao Tong University — Renowned for autoimmune and inflammatory dermatology, home to Dr. Zheng Jie (郑捷), Director of Dermatology and a nationally recognized authority on psoriasis and autoimmune skin disease
- Renji Hospital (仁济医院), Shanghai Jiao Tong University — Strong dermatology-rheumatology integration for psoriatic arthritis, with experts including Dr. Shen Nan (沈南), Director of Rheumatology, specializing in autoimmune and inflammatory disease
- Changhai Hospital (长海医院), Naval Medical University — Experienced in phototherapy and systemic psoriasis management, with a multidisciplinary team including specialists such as Dr. Lu Qingsheng (陆清声) representing the hospital's broader clinical excellence
For international patients, navigating appointments, medical records translation, and treatment coordination across these institutions can be complex. This is where a dedicated medical concierge service becomes invaluable.
How CMCS Supports Psoriasis Patients in Shanghai
China Medical Concierge Shanghai (CMCS) is a professional health management company — not a hospital — that connects international patients with Shanghai's leading dermatology and rheumatology specialists.
Our services for psoriasis patients include:
- Identifying the most appropriate specialist based on disease type, severity, and prior treatment history
- Priority appointment scheduling at top-tier Shanghai hospitals
- Medical records translation (English, French, German, and other languages)
- Accompaniment and interpretation during consultations
- Coordination of biologic therapy initiation and monitoring
- Ongoing case management for patients requiring long-term follow-up
To discuss your case or arrange a consultation, please contact our Case Manager:
📧 contract@medicalsh.com
💬 WhatsApp: https://wa.me/message/3AM6KAGCW2BAD1
🌐 www.medicalsh.com
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