Alexandra K. Golant, MD, and Mona Shahriari, MD, provide an overview of the pathophysiology of plaque psoriasis, commenting on the many comorbidities that stem from this disease.
Alexandra K. Golant, MD: Hello and welcome to this dermatology times DermView titled “Topical Therapy for Plaque Psoriasis, Efficacy, Safety, and Practical Considerations.” I’m Dr Alexandra Golant, the medical director of the dermatology faculty practice and the program director of the dermatology residency at Mount Sinai in New York City, New York. Joining me today in this discussion is my friend and colleague Dr Mona Shahriari, an assistant clinical professor of dermatology at Yale University School of Medicine, the associate director of clinical trials at CCD Research, and a senior editor for the Journal of Psoriasis and Psoriatic Arthritis. Our discussion focuses on the role of nonsteroid topicals in the treatment of plaque psoriasis, where we highlight the safety and efficacy of these treatments and their role in the management of patients with plaque psoriasis. Welcome, everyone. And let’s get started. Mona, we’re both here to talk about a hot topic in dermatology always, which is psoriasis. We can start with our understanding of the disease state. How we understand this disease, how we think about treatment, and rooted in that at the center of that is our understanding from a pathophysiology standpoint of psoriasis being a systemic disease.
Mona Shahriari, MD: All of us are familiar with psoriasis. It’s an immune-mediated skin disease. And for patients that have more fair skin, they get these erythematous plaques with some silvery scale. But some of our patients who have melanin-rich skin, their plaques may look violaceous, reddish brown, and the condition is pretty common. We have about 125 million people worldwide who are affected by psoriasis, with about 8 million adults in the United States having this condition. In terms of pathophysiology, we know that there’s a lot of different proinflammatory cytokines involved in the development of the disease. In particular, interleukin [IL]-17, interleukin [IL]-23, tumor necrosis factor [TNF]-⍺, all of which not only have effects at the level of the skin, but they can also have systemic effects as well. I always say that the multidimensional burden of psoriasis goes beyond the skin. Those cytokines can go to other places in the body, they go to the joints, and you can get psoriatic arthritis. They can impact the gut, you get inflammatory bowel disease, and other comorbidities, [such as] metabolic syndrome, cardiovascular disease, hypertension, diabetes, are also well-known associations with this condition.
Alexandra K. Golant, MD: I would think the same. From a patient standpoint, too, we’ve seen more evolution of how we counseled these patients about their disease because when you can sit with a patient and explain that, yes, you see the cutaneous outward effects of your disease and how your skin looks or feels. There is inflammation below the surface, and that can sometimes be incorporated, and how we talk to these patients about their disease.
Transcript edited for clarity.