Saakshi Khattri, MD, is a board certified Dermatologist, Rheumatologist and Internist and one of only a handful of triple board-certified physicians across the US.

Saakshi Khattri, MD, FACR, FAAD

In "The Next Five Years in Psoriasis: Remission, Access, and Combinations," the panel looks ahead to the advances and the unfinished work of the coming years.

The Next Five Years in Psoriasis: Remission, Access, and Combinations

Dr. Han hopes the field will embrace all components of psoriatic disease equally and reach consensus on remission for the joints, not just the skin. He points out that even very low disease activity still allows up to one joint, so the definitions themselves show how far the joint side has to go. He is encouraged that development has not truly slowed.

Dr. Han previews a next era of biologics using dual inhibition and multi-active designs that target several cytokines at once. He notes patients may soon face a once-a-year injection, something few would have believed five years ago, and stresses that even a strong landscape leaves room to improve quality of life. He returns forcefully to access, describing patients who watch drug commercials with a call to action they cannot fulfill because the nearest dermatologist is a four-hour drive and six months away.

Dr. Wright picks up the access thread, citing recent work showing that where a patient lives shapes which drug they receive first and maps onto disease burden. She calls these the social and commercial determinants of health that decide who ever gets a chance at remission.

Dr. Wright wants the field to unpack what challenging-to-manage and treatment-refractory truly mean, ideally with predictive biomarkers so patients do not cycle through drugs while damage accrues. She insists on treating the whole person, including mental health, obesity, and cardiovascular risk, summed up in her line that bones hurt but heart kills. She predicts combination therapy will be essential for complex patients, even without large randomized trials to guide it.

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"The Patient Who Is Better but Not Clear: Shared Decisions in Psoriasis" takes up the common scenario of a patient content with partial improvement.

The Patient Who Is Better but Not Clear: Shared Decisions in Psoriasis

Dr. Han says fear of the unknown is powerful. A patient who remembers how bad things were feels better and hesitates to switch. It is the devil they know versus the one they don't. They wonder whether a new medicine will truly be better or carry some side effect, and they have grown used to their current injection.

Dr. Han describes a gentle, repeated approach across visits. He reminds patients he still notices them changing their clothing or dropping activities they used to enjoy. He tells them the arsenal now holds tools he is confident can help more, possibly with a better dosing regimen. Crucially, he does not lead with numbers like a PASI 90 comparison. He leads with seeing the patient as a person who is struggling and a bit fearful, backed by his own confidence and experience.

Dr. Wright calls that genuine shared decision-making rather than dictating a switch. She recounts a patient she had followed for milder rheumatic disease who suddenly presented with a scalp covered 100%, plus enthesitis, dactylitis, and synovitis. The patient's risk threshold favored the safest option even if slower, so Dr. Wright started with that drug.

Dr. Wright reports the patient improved only about 45% and returned frustrated by the slow pace, now willing to try the faster agent originally recommended. Within days the patient felt dramatically better and was grateful. Dr. Wright frames this as the art of medicine, moving someone from fear to confidence, and understanding that patients ultimately choose not a pill or a shot but where they want to land in their lives.

In "The Next Five Years in Psoriasis: Remission, Access, and Combinations," the panel closes by looking ahead at where psoriatic disease management is heading over the next five years, and what is still missing.

In "Putting On-Treatment Remission Into Practice: A Patient-Defined Target in Psoriasis," the panel returns to remission and grounds it in what patients actually live with.

Putting On-Treatment Remission Into Practice: A Patient-Defined Target in Psoriasis

Dr. Han starts by qualifying the 0% BSA goal. Clear skin with swollen, painful joints is not remission by any human standard. He frames the real target as a life free of psoriatic disease, where a patient functions normally and does not have to think about it. He points to DLQI items that reveal how disease shapes what people wear and whether they go out.

