When today’s dermatology residents were born, the concept of psoriasis as a systemic disease was relatively new. Early in the 1980s, topical therapy was the mainstay for medical management of this “skin condition.” Systemic therapies were beginning to be used for severe psoriasis, although it was unclear how they provided benefit. Three decades later, dermatologists have a much better—though perhaps still incomplete—understanding of the pathogenesis of psoriasis and its related comorbidities. Novel therapies have emerged to target the immunologic drivers at the heart of the disease
J Drugs Dermatol. 2019;18(8 Suppl 2):s202-208.
In this paper, we describe the importance of the TH17 pathway in psoriasis pathogenesis with a focus on the roles of IL-23 and IL-17 within this pathway. We also discuss the different IL-17 subtypes involved in psoriasis immunopathology and the multitude of cells that can produce these subtypes. Finally, we examine treatments that inhibit IL-23 and IL-17.
When today’s dermatology residents were born, the concept of psoriasis as a systemic disease was relatively new. Early in the 1980s, topical therapy was the mainstay for medical management of this “skin condition.” Systemic therapies were beginning to be used for severe psoriasis, although it was unclear how they provided benefit. Three decades later, dermatologists have a much better—though perhaps still incomplete—understanding of the pathogenesis of psoriasis and its related comorbidities. Novel therapies have emerged to target the immunologic drivers at the heart of the disease.
What questions should you be asking? What matters most when discussing therapeutic options? What is the best way to partner to ensure a long term relationship? If we could read minds this podcast would not be necessary but alas, it sorely is. Check it out!
We (and our patients) are fortunate to live during a time when we have many safe and effective options to treat a chronic inflammatory skin disease such as Psoriasis. We are reminded of this, nay inundated, with warm and fuzzy headlines in the lay dermatology press that humblebrag said efficacy. However, how does this translate to the real world, when the perfect, neat lines of clinical trials are blurred by practical issues such as access, patient and practitioner perception, and long term use and efficacy? In a JDD Podcast first, we had not one but two investigators share their work and first steps to evaluate just that.
I’m a biologic girl in a biologic world…or so I think myself and never say out loud when reviewing therapeutic options for moderate to severe psoriasis. We are so fortunate to have so many wonderful options, however certain clinical scenarios may limit our ability to capitalize on said armament mostly due to limited experience and data. Enter previous malignancy – in most phase 3 studies these patients are weeded out or the history of malignancy must be at least 5 years prior to entry. So what to do? Our colleagues at Tufts Medical Center asked this very question. Tune in to hear what Dr. David Rosmarin, Assistant Professor of Dermatology and Residency Program Director learned from performing a retrospective chart review and how his work and his experience guides his clinical decision making when managing psoriasis. Don’t flake (or is it scale?)….check it out.
In this edition of the JDD Podcast, Dr. Adam Friedman reviews phototherapy protocols and pearls with psoriasis expert Dr. Jashin Wu, Director of Research at Kaiser Permanente based on his study published in the August 2016 Journal of Drugs in Dermatology titled “Comparison of Phototherapy Guidelines for Psoriasis: A Critical Appraisal and Comprehensive Review.” Also tune in to hear how Dr. Wu counsels his psoriasis patients on psoriasis comorbidities and initiates, and manages them with phototherapy, topicals, and systemic immunosuppressants.
Dr. Jon Zippin elucidates the complexity of cAMP biology and the translational impact of PDE4 inhibition as it relates to chronic inflammatory skin diseases. Tune in to learn why targeting this pathway is clinically meaningful but also where more work is needed to improve outcomes.
Dr. Abrar Qureshi, Professor and Chair of Department of Dermatology at The Warren Alpert Medical School of Brown University, reviews his research to uncover the biological basis for many of the co-morbidities associated with, and risk factors for, psoriasis. Through this clear and clinically oriented presentation, the common pathophysiological threads are elucidated with a focus on identifying preventive strategies and therapeutic targets for current and future treatments.
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