# Understanding the Intricate Pathophysiology of Psoriasis and Related Skin Disorders
## 4 Sporiasis and Associated Dermatologic Disorders
Adalimumab is a monoclonal antibody that binds to TNF and inhibits the interaction of this cytokine with TNF receptors, thereby interrupting the inflammatory cascade. The dosing regimen of adalimumab indicated for treating psoriasis is half of the recommended dosing regimen for HS [4]. When psoriasis occurs in association with HS, the therapeutic strategy should be chosen in concordance with the disease severity bearing in mind that almost all the biologics approved for the treatment of psoriasis are still off-label for HS due to the absence of randomized controlled trials [12]. Both vitiligo and psoriasis share common underlying mechanisms related to immune system dysfunction. While psoriasis involves the rapid turnover of skin cells leading to thick, scalp patches, vitiligo is characterized by the progressive loss of pigment in certain areas of the skin. Despite their distinct clinical presentations, individuals with psoriasis may have an increased risk of developing vitiligo, and vice versa, suggesting a potential link between their genetic factors and immune system pathways. This connection underscores the complexity of autoimmune skin disorders and the need for careful management when both conditions coexist. In January 2018, [PERSON], [PERSON] and [PERSON]. conducted a search of the MEDLINE and EMBASE electronic databases examining the association between psoriasis and vitiligo. There were 2453 citations identified from the literature search, with a total of 120,866 psoriasis cases and 79,907 vitiligo cases included in this study. There were found significantly increased odds for vitiligo in psoriasis patients (summary OR 2.29, 95% CI 1.56-3.37, studies = 7), as well as significantly elevated odds for psoriasis in vitiligo patients (summary OR 3.43, 95% CI 1.86-6.33, studies = 4). The meta-analysis clearly showed that psoriasis and vitiligo are two intertwined conditions associated with each other [15]. In 2017, [PERSON], [PERSON], and [PERSON] conducted a study that aimed to assess the occurrence of vitiligo in psoriasis patients and vice versa. Their research included 1000 participants, comprising 250 individuals with vitiligo, 250 with psoriasis, and 500 healthy controls. Results showed that the frequency of vitiligo among psoriasis patients was 5 (2%), while among healthy controls, the frequency was 3 (0.6%); the frequency of psoriasis among vitiligo patients was 15 (6%), while among healthy subjects, the frequency was 2 (0.4%). Therefore, a statistically significant difference (\(p\) = 0.001) was observed regarding the occurrence of psoriasis among vitiligo patients. The adjacent relationship between vitiligo and psoriasis was further confirmed by the family history of vitiligo in psoriasis patients and by the family history of psoriasis in vitiligo patients [16]. Chronic spontaneous urtic (CSU) is defined as the appearance of wheels and/or angioedema for six weeks or more. Referred to as both \"chronic urticaria\" and \"chronic idiopathic urticaria\", this debilitating disorder can have a considerable negative effect on a patient's quality of life. Psychological stress significantly impacts skin diseases like psoriasis, atopic dermatitis, acne, and urtica. Stress can worsen these conditions by disrupting immune balance, impairing skin barrier function, and promoting inflammation. The skin's complex immune and neuroendocrine systems are involved in this process. In CSU, stress likely worsens symptoms through complex interactions involving mast cells, neuropeptides, and inflammatory cytokines, with hormonal factors like estrogen and progesterone potentially playing a role. Effective management of stress through psychiatric treatments and stress-reducing strategies is crucial for improving symptoms, highlighting the need for an interdisciplinary approach to treating stress-related skin disorders [17]. Research shows that serum levels of IL-31, a cytokine associated with itch, are elevated in patients with CSU and psoriasis compared to healthy controls.