This section of The Psoriasis Academy covers the inflammatory pathways involved in disease initiation and progression. Within the treatment section we also review the established systemic and biologic treatments available for psoriasis, considering their different modes of action, the available clinical data and their place in the therapeutic pathway according to guidelines.
Psoriasis is associated with epidermal thickening and keratinocyte hyperproliferation. As a result, the skin becomes inflamed and has raised plaques with silvery scales, which can cover large areas of the body (Nestle et al., 2009; Boehncke & Schön, 2015; Palfreeman et al., 2013).
For patients with milder disease, first-line psoriasis treatment often involves topical therapies including corticosteroids, vitamin D3 analogues, and combination products. However, patients with moderate to severe and refractory symptoms may be candidates for systemic therapy (Kim et al., 2017).
In a survey conducted in the United States, Canada, France, Germany, Italy, Spain, and the United Kingdom, dermatologists reported that among patients with moderate to severe psoriasis, approximately 75% of patients were receiving topical therapy, 20% of patients were receiving conventional oral therapy and 20% of patients were receiving biologics (Feldman et al., 2016a).
Psoriasis-related publications have grown substantially since 1960 and recent discoveries have paved the way for future research. Although research topics have expanded and diversified, the goal of research has remained to better understand psoriasis and its treatment to benefit patients living with the disease (Sako, 2016).
The ever-changing psoriasis therapeutic landscape makes it particularly important to not only acknowledge the efficacy and safety of treatments in clinical trials, but also to consider results from long-term registry-based observational studies (Altenburg et al., 2018).
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