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Psoriasis in Focus: Current Research, Treatments, and Future Directions

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

Deadline for manuscript submissions: closed (20 March 2026) | Viewed by 10799

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Dr. Tamara Gracia-Cazaña

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Guest Editor

Department of Dermatology, Miguel Servet University Hospital, 50009 Zaragoza, Spain
Interests: photodynamic therapy; non-melanoma skin cancer; psoriasis; photodermatology
Special Issues, Collections and Topics in MDPI journals

Dr. Josep Riera-Monroig

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Guest Editor

Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
Interests: dermatology; psoriasis; monographic consultation; genodermatosis; sexually transmitted infections

Special Issue Information

Dear Colleagues,

Psoriasis is a chronic, immune-mediated, inflammatory skin disease that reduces individuals’ quality of life and can shorten their lifespan. It affects at least 60 million people worldwide and is associated with several important medical conditions, including cardiometabolic disease, psoriatic arthritis, and depression. Psoriasis poses a challenge for healthcare professionals. In recent years, advances in the understanding of its pathogenesis, as well as the development of novel therapeutic strategies, have transformed the clinical management of this condition.

This Special Issue aims to present recent research on psoriasis, including its immunopathogenesis, genetic predisposition, and environmental triggers. We welcome contributions that address a wide range of topics, such as emerging systemic and topical treatments, biologic and small-molecule therapies, precision medicine approaches, and the role of comorbidities in disease progression. Additionally, we encourage the submission of studies that present patient-reported outcomes, digital health interventions, and real-world data to provide a holistic perspective on psoriasis care.

By compiling high-quality original research, reviews, and clinical studies, this Special Issue seeks to enhance our understanding of psoriasis and foster discussions regarding the future of disease management. We invite researchers and clinicians to contribute their valuable insights and help shape the future of psoriasis treatment.

We look forward to receiving your submissions!

Dr. Tamara Gracia-Cazaña
Dr. Josep Riera-Monroig
Guest Editors

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Keywords

psoriasis
biologic therapies
immunopathogenesis
precision medicine
comorbidities in psoriasis
psoriatic arthritis
phototherapy
topical treatments
systemic therapies

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Published Papers (6 papers)

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Research

19 pages, 1466 KB

Open AccessArticle

Seasonal Variation of Plaque Psoriasis in Relation to Individualized MED-Adjusted Ultraviolet Exposure: A Cross-Sectional Study in Poland

by Michał Niedźwiedź, Agnieszka Czerwińska, Janusz Krzyścin, Joanna Narbutt and Aleksandra Lesiak

J. Clin. Med. 2026, 15(7), 2708; https://doi.org/10.3390/jcm15072708 - 3 Apr 2026

Viewed by 385

Abstract

Background: Patient-perceived seasonality of psoriasis is frequently reported, yet the independent contribution of objectively quantified, individualized ultraviolet (UV) exposure remains insufficiently characterized. We evaluated seasonal variation in plaque psoriasis and its association with geocoded, phototype-adjusted ambient antipsoriatic radiant exposures (ARE) using mixed-effects modeling. Methods: This cross-sectional study included 119 adults with plaque psoriasis (476 seasonal observations). Participants rated seasonal disease courses using a 7-point scale. Ambient ARE was geocoded to residential postal codes and quantified as a behaviorally weighted dose normalized to individual minimal erythema dose (MED). Mixed-effects logistic regression models, adjusted for relevant confounders, estimated associations with seasonal improvement and worsening. Results: Seasonality was reported by 89.9% of participants (p < 0.001). Summer was the most favorable season, whereas winter was the most detrimental. The highest ARE quartile was independently associated with increased odds of improvement (OR 4.65, 95% CI 2.04–10.58, p < 0.001) and reduced odds of worsening (OR 0.16, 95% CI 0.08–0.33, p < 0.001). Crucially, continuous quadratic modeling revealed a significant inverted U-shaped relationship between UV exposure and improvement, with an estimated turning point of 3.85 (95% CI 1.88–5.82, p < 0.001) for the declared daily ARE (UV_decl) normalized by MED. Beyond this threshold, the probability of improvement attenuated. The protective effect against seasonal worsening remained linear. Conclusions: Psoriasis seasonality demonstrates a robust exposure–response association relationship with ambient UV. The estimated turning point (UV_decl/MED = 3.85) within our modeled exposure metric is exploratory and hypothesis-generating. It suggests an association where moderate UV exposure correlates with patient-perceived benefits, but these diminish at very high levels. This threshold requires external prospective validation before being considered a clinically actionable recommendation. Full article

