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Remission Possible

What does it mean to put psoriasis on pause?

Whether you have been living with psoriatic disease for decades or were diagnosed only recently, you probably know that it is a lifelong companion that never seems to be quiet, even when it is in the background. But what if you could put your psoriasis on pause?

Wilson Liao, M.D., director of the Psoriasis and Skin Treatment Center at University of California, San Francisco, talked to the National Psoriasis Foundation (NPF) about what remission means for psoriatic disease and how it may be possible to achieve remission. “Remission generally refers to a disease no longer being active or bothersome to a person,” he says. “However, different patients may interpret remission in different ways.”

Among people who felt their psoriasis was in remission, 73.3% had 1-3% body surface area (BSA) with psoriasis involvement, while only 22.7% had full clearance (0% BSA), according to the 2019 NPF Annual Survey. [1]

“Achieving minimally bothersome psoriasis is now more than ever possible with the large number of psoriasis treatments available, including the biologic therapies,” says Dr. Liao. He adds that psoriatic arthritis (PsA) treatments still have a ways to go before patients experience full improvement of their symptoms.

How Do You Solve a Problem Like Remission?

A review of research studies that define remission in psoriasis found 41 different definitions, with most dependent on the Psoriasis Area and Severity Index (PASI) rather than BSA. [2] With such a variety of definitions, it is difficult for people with psoriasis, providers, researchers, and others to all be on the same page.

To facilitate the generation of a single definition for remission in 2018, NPF launched the Remission and Cure Consensus Project, which also aims to define what “cure” means for psoriatic disease. The initial work included a variety of stakeholders, such as insurers, researchers, and industry experts, to discover how psoriasis remission applies to the stakeholders and their work.

Now, NPF is gathering input from the NPF Scientific Advisory Committee and Medical Board, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), International Dermatology Outcome Measures (IDEOM), and the Psoriasis & Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN). Using a methodology called a Delphi consensus, which also was used to generate the NPF COVID-19 guidelines, the project will result in a definition for psoriasis remission that is agreed upon by the majority of stakeholders.

With so many cooks in the kitchen, it is important to remember whom this project ultimately aims to benefit. “It’s hugely important for work like this to be driven by the patient advocacy organization because that really means that our focus is what’s best for the patient,” says George Gondo, associate director of research for NPF.

What’s in a Name?

After a consensus is reached, and the resulting definition of psoriasis remission is published, the real work begins. “We’ll start educating health care providers on what this definition of remission is, what it means for them and their practice, how they can incorporate it in their practice and talk with their patients about it,” says Gondo.

Since 2016, NPF has recommended a treat-to-target approach where an “acceptable response” to treatment results in psoriasis covering 3% or less BSA after three months. [3] With the new definition, remission will be the recommended target, says Gondo.

The goal is for clinical trials and patient registries to utilize these new recommendations, updating what success means across treatment options. Gondo explains that this could impact which treatments are prescribed by health care providers and possibly even the level of coverage by insurers.

“So that’s where the impact actually happens. We’re just trying to gather the evidence to allow us to have that greater impact,” says Gondo.

For those living with psoriasis, it means that at each step along the way, every person involved in creating your treatment, paying for your treatment, and prescribing your treatment is aiming to achieve remission – and this means better health outcomes.

Although all of the work so far has focused on psoriasis, the same process will be followed for PsA. “This is not the end,” says Gondo. “It’s actually the beginning.”

First Remission and Then a Cure?

“Although a psoriatic disease ‘cure’ has not been formally defined yet, most patients and providers I have talked with feel that a cure is a permanent, lifelong state of being free of a disease that does not require any ongoing treatment,” says Dr. Liao.

Without an agreed-upon definition of the goal, however, it is more difficult to know when it has been achieved. The strategy and process of defining remission for psoriatic disease will act as a framework for defining a cure, Gondo says.

In the past it may have seemed impossible, but today we get closer to a cure with each new discovery. “I am grateful that the National Psoriasis Foundation is committed to a cure, and I believe we will get there one day,” says Dr. Liao.

Milestones on the Road to a Cure

The inaugural Cure Symposium offered plenty of reasons to be optimistic about the future of psoriatic disease research.

Read more


1. Gondo G, Hadeler E, Brownstone N, et al. Demographic and clinical factors associated with patient-reported remission in psoriasis. Dermatol Ther (Heidelb). 2022; 12:753-760.

2. Balak DMW, Perez-Chada LM, Guo LN, et al. Definitions of remission in psoriasis: a systematic literature review from the National Psoriasis Foundation [published online ahead of print, 2022 Aug 4]. J Eur Acad Dermatol Venereol. 2022. doi:10.1111/jdv.18477.

3. Armstrong AW, Siegel MP, Bagel J, et al. From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017; 76(2): 290-298. doi:10.1016/j.jaad.2016.10.017.

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