The umbrella term psoriasis is now understood to incorporate several distinct phenotypes or endotypes along the disease spectrum that in turn will dictate different therapies. A stratified medicine approach to psoriasis using this clinical information coupled with pharmacogenomic and immunologic data will become more widely acceptable in the future. Comorbidities associated with psoriasis, such as diabetes, depression, and Crohn disease, and the debate about the interdependence of psoriasis and cardiovascular disease will also dictate future research and holistic and management plans for this complex disease.
Key points
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Personalized or stratified medicine will become increasingly important.
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The cost-effectiveness of treatments will be ever more germane to health care providers.
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Psychological comorbidities and their management will be an integral part of psoriasis management.
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The identification of, and management plans for, subpopulations of patients with psoriasis will become important aspects of clinical practice.
Introduction
The articles that constitute this detailed review of psoriasis have each focused on specific areas of interest in this fascinating disease which affects 120 million people globally. The authors have assimilated specific areas of interest discussed in prior articles with their personal views into a coherent “The Future” review of interest to clinicians and researchers alike. The scope and interest of this final article is what is anticipated to change the landscape of both our understanding of psoriasis and implications for therapy by 2020.
We are fortunate to have a full range of therapeutic options available for our patients with psoriasis, ranging from topicals to phototherapy to systemic and biological agents. Scientific research, in which our International Psoriasis Council (IPC) members are committed to maintaining their leading role, will, we believe, drive the optimal use, cost-effectiveness, and safe utilization of this spectrum of therapies allied to new agents in the pipeline.
Introduction
The articles that constitute this detailed review of psoriasis have each focused on specific areas of interest in this fascinating disease which affects 120 million people globally. The authors have assimilated specific areas of interest discussed in prior articles with their personal views into a coherent “The Future” review of interest to clinicians and researchers alike. The scope and interest of this final article is what is anticipated to change the landscape of both our understanding of psoriasis and implications for therapy by 2020.
We are fortunate to have a full range of therapeutic options available for our patients with psoriasis, ranging from topicals to phototherapy to systemic and biological agents. Scientific research, in which our International Psoriasis Council (IPC) members are committed to maintaining their leading role, will, we believe, drive the optimal use, cost-effectiveness, and safe utilization of this spectrum of therapies allied to new agents in the pipeline.
Manuscript
The preceding articles in this issue of Dermatologic Clinics devoted to psoriasis have detailed the full extent of this complex, immune-mediated, genetic disorder and included measurements of outcome used in clinical trials and clinical practice. In addition, the life cycle stages of this lifelong disease from childhood to old age are reviewed, as are the significant comorbidities associated with psoriasis.
Will it be possible in the future to assess each patient with psoriasis ab initio from a genetic perspective, building on a new molecular taxonomy for the disease so that appropriate therapy can be tailored to the individual thereby affording them a normal lifestyle? The IPC’s proposal toward completing the genetic map of psoriasis is, we believe, one of the most important current research projects likely to change our understanding of the disease. The intricacies of protein variants may enable targeting of specific therapies to the wide spectrum of psoriasis phenotypes ( Figs. 1–8 ) with a significantly higher likelihood of clinical success.
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