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Since the clinical and epidemiological characteristics of psoriasis can vary widely, it is important to understand the degree of control that can be achieved using available systemic agents and to develop a therapeutic strategy for the control of psoriasis in specific patients. Although the exact underlying immunopathogenic mechanisms of psoriasis are not fully understood, it is widely believed that T cells play a key role in the pathogenesis of the disease.This chapter discusses the management of psoriasis as a chronic inflammatory skin condition, with emphasis on the role of systemic therapy. After a brief review of the epidemiology, clinical presentation, and pathophysiology of psoriasis, the following sections discuss the current treatment options for psoriasis. In addition to general measures, the use of phototherapy, anti-psoriatic agents, and other systemic medications are reviewed. The chapter concludes with a discussion of recent and future developments in systemic therapy for psoriasis.Finally, this chapter contains a brief overview of standard diagnostics and important dermatologic surgical and cosmetic procedures for the patient with psoriasis.The pathophysiology and progression of psoriasis have been extensively studied. In psoriasis, the proliferative and degradative processes of the dermis are dysregulated and epidermal proliferation is increased. The epidermal differentiation complex is dysregulated, resulting in abnormal keratinocyte differentiation. Skin inflammation and the subsequent proliferation and inflammation of the skin are caused by the release of inflammatory cytokines (IL-17, IL-22, IL-23, IL-31, and TNF-β). Although cytokines have been implicated in the pathogenesis of psoriasis, they are not the primary immunopathogenic event in psoriasis. Rather, it is the dysregulation of keratinocyte proliferation that leads to a production of cytokines that contributes to the pathogenesis of psoriasis.
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