A Better Understanding of the Pathogenesis of Plaque Psoriasis

Melodie Young, MSN, RN, ANP-C: Psoriasis is a chronic inflammatory immune-mediated skin disease that is characterized by a complex pathophysiology. Recent advances in the understanding of psoriasis pathogenesis have clarified the pivotal role of interleukin-23 [IL-23]. This cytokine has become the therapeutic target of a new category of biologic drugs for psoriasis.

In this this HCPLive® Peer Exchange® discussion, I am joined by a panel of expert nurse practitioners and physician assistants. Together, we are going to discuss the advances in diagnosing psoriasis, and the strategies for the practical management of plaque psoriasis, including the use of IL-23 inhibitors.

I am Melodie Young, a nurse practitioner at Mindful Dermatology and Modern Research Associates in Dallas, Texas. Today I am joined by Margaret Bobonich, assistant professor in the Department of Dermatology at Case Western Reserve University [School of Medicine] and University Hospitals Cleveland Medical Center in Cleveland, Ohio; Melissa Davis, a physician assistant at Associates in Dermatology in Louisville, Kentucky; and Douglas DiRuggiero, a physician assistant at the Skin Cancer & Cosmetic Dermatology Center in Rome, Georgia. Thank you for joining us. Let‘s begin.

To start, Margaret, I’m going to ask you to begin by explaining and discussing the pathogenesis of psoriasis, the genetics associated with the disease, and what we’ve learned over the last few decades about this very interesting disease.

Margaret Bobonich, DNP, FNP-C, DCNP, FAANP: You know, I think a lot of us feel that it’s a good day and age to be a psoriasis patient. We’ve learned so much in the past few decades about not only the pathogenesis but also the treatments that are offered. First and foremost, people see psoriasis on their skin, but what providers and patients need to learn is that this is about their immune system. Psoriasis is inflammation of the skin, but it also can be found in the synovial fluid. And we see through more and more research that we’re doing that there can be inflammation in other parts of our body. But it’s not what we see. Oftentimes, patients come in because they see the plaques on their skin, or maybe they have joint pain.

Psoriasis is inflammatory cytokines in other inflammation in our body that’s triggered, and it is present in the keratinocytes. And what we are learning more and more is that there’s a broad spectrum. Decades ago, we began by looking at cytokines like TNF [tumor necrosis factor]. Now we’ve learned that there are other cytokines and other pathways that trigger it. So it’s not a simple process that we can put our finger on, and we are learning more and more about that and the comorbidities that are associated.

We also know there’s some genetics to it. Patients come in and tell us they have no family history, but what we’ve learned is just because a patient doesn’t have a family history of psoriasis, that doesn’t mean they don’t have it. There is still a significant portion of patients who have psoriasis with no family history. A lot of people will phrase it, “This is the most heritable skin disease that you can have.”

So there is more and more that we’ve learned.

Transcript edited for clarity.