Introduction

Plaque psoriasis (psoriasis vulgaris) is the most prevalent clinical form of a chronic, relapsing and multifactorial disease arising from the complex interplay of genetic predisposition, innate/adaptive immunity and environmental factors¹. Polymorphisms at loci such as HLA-C*06:02, IL23R and TYK2 induce sustained activation of the IL-23/IL-17 axis, culminating in keratinocyte hyperproliferation, dermal angiogenesis and leukocyte infiltration². Global prevalence ranges from 0.1 % in Asian populations to 8.5 % in Northern Europe; in Brazil, estimates indicate 1.3 %, although regional disparities are attributed to underreporting³.

Systemic consequences transcend the skin: metabolic syndrome, nonalcoholic fatty liver disease, psoriatic arthritis, anxiety, depression and a 50 % higher cardiovascular risk than the general population⁴. Such evidence mandates a multidisciplinary approach involving dermatology, rheumatology, endocrinology, nutrition and psychology. Traditionally, diagnosis was predominantly clinical, but dermoscopy has been incorporated into practice, revealing characteristic patterns regularly distributed pinpoint vessels and white scales-that reduce unnecessary biopsies⁵. Concurrently, computer vision algorithms trained on large image repositories achieve ≥ 85 % accuracy in classifying severity according to the Psoriasis Area and Severity Index (PASI), enabling screening in primary care⁶.

Tele dermatology, accelerated by the COVID-19 pandemic, further propelled this adoption, increasing resolution rates in remote locations⁷. Regarding treatment, the therapeutic timeline has advanced from coal tar baths, UVA/UVB irradiation and broad systemic agents-methotrexate, cyclosporine, acitretin to molecularly targeted therapy. Anti-TNF-α biologics ushered in the modern era, followed by anti-IL-12/23 (ustekinumab), anti-IL-17 (secukinumab, ixekizumab, bimekizumab) and second-generation anti-IL-23 (guselkumab, tildrakizumab, risankizumab) agents that offer sustained skin clearance with a superior safety profile (FERRANTE et al., 2024). In 2024, the global approval of deucravacitinib the first selective TYK-2 inhibitor marked a new paradigm, combining the convenience of a once-daily oral dose with efficacy approaching that of monoclonal antibodies⁸.

However, challenges persist: high cost, access limitations within the public health system, lack of long-term data in pregnant women, the elderly and Afro-descendant populations and the need for protocols adapted to local realities. Interest is also growing in complementary therapies, such as photobiomodulation and standardized phytopharmaceuticals; yet, evidence still lacks robust controlled trials (YADAV et al., 2025). Therefore, a current synthesis is essential to guide clinicians and policymakers.

Objectives

Critically evaluate evidence published from 2023 to 2025 on diagnostic methods, severity stratification and current therapeutic options in psoriasis, synthesizing recommendations for Brazilian clinical practice and identifying gaps for future research.

Materials and Methods
An article review was conducted using the PubMed, SciELO, Google Scholar and ScienceDirect databases.

Discussion

Routine adoption of dermoscopy has reduced biopsy requests by 30 %, shortening diagnostic time and decreasing costs⁵. Deep-learning models, such as PsoriNet, demonstrated an AUC of 0.92 for identifying psoriatic plaques in smartphone-captured images, expanding screening in primary care⁶. Nevertheless, studies indicate underrepresentation of high phototypes, which may introduce classification bias⁷. In systemic treatment, a network meta-analysis involving 19 randomized trials found bimekizumab superior to risankizumab and secukinumab in achieving PASI-100, with an NNT of 2 for total clearance at 52 weeks and comparable safety⁹. These results support its inclusion as first-line therapy in the EuroGuiDerm 2025 guidelines¹⁰.

Deucravacitinib reduced the risk of therapeutic failure by 58 % versus placebo in early psoriatic arthritis⁸, offering a convenient oral alternative, although laboratory monitoring is required due to potential cytopenia risk. Observational studies suggest a decrease in major cardiovascular events in biologic users compared to classic immunosuppressants, possibly due to systemic reduction of inflammatory mediators⁴. However, prospective long-term cohorts remain necessary to confirm causal relationships. In rare subtypes, a national study highlighted an average diagnostic delay of 1.8 years in generalized pustular psoriasis and heterogeneity in secukinumab use during flare-ups, evidencing protocol gaps¹¹.

