Psoriasis

This issue of the Dermatology Clinics reviews in a comprehensive fashion the important features of psoriasis, of relevance to the practicing dermatologist. All the authors are acknowledged leaders in the field, having written extensively on various aspects of psoriasis.

The initial three articles discuss the genetics of psoriasis, immunopathogenesis of psoriasis, and the rationale for the use of biologic therapy based on our current knowledge of both genetics and immunopathogenesis of this prevalent disease. In addition, the realization of the significant impact that quality of life issues play in the lives of our psoriasis patients warrants a full article. All too often we, as busy dermatologists, do a cursory clinical evaluation without discussing the day-to-day impact that this highly visible and distressful disease has on our patients. Thereafter, the full range of therapeutic modalities in psoriasis are covered in multiple articles, starting with a review of the phototherapy arsenal available to us in clinical practice, together with a comprehensive review of the major systemic tools available to the practicing dermatologist, prior to the advent of biologic therapy.

Biologic therapy of psoriasis has become—as with other immunomediated diseases such as rheumatoid arthritis and Crohn's disease—increasingly important. Dermatology has “come lately” to the biologic therapeutic era, with hundreds of thousands of patients already being treated over the past 5 or 10 years for the two aforementioned diseases. The promise of biologics, based on our knowledge of the specific immunopathogenesis of psoriasis reviewed in this issue, has allowed biotechnology companies to more specifically target individual molecules involved in antigen presentation and T-cell interaction with the release of individual cytokines, particularly tumor necrosis factor α, thus allowing for more precise therapeutic options for the practicing dermatologist. With the first biologic drug Alefacept, having been released in January 2003, the second, Efalizumab, in November 2003, and the third, Etanercept, in May 2004, it is important for the practicing dermatologist to have a full understanding of these agents and subsequent agents likely to be approved in the months and years ahead. All these biologic agents are reviewed in individual articles, again by physicians experienced both in clinical research as well as in the subsequent therapy of these individual agents.

In addition to our standard tools and the biologic agents for psoriasis, other new agents have potential for adding to our therapeutic armamentarium in the years ahead. Dermatologists are fully versed in retinoid therapy for psoriasis, acne, and other dermatoses. With the likely advent of future systemic retinoids, particularly oral Tazarotene, it is important that this be reviewed in full in a separate chapter. In addition, the systemic form of pimecrolimus has received a lot of attention and is likewise discussed.

The next two articles review two important issues for the practicing dermatologist. First, the realization that psoriatic arthritis is far more prevalent than we had once believed. Drs. Ruderman and Mease, two rheumatologists who are fully conversant with psoriatic arthritis and its impact on the dermatologist, review psoriatic arthritis in a way that will prove of great value to the dermatologist in clinical practice. The next article reviews how we as dermatologists can integrate all these new drugs, particularly the biologic agents, into our clinical practices.

Finally, Dr. Griffiths, an acknowledged leader in investigative and clinical research as well as psoriasis therapy, gives a fascinating insight into how psoriasis research and therapy is likely to evolve in the years ahead.

We sincerely hope that this issue of the Dermatologic Clinics, which is designed to familiarize the reader with the latest updates in psoriasis, will prove both interesting and valuable as a ready reference for practitioners who have an interest in psoriasis.