(This article belongs to the Special Issue Psoriasis in Focus: Current Research, Treatments, and Future Directions)

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14 pages, 695 KB

Open AccessArticle

Prevalence of Psoriatic Arthritis in Patients with Moderate-to-Severe Psoriasis in the Era of Biologics and Small Molecule Therapies

by Cristina Vergara-Dangond, Tatiana Cobo-Ibáñez, Gabriela Cueva-Nájera, Ricardo Valverde-Garrido, Cristina García-Yubero, Laura Trives-Folguera, Beatriz Paredes-Romero, Ana Victoria Esteban-Vázquez, Liz Romero-Bogado, Isabel De La Cámara-Fernández, Martina Steiner, Patricia Richi-Alberti, Ana Valeria Acosta-Alfaro, Iolanda Prats and Santiago Muñoz-Fernández

J. Clin. Med. 2025, 14(23), 8359; https://doi.org/10.3390/jcm14238359 - 25 Nov 2025

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Abstract

Objectives: To estimate the prevalence of psoriatic arthritis (PsA) and associated factors in patients with moderate-to-severe psoriasis. Methods: Retrospective, single-center study of a cohort of psoriasis patients in standard follow-up in a dermatology department from July 2008 to January 2024. Patients ≥18 years with moderate-to-severe psoriasis were included and classified into three groups according to the treatment received: group 1, biologics or small molecules with or without conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs); group 2, only csDMARDS; and group 3, non-pharmacological treatments. Demographic and clinical variables were collected. The prevalence of PsA was estimated with its 95% confidence interval (CI). The cumulative incidence of PsA was analyzed across groups, and logistic regression models were built. Results: The study population comprised 308 patients (67.2%, 22.7%, 10% in groups 1, 2, and 3, respectively). Differences between the groups were observed in severity of psoriasis, weight, smoking status, and dyslipidemia (p < 0.05). The prevalence of PsA was 11.7% (95% CI, 8.1–15.3), with most patients in group 1. This group had a higher risk of PsA following diagnosis of psoriasis or initiation of treatment. Belonging to groups 2 and 3 had a smaller effect than belonging to group 1 in the development of PsA; nail involvement and obstructive sleep apnea (OSA) were associated with development of PsA (p < 0.05). Conclusions: The prevalence estimate was lower than previous estimates, probably owing to the increased use of biologics. Nail involvement and OSA were associated with PsA. Full article

(This article belongs to the Special Issue Psoriasis in Focus: Current Research, Treatments, and Future Directions)

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12 pages, 784 KB

Open AccessArticle

Real-Life Effectiveness and Safety of Bimekizumab in Plaque Psoriasis Involving Difficult-to-Treat Areas: A 52-Week, Retrospective Real-World, Single-Center Study

by Matteo Bianco, Francesco D’Oria, Gioele Ghezzi, Luciano Ibba, Sara Di Giulio, Mario Valenti, Antonio Costanzo, Alessandra Narcisi and Luigi Gargiulo

