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Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors: 3rd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: closed (25 March 2026) | Viewed by 15335

Editors

Dr. Mayumi Komine

E-Mail Website
Guest Editor
Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
Interests: dermatology; keratinocyte biology; psoriasis; psoriatic arthritis; inflammatory reaction; ichthyosis
Special Issues, Collections and Topics in MDPI journals
Dr. Takemichi Fukasawa

E-Mail Website
Guest Editor
Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Interests: systemic sclerosis; B cells; T cells; psoriasis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Recent advancements have allowed us to use various biological drugs and small molecule inhibitors, such as JAK inhibitors and phosphodiesterase inhibitors, to treat psoriasis and psoriatic arthritis. We are now facing the question of how to best use these drugs, how to choose which to use, when to start, and for whom they should be used. Recent recommendations for psoriasis and psoriatic arthritis tell us that early intervention to prevent their development into deformities and/or functional defects is of importance and prevents cumulative impairment. It is difficult, however, to identify patients who would develop severe disease during the early phase of psoriasis with biologics or small molecule inhibitors. Recent research has started to reveal some clues about how to distinguish these patients, and we should include them in our daily clinics.

We previously launched the Special Issue “Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors?” Volume 1 and Volume 2 (https://www.mdpi.com/journal/jcm/special_issues/Psoriasis_Psoriatic_Arthritis, https://www.mdpi.com/journal/jcm/special_issues/7QB0YO66H6), in which various important novel findings and review articles were published and attracted significant attention. Because of the substantial need for and special interest in this field, we decided to launch “Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors: 3rd Edition” as a sequel to the previous Special Issue.

We welcome articles assessing and providing insights into the following issues: 1) how and when to treat psoriasis and psoriatic arthritis patients, 2) which patients need early intervention, 3) whether there are any disease markers that can be used to identify patients in need of early intervention, 4) how to detect early clinical signs of psoriatic arthritis, and 5) what dermatologists should do to address comorbid systemic disorders. We also welcome other topics related to psoriasis and psoriatic arthritis.

We welcome both review articles and research articles that present novel findings in this field and we hope to improve readers’ recognition of this systemic disease by presenting new understandings of it .

Dr. Mayumi Komine
Dr. Takemichi Fukasawa
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • psoriasis
  • psoriatic arthritis
  • biologics
  • small molecule inhibitors
  • conventional therapies

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Published Papers (4 papers)

