Karan Lal, DO: Psoriasis Treatment Advances, Spesolimab for Generalized Pustular Psoriasis

During a segment of his interview with HCPLive, Karan Lal, DO, MS, FAAD, described the year of 2022 in terms of psoriasis treatment advances. He explored the specifics of FDA approvals such as spesolimab, the first treatment of generalized pustular psoriasis flares in adults.

Lal works as the director of pediatric dermatology and cosmetic surgery for Affiliated Dermatology Scottsdale, and he also serves as the social media chair for the Society for Pediatric Dermatology.

First, he described the treatment of psoriasis in the United States in general terms, highlighting the financial incentives companies have for pursuing a variety of treatments.

Advancements in 2022

“Well, I think what's amazing about psoriasis is it's a big disease, a big pharmaceutical influence, right?” Lal explained. “It's one of the most profitable diseases in the United States, for pharmaceutical companies, because there's just so much we're learning about psoriasis. We're learning about the different phenotypes, the different genotypes, the correlation between this type and phenotype, and how to target the disease in a safer way.”

Lal later went into a description of some of the advancements in treatment made this year, including topical and oral therapies.

“So we've had tapinarof, which is a topical, we have roflumilast, which is a topical that was approved, deucravacitinib, which was an oral that was approved,” he said. “And then we have specific spesolimab…which is going to be a biologic that's approved for generalized pustular psoriasis, which I think is very exciting, because we're going to learn and talk more about that this upcoming year through education and getting people on board about recognizing this condition.”

Psoriasis Versus Atopic Dermatitis

Lal also pointed out that there are a wide variety of treatments for psoriasis compared to conditions such as atopic dermatitis, a disparity which he says exists for several specific reasons.

“So it's interesting, frankly, in my opinion,” he said. “Atopic dermatitis is more prevalent, and I think atopic derm is a little bit more complex…But, you know, the problem is we haven't really gotten a lot of long-term data as to what the other implications are, you know, (regarding) comorbidities with atopic dermatitis. For psoriasis, we know there's obesity, there's heart disease, there's atherosclerosis, PCOS, inflammatory bowel disease.”

Additionally, he pointed out during his discussion that recent data in the atopic dermatitis field is growing, which may give pharmaceutical companies a bigger push in that direction. That said, he added that it is difficult to create biologic treatments for younger patients and that atopic dermatitis is a younger person’s disease.

“And another reason why I don't think we have a lot of advancements in atopic derm is that, honestly, dupilumab is so successful,” he explained. “I’d almost argue that if patients don't respond under dupilumab, then your diagnosis is likely incorrect.”

For more information about psoriasis treatment advancements, view the interview above.