Biological treatment for erythrodermic psoriasis

Area of Science:

• Dermatology
• Immunology

Background:

• Erythrodermic psoriasis (EP) is a severe, potentially life-threatening psoriasis variant affecting most of the body surface area.
• EP is less responsive to conventional therapies, necessitating advanced treatment strategies.

Approach:

• This review examines the pathophysiology of EP.
• It covers current evidence on established and emerging targeted therapies, including anti-TNF-α, IL-12/23, IL-17, and IL-23 inhibitors.

Key Points:

• Newer biologics, particularly IL-17 and IL-23 inhibitors, provide rapidly acting, safe, and effective options for EP.
• Novel agents like bimekizumab, mirikizumab, netakimab, and sonelokimab show potential for EP management.
• Managing patients with prior biologic failure remains a significant challenge.

Conclusions:

• IL-17 and IL-23 inhibitors are considered potential first-line treatments for EP, though long-term data is limited.
• Further research into novel biologics and nanobodies for EP is warranted.
• Existing EP management guidelines require updates to reflect recent therapeutic advancements.