Psoriasis: the future

The aetiology of psoriasis is still unclear but our knowledge of the psoria tic process has grown substantially over the last two decades. The future w ill undoubtedly bring advances in our understanding of the pathogenesis of psoriasis and, as a consequence, new therapies. Defining the molecular gene tics of psoriasis will enhance our understanding of the disease process and hopefully facilitate the development of a representative animal model. Thi s in itself will be a key step in the development and testing of new therap ies. Precise identification of the immunological events involved in psorias is will allow specific T-cell- and cytokine-targeted. and perhaps less toxi c, immunotherapies. Anti-angiogenic agents that are in development for use in oncology may also be effective in psoriasis. The adaptation of current t opical therapies such as retinoids and vitamin D analogues to produce more effective and better-tolerated formulations will also play a significant ro le in our future first-line management of patients. The increased recogniti on and better management of environmental trigger factors such as psycholog ical distress will become an important factor in future psoriasis care. The development of physical therapies including photodynamic therapy and excim er lasers has the potential to expand the remit of psoriasis therapy. There is little doubt that the future for our patients with psoriasis is bright. However, this will only be achievable by a concerted research effort to un derstand all facets of this enigmatic disease ranging from the molecular to the environmental.