Psoriasis, a chronic dermatological condition that has perplexed clinicians for centuries, was the focal point of the Gunnar Lomholt Symposium during the IPC 2023 Think Tank held in the Faroe Islands. This event provided an in-depth exploration of the historical, current, and future perspectives of psoriasis management, shedding light on the evolution of understanding this complex disease.

A comprehensive review of the symposium’s proceedings was summarized by a team of researchers, led by Dr. Francis Lai from the Skin Health Institute,  and including, Professor Peter van de Kerkhof from Radboud University, Professor Hervé Bachelez from Paris Cité University, Dr. Johann Gudjonsson from the University of Michigan, Professor Lone Skov and Professor Claus Zachariae from the University of Copenhagen, and Professor Jonathan Barker from King’s College London. Their work was published in the journal JID Innovations.

The symposium began with a review of the historical landscape of psoriasis research, emphasizing the contributions of pioneers like Gunnar Lomholt, whose groundbreaking thesis in the 1960s laid the groundwork for understanding the genetic basis of psoriasis. Lomholt’s census surveys in the Faroe Islands revealed a notable prevalence of psoriasis, evenly distributed across genders, with typical onset during early adolescence.

In contemporary research, Tamar Nijsten discussed the paradigm shift brought by Big Data in psoriasis research, highlighting the potential of machine learning to manage the vast and complex datasets generated in healthcare. Michael Simpson’s research on genetic associations, particularly the role of HLA-C*06:02 in psoriasis, underscored the intricate relationship between genetics, clinical features, and treatment response.

Johann Gudjonsson provided a detailed view of psoriasis pathogenesis, focusing on the dynamic interactions between immune and stromal cell populations. He highlighted the significant roles of IL-17, TNF, IFNs, and IL-36 in the disease’s underlying mechanisms. Gudjonsson emphasized that understanding these interactions could lead to more targeted and effective treatments for different psoriasis subtypes and severities.

Exploring the future of psoriasis management, Hervé Bachelez discussed the immunogenetic dissection of pustular forms of psoriasis, which has identified key pathogenic cytokines and paved the way for new therapeutic approaches. Liv Eidsmo’s research on inflammatory memory in psoriasis suggested that altering the microenvironment and prolonged T-cell starvation could lead to long-term remission, advocating for early and aggressive treatment strategies.

Oliver Fitzgerald’s insights into psoriatic arthritis highlighted the need for understanding the genetic HLA subsets for more targeted treatments. He emphasized the complexity of psoriatic arthritis and the importance of tailored interventions. Catherine Smith discussed therapeutic drug monitoring (TDM) as a means to optimize drug exposure and improve responses to biologic therapy, indicating the future of precision medicine in psoriasis treatment.

Ulrich Mrowietz advocated for a holistic approach to psoriasis care, addressing risk factors, trigger factors, and comorbidities. This approach acknowledges the interplay between various factors in managing this complex condition. Lone Skov highlighted the importance of real-world evidence (RWE) in psoriasis research, which offers long-term efficacy and safety data that can inform treatment decisions beyond the constraints of randomized controlled trials.

The symposium concluded with a forward-looking perspective on psoriasis management, emphasizing the integration of genetic insights, immunological memory, and real-world evidence to shape individualized and effective treatment strategies. As Gudjonsson noted, “The future of psoriasis management lies in understanding the complex interactions between genetic and environmental factors and leveraging this knowledge to develop personalized therapies.”

This event underscored the significant progress made in understanding and managing psoriasis, from historical epidemiological studies to contemporary big data analytics and future precision medicine approaches. The insights gained from this symposium promise to enhance the quality of life for individuals affected by psoriasis and mark a significant shift towards holistic and personalized patient care.

