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Skin and Dermatology 2019

Targeted therapies set to reduce impact of the most severe psoriasis cases

iStock / Getty Images Plus / Artfully79

Professor Christopher Griffiths OBE

Foundation Professor of Dermatology, The University of Manchester and Consultant Dermatologist, Salford Royal NHS Foundation Trust

Psoriasis is an incurable condition that can have a painful and psychologically disabling effect on patients’ lives. Expert Professor Christopher Griffiths, from the University of Manchester, discusses how it’s being tackled and how patients will be better able to manage in the years to come.

How does psoriasis present, and what causes it to come on?

Psoriasis typically presents as red, scaly patches on the skin called ‘plaques’. These usually appear on the scalp, the outer part of the elbows and the knees and the lower back. However, it can involve any part of the skin surface and very severe cases can affect all of the skin.

In children, psoriasis often occurs in little teardrop formations on areas such as the trunk. This early onset – or guttate – psoriasis can occur quite suddenly in a lot of cases following a throat infection.

In terms of the ‘why’, genetics and family links play a huge role, but there are other environmental triggers that can cause the onset of psoriasis. Smoking, alcohol, stress and being overweight aren’t root causes but have been shown to exacerbate the onset of psoriasis and its severity.

What treatments are prescribed to someone diagnosed with the psoriasis?

Firstly, topical creams or ointments are prescribed and applied directly to the skin. They usually contain vitamin D and may be combined with a steroid. This, alongside emollients and moisturisers, can be all that some people need.

More serious cases typically require ‘phototherapy’, which involves doses of ultraviolet (UV) light administered to the skin. UV light reduces inflammation quite significantly, but only produces temporary benefit. At the moment there is no cure and we can only suppress the symptoms.

How has treatment changed in the last 10-15 years?

Conventional treatments historically included drugs that can act as immune system suppressants. They tackle the parts of the immune system that we now know are related to the onset of psoriasis. They work in around 50% of people and can reduce symptoms by 75% in some cases, but side effects, such as nausea, liver toxicity and high blood pressure make them less than ideal.

What breakthroughs have there been recently?

The key discovery has been that psoriasis is driven by the immune system. We now have drugs called biologic therapies, which target the specific areas of the immune system linked to the onset of psoriasis. People with very severe psoriasis can have their lives transformed for the better by these drugs – their impact can be huge.

How do you see treatment changing in the coming years?

We’ll see greater uptake of the targeted biologic therapies, certainly. Drugs that act as broad immune suppressants have done a good job in many cases, but they’re nowhere near as effective at clearing psoriasis as the new generation of drugs. Drug therapies will become more targeted to the individual as we come to better understand people’s responses to medicines – known as personalised medicine. Combined with lifestyle modification such as weight loss and stopping smoking are a powerful way of managing even the most severe cases of psoriasis.

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