## 3 Signs and Symptoms of Psoriasis  
Diagnosis of psoriasis in a population through a definite procedure by noting signs and symptoms is meaningful for determining the method of treatment. Previously, researchers confirmed that the application of the Psoriasis Symptom Inventory (PSI) by patients themselves, along with Static Physician Global Assessment (sPGA) and Body Surface Area (BSA), were meaningful for diagnosing psoriasis and the subsequent choice of treatment. Also, psoriasis symptoms of the median degree were found to actually take a severe form in patients [40]. The authors defined such signs of psoriasis as (1) damage to the distal interpha-langeal joints; (2) axial damage to three joints of one finger; (3) early involvement of the toes; (4) thalalgia; (5) the presence of skin rashes; (6) psoriasis in the family; (7) negative rheumatoid factor; (8) osteolysis; (9) sacroliiitis; and (10) development of paravertebral ossifications. Within this, the symptoms were characterized as asymmetrical damage in the joints; purple-bluish coloration of the skin over the affected joint, pain and swelling of the joints, and early damage to the big toe; mild muscle atrophy near the affected joints, and articular syndrome (swelling, pain on palpation, changes in the nail plates) [41]. Patients with psoriasis may also have the following symptoms, with effects on the quality of life:psychological disorder, past acuteness, alexithymia, anxiety, and depression. It was noted that the use of the questioning method was very useful for defining those symptoms [42]. [PERSON] et al. defined the next most common signs of psoriasis as erythematosus occurrence and the formation of apathetic, flaking plaques of the skin [43]. The risk factors for psoriasis include air pollution, drug intolerance, vaccination, infections, smoking, alcohol consumption, metabolic syndrome, obesity, diabetes, dyslipidemia, hypertension, and mental stress [3]. Also, suffering from psoriasis can lead to the following consequences: systemic inflammation and cardiovascular diseases, metabolic syndrome, hypertension, high lipid levels, liver diseases, diabetes, obesity, deterioration in the quality of life, anxiety, sleep contravention, decrease in cognitive functions, and depression [44; 45; 46]. Genetic factors play a substantial role in the onset and progression of psoriasis. Certain populations have genetic predispositions that make them more susceptible to developing the condition. Previous genome-wide studies identified several major susceptibility loci. Among them, the major histocompatibility complex (MHC) region, particularly class I HLA genes like HLA-C, is strongly associated with psoriasis. The HLA-C*06:02 allele is especially significant, being identified as a primary genetic factor in psoriasis susceptibility across different populations [47]. Genetically predisposed individuals are subject to both external and internal factors that elicit psoriasis initiation and pathogenesis. External risk factors include mechanical damage, individual habits, such as smoking and alcohol consumption, as well as environmental factors like air pollution and sun exposure [48; 49; 50]. Psoriasis patients may suffer from various infections due to their weakened immune system. Accordingly, patients who are administered vaccinations against infections experience further exacerbation of their condition. For instance, studies pointed out the possible association between influenza vaccine and psoriasis onset [51; 52]. Other researchers found that patients developed psoriasis post BCG (Bacillus Calmette-Guerin) vaccine shots [53]. Beyond external triggers, internal factors exacerbate the perpetuation of the condition. For instance, people with other medical conditions, including diabetes mellitus, dyslipidemia, and obesity, are at a higher risk of developing psoriasis [54; 55; 56]. Hypertension and mental stress are other risk factors, and the latter needs to be extensively investigated to further corroborate its relationship with psoriasis progression.