Journal Reference

Peter van de Kerkhof, Francis Lai, Hervé Bachelez, Johann Gudjonsson, Lone Skov, Claus Zachariae, and Jonathan Barker. “Proceedings of the Gunnar Lomholt Symposium during the IPC 2023 Think Tank at Faroe Islands, Friday, September 8, 2023.” JID Innovations (2024). DOI: https://doi.org/10.1016/j.xjidi.2024.100267

About The Authors

Professor Peter van de Kerkhof served as head of the Department of Dermatology at the Radboud University Nijmegen Medical Centre, The Netherlands, since 1992 and is currently a Professor Emeritus there. He graduated in medicine from the Catholic University of Nijmegen in 1978 and trained in dermatology at the St. Radboud Hospital, Nijmegen. In 1983 and in 1990 he completed his theses in the faculty of medicine and faculty of sciences resp. Between 1980 and 1984 he completed his training as a dermatologist. Research interests of Professor van de Kerkhof are psoriasis, disorders of keratinization, inflammation and clinical pharmacology of the skin. He has been president of major European Dermatological societies such as the European Society of Dermatological Research and the European Dermatology Forum. He is a member of the editorial board of several international dermatological journals. He is an author or co-author of more than 800 peer-reviewed dermatological journals. He joined the IPC Staff as Chief Medical Officer in July 2018.

Dr. Francis Lai is a dermatologist at the Psoriasis Biologics clinic at Skin Health Institute and Monash Health in Melbourne, Australia. He is a sub-investigator in multiple psoriasis clinical trials and is actively involved in psoriasis education and advocacy. In 2018, Dr. Lai was selected to undertake a 12-month fellowship at St John’s Institute of Dermatology, London, where he gained hands-on experience with severe inflammatory skin diseases, including complex psoriasis management. Dr. Francis Lai studied with IPC Board Member Ricardo Romiti at the University of São Paulo, São Paulo, Brazil.

Professor Hervé Bachelez is a professor at the Department of Dermatology of the Saint-Louis University Hospital in Paris, France. Since 2004, Professor Bachelez has been a Full Professor of Clinical Dermatology at the Université Paris-Diderot/Université de Paris, where he received his PhD in Immunology in 1999. Professor Bachelez’s clinical and research activities focus on inflammatory skin diseases, mainly psoriasis and psoriasis-related diseases, hidradenitis suppurativa, and lichen planus. He is conducting his basic and translational research at the Institut National de la Santé et de la Recherche Médicale (INSERM U1163) in the Laboratory of Genetics of Skin Diseases at the Imagine Institute for Human Genetic Diseases in Necker Hospital, Paris. His areas of scientific research include immunogenetics and molecular mechanisms of the aforementioned immune-mediated and inflammatory skin diseases. Professor Bachelez has received several scientific awards, including the Robert Degos Award. He is a member of several national and international scientific societies, including the European Academy of Dermatology and Venereology (EADV) and the European Dermatology Forum (EDF). He is the past president of the French Society for Dermatological Research and the Group for Research on Psoriasis of the French Society for Dermatology. Internationally, he is a Board Member of the International Psoriasis Council (IPC) and the past president of the European Society for Dermatological Research (ESDR). Professor Bachelez has published over 295 manuscripts in peer-reviewed journals, including the New England Journal of Medicine, Journal of Clinical Investigation, the Lancet, and Arthritis and Rheumatism as a leading author.

Dr. Johann Gudjonsson is the Arthur C. Curtis Professor of Skin Molecular Immunology at the University of Michigan. Dr. Gudjonsson graduated from the University of Iceland Medical School and completed his internship and dermatology residency training at the University of Michigan. In 2008, Dr. Gudjonsson joined the faculty of the University of Michigan Department of Dermatology. Dr. Gudjonsson sees general dermatology patients at the University of Michigan Taubman Center. Dr. Gudjonsson came to the U-M in 2003 as part of an innovative research residency training program. Dr. Gudjonsson’s primary research focus is basic immunological and genetic research on psoriasis and other inflammatory diseases of the skin, with projects directed at improving the diagnosis and treatment of psoriasis. Dr. Gudjonsson is the Frances and Kenneth Eisenberg Emerging Scholar of the Taubman Medical Research Institute. He received the Young Investigator Award from the American Academy of Dermatology in 2007 and his work has earned several research awards, including from the American Skin Association, the Dermatology Foundation, Doris Duke Foundation, and the NIH. He is a Director of an NIH-sponsored Skin Biology Research Center at Michigan and a member of the American Society for Clinical Investigation (ASCI). He serves on the Board of Scientific Counselors to NIAMS.

