To date, there are few guidelines to help physicians select the optimal biology agent and none that have looked specifically at plantar psoriasis. For this patient, finding a biologic that worked and was tolerable was a process of trial and error that took four years. The results achieved in this previously refractory patient with difficult-to-treat psoriasis may be due to the unique mechanism of action of brodalumab, though this will need to be confirmed in larger studies.

Herein, we report a case of a 46-year-old woman with a 12-year history of severe plaque psoriasis and psoriatic arthritis who was treated successfully with guselkumab and adalimumab after failure of prior topical corticosteroids, cyclosporine and narrow-band ultraviolet B (NBUVB) phototherapy.

When today’s dermatology residents were born, the concept of psoriasis as a systemic disease was relatively new. Early in the 1980s, topical therapy was the mainstay for medical management of this “skin condition.” Systemic therapies were beginning to be used for severe psoriasis, although it was unclear how they provided benefit. Three decades later, dermatologists have a much better—though perhaps still incomplete—understanding of the pathogenesis of psoriasis and its related comorbidities. Novel therapies have emerged to target the immunologic drivers at the heart of the disease

In this paper, we describe the importance of the TH17 pathway in psoriasis pathogenesis with a focus on the roles of IL-23 and IL-17 within this pathway. We also discuss the different IL-17 subtypes involved in psoriasis immunopathology and the multitude of cells that can produce these subtypes. Finally, we examine treatments that inhibit IL-23 and IL-17.

When today’s dermatology residents were born, the concept of psoriasis as a systemic disease was relatively new. Early in the 1980s, topical therapy was the mainstay for medical management of this “skin condition.” Systemic therapies were beginning to be used for severe psoriasis, although it was unclear how they provided benefit. Three decades later, dermatologists have a much better—though perhaps still incomplete—understanding of the pathogenesis of psoriasis and its related comorbidities. Novel therapies have emerged to target the immunologic drivers at the heart of the disease.