Decoding psoriasis: pathological mechanisms, evolving treatments, clinical investigations, and future perspectives

The reviewed evidence indicates that advances in genetic and molecular understanding have clarified key mechanisms involved in psoriasis pathogenesis. Genetic markers such as <i>HLA-Cw6, IL-12B,</i> and <i>IL-23R</i> highlight the role of immune dysregulation and keratinocyte hyperproliferation, which has guided therapeutic development. Conventional treatments namely topical agents, phototherapy, and traditional regimens such as Goeckerman therapy, remain important, particularly for mild-to-moderate disease and selected patients. Building on these approaches, systemic agents and biologics targeting TNF-α, IL-17, and IL-23 pathways have significantly improved outcomes in moderate-to-severe psoriasis. Current research is now exploring molecular therapeutics and nanotechnology driven drug delivery systems as adjunct strategies to enhance efficacy and reduce systemic toxicity. However, these approaches are still evolving and are not yet established standards of care. Despite ongoing progress, challenges related to long-term safety, accessibility, and sustained disease control remain. Integrating mechanistic insights with evolving therapies and multidisciplinary care will be essential for advancing psoriasis management.