About this Series

Increased understanding of plaque psoriasis as an immune-mediated chronic skin disease has propelled the development of biologic therapies, and there are more than a dozen currently approved for use in psoriasis.

For patients with moderate to severe psoriasis, these systemic drugs cannot only reduce but clear the raised, scaly patches that are the hallmark of the condition. These agents work by targeting specific inflammatory cytokines along the immune pathway that underlies psoriasis, including interleukin (IL)-17, IL-23, IL-12/IL-23, and TNF-alpha.

Biologic selection and response are highly individualized. Dermatologists work closely with eligible patients to choose an appropriate biologic and, when necessary, switch therapies to improve outcomes. Shared decision-making accompanies an empathetic approach to psoriasis patients, who report a significant psychological burden from this lifelong disease.

Greater knowledge about the pathogenesis of psoriasis has brought greater awareness of comorbidities that are associated with psoriasis (most likely because of a shared inflammatory milieu). Obesity and cardiometabolic disease have a significant prevalence among psoriasis patients. Depression is also prevalent. The combination of these conditions often results in a vicious cycle of compensatory unhealthy habits. Thus, treating psoriasis demands a holistic approach that includes pharmacologic therapy, counseling or psychotherapy, stress relief, lifestyle intervention, and weight loss strategies.

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