Advancing insights into psoriasis: from pathogenesis to current and emerging therapies

Psoriasis is a chronic, immune-mediated skin disease, with Plaque Psoriasis being its most common form. It is characterized by well-defined red plaques with raised white crusts. While its pathogenesis remains complex, involving keratinocytes, inflammatory cells and both adaptive and innate immunity, studies have highlighted an association with genetic predisposition. However, the absence of disease in subsequent generations suggests that environmental factors, such as sun exposure, also play a role in the pathology. Beyond skin manifestations, Plaque Psoriasis is linked to several comorbidities, and reduced quality of life, thus requiring an effective treatment. The Psoriasis Area and Severity Index and the Dermatology Quality of Life Index are used to assess the degree of the disease and guide therapy selection. Available therapies are suppressive rather than curative and include topical drugs, phototherapy, systemic oral agents and biological drugs. However, current and most widely used treatments present some drawbacks. Considering these disadvantages and combining the fact that more is known about the pathogenesis of the disease, research focuses on optimizing existing treatments and developing new drugs. In the context of innovations in the Psoriasis treatment, this review highlights biological drugs that have recently entered the market, those in the final phase of development, bisomilars and changes to topical formulations, aimed at improving therapeutic efficacy. These advances contribute to more informed treatment choices and sustained clinical outcomes.