Abstract
Psoriasis is the type of one of the most prevalent forms of chronic inflammatory skin diseases globally with prevalence rates of 0.11 -1.58% and prevalence among the global population of 125 million patients. The review offers an in-depth analysis of the existing knowledge about the pathophysiology of psoriasis, its clinical presentation, and treatment. Psoriasis immunopathogenesis focuses on the interleukin-23/T- helper 17 cell axis, and the recent developments have explained the intricate interrelationship between innate and adaptive immune responses. Therapy modes currently used include topical therapy, phototherapy, traditional systemic therapy and biologic therapy which are aimed at particular cytokine pathways. The biologics landscape has radically changed with the introduction of tumor necrosis factor-alpha, interleukin-12/ 23, interleukin-17, and interleukin-23 biologics, which are showing never-before-seen disease clearance. Newer treatment modalities such as Janus kinase-signal transducer, next-generation biologics, and microbiome-targeted therapies are assured to enhance patient outcome further. This review summarizes the existing evidence on the treatment algorithms, special population issues and the new paradigm of personalized medicine in the management of psoriasis. The combination of biomarkers, genetic profiling, and therapeutic drug monitoring is the future trend towards optimal choice of treatments and the attainment of lasting disease remission. Even though this has been achieved to a greater extent, there are still certain challenges in accessing treatment, long-term safety, and the ultimate cure of the disease instead of managing it.