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

A 2026 study in the Journal of the American Academy of Dermatology (JAAD) identified a dual T-helper 17/type 2 transcriptomic endotype in psoriasis, 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 HCPLive about the biggest takeaways and other relevant points regarding raising awareness for psoriasis.

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 HCPLive.

The JAAD 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, still 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.

References

1. Chen CH, Lee MS, Chang WY, et al. Uncovering a dual T-helper 17/type 2 transcriptomic endotype in psoriasis. J Am Acad Dermatol. 2026. doi:10.1016/j.jaad.2026.06.131.