Management of Psoriasis as a Systemic Disease: What Is the Evidence?

N.J. Korman


The British Journal of Dermatology. 2020;182(4):840-848. 

In This Article


Given the breadth of data indicating that psoriasis is a systemic disease and should be managed as such, it seems clear that systemic treatments are needed to optimize patient outcomes. Two goals were set forth to guide practitioners towards effective management of systemic inflammation in psoriasis. Based on the available evidence, the first goal – to prevent damage associated with inflammation and prevent future damage/comorbidities – appears to be attainable for many patients with the use of biological agent therapy early in the course of disease, which targets the appropriate proinflammatory cytokines. The second, loftier, goal – to reverse existing damage/comorbid conditions caused by inflammation – has less evidence supporting its attainability. However, results from several studies in both animals and humans suggest that reversing damage may be more achievable than practitioners currently appreciate. The advancement of research on new biomarkers, which could improve either earlier diagnosis of comorbidities or clinical evaluation of comorbidities, may help practitioners better evaluate patient response to systemic therapies. In order to provide further support for the attainability of these treatment goals, efforts to collect prospective data are underway. Results from these prospective trials are expected to deliver important insights into the role that biological agents may play in treating systemic inflammation associated with psoriasis.