Abstract
Plaque psoriasis is a chronic, immune-mediated inflammatory skin disease that has considerable effects on patients’ physical, psychological and social well-being. It is strongly influenced by genetic predisposition, with HLA-C*06:02 showing the strongest association, particularly in those with early-onset disease. Additional susceptibility loci, including IL23A, IL12B and IL17RA, are linked to dysregulation of the IL-23–T helper 17 axis, which contributes to chronic inflammation and keratinocyte hyperproliferation. Plaque psoriasis is frequently associated with psoriatic arthritis and other comorbidities, such as cardiovascular disease, metabolic syndrome and psychiatric disorders, all of which contribute to increased morbidity and mortality. Management strategies are tailored to disease severity and the presence of comorbidities. For mild disease, topical therapies remain the first-line treatment, including corticosteroids, vitamin D analogues and topical calcineurin inhibitors. New non-steroidal agents, such as topical PDE4 and aryl hydrocarbon receptor agonists, offer additional options. In moderate-to-severe disease, oral systemic therapies, such as methotrexate, ciclosporin, acitretin, apremilast and deucravacitinib, provide a range of immunomodulatory effects. Biologic therapies targeting TNF, IL-17, IL-23 and IL-12/23 have demonstrated high efficacy in improving both cutaneous and systemic inflammation. Current research on systemic therapies is focused on the development of additional inhibitors of the Tyk2 pathway and inhibitors to IL-23 receptor, IL-17, and TNF. Early screening for psoriatic arthritis, proactive cardiovascular risk reduction and multidisciplinary care are crucial to optimizing long-term outcomes. Ongoing research continues to advance precision medicine approaches, with the goal of enhancing treatment durability and improving quality of life for individuals living with psoriasis.
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Introduction (A.W.A.); Epidemiology (A.W.A.); Mechanisms/pathophysiology (A.B.); Diagnosis, screening and prevention (Y.-H.H); Management (A.W.A., K.C.D., L.J.S. and J.F.M.); Quality of life (L.G.); Outlook (A.W.A. and A.B.); overview of the Primer (A.W.A. and L.G.).
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A.W.A. has served as a research investigator, scientific adviser or speaker for AbbVie, Amgen, Almirall, Arcutis, ASLAN, Beiersdorf, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Mindera, Nimbus, Novartis, Ortho, Sun, Dermavant, Dermira, Sanofi, Takeda, Organon, Regeneron, Pfizer and Ventyx. A.B. has served as a speaker (received honoraria) for Eli Lilly and Company and UCB; has served as a scientific adviser (received honoraria) for AbbVie, Almirall, Alumis, Amgen, Anaptysbio, Apogee, Arcutis, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Corvus, Dermavant, Eli Lilly and Company, Galderma, GlaxoSmithKline, Immunovant, Incyte, IQVIA, Janssen, Leo, Lipidio, Merck, Novartis, Oruka, Paragon, Pfizer, Regeneron, Sanofi, Spherix Global Insights, Sun Pharma, Syncona, Takeda, UCB and Union; has acted as a clinical study investigator (institution has received clinical study funds) for AbbVie, Acelyrin, Almirall, Alumis, Amgen, Arcutis, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, Eli Lilly and Company, Galderma, Incyte, Janssen, Leo, Merck, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, Takeda and UCB; owns stock in Lipidio and Oruka; and has acted as Member and Owner of Blauvelt Consulting, LLC. In this capacity, A.B. has provided scientific consulting services (for example, protocol development, data analysis) to the following companies: AbbVie, Almirall, Alumis, Amgen, Anaptysbio, Apogee, Arcutis, Astria, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Corvus, Dermavant, Eli Lilly and Company, Galderma, GlaxoSmithKline, Immunovant, Incyte, IQVIA, Janssen, Leo, Lipidio, Merck, Novartis, Oruka, Paragon, Pfizer, Regeneron, Sanofi, Spherix Global Insights, Sun Pharma, Syncona, Takeda, UCB, Union and Zai Lab. K.C.D. has served as a consultant (received honoraria) for AbbVie, Amgen/Celgene, Boehringer Ingelheim, Bristol Myers Squibb, Lilly, FIDE (which is sponsored by multiple pharmaceutical companies), CorEvitas, Janssen, Leo, Novartis, Pfizer, Stiefel and CorEvitas; and as an investigator for AbbVie, Amgen/Celgene, Boehringer Ingelheim, Bristol Myers Squibb, CorEvitas, Lilly, Janssen, Novartis, Pfizer, Regeneron, Stiefel and UCB. Y.-H.H. has conducted clinical trials or received honoraria as a consultant for Abbvie, Bristol Myers Squibb, Celgene, Janssen-Cilag Pharmaceuticals, Novartis and Pfizer Pharmaceuticals. L.J.S. has provided education or served on the advisory boards for AbbVie, Almirall, Amgen, Aspire Pharma, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Fresenius Kabi, Galderma, Janssen, Leo, Lilly, Medac, Moonlake, Novartis, Pfizer, Sanofi, Takeda and UCB; and has received research funding from Janssen, Novartis and Pfizer. J.F.M. is a consultant and/or investigator for Amgen, Astra-Zeneca, Boehringer Ingelheim, Bristol Myers Squibb, Abbvie, Dermavant, Eli Lilly, Moonlake, Novartis, Janssen, UCB, Sanofi, Regeneron, Sun Pharma, Biogen and Pfizer. L.G. declares no competing interests.
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Armstrong, A.W., Blauvelt, A., Callis Duffin, K. et al. Psoriasis. Nat Rev Dis Primers 11, 45 (2025). https://doi.org/10.1038/s41572-025-00630-5
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DOI: https://doi.org/10.1038/s41572-025-00630-5
