Targeted therapies continue to revolutionize the way we manage chronic inflammatory diseases in dermatology. In contrast to conventional immunosuppressive agents such as methotrexate, cyclosporine, and azathioprine, targeted therapies have the advantage of reducing inflammation to improve cutaneous disease while diminishing the concerns of cumulative end-organ toxicity. This has led to a paradigm shift from approaching disease management from a primarily as-needed basis to the goal of achieving continuous control.
Nowhere in dermatology is this transformation more evident than in the treatment of psoriasis. Advances in basic science have furthered our understanding of the pathogenesis of this disease and have led to additional targets for therapeutic intervention. In 2018, we now have 4 categories of biologics agents and 1 oral small molecule approved to treat the disease. The first 5 articles of this issue detail the key efficacy and safety considerations of drugs in each therapeutic class: tumor necrosis factor-α inhibitors, interleukin (IL)-12/23 inhibitors, IL-17 inhibitors, IL-23 inhibitors, and oral small molecules. Additionally, I have asked each author, all noted and respected authorities in the treatment of psoriasis, to comment on how to select appropriate therapies for an individual patient as well as provide personal observations of using these agents in their clinical practice.