Decoding psoriasis: pathological mechanisms, evolving treatments, clinical investigations, and future perspectives

This narrative review summarizes current practices and emerging technologies on psoriasis with an emphasis on key genetic and molecular mechanisms that contribute to disease pathogenesis and inform therapeutic development. In particular, genetic associations involving HLA-Cw6, IL-12B, and IL-23R are discussed in the context of immune dysregulation and keratinocyte hyperproliferation. The review aims to contextualize how these mechanistic insights have influenced existing treatments and continue to guide the development of therapeutic strategies.

This review is based on published experimental studies, clinical trials, and authoritative reviews addressing the genetic, molecular, and immunological aspects of psoriasis. The review discusses therapeutic approaches, including topical agents, phototherapy, and traditional regimens such as Goeckerman therapy, alongside systemic agents and biologics targeting TNF-α, IL-17, and IL-23 pathways. Emerging approaches, including molecular therapeutics and nanotechnology driven drug delivery systems are explored as evolving strategies currently under investigation rather than established standards of care.

The reviewed evidence indicates that advances in genetic and molecular understanding have clarified key mechanisms involved in psoriasis pathogenesis. Genetic markers such as HLA-Cw6, IL-12B, and IL-23R highlight the role of immune dysregulation and keratinocyte hyperproliferation, which has guided therapeutic development. Conventional treatments namely topical agents, phototherapy, and traditional regimens such as Goeckerman therapy, remain important, particularly for mild-to-moderate disease and selected patients. Building on these approaches, systemic agents and biologics targeting TNF-α, IL-17, and IL-23 pathways have significantly improved outcomes in moderate-to-severe psoriasis. Current research is now exploring molecular therapeutics and nanotechnology driven drug delivery systems as adjunct strategies to enhance efficacy and reduce systemic toxicity. However, these approaches are still evolving and are not yet established standards of care. Despite ongoing progress, challenges related to long-term safety, accessibility, and sustained disease control remain. Integrating mechanistic insights with evolving therapies and multidisciplinary care will be essential for advancing psoriasis management.