Psoriasis Treatment
Treatment goals for psoriasis
How important is maintenance of response to patients with psoriasis?
Psoriasis is a chronic systemic inflammatory condition, with long-term systemic maintenance therapy recognised as the preferred method of clinical management. Greater understanding of the inflammatory and immunological pathways involved in psoriasis has led to the development of many targeted psoriasis treatments1–8.
Many people with psoriasis express frustration and dissatisfaction with their treatment because of a failure to achieve their treatment goals and long-term control9
This is especially true for people with moderate-to-severe psoriasis who experience a high impact on quality of life, long absences from work, and require frequent inpatient care9. In cases of high disease activity, continual treatment is the preferred option over switching of therapies9. Data from long-term clinical studies could therefore be a valuable guide for determining treatment goals.
Clinically meaningful goals for psoriasis
Several factors should be taken into account when establishing treatment goals for systemic therapy in people with moderate-to-severe psoriasis, including disease severity, the coexistence of psoriatic arthritis (PsA) or other comorbidities, physical impact, psychological and social well-being, and the risk–benefit ratio of continuous systemic treatment1–8.
A person-centred approach to care requires therapeutic decisions to align with patients’ needs and goals for treatment. In people with moderate-to-severe psoriasis, the desired treatment goals can be wide-ranging and go beyond merely achieving skin clearance10.
An analysis of the German Psoriasis Registry (PsoBest), that aimed to establish important treatment goals for patients receiving systemic treatment, found that, in addition to symptom reduction, patients desired a normal everyday life and treatment that did not constitute an additional burden (N=3,066)10.
Greater clearance also translates to greater patient satisfaction; however, effective treatment of psoriasis may lead to a lower level of disease that can be tolerated11. As a consequence, discontinuation of treatment following an initial success can also lead to a worsening of quality of life11.
How important is maintenance of response to people with psoriasis?
Learn about the importance of maintaining treatment response for improving the social, environmental, and occupational quality of life of patients.
Even small recurrences of psoriasis can have a disproportionately large impact on quality of life in patients with psoriasis12. This may also be true of drug dose reduction following initial treatment success13.
This highlights the importance of avoiding unnecessary switching and recognising patient expectations for long-term control and improved quality of life in order to develop and reach achievable clinical goals. Failure to do so could also be a contributing factor to the lower adherence to treatment in psoriasis compared to other chronic conditions11.
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Inflammatory pathways in psoriasis
Psoriasis is more than a dermatological disorder – it is a chronic, immune-mediated disease, in which genetically susceptible individuals develop cutaneous inflammation and keratinocyte hyperproliferation23,24
Psoriasis is associated with epidermal thickening and keratinocyte hyperproliferation. As a result, the skin becomes inflamed and develops raised plaques with silvery scales, which can cover large areas of the body23,24,25.
Clinical course of psoriasis
The clinical course of psoriasis can be divided into two stages: an initiation phase and a maintenance phase that perpetuates the inflammatory state26. This separation may be helpful when considering treatments that act in the trigger phase and those that block the self-perpetuating cycle of inflammation27.
The histological features of psoriasis include epidermal (keratinocyte) hyperplasia, leukocyte infiltration and an increased number of leaky vessels in the dermis of the skin; lymphoid-like tissues have been identified in psoriatic plaques27
The pathophysiology of psoriasis is summarised in Figure 2.
Figure 2. Psoriasis pathophysiology (Adapted25).
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Systemic treatments for psoriasis
Professor Peter van de Kerkhof (Radboud University Nijmegen Medical Centre, Netherlands) discusses treatment options for localised psoriasis and highlights the importance of contraindications and risk factors when considering systemic treatments for psoriasis.
Systemic treatments for psoriasis
Professor Peter van de Kerkhof (Radboud University Nijmegen Medical Centre, Netherlands) discusses treatment options for localised psoriasis and highlights the importance of contraindications and risk factors when considering systemic treatments for psoriasis.
What should you consider in managing patients with moderately severe psoriasis?
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Effective treatment selection in psoriasis
Effective treatment selection in psoriasis
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Achieving long-term control in moderate-to-severe psoriasis
Listen to expert insights on treatment considerations for long-term control of moderate-to-severe psoriasis.
Achieving long-term control in moderate-to-severe psoriasis
Listen to expert insights on treatment considerations for long-term control of moderate-to-severe psoriasis.
Expert-led assessment of relevant clinical guidance
Free scientific information and eLearning for healthcare professionals only
Including CME accreditation, podcasts, webinars and over 50 Learning Zones
Medthority is ad free, so you can learn without distraction
Expert-led assessment of relevant clinical guidance
Free scientific information and eLearning for healthcare professionals only
Including CME accreditation, podcasts, webinars and over 50 Learning Zones
Medthority is ad free, so you can learn without distraction
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The people-centred care in psoriasis, psoriasis management, psoriasis treatment, key evidence on psoriasis treatments, clinical guidelines and expert opinion content has been developed by EPG Health for Medthority. This content has been developed independently of the sponsor Almirall S.A, who have had no editorial input into the content. EPG Health received educational funding from the sponsor in order to help provide its healthcare professional members with access to the highest quality medical and scientific information, education and associated relevant content.