J. Clin. Med. 2025, 14(20), 7412; https://doi.org/10.3390/jcm14207412 - 20 Oct 2025

Cited by 1 | Viewed by 2182

Abstract

Background: Psoriasis is a chronic inflammatory disease that frequently affects difficult-to-treat areas such as the scalp, nails, genitalia, and palms/soles, with significant physical and psychological burden. Bimekizumab, a monoclonal antibody targeting both interleukin (IL)-17A and IL-17F, has shown rapid and durable efficacy in clinical trials, but real-world data in these subgroups remain limited. Methods: We performed a 52-week, single-center retrospective study including patients with psoriasis involving at least one difficult-to-treat area. Effectiveness was assessed using site-specific Physician’s Global Assessment (sc-PGA, f-PGA, sPGA-G, pp-PGA). The primary endpoint was the proportion of patients achieving a PGA 0/1 (clear or almost clear). Safety data were collected at each visit. Results: Eighty-five patients were included (61.8% male; mean age 48.1 years; mean Body Mass Index (BMI, 26.9 kg/m²). Difficult-to-treat areas involved were the scalp (70.6%), nails (41.2%), genitalia (27.1%), and palms/soles (24.7%). At week 52, sc-PGA 0/1 was achieved in 90.6% of patients, sPGA-G 0/1 in 81.3%, f-PGA 0/1 in 66.7%, and pp-PGA 0/1 in 87.5%. Mean PGA values progressively decreased across all sites. The most common adverse event was oral candidiasis (11.8%). Conclusions: Bimekizumab showed rapid, sustained, and clinically meaningful improvement across all difficult-to-treat areas with a favorable safety profile. Full article

(This article belongs to the Special Issue Psoriasis in Focus: Current Research, Treatments, and Future Directions)

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13 pages, 764 KB

Open AccessArticle

Super Responders in Plaque Psoriasis: A Real-World, Multi-Agent Analysis Showing Bimekizumab Associated with the Highest Odds of PASI = 0 at Week 12

by Dominika Ziolkowska-Banasik, Kamila Zawadzinska-Halat, Paulina Basta and Maciej Pastuszczak

J. Clin. Med. 2025, 14(20), 7293; https://doi.org/10.3390/jcm14207293 - 16 Oct 2025

Viewed by 1952

Abstract

Introduction: Super responders (SRs)—patients achieving complete skin clearance (PASI = 0) soon after biologic initiation—represent a clinically relevant but underexplored phenotype. This study is one of the first real-world, multi-agent analyses comparing SR likelihood across biologic classes in plaque psoriasis. We assessed whether biologic choice predicts SR in routine clinical practice. Methods: We performed a retrospective, single-center study of 116 adults with moderate-to-severe plaque psoriasis initiating their first biologic (adalimumab, tildrakizumab, guselkumab, risankizumab, bimekizumab, or secukinumab). SR was defined as PASI = 0 at week 12. SR proportions (exact 95% CIs) were compared using Fisher’s exact tests and odds ratios (ORs). Multivariable logistic regression estimated adjusted associations between biologic and SR, controlling for age, sex, disease duration, BMI, baseline PASI, and prior cyclosporine/acitretin. Sensitivity analyses included Firth bias-reduced regression, the exclusion of sparse drug strata, and an alternative endpoint (PASI ≤ 1 at week 12). Results: Overall, 26/116 patients (22.4%) achieved SR. SR proportions differed by agent, highest with bimekizumab (11/17; 64.7%); Fisher’s p < 0.001 vs. others; OR = 12.83 (95% CI 4.17–39.50). In adjusted models, bimekizumab remained independently associated with SR (adjusted OR = 17.30; 95% CI 4.62–64.82; p = 2.35 × 10⁻⁵), while other covariates were not significant. Conclusions: In this real-world cohort, biologic selection—particularly bimekizumab—was the main determinant of early complete clearance. These findings highlight mechanistic class as a key driver of rapid, deep responses and support prospective validation with harmonized SR definitions and extended follow-up. Full article

(This article belongs to the Special Issue Psoriasis in Focus: Current Research, Treatments, and Future Directions)

