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Psoriasis is an immune-mediated disease, with various triggering factors, genetic predisposition, and an altered immune response concurring in the development of this disease. The eosinophil is a cell with an important role in various kinds of inflammatory processes. Scarce data are available regarding the role of the eosinophil in psoriasis. This study aims to address the overall relationship between eosinophil-count-derived inflammatory markers and psoriasis severity. There were 366 patients fulfilling the inclusion criteria included in this retrospective study and they were divided based on the body surface area (BSA) scale in mild and moderate-to-severe psoriasis. White blood cell (WBC), neutrophil, lymphocyte, monocyte, and eosinophil count, along with eosinophil-to-monocyte ratio (EMR) and eosinophil-to-neutrophil ratio (ENR) differed significantly between the two study groups. Eosinophil count, EMR, and ENR negatively correlated with disease severity. ENR is the most reliable eosinophil-count-derived marker in assessing psoriasis severity with an AUC of 0.627 and a cut-off value of 0.03. Eosinophil-count-derived inflammatory markers’ usefulness in appreciating disease severity was assessed for the first time in the literature in this study and proved to be reliable for the eosinophil count, EMR, and ENR.

Psoriasis is a chronic immune-mediated disease, linked to local and systemic inflammation and predisposing patients to a higher risk of associated comorbidities. Cytokine levels are not widely available for disease progression monitoring due to high costs. Validated low-cost and reliable markers are needed for assessing disease progression and outcome. This study aims to assess the reliability of blood-count-derived inflammatory markers as disease predictors and to identify prognostic factors for disease severity. Patients fulfilling the inclusion criteria were enrolled in this study. Patients were divided into three study groups according to disease severity measured by the Body Surface Area (BSA) score: mild, moderate, and severe psoriasis. White blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), derived neutrophil-to-lymphocyte ratio (d-NLR), systemic immune index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) positively were correlated with disease severity (p < 0.005). d-NLR, NLR, and SII are independent prognostic factors for mild and moderate psoriasis (p < 0.05). d-NLR is the only independent prognostic factor for all three study groups. Moderate psoriasis is defined by d-NLR values between 1.49 and 2.19. NLR, PLR, d-NLR, MLR, SII, SIRI, and AISI are useful indicators of systemic inflammation and disease severity in psoriasis.