Professor Lone Skov is a Professor and Senior Physician in the Department of Dermatology and Allergy at Herlev and Gentofte Hospital, University of Copenhagen. Since 2004, she has served as a Professor of Clinical Dermatology at the University of Copenhagen, where she earned her PhD in Dermatology in 1997. Her primary clinical and research interests lie in inflammatory skin diseases, mainly psoriasis and atopic dermatitis, focusing on translational research and investigating comorbidities in psoriasis. Her work includes immunological studies of eczema and psoriasis, characterizing lymphocyte subtypes, their function, phenotype, and regulatory mechanisms. Since 2013, Professor Skov has been a Coordinating Professor for a major hospital in the Copenhagen area. She holds memberships in various national and international scientific societies, including the European Academy of Dermatology and Venereology (EADV) and the Skin Inflammation & Psoriasis International Network (SPIN). She has served as the past president of the Danish Society of Dermato-Venerology and chair of the Group for Guidelines and Research on Psoriasis of the Danish Society for Dermatology. Internationally, she is a Board Member of the International Psoriasis Council (IPC). Professor Skov’s extensive research contributions include over 350 manuscripts published in peer-reviewed journals.

Professor Claus Zachariae serves as Chairman of the Department of Dermatology and Allergy at Gentofte and Herlev Hospital, University of Copenhagen. Professor Zachariae has also served as President of the Danish Dermatological Society. Professor Zachariae serves as a consultant in Dermatovenerology to the Danish National Board of Health and a medical advisor to The Danish National Board of Appeal for occupational disease and Danish medical devices certification. He is a member of the Danish Dermatological Society, American Academy of Dermatology, European Society of Contact Dermatitis, European Academy of Dermatology and Venerology (board member), the International Psoriasis Council (IPC), and the European Dermatology Forum. He lectures at the University of Copenhagen and consults for companies in the cosmetological and biotechnological industries. Over the years, Professor Zachariae has been honored with Glaxo, Henry Guze, and Warming awards. He has over 270 original publications and has contributed significantly to his field in peer-reviewed journals, the writing of textbooks, and participating in clinical trials of dermatological products.

Professor Jonathan Barker is a Professor of Medical Dermatology at St. John’s Institute of Dermatology, King’s College London, and an honorary consultant dermatologist at Guy’s and St. Thomas’s Hospitals specializing in complex hospital-based medical dermatology. Professor Barker is the immediate past President of the International Psoriasis Council having previously been a Board member and Chair of the Scientific Committee. He is a principal investigator in national and international consortia using genetic and multi-omic approaches to discover causal disease mechanisms, new drug targets, and biomarkers of disease subtypes and outcomes to therapeutic interventions. These are being applied to important chronic skin diseases such as psoriasis, acne, and eczema. Professor Barker has published over 300 peer-reviewed papers and authored and edited several books including the latest (10th) edition of Rook’s Textbook of Dermatology. Highly cited publications include those in The Lancet, Nature Genetics, and the New England Journal of Medicine. Professor Barker was Head of the Department at the Institute of Dermatology from 2002-2018 and a course director of the Institute’s MSc Clinical Dermatology for overseas graduates. He is a past President of the European Dermatology Forum and the European Society for Dermatological Research. He is an honorary overseas member of several national dermatological associations including Denmark, France, Germany, Japan, and the USA.