Clinical stratification of psoriasis phenotypes considering neuroimmune markers and associated psycho-emotional disorders

Introduction. Psoriasis is considered as a systemic immunoinflammatory disease, in the pathogenesis of which the IL-23/IL-17 axis and the interaction of congenital and adaptive immunity play a key role. In recent years, great importance is given to a «skin-brain axis» concept, explaining the relationship between skin manifestations, nervous system and psycho-emotional disorders. In addition to cutaneous symptoms, patients often develop itching, sleep disorders, depression and anxiety disorders, which significantly reduce the quality of life and require new personalized approaches to therapy. Objective. To develop a clinical biological model of the stratification of psoriasis phenotypes taking into account neuroimmune markers and psycho-emotional characteristics, suitable for implementation in clinical practice. Material and methods. A review and analytical synthesis of modern data (PubMed, Embase, 2022—2025), including systematic reviews, cohort studies, works with the use of single-cell transcriptomics and mendelian randomization, were carried out. Based on the analysis, a conceptual model of stratification on the basis of the combination of immunological, neurosensory and psycho-emotional indicators was developed. Results and discussion. The following phenotypes of psoriasis were identified: 1) inflammatory IL-23/IL-17 dominant; 2) neurosensory associated with increased substance P, BDNF, NGF and severe itching; 3) stress reactive characterized by a disturbance of the hypothalamic-pituitary-adrenal axis and exacerbations against stress factors; 4) psychiatrically comorbid associated with depression, anxiety disorders and high risk of suicidal behavior. Each phenotype requires an individualized approach: biological therapy in the IL-23/IL-17 dominant type, symptomatic and behavioral therapy in the neurosensory variant, integration of psychotherapy in stress reactive course and multidisciplinary observation in psychiatrically comorbid patients. The proposed stratification algorithm increases the accuracy of treatment tactics and outcome predictions. Conclusion. Psoriasis is a heterogeneous disease where the skin, immune, and psycho-emotional mechanisms are closely connected. The developed phenotype stratification opens the way to personalized therapy strategies, allowing to increase treatment effectiveness, reduce the frequency of therapeutic failures and improve the quality of life of patients. Further validation of the model in multicenter studies is necessary for its implementation into routine practice.