ABSTRACT
Psoriasis has traditionally been considered an inflammatory skin disorder of unknown etiology producing red scaly patches of mere cosmetic nuisance to patients. However, with recent knowledge gleaned from the immunopathogenesis and genetics of psoriasis together with what may be termed the biological revolution in therapy, all of which will be discussed in later chapters, psoriasis now has to be considered a dynamic, genetic, immunological, systemic disorder manifesting on the body surface as well as in the joints in a significant proportion of patients. Patients and dermatologists alike thus need to shift their focus from considering psoriasis as a mere skin disease likely to be controlled with topical therapy to a condition no different from other immune-mediated disorders such as Crohn’s disease, rheumatoid arthritis, and lupus erythematosus, all of which have a vast range of clinical manifestations. Just as the full spectrum of these disorders of the immune system need to be carefully considered, so too does psoriasis need a careful clinical evaluation, taking into account the extent of disease, the form of the disease, and quality of life issues for each individual patient as well as the potential for coexistent psoriatic joint disease. All of this, particularly on an initial patient visit, will not be accomplished in a 5-10 min patient encounter. It will require time and dedication from the physician and his or her support staff to improve patient compliance as well as the disappointment factor
currently prevalent in the psoriatic population. Never has psoriasis been so much at the forefront; the buzz among researchers, clinicians, and indeed patients with the advent of new therapies, is palpable. It behooves us as dermatologists to rise to the challenge, refocus our energies and thought processes to the treatment of this most prevalent of all immune-mediated diseases, and take center stage along with our rheumatology and gastroenterology colleagues in biotechnology, target-based therapeutics. Certainly, we will continue to utilize the full therapeutic armamentarium currently available to us, as will be discussed later in this chapter. The explosion of this new knowledge, and with it new therapeutics, will enable patients and physicians alike to tailor therapy to individual forms of psoriasis as well as to individual patient needs.
