Of the estimated 4.5 million Americans who suffer from psoriasis, a great many are also at risk for numerous comorbidities that may include an increased frequency of psoriatic arthritis, cardiovascular disease, hypertension, obesity, diabetes, immune-related ailments such as Crohn’s disease, and a 50% increased risk of mortality.  Additionally, there is concern that the biologic therapies used to treat psoriasis, which selectively target specific components of the immune system, may also increase the risk of lymphoma in these patients.

The effects of psoriasis on health-related quality of life issues for patients is comparable to that found in cardiac failure, cancer or diabetes. Persistent itching and pain in the skin, embarrassment, and the stigmatizing effects of a disfiguring condition all contribute to the overall disease burden. In fact, studies have shown that less than 40% of the patients who use systemic therapy are satisfied with their treatment, and a comparable proportion indicate dissatisfaction with the agents used, indicating that current systemic therapies often fail to satisfy the needs of psoriasis patients, and revealing the compelling need for new, alternative therapies.

Conventional systemic treatments such as methotrexate, cyclosporine, and acitretin may be associated with side effects and end-organ toxicity that preclude long-term therapy, and with anti-TNF-α agents, the potential increased risk of infection and malignancies, as well as the long-term emergence of autoimmune responses, are a lingering concern.

Elucidation of the immunopathogenesis of psoriasis has led to the emergence of new therapies targeting the immune cells and molecules that induce and maintain psoriatic lesions, resulting in an improved understanding of the disease, and in the development of new, targeted, biological treatments.

The effective management of psoriasis remains a challenge for the dermatological community, as optimal treatment requires a balanced, individualized approach. Because dermatologists may be the sole healthcare provider for many psoriasis patients, it is imperative that they be aware of the potentially negative effects of the disease as it relates to other aspects of patient health, as well as the most current therapeutic advances available for patient care.

Given the current patient dissatisfaction with conventional therapies, the demand for new biological treatments is high, but clinical experiences with biological therapies in dermatology are relatively limited, and their long-term safety after continuous use remains uncertain.

Current research into the pathophysiology of psoriasis has uncovered novel methods by which to manipulate complex the biological processes in the development of psoriasis which is leading to unique and novel biologic treatment approaches that may achieve greater optimal therapeutic ends.  This course will attempt to review the current state of biologics in the treatment of psoriasis as well as look to future biologic treatments.

Faculty