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Research

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12 pages, 1166 KB  
Article
Segmental PASI Evaluation Reveals Reduced PUVA Responsiveness of Lower-Limb Psoriasis in Patients with Internal Organ Malignancy
by Miguel Alpalhão, Joana Antunes, João Augusto Ferreira, René Santus and Paulo Filipe
J. Clin. Med. 2026, 15(12), 4525; https://doi.org/10.3390/jcm15124525 - 11 Jun 2026
Viewed by 260
Abstract
Background/Objectives: The management of moderate-to-severe psoriasis in patients with a recent history of internal malignancy is a clinical challenge, as systemic immunosuppressive therapies are often avoided because of concerns about cancer recurrence. While Psoralen and Ultraviolet A (PUVA) photochemotherapy remains a valuable non-immunosuppressive [...] Read more.
Background/Objectives: The management of moderate-to-severe psoriasis in patients with a recent history of internal malignancy is a clinical challenge, as systemic immunosuppressive therapies are often avoided because of concerns about cancer recurrence. While Psoralen and Ultraviolet A (PUVA) photochemotherapy remains a valuable non-immunosuppressive alternative, regional variations in therapeutic response are not well-characterized in this population. This study aimed to evaluate total and segmental Psoriasis Area and Severity Index (PASI) responses to PUVA in patients with chronic plaque psoriasis and recent internal organ malignancy. Methods: This prospective, single-center, real-world cohort study enrolled 20 adults with moderate-to-severe chronic plaque psoriasis and a recent (<5 years) diagnosis of internal organ malignancy in complete remission. Participants received oral PUVA three times weekly for up to 30 sessions. Primary and secondary outcomes included changes in total PASI, segmental PASI (head/neck, trunk, upper limbs, and lower limbs), and Dermatology Life Quality Index (DLQI) at baseline, completion of therapy, and 6 months post-treatment. Results: PUVA led to a significant reduction in mean total PASI from 18.6 ± 3.2 at baseline to 5.7 ± 6.0 at treatment completion (69% reduction; p < 0.001). However, regional responses differed significantly: the head and neck improved the most (80.4%), followed by the trunk (72.2%) and upper limbs (72.3%), while the lower limbs showed the weakest response (59.5%; p < 0.001). At baseline, trunk contributed the most to total PASI (38%), while post-treatment, lower-limb lesions accounted for approximately 47% of the remaining total disease burden, showing the highest contribution to total PASI of all body regions. At 6 months, the lower limbs remained the most affected area, with significantly lower improvement (52.9%) compared to other regions. Mean DLQI also improved significantly from 17.2 ± 2.8 to 5.6 ± 2.6 (p < 0.001). Conclusions: PUVA is an effective and safe treatment for patients with psoriasis and a recent history of malignancy. Nevertheless, lower-limb psoriasis is relatively recalcitrant and contributes disproportionately to residual disease burden and relapse. These findings support the use of regional PASI assessment to guide individualized management and clinical expectations in this complex patient group. Full article
(This article belongs to the Special Issue Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors: 3rd Edition)
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18 pages, 1404 KB  
Article
Comparative Analysis of the Long-Term Real-World Efficacy of Interleukin-17 Inhibitors in a Cohort of Patients with Moderate-to-Severe Psoriasis Treated in Poland
by Wiktor Kruczek, Aleksandra Frątczak, Iga Litwińska-Inglot, Karina Polak, Zuzanna Pawlus, Paulina Rutecka, Beata Bergler-Czop and Bartosz Miziołek
J. Clin. Med. 2025, 14(15), 5421; https://doi.org/10.3390/jcm14155421 - 1 Aug 2025
Cited by 4 | Viewed by 7969
Abstract
Background: Bimekizumab, secukinumab, and ixekizumab are IL-17-targeting biologics approved for the treatment of moderate-to-severe plaque psoriasis. While secukinumab and ixekizumab selectively inhibit IL-17A, bimekizumab targets both IL-17A and IL-17F, potentially providing greater anti-inflammatory efficacy. This study aimed to compare the real-world effectiveness, [...] Read more.
Background: Bimekizumab, secukinumab, and ixekizumab are IL-17-targeting biologics approved for the treatment of moderate-to-severe plaque psoriasis. While secukinumab and ixekizumab selectively inhibit IL-17A, bimekizumab targets both IL-17A and IL-17F, potentially providing greater anti-inflammatory efficacy. This study aimed to compare the real-world effectiveness, safety, and tolerability of these agents in a Polish dermatology center between 2019 and 2024. Methods: We conducted a retrospective analysis of 98 patients meeting at least one of the following criteria: PASI ≥ 10, BSA ≥ 10, DLQI ≥ 10, or involvement of special areas with inadequate response or contraindications to ≥2 systemic therapies. Patients with prior exposure only to IL-17 inhibitors were excluded. PASI, BSA, and DLQI scores were recorded at baseline, week 4, and week 12. Due to differences in dosing schedules, outcomes were aligned using standardized timepoints and exponential modeling of continuous response trajectories. Mixed-effects ANOVA was used to assess the influence of baseline factors (age, BMI, PsA status) on treatment outcomes. Adverse events were documented at each monthly follow-up visit. Results: Bimekizumab showed the greatest effect size for PASI reduction (Hedges’ g = 3.662), followed by secukinumab (2.813) and ixekizumab (1.986). Exponential modeling revealed a steeper response trajectory with bimekizumab (intercept = 0.289), suggesting a more rapid PASI improvement. The efficacy of bimekizumab was particularly notable in patients who were previously treated with IL-23 inhibitors. All three agents demonstrated favorable safety profiles, with no serious adverse events or discontinuations. The most frequent adverse events were mild and included upper respiratory tract infections and oral candidiasis. Conclusions: This real-world analysis confirmed that IL-17 inhibitors effectively improved PASI, BSA, and DLQI scores in moderate-to-severe psoriasis. Bimekizumab demonstrated the most rapid early improvements and a higher modeled likelihood of complete clearance, without significant differences at week 12. All agents were well tolerated, underscoring the need for further individualized, large-scale studies. Full article
(This article belongs to the Special Issue Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors: 3rd Edition)
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11 pages, 1022 KB  
Article
Comparative Analysis of Ixekizumab Effectiveness with and Without Induction Therapy in Moderate-to-Severe Psoriasis: A Real-World Study
by Ricardo Ruiz-Villaverde, Pedro José Ezomo-Gervilla, Jose Molina-Espinosa, Manuel Galán-Gutierrez, Enrique Herrera-Acosta and Jorge Alonso Suarez-Perez
J. Clin. Med. 2025, 14(3), 833; https://doi.org/10.3390/jcm14030833 - 27 Jan 2025
Viewed by 5262
Abstract
Background: Ixekizumab, an IL-17A inhibitor, is an effective treatment for moderate-to-severe plaque psoriasis. Although clinical trials support the use of an induction phase for optimal results, real-world evidence comparing induction versus maintenance-only regimens is limited. Objectives: This study assessed the real-world effectiveness, safety, [...] Read more.
Background: Ixekizumab, an IL-17A inhibitor, is an effective treatment for moderate-to-severe plaque psoriasis. Although clinical trials support the use of an induction phase for optimal results, real-world evidence comparing induction versus maintenance-only regimens is limited. Objectives: This study assessed the real-world effectiveness, safety, and drug survival of ixekizumab with and without an induction phase in patients with moderate-to-severe plaque psoriasis. Methods: A multicenter, observational study was conducted with 183 patients treated with ixekizumab over five years at tertiary hospitals in Andalucía, Spain. Patients were divided into two groups: an induction group (160 mg at baseline, followed by 80 mg at weeks 2, 4, 6, 8, 10, and 12, then every 4 weeks) and a non-induction group (80 mg every 4 weeks from initiation). Baseline characteristics, clinical outcomes (PASI [Psoriasis Activity Skin Index] and PGA [Physician Global Assessment] scores), and drug survival were analyzed. Results: The majority of patients were male (64.48% in the induction group, 58.74% in the non-induction group). No significant differences were found in age or BMI [body mass index] between groups. Baseline PASI and PGA scores were higher in the induction group, reflecting greater initial disease severity. Both regimens achieved significant clinical improvements, though the induction group demonstrated faster initial responses. Drug survival was lower in the induction group (p = 0.0033), potentially due to the higher baseline disease burden and severity in these patients. Comorbidities, including metabolic syndrome, cardiovascular risks, and psychiatric conditions, were prevalent, particularly in the induction group. Conclusions: Ixekizumab is effective for moderate-to-severe plaque psoriasis, with induction therapy yielding faster responses. However, lower drug survival in the induction group highlights the influence of initial disease severity on long-term outcomes. Real-world findings support the flexibility of ixekizumab across diverse patient populations, though further research is warranted. Full article
(This article belongs to the Special Issue Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors: 3rd Edition)
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Review

