- Mona El-Kalioby, MBBCh, MSc, MD
- Congress Reports, Comorbidities, Disease Severity, Pediatrics, Research, Treatment
The 33rd Annual European Academy of Dermatology and Venereology (EADV) Congress was held in Amsterdam, Netherlands, from September 25 to 28, 2024. With over 650 speakers from more than 50 countries and over 180 presentations, the event attracted more than 17,000 delegates worldwide. This Congress Report summarizes 23 of the lectures on psoriasis, including highlights from the International Psoriasis Council (IPC) Symposium: Data Driven Care in Psoriasis. Download the full EADV Report or continue reading for key highlights.
IPC SYMPOSIUM: DATA DRIVEN CARE IN PSORIASIS
Big Data: Challenges and Opportunities
Tamar Nijsten, PhD
Big data relies not only on data volume but also on data variety, speed of generation, data variability, and quality. Artificial intelligence processing of data gives more structured outcomes, and machine learning is promising for data processing and combining data sets.
The Role of AI in Psoriasis Care: A Vision for the Future
Alexander Navarini, MD, PhD, IPC Councilor
Artificial intelligence introduces crucial changes to the field of psoriasis including:
- Psoriasis diagnosis for patients and non-dermatologists
- Automated psoriasis scoring e.g. PASI scoring
- Omics for personalized treatments and predictive analysis
- AI-automated documentation and patient information
- Telemedicine and remote diagnosis, and virtual follow up.
Preventing Psoriatic Arthritis
Frank Behrens, MD
There are stages between psoriasis and PsA, such as preclinical, subclinical, and prodromal phases. It is crucial to detect PsA in its preclinical phase when the immune system shifts from skin to joints. While retrospective studies suggest biologics may prevent PsA, more evidence is needed due to potential bias in these non-randomized studies.
Sustaining Psoriasis Remission
Satveer Mahil, PhD, FRCP, IPC Councilor
Definitions of remission vary across studies. Early intervention improves skin clearance, but access to specialized care remains a barrier. Once achieved, skin clearance allows for biologic dose reduction, lowering health burden and cost. She also highlighted the discovery of proinflammatory fibroblasts, which may explain biologic-induced psoriasis resolution and the role of inflammatory memory in tissue.
Recent Treatment Advances in Pediatric Psoriasis
Amy Paller, MS, MD, IPC Board Member
Pediatric cases often differ from adults, with thinner scales and more facial and scalp involvement, leading to frequent misdiagnosis. Over 90% of cases are preceded by obesity. Methotrexate remains the most common systemic treatment, while newer topicals like roflumilast and FDA-approved biologics (etanercept, adalimumab, ustekinumab, secukinumab, ixekizumab) are emerging. IL-23/Th17-targeted therapies show better efficacy, and safer treatments are lowering the threshold for systemic use in moderate to severe cases.
Recategorization of Disease Severity in Pediatric Psoriasis
Marieke Seyger, MD, PhD, IPC Councilor
An observational study from Nijmegen, Netherlands found that 49% of children met the Rule of 10 definition for severe psoriasis, but according to IPC criteria, 90.6% had high-impact site involvement, and 92.4% were candidates for systemic treatment. These findings show that adult severity definitions don’t apply to pediatric cases, underscoring the need for a new definition for initiating systemic therapy in children with psoriasis.
Challenging Case with a Focus on Pediatrics
Mona El-Kalioby, MBBCh, MSc, MD, 2022 IPC Fellow
A 9-year-old boy with plaque psoriasis and multiple systemic issues, including persistent diarrhea, hepatomegaly, severe autoimmune hemolytic anemia, immune thrombocytopenia, humoral immune defect, regulatory T cell defect, and recurrent pneumonia. He was diagnosed with LRBA deficiency, a rare disorder involving autoimmunity, lymphoproliferation, and immune deficiency. His psoriasis improved with the overall condition and infection management.
Challenging Case with a Focus on Data Driven Care
Ravi Ramessur, MD
A 30-year-old woman with extensive psoriasis who developed an acute ischemic stroke. He discussed a Mendelian randomization study to explore the bidirectional relationship between psoriasis and cardiovascular disease. The findings showed no genetic link from psoriasis to cardiovascular disease, but genetic predictors of cardiovascular disease do increase psoriasis risk. He highlighted the importance of genetics as a tool to understand psoriasis and its comorbidities.
PSORIASIS I
Inflammatory Memory and Disease Modification
Kilian Eyerich, MD, PhD, IPC Councilor
The definition of disease modification is debatable in psoriasis. The maximum definition for disease modification is cure. Insights from clinical trials and real-world evidence provide that disease modification is probably possible, especially with short disease duration. Early and effective treatment may reduce the development of psoriasis comorbidities such as psoriatic arthritis. Potential mechanisms of IL-23-mediated disease modifications include epi-genetic resolution and normalization of tissue-resident memory cells.
Population Differences in Psoriasis
Hok Bing Thio, MD, PhD
While psoriasis is most prevalent in white ethnic groups, it tends to be more severe in Asian and Black individuals. Triggers include genetic, epigenetic, and environmental factors like diet, metabolism, and air pollution. Medications such as metformin and semaglutide can influence these triggers.
