PSORIASIS AS AN IMMUNE-MEDIATED SYSTEMIC DISEASE: INTEGRATION OF MULTI-OMICS, SKIN-GUT AXIS (MICROBIOME), AND REAL-WORLD EVIDENCE FOR RISK STRATIFICATION

Abstract

Introduction: Psoriasis had been understood as an isolated dermatosis, but accumulated evidence from immunological, genetic, and clinical studies has demonstrated that it is a systemic immune-mediated disease characterized by widespread chronic inflammation. Objective: To synthesize recent data to understand how the integration of multi-omics, the skin-gut axis, and real-world evidence has contributed to stratifying clinical risk in psoriasis as a systemic disease. Methodology: The review followed the PRISMA checklist and used the PubMed, SciELO, and Web of Science databases, considering exclusively articles published in the last 10 years. The five descriptors used were "psoriasis," "microbiome," "multi-omics," "systemic inflammation," and "clinical evidence." Inclusion criteria encompassed original or review studies, human samples, and analyses related to systemic biomarkers. Exclusion criteria included articles without full text access, studies with exclusively pediatric populations, and research unrelated to the topic of systemic immunoinflammatory disease. Results: The analyzed studies showed that multi-omics signatures had allowed the identification of clinical subgroups with an increased risk for psoriatic arthritis and cardiometabolic diseases, especially in adult women. Conclusion: The literature showed that psoriasis operates as a systemic immune-mediated condition in which multi-omics, microbiome, and real-world data have broadened the capacity for risk stratification, favoring more precise interventions and more consistent prognoses.