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15 pages, 2065 KB  
Review
Psoriasis in Obese Patients: Pathophysiological Interactions, Clinical Consequences, and Therapeutic Implications
by Gustavo Almeida-Silva, Joana Antunes, João Ferreira and Paulo Filipe
J. Clin. Med. 2026, 15(11), 4302; https://doi.org/10.3390/jcm15114302 - 2 Jun 2026
Viewed by 954
Abstract
Background/Objectives: Psoriasis is a chronic immune-mediated inflammatory disease increasingly recognized as a systemic disorder associated with significant metabolic and cardiovascular comorbidities. Among these, obesity (defined as BMI > 30 kg/m2) plays a pivotal role, acting both as a risk factor [...] Read more.
Background/Objectives: Psoriasis is a chronic immune-mediated inflammatory disease increasingly recognized as a systemic disorder associated with significant metabolic and cardiovascular comorbidities. Among these, obesity (defined as BMI > 30 kg/m2) plays a pivotal role, acting both as a risk factor for psoriasis development and as a modifier of disease severity, clinical phenotype, and therapeutic response. The relationship between psoriasis and obesity is bidirectional and sustained by shared inflammatory and metabolic pathways. This review aims to provide a comprehensive and updated synthesis of the epidemiological association between psoriasis and obesity, to elucidate the underlying pathophysiological mechanisms, and to discuss the clinical and therapeutic implications of excess body weight in psoriasis management. Methods: A narrative review of the literature was conducted, including epidemiological studies, mechanistic research, clinical trials, and real-world evidence addressing the interplay between psoriasis and obesity. Relevant data were identified from peer-reviewed publications focusing on inflammatory pathways, metabolic dysfunction, cardiovascular risk, and treatment outcomes in obese patients with psoriasis. The graphical figures included in this manuscript were created with the assistance of a large language model–based image-generation tool, ChatGPT-5 by OpenAI, using author-defined prompts. The prompts requested schematic medical illustrations summarizing the pathophysiological links between obesity and psoriasis, including adipose tissue dysfunction, adipokine imbalance, systemic inflammation, and activation of the IL-23/Th17 axis. For the therapeutic algorithm, the prompt requested a stepwise clinical flowchart for obese patients with psoriasis, including BMI assessment, comorbidity screening, universal weight-management measures, psoriasis severity stratification, obesity-adapted biologic selection, and management of suboptimal response. The generated images were subsequently reviewed, edited, and approved by the authors to ensure scientific accuracy, clarity, and consistency with the manuscript content. Results: Epidemiological evidence consistently demonstrates a higher prevalence of obesity among patients with psoriasis, with obesity independently associated with increased disease severity. Shared mechanisms include adipose tissue–driven cytokine production, dysregulated adipokine secretion, insulin resistance, endothelial dysfunction, and activation of the IL-23/Th17 axis, collectively contributing to systemic inflammation and accelerated atherogenesis. Obesity negatively impacts the efficacy, pharmacokinetics, and long-term drug survival of conventional systemic agents and biologic therapies, leading to suboptimal clinical outcomes. Conclusions: Obesity is a key determinant of psoriasis burden, influencing disease expression, comorbidities, and therapeutic response. Integrating weight reduction strategies into personalized psoriasis management may improve both dermatological outcomes and overall cardiometabolic health, supporting a holistic approach to patient care. Full article
(This article belongs to the Special Issue Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors: 3rd Edition)
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