Treating psoriasis: Take the elevator, not the stairs

Instead of offering biologic therapies only when all other treatments have failed, why not start them as soon as psoriasis symptoms appear? According to researchers, this approach has the potential to "cure" this inflammatory disease.While some topical treatments are successful in controlling psoriasis, patients cannot expect long-term remission, let alone a cure.Dermatologist Dr. Christopher Griffiths, a professor at the University of Manchester and King's College London, is advocating for a paradigm shift in the management of psoriasis. In a recent publication in the British Journal of Dermatology, he and his colleagues suggest "taking the elevator, not the stairs," by quickly offering biologic treatments or immunomodulators at the very beginning of the disease.According to them, a progression from topical to systemic treatments offers little hope of remission for patients. “Early intervention with systemic therapies could alter the course of the disease by preventing or minimizing the development of inflammatory memory, which appears to play a key role in the chronicity of psoriasis,” they suggest.A race against timeTheir findings are echoed in the scientific literature. This inflammatory memory is thought to be attributable to memory T cells (MTCs), which have been identified as being responsible for the recurrence of psoriasis in previously affected areas. It has been observed that the duration of the disease coincides with the number of MTCs: the longer a patient has lived with psoriasis, the more MTCs they will have, unlike patients with a more recent diagnosis. Furthermore, patients with thicker plaques and more severe psoriasis have a higher concentration of memory T cells in their lesions.While topical treatments can target the cytokines involved and reduce their population, a subset of CD8+ cells located in the basal layer of the epidermis resists all topical treatments, causing psoriasis to recur after treatment is discontinued.Biological treatments, by targeting interleukins, weaken the presence of TRMs. According to Dr. Griffith, by addressing TRMs early in the disease course, ideally within the first year of symptom onset, a cure may be possible.A clinical trial conducted with guselkumab (anti-IL-23) in 2023 showed that patients who started this treatment less than two years after symptom onset were more likely to achieve a better response and reach a PASI90 or PASI100 score more quickly compared to patients with a longer disease duration.In a 52-week trial involving 160 patients with a recent (

Treating psoriasis: Take the elevator, not the stairs

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