Targeting the Plasticity of Psoriasis

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Psoriasis affects 1-2% of the population as a common inflammatory condition.
• Severe psoriasis treatment has advanced from systemic small molecules to targeted biologic agents.
• Biologics target cytokines like TNF-α, IL-12, IL-23, and IL-17, offering alternatives to older systemic drugs.

Purpose of the Study:

• To review the evolution of psoriasis treatment, focusing on the shift from systemic small molecules to biologics.
• To highlight the limitations of current biologic therapies, including adverse effects and cost.
• To underscore the relative neglect and potential of small molecule therapies in psoriasis management.

Main Methods:

• Literature review of psoriasis treatment modalities.
• Analysis of systemic and topical treatments, including small molecules and biologics.
• Comparison of efficacy, safety profiles, and cost-effectiveness of different treatment classes.

Main Results:

• Biologics targeting specific cytokines have shown significant efficacy in severe psoriasis.
• Biologic therapies carry risks of systemic infections and cancer, alongside high costs.
• Topical glucocorticoids remain the standard for mild to moderate psoriasis.
• Small molecule therapies have been relatively overlooked despite their potential for topical or systemic use.

Conclusions:

• While biologics represent a major advance for severe psoriasis, their associated risks and expenses necessitate continued research into alternative therapies.
• Small molecules, despite historical limitations against topical glucocorticoids, warrant further investigation for psoriasis treatment, potentially offering a more accessible and safer option.