Understanding therapeutic pathways and comorbidities in psoriasis

Psoriasis is now recognized as an immunologically mediated systemic disease that may be expressed in cutaneous and joint symptoms. Medications that were once thought to control psoriasis by reducing keratinocyte proliferation are now known to act on immunologic pathways. In recent years, the emerging understanding of immunologic pathways in psoriasis has resulted in the use of biologic medications (eg, inhibitors of tumor necrosis factor) to treat psoriasis. More recently, other pathophysiologic pathways have been identified that have the potential to expand the therapeutic armamentarium. Other avenues of research within the past decade have demonstrated that a range of health risks and comorbid inflammatory diseases are associated with psoriasis, and they have the potential to increase morbidity and mortality and adversely affect quality of life.