Pustular Psoriasis: Is It Really Psoriasis?
Hervé Bachelez, MD, PhD, IPC President
Pustular and plaque psoriasis are likely linked, supported by genetic evidence in some patients (CARD14). This suggests they belong to the same disease spectrum. Despite new targeted therapies for GPP, more research indicates other mechanisms may be involved, paving the way for precision medicine.
Personalized Medicine Approaches for Tailored Treatments
Satveer Mahil, PhD, FRCP, IPC Councilor
Personalized medicine may prevent disease onset, enable early targeted treatment, and improve long-term prognosis in psoriasis. Predictive biomarkers help assess disease risk and treatment response. Dose reduction, patient-led as-needed treatment, and therapeutic drug monitoring are key strategies for personalized management.
PSORIASIS II
New Topicals
Diamant Thaçi’s MD PhD, IPC Councilor
Most psoriasis patients need topical therapy. Topical corticosteroids, alone or with vitamin D analogs, are the main treatments for mild to moderate cases. He also reviewed new topicals like Tapinarof and roflumilast and advances in drug delivery systems.
Do We Need Oral Treatment Options?
Richard Warren, BSc, MBChB, PhD, IPC Councilor
The convenience of oral treatments over injections is emphasized, with new TYK-2 and PDE-4 agents showing promise, along with the IL-23R antagonist JNJ-77242113. Upadacitinib also demonstrates good efficacy for psoriatic arthritis.
Therapeutic Drug Monitoring in your Practice?
Jo Lambert, MD, PhD, IPC Councilor
Therapeutic drug monitoring (TDM) helps manage biologic side effects, optimize dosing, reduce healthcare costs, and personalize treatment. The HELIOS trial suggests that a “one dose fits all” approach may lead to dosing issues.
Does Psoriasis Treatment Prevent the Development of Psoriatic Arthritis?
April Armstrong, MD, MPH, IPC Councilor
While some studies show biologics and DMARDs reduce psoriatic arthritis risk, others suggest an increased risk due to protopathic and survival biases.
PSORIASIS III
Pathogenesis and the Therapeutic Landscape
Tiago Torres, MD, PhD, IPC Councilor
The advances in psoriasis treatment and targeted therapies have led to clearer skin for patients. The IL-23/IL-17 axis drugs are the most effective, with IL-17 inhibition achieved through various strategies. Selective IL-23 inhibitors are effective, safe, and convenient, allowing longer injection intervals. Small-molecule drugs targeting the IL-23 pathway offer an alternative to biologics.
Comorbidities and Their Management
Catherine Smith, MD, IPC Board Member
Comorbidities burden contributes to the cumulative life force impairment in people with psoriasis. Screening for comorbidities, e.g., arthritis, cardiovascular, etc., is crucial. It is important to ask about mental health in psoriasis patients as the Dermatology life quality index (DLQI) will not pick up depression, suicidality, or anxiety.
Which Drug for Which Patient?
Reinhart Speeckaert, MD, PhD
Choosing the right drug for the right patient depends on the age, severity, comorbidities, patient history, earlier treatments, and other autoimmune disorders.
Subtypes and Their Management
Lluís Puig, MD, PhD, IPC Board Member
Psoriasis subtypes can be classified by location (scalp, flexural, sebopsoriasis, palmoplantar, nail), morphology (circinate/gyrate, follicular, linear, small plaque in Asians), stability (acute/unstable: guttate, erythrodermic, paradoxical), and autoinflammatory types (pustular psoriasis, pityriasis rubra pilaris). Unlike guttate psoriasis, small plaque psoriasis typically begins in adults and presents with larger, thicker lesions.
PLENARY LECTURE
Pustular Psoriasis: Clinical Continuum or Separate Entity?
Jonathan Barker, MD, FRCP, IPC Past President
Pustular psoriasis is under focus due to the substantial unmet needs in the disease and the dramatic progress in the science and practice of psoriasis vulgaris. He reviewed the association and differences between pustular psoriasis and psoriasis vulgaris and thoroughly explained each subtype’s classification, subtypes, and evidence for treatment response.
OTHER PSORIASIS LECTURES
Psoriasis and Ethical Aspects
Vanda Bondare-Ansberga, PhD Student
Ethical considerations in psoriasis include a range of issues related to stigmatization, treatment access, and research. Psoriasis can affect relationships at home, school, or work, as well as sexual relationships, and thus reduce the quality of life and cause psychological strain. Patient or frequently excluded from normal social environments. Shame has been the most often reported emotion, especially by women, patients in the countryside, and patients with long disease duration.
Erasing Inequities: Strategies for Addressing Bias in Dermatology
Jui Vyas, MBBS, DVD, DDSC, MSc Dermatology, MSc Medical Education, FHEA
Inequity leads to unequal healthcare outcomes, with equity focusing on providing individuals with the resources they need to achieve equal results. Reducing bias, especially in dermatology, requires education on recognizing skin diseases across all skin tones and ensuring diverse representation in research, guided by the CARE approach: Communication, Assess for bias, Reassess diagnosis, and Enact a culturally sensitive plan.
For a comprehensive look into the sessions and findings, we encourage you to download the full 2024 EADV Congress Report.
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