• Kamran Ghoreschi, Anna Balato, Charlotta Enerbäck, and Robert Sabat.
• Department of Dermatology, Venereology, and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany; Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: kamran.ghoreschi@charite.de.
• Lancet. 2021 Feb 20; 397 (10275): 754-766.

AbstractPsoriasis is a chronic inflammatory disease characterised by sharply demarcated erythematous and scaly skin lesions accompanied by systemic manifestations. Classified by WHO as one of the most serious non-infectious diseases, psoriasis affects 2-3% of the global population. Mechanistically, psoriatic lesions result from hyperproliferation and disturbed differentiation of epidermal keratinocytes that are provoked by immune mediators of the IL-23 and IL-17 pathway. Translational immunology has had impressive success in understanding and controlling psoriasis. Psoriasis is the first disease to have been successfully treated with therapeutics that directly block the action of the cytokines of this pathway; in fact, therapeutics that specifically target IL-23, IL-17, and IL-17RA are approved for clinical use and show excellent efficacy. Furthermore, inhibitors of IL-23 and IL-17 intracellular signalling, such as TYK2 or RORγt, are in clinical development. Although therapies that target the IL-23 and IL-17 pathway also improve psoriatic arthritis symptoms, their effects on long-term disease modification and psoriasis-associated comorbidities still need to be explored.Copyright © 2021 Elsevier Ltd. All rights reserved.

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