So now, I will proceed to pathophysiology of psoriasis.

 
 
So there are several risk factor but mainly psoriasis due to some genetic factor and 
combination of environmental factor such as stress which trigger the flares. 
 
So with psoriasis, there is due to autoimmune disease where there is defect in T cell 
regulatory system where the person immune system , T cell mistakenly attack the skin 
cells which trigger ongoing inflammatory cascade inside the dermis. This resulting in 
dilation of blood vessels that in turns lead to more and more recruitment of inflammatory 
cells such as macrophages , dendritic cells. This inflammatory cells will migrate to 
epidermis and lead to stimulation and favour more keratinocyte proliferation where in 
turns lead to overabundance keratinocyte that resulting in the epidermal thickening where 
the skin become thickened and looked like a plaque.  
 
Moreover , with this overabundance keratinocyte also lead to rapid turnover of stratum 
corneum.  
This means that the skin cells multiply faster which instead of 28 days cycle , , now it 
become shortened 6-7 days for skin turnover. Hence, Due to the shortened turnover skin 
cycle, make the skin cell don't mature enough which made the appearance of flaky and 
silvery scales.