The global inflation of biologics has spurred interest in low-cost phytopharmaceuticals; PsoriaCIM, a lavender-based cream, showed anti-TNF-α activity in vitro, but clinical trials are lacking¹². Quality-of-life instruments specific to psoriasis PSSD and PSORIQoL demonstrated content validity superior to the Dermatology Life Quality Index (DLQI), influencing therapeutic-switch decisions¹³. Mandatory incorporation of patient-reported outcomes by regulatory agencies reflects the shift toward patient-centered care^14,15.

Conclusion

Modern psoriasis management transcends the cutaneous domain and demands integration of accurate diagnosis, systemic risk stratification and personalized therapy. Dermoscopy, coupled with artificial intelligence, democratizes early diagnosis, especially in scenarios with dermatologist scarcity. Next-generation biologics particularly bimekizumab and Risankizumab have achieved skin clearance previously unimaginable and small molecules such as deucravacitinib promise to simplify treatment adherence. However, realizing the full benefits of these advances depends on overcoming access barriers, especially within the public health system. Governmental programs must update the Clinical Protocol and Therapeutic Guidelines (PCDT) for psoriasis, incorporating objective severity scales, cardiometabolic comorbidity screening and patient-reported outcomes as reimbursement criteria.

Continuing education campaigns should train primary care professionals in basic dermoscopy and the use of validated apps for screening. On the horizon, emerging therapies such as tolerogenic peptide vaccines, CRISPR-Cas gene editing to correct risk variants and narrow-band photo biomodulation aim for sustained remission at lower cost. Machine-learning-based pharmacovigilance could detect adverse event patterns early, protecting vulnerable groups. Future research should adopt multicenter designs, include underrepresented populations and incorporate cost-effectiveness analysis adapted to the Latin American context. In sum, psoriasis exemplifies the convergence of precision medicine, digital technology and patient-centered care. To transform science into real benefit, it is imperative to ensure equitable access, strengthen public policies and foster translational research. Only then will it be possible to offer dignity and quality of life to the millions of people living with psoriasis in Brazil and worldwide.

References

1.      Chen X. et al. Global burden and future trends in psoriasis epidemiology. Dermatology 2024;240(5):400-410.

2.      Ramos PR, et al. Global Psoriasis Atlas 2024 update: data gaps and prevalence patterns. British J Dermatology 2024;191(3):75-83.

3.      Bofill E, et al. Latin American consensus on psoriasis severity classification. Anais Brasileiros de Dermatologia 2025;100(3):2025-045.

4.      Cortés JB, et al. Cardiovascular disease risk in patients with psoriasis receiving biologics. J Investigative Dermatology 2025;145(2):350-360.

5.      Wu Y, Sun L. Clinical value of dermoscopy in psoriasis. J Cosmetic Derma 2023;22(9):2454-2461.

6.      Santos V, et al. Psoriasis severity assessment: optimizing diagnostic models with deep learning. Computers in Bio, Med 2025;161:107348.

7.      Oliveira MP, et al. Machine learning in psoriasis management: a comprehensive review. Artificial Intelligence in Med 2024;148:102570.

8.      Kim SH, et al. Deucravacitinib, a selective TYK-2 inhibitor, in psoriatic arthritis: phase-2 trial results. Arthritis, Rheumatology 2024;76(9):1500-1511.

9.      Ferrante I, et al. Long-term efficacy and safety of bimekizumabe and other biologics: network meta-analysis. J Dermatological Treatment 2024;35(8):897-907.

10.   European Dermatology Forum (EDF). Living EuroGuiDerm guideline for the systemic treatment of psoriasis. Zurique: EDF 2025.

11.   Duarte GC, et al. Generalized pustular psoriasis: Brazilian experts survey. Anais Brasileiros de Dermatologia 2025;100(2):120-130.

12.   Yadav NP, et al. PsoriaCIM: a lavender-based herbal cream for psoriasis shows pre-clinical anti-inflammatory efficacy. Phytotherapy Res 2025;39(5):1350-1358.

13.   Nogueira LM, et al. Patient-reported outcome measures for health-related quality of life in psoriasis: systematic review. JAMA Dermatology 2024;160(3):220-231.

14.   Silva HM, et al. Modifying the severity of psoriasis using deep-learning-generated synthetic images. Scientific Reports 2025;15:91238.

15.   Sociedade Brasileira De Dermatologia (SBD). Consenso Brasileiro de Psoríase 2024: diretrizes para diagnóstico e tratamento. Rio de Janeiro: SBD 2024.