Psoriasis: talking points from recent clinical trials

Psoriasis is a chronic inflammatory skin disease that includes a wide spectrum of clinical variants. The most common form of psoriasis is chronic plaque psoriasis, which manifests as well- demarked, erythematous, and scaly plaques. The pathogenic mechanisms underlying either plaque or pustular psoriasis overlap because of the central role of the interleukin-(IL-)23/ IL-17A axis in both conditions, though pustular psoriasis is characterized by a more prominent contribution of the innate immune compartment involving the IL-1 cytokine family [1]. Besides the development of antibodies targeting either solu-ble pathogenic cytokines or their receptor, the inhibition of the intracellular signaling induced by multiple cytokines and chemokines has been proposed as an alternative therapeutic strategy. Nowadays, the therapeutic paradigm for plaque psor-iasis includes topical, phototherapy, conventional systemic treatments, different classes of biological agents, and small molecules. Contrary to plaque psoriasis, only one biologic agent has received approval for the treatment of pustular psoriasis. The pipeline of plaque psoriasis consists of topical and systemic agents that showed promising results in phase II trials, as well as for pustular psoriasis, with one additional IL-36 receptor antagonist under investigation. This editorial aimed to collect and discuss clinical outcomes deriving from the most advanced trials testing promising agents, either topical or systemic. A narrative review for selected agents with a robust clinical trial program was performed.