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Its pathogenesis involves complex interactions among keratinocytes, fibroblasts, T cells, and myeloid cells, where dynamic cytoskeletal and extracellular matrix changes critically mediate intercellular communication. Emerging evidence highlights the pivotal roles of miRNAs and exosomes in coordinating these processes: miRNAs regulate cytoskeletal organization and extracellular matrix composition, while exosomes act as intercellular messengers that deliver miRNA-mediated signals, collectively shaping cell behavior and disease progression. This review synthesizes current knowledge on how miRNA-exosome networks drive cytoskeleton-extracellular matrix crosstalk in psoriasis, emphasizing their implications for cellular communication and tissue remodeling. 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