The New Era of Predictive, Preventive, and Personalized Medicine
For decades, psoriasis has been misunderstood as merely a cosmetic skin condition. Yet this complex disease affects over 125 million people worldwide, causing not just visible plaques but increasing the risk of heart disease, diabetes, and mental health challenges 3 .
People affected worldwide
Higher risk of heart disease
Increased depression risk
The traditional one-size-fits-all approach to treatment—where patients cycle through medications until they find one that works—is rapidly becoming obsolete. Today, a revolutionary framework is transforming psoriasis management: Predictive, Preventive, Participatory, and Personalized Medicine (PPPM).
Moving from reactive treatment to prediction and prevention using biomarkers that signal future risk 3 .
Evolving from population-based to individualized care based on genetic variations and unique disease mechanisms 4 .
Transforming patients from passive recipients to active participants in their care 7 .
The scientific foundation of personalized psoriasis care lies in identifying reliable biomarkers—biological signals that predict how an individual's disease will behave and respond to treatment.
The most discussed biomarker gene associated with psoriasis risk and differential responses to treatments 4 .
Investigating biomarkers at genetic, microRNA, serum cytokine, and protein levels for comprehensive profiling.
The psoriasis treatment arsenal has expanded dramatically, moving from broad immunosuppressants to precisely targeted therapies that address specific components of the psoriatic inflammation cascade.
| Treatment Category | Example Medications | Primary Target | Special Considerations |
|---|---|---|---|
| IL-23 Inhibitors | Risankizumab, Guselkumab, Tildrakizumab | IL-23 cytokine | Also effective for psoriatic arthritis; don't trigger IBD |
| IL-17 Inhibitors | Secukinumab, Ixekizumab, Bimekizumab | IL-17 cytokine | Rapid onset; may trigger oral candidiasis; caution with IBD |
| PDE4 Inhibitors | Apremilast | Intracellular inflammation | Oral medication; no lab monitoring; good for mild cases |
| TYK2 Inhibitors | Deucravacitinib | TYK2 enzyme | Oral; no black box warning for cardiovascular events |
| Topical Innovations | Tapinarof, Roflumilast | Skin barrier repair | Non-steroidal; provides remission after discontinuation |
The emerging evidence strongly supports the superior effectiveness of certain therapeutic classes. Recent real-world studies comparing biologics through 24 months of treatment demonstrate that patients treated with anti-IL-17A biologics had significantly higher odds of achieving complete skin clearance compared to those treated with anti-IL-12/23 and anti-TNFα biologics 5 .
The groundbreaking POSITIVE study represents a paradigm shift in how we evaluate psoriasis treatment success. Unlike traditional studies that primarily measure skin clearance, this 24-month, multinational, observational study made patient well-being its primary endpoint 7 .
The research enrolled 785 adult patients with moderate-to-severe plaque psoriasis across nine European countries, all receiving the IL-23p19 inhibitor tildrakizumab in real-world clinical practice .
The POSITIVE study demonstrated that effective psoriasis treatment involves far more than clearing skin lesions. After 52 weeks of treatment, patients experienced dramatic improvements across all measured parameters 7 :
| Outcome Measure | Baseline | Week 28 | Week 52 | Improvement |
|---|---|---|---|---|
| WHO-5 Well-Being | 53.8 | 66.0 | 65.7 | +22% |
| PASI Score | 13.1 | 1.7 | 1.5 | -89% |
| DLQI-R Quality of Life | 12.6 | 3.3 | 3.1 | -75% |
| PASI ≤1 (Clear) | 0% | 54.8% | 56.8% | - |
| PASI ≤3 (Minimal) | 0% | 85.8% | 88.4% | - |
Perhaps most remarkably, the well-being scores of psoriasis patients—which started significantly below the European population average—not only caught up to but surpassed the general population mean after two years of treatment, reaching 70.43 .
Modern psoriasis research relies on sophisticated tools and methodologies that allow scientists to unravel the complexity of this disease at multiple biological levels.
| Research Tool | Primary Function | Application in Psoriasis |
|---|---|---|
| Genomic Sequencing | Identifies genetic variations | HLA typing; pharmacogenetics to predict treatment response |
| Proteomic Analysis | Measures protein expression | Serum cytokine profiling; drug target identification |
| MicroRNA Profiling | Assesses gene regulation | Biomarker discovery; understanding treatment resistance |
| Real-World Evidence (RWE) | Captures clinical practice data | Understanding long-term effectiveness outside clinical trials |
| Patient-Reported Outcomes | Quantifies patient experience | Measuring well-being, quality of life, treatment satisfaction |
These tools have enabled researchers to move beyond the laboratory and understand how treatments perform in diverse real-world settings. For instance, recent analyses of 31,521 patients receiving different biologics have revealed notable differences in treatment patterns, discontinuation rates, and persistence 9 .
Researchers have noted that despite identifying numerous candidate biomarkers, the scarcity and heterogeneity of results don't yet allow for a gold-standard biomarker for each treatment 4 .
The field is rapidly expanding its understanding of how different treatments perform over the long term. The Psoriasis Study of Health Outcomes (PSoHO) is providing valuable 24-month data on comparative effectiveness and durability 5 .
Perhaps most exciting is the growing recognition that psoriasis management must address the whole person—not just their skin. This approach was reinforced by the WHO's 2025 resolution on skin diseases as a global public health priority .
The era of one-size-fits-all psoriasis treatment is ending. The emerging paradigm of Predictive, Preventive, Participatory, and Personalized Medicine offers a more compassionate, effective, and comprehensive approach to psoriasis care.
As research continues to unravel the complexity of psoriatic disease, the promise of truly personalized medicine becomes increasingly tangible. The future of psoriasis care is not just about developing new drugs, but about matching the right patient with the right treatment at the right time—and measuring success not just in PASI scores, but in restored hope, functionality, and joy in patients' lives.