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13 pages, 1686 KB

Open AccessArticle

Early Risk Prediction for Biologic Therapy in Psoriasis Using Machine Learning Models Based on Routine Health Records

by Tair Lax, Noga Fallach, Edia Stemmer, Guy Shrem and Mali Salmon-Divon

J. Clin. Med. 2025, 14(18), 6421; https://doi.org/10.3390/jcm14186421 - 11 Sep 2025

Cited by 2 | Viewed by 2077

Abstract

Background: Psoriasis is a chronic inflammatory skin disease with a variable course. Early identification of patients likely to require biologic therapy may help reduce complications and optimize care. In this study, we developed machine learning (ML) models to predict future biologic therapy use in psoriasis patients. Methods: We conducted a retrospective study using electronic health records (EHR) from Clalit Health Services in Israel, including psoriasis patients who started biologic therapy and matched psoriasis controls. Predictors included demographics, comorbidities, treatment history, and laboratory test results. KNN, SVM, Random Forest, and Logistic Regression ML models were trained on data from either the first five years post-onset or the five years preceding biologic therapy. Performance was evaluated on a held-out test set using AUC-ROC, precision, recall, and F1-score, with an emphasis on recall to maximize identification of true positive cases. Results: The best-performing models incorporated clinical, demographic, and laboratory data. Using data from the first five years after onset, the SVM model achieved the highest performance (AUC = 0.83, recall = 0.7). For data from the five years preceding biologic therapy, the Random Forest model performed best (AUC = 0.93, recall = 0.95). Key predictors included comorbid immune-mediated conditions, topical treatment frequency, and markers of inflammation and metabolism. Conclusions: EHR-based ML models, particularly those incorporating routine laboratory, demographic, and clinical data, can effectively predict future biologic therapy use in psoriasis patients. Model performance may be improved with larger cohorts and more complete clinical and laboratory data. Full article

(This article belongs to the Special Issue Psoriasis in Focus: Current Research, Treatments, and Future Directions)

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12 pages, 1262 KB

Open AccessArticle

Exploring the Impact of Gender and Age of Onset on Psoriasis Treatment Management

by Tair Lax, Edia Stemmer, Noga Fallach, Guy Shrem, Michal Schreiber-Divon, Snait Ayalon, Eitan Giat, Inbal Mor and Mali Salmon-Divon

J. Clin. Med. 2025, 14(12), 4090; https://doi.org/10.3390/jcm14124090 - 10 Jun 2025

Cited by 1 | Viewed by 2114

Abstract

Background: Psoriasis is a chronic inflammatory skin disease characterized by a bimodal onset distribution, with cases categorized as early-onset or late-onset. While the prevalence of psoriasis is nearly equal between genders, men typically experience more severe forms of the disease, leading to differences in treatment approaches and clinical outcomes. The aim of this study was to investigate gender-based differences in treatment patterns among psoriasis patients, with a focus on how these differences vary by disease onset (early vs. late). Methods: A retrospective cohort study including individuals diagnosed with psoriasis between 1998 and 2022 through Clalit Health Services (CHS) in Israel. Gender-based differences in treatment patterns by psoriasis onset were analyzed using Chi-square and Fisher exact tests and survival analyses. Results: The disease onset showed a bimodal distribution among 3999 individuals, with women experiencing earlier onset compared to men (median age 37.2 vs. 40.1 years; p < 0.001). In early-onset psoriasis, men were significantly more likely than women to receive systemic (17.9% vs. 6.5%; p < 0.001) and biological therapies (3.8% vs. 1.6%; p = 0.005) and initiated these treatments earlier (p < 0.001). In contrast, no significant gender-based treatment differences were observed in late-onset cases. Regardless of gender, early-onset patients began phototherapy earlier than late-onset patients (p < 0.001). Conclusions: Our results suggest that disease onset timing may influence treatment decisions and highlight the need for a more personalized approach to psoriasis management that considers both gender and age of onset. Full article

(This article belongs to the Special Issue Psoriasis in Focus: Current Research, Treatments, and Future Directions)

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