Biological treatment for erythrodermic psoriasis

Introduction: Erythrodermic psoriasis (EP) is an extreme and potentially life-threatening form of psoriasis in which most or all of the body surface area is affected by psoriasis. It occurs in 1-2% of patients with psoriasis and is less responsive to conventional therapies. Biologics have shown promise in the management of EP. Areas covered: This review briefly discusses the pathophysiology of EP. Current evidence on established and emerging targeted therapies for EP is covered, including anti-TNF-alpha biologics, IL-12/23, IL-17, and IL-23 inhibitors. Expert opinion: The need for rapidly acting, safe, and efficacious agents in EP has been met with advent of newer biologics, particularly IL-17 and IL-23 inhibitors. These targeted approaches warrant consideration as first-line management option for the management of EP; however, high-quality evidence regarding their long-term efficacy and safety in EP is lacking. Novel biologics such as bimekizumab and mirikizumab, and nanobodies such as netakimab and sonelokimab have shown promise in the management of plaque psoriasis, and potential of these molecules in management of EP should be explored. Management of patients with prior biologic failure remains a challenge. Guidelines for the management of EP need to be revisited in light of the recent advances.

Automated summary

Erythrodermic psoriasis is a severe and potentially life-threatening form of psoriasis, which is less responsive to conventional therapies. The advent of newer biologics, particularly IL-17 and IL-23 inhibitors, has shown promise in the management of EP. However, there is a lack of high-quality evidence regarding their long-term efficacy and safety, and the management of patients with prior biologic failure remains challenging.