Personalised medicine for psoriasis: a real possibility ahead.

In the last decade, our understanding of psoriasis has increased by leaps and bounds, resulting in many new targeted therapies being introduced for those with recalcitrant psoriasis. However, despite the plethora of new treatment options and biologics to treat the most difficult cases of psoriasis, dermatologists are still confronted with the heterogeneity of treatment effects for psoriasis in the area of treatment response as well as adverse drug effects. While many factors (age, obesity, drug-drug interactions, hepatic and renal function etc,) affect drug responses and adverse effects, genetic factors have been recognised to play a big role in drug response and toxicity. With the unravelling of the human genetic code and discovery of single nucleotide polymorphisms, researchers can now study DNA polymorphisms in our patients and this, coupled with recent improvement in genomic technologies, allow us to reveal disease processes at molecular levels that were not available in the past. This new powerful knowledge and technologies now provide clinicians with the real possibility of personalising medicine for our patients, predicting who will respond to which treatment options and the likelihood of toxicity associated with the proposed treatment. This promise of “personalised medicine”, an exciting area of development that is especially relevant to a chronic disease like psoriasis, is certainly not science fiction and could be a reality in the near future. This idea of “personalised medicine” can be applied to 3 main areas in the future management of psoriasis, namely a) Identifying new molecular targets for new treatment options, b) Prediction of course of disease, and c) Prediction of toxicity of treatment. Personalised Medicine for Psoriasis: A Real Possibility Ahead Tien Guan Thng1MBBS, MRCP (UK), Kar Seng Lim,1MBBS, MRCP (UK), FAMS