Dr. Han highlights skin of color patients, describing Hispanic patients cleared for two years who still have post-inflammatory hyperpigmentation and still will not wear shorts. He reframes early, effective treatment as appropriate rather than aggressive. He argues clinicians talk too little with patients about realistic steps, which drives poor compliance and the shopping bags full of expired creams that arrive at second opinions.

Dr. Wright defines remission through the patient's lived experience rather than her measures. In New York, a patient who always wore black suddenly not wearing black tells her the skin is bad without a word. A patient who cannot get to dinner, the theater, or down to the floor with grandchildren signals disease interfering with existence. She ties this to depression and social context.

Dr. Wright describes herself as treating to a target of zero, so function is restored. She acknowledges ACR50 and MDA are useful for trials, but real-world MDA tops out near 40 to 60%, and only 5 of 7 domains. She wants the specific domain bothering a patient gone. Her patients name tangible milestones: dancing at a granddaughter's wedding, walking down the aisle, holding a baby.

Our next episode, "The Patient Who Is Better but Not Clear: Shared Decisions in Psoriasis," features Dr. Han and Dr. Wright on the patient who is better but not clear, and how shared decision-making guides the next step.

Journal of the American Academy of Dermatology

) identified a dual T-helper 17/type 2 transcriptomic endotype in 

 offering a possible explanation for why some patients respond inconsistently to interleukin (IL)-17 and IL-23 inhibitors, according to Saakshi Khattri, MD, FACR, FAAD, associate professor and director of the Center for Connective Tissue Diseases at the Icahn School of Medicine at Mount Sinai.

Khattri discussed the findings and what they mean for personalized psoriasis care during Psoriasis Awareness and Action Month, observed each August. She spoke in this interview segment with 

 about the biggest takeaways and other relevant points regarding raising awareness for psoriasis.

A New Immune Signature and Path to Personalized Psoriasis Care, With Saakshi Khattri, MD

Psoriasis Awareness and Action Month prompts patients to revisit stalled treatment plans rather than settle for inadequate disease control. Khattri recently discussed newer oral options and combination-therapy data reshaping psoriasis and psoriatic arthritis care this same month.

"In some ways, do we need personalized medicine? The answer is maybe not, and this might be a controversial statement to make, because our systemic therapies are doing a pretty good job of keeping skin clear. Personalized medicine comes into play where a patient has had an inadequate response to a systemic therapy I would expect to work," Khattri said to 

 study found concurrent activation of the IL-23/Th17 pathway alongside type 2 inflammatory markers, including IL-4R, CCL17, and thymic stromal lymphopoietin, in a subset of patients with psoriasis. Khattri said the dual endotype adds a plausible explanation for reduced or waning response to biologics targeting a single pathway. No validated biomarker test yet distinguishes which patients carry the signature.

Khattri reserves combination therapy for patients who have not responded adequately to a conventional systemic agent, rather than applying it broadly. She considers an additional pathway only after a patient has cycled through multiple biologics with diminishing response. Most patients, she said, get clear and stay clear on existing IL-17 and IL-23 inhibitors alone.

Khattri, who is also trained as a rheumatologist, said the field has moved toward personalized psoriasis treatment for several years without major headway. She still considers most systemic therapies highly effective for clearing skin across her patient population. The gap, she said, lies in confirming which patients truly need an endotype-guided approach.

For patients whose past treatments fell short, Khattri encourages another conversation with a dermatologist. She pointed to newer oral options and next-generation biologics as reasons the treatment landscape has shifted since earlier, less successful attempts. Her message this awareness month: A prior setback should not define what is possible today.

Chen CH, Lee MS, Chang WY, et al. Uncovering a dual T-helper 17/type 2 transcriptomic endotype in psoriasis. 

. Published online July 2, 2026. doi:10.1016/j.jaad.2026.06.131

Saakshi Khattri, MD, discusses a new JAAD dual Th17/type 2 signature study and what it means for personalized psoriasis care this awareness month.

Saakshi Khattri, MD, FACR, FAAD

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