Q&A: Mental Health and Precision-Medicine Gaps in Psoriasis Care Today

Psoriasis carries a well-documented mental health burden, extending beyond skin symptoms into anxiety, depression, and social withdrawal. A 2025 scoping review confirmed elevated anxiety and depression prevalence across dermatologic conditions, including psoriasis, yet clinician screening for psychiatric comorbidity remains inconsistent in routine visits.¹

"These things can have that subtle impact on a patient's quality of life, and if we don't ask, then we will never find out," said Saakshi Khattri, MD, associate professor and director of the Center for Connective Tissue Diseases at the Icahn School of Medicine at Mount Sinai.

A 2026 study in the Journal of the American Academy of Dermatology (JAAD) identified a dual T-helper 17/type 2 transcriptomic endotype in a subset of psoriasis patients.² Patients meeting this profile showed concurrent interleukin (IL)-23/Th17 pathway activation alongside type 2 markers including IL-4R, CCL17, and TSLP.² The authors propose the finding may help explain variable biologic response and inform more individualized treatment selection.²

Reliable, clinically validated biomarkers remain unavailable, so most prescribers still choose systemic therapy based on population-level efficacy and safety data rather than an individual patient's molecular profile. Personalized treatment selection remains largely aspirational for psoriasis, and Khattri noted most respond well to existing IL-17 and IL-23 inhibitors without requiring biomarker-guided therapy.

Psoriasis Awareness and Action Month, observed each August, pushes patients to revisit stalled treatment plans rather than settle for inadequate disease control. In the following segment of her Q&A interview, Saakshi Khattri, MD, discusses persistent gaps in psychosocial screening, what a 2026 immune signature study means for personalized psoriasis care, and her message to patients this month:

HCPLive: What are you hearing from patients about the emotional toll of psoriasis, and do screening or referral pathways still fall short?

Khattri: With psoriasis, we know there's enough data to say patients with psoriasis have a significant burden on their mental health, whether it's anxiety, depression, or quality of life impact. Unfortunately, I think we as clinicians are still not doing a great enough job of asking about it, and I'm certainly guilty of that in my practice as well. More often than not, I wait for a patient to mention something, or if I'm thinking of systemic therapy that has a cautionary point around inquiring about mental health, then I ask about it.

But I do think we need to build greater awareness of bringing it to the forefront as a conversation to have with a psoriasis patient at perhaps each visit. All of us in the derm space have psoriasis patients who mention how having psoriasis on their skin impacts their quality of life: they don't like going out, they don't socialize as much, or if they have psoriasis on their scalp, they don't wear black anymore. I live in Manhattan, where black is everybody's favorite color, so these things can have that subtle impact on a patient's quality of life, and if we don't ask, we will never find out. There is still a gap that needs to be bridged when it comes to talking about the mental health impact patients with psoriasis have. We could do better.

HCPLive: Does the dual Th17/type 2 immune signature finding in the recent JAAD study move psoriasis closer to a personalized treatment approach?

Khattri: We've been heading in the direction of personalized medicine for a few years now, but we've not really made much headway, so I'm cautious about it. I think for the most part, the systemic medications we have to treat psoriasis do a good job of clearing skin and keeping it clear. We can have outliers, patients who might not have the same degree of response we expect to see in a majority of our patients, and that's when I start thinking there might be an additional pathway coming into play.

That JAAD study was promising in that regard, but I wouldn't jump to combination therapy in that scenario unless a patient has had an inadequate response to a conventional psoriasis medication. Then I'd start thinking, if you're not responding as well as I'd expect, is there something else coming into play? I might think of combination therapy then, but I wouldn't think of it right off the bat.

HCPLive: Where do you think the field stands on personalized medicine overall, and how far do you feel we still are from it?

Khattri: We're definitely a long way from personalized medicine, in the sense we still don't have a reliable biomarker test that tells me which biomarker is implicated in a particular patient's psoriasis. That being said, we know it's the IL-23/Th17 pathway implicated in psoriasis, and we have systemic therapies that block IL-17 and IL-23 that are extremely efficacious. So in some ways, do we need personalized medicine?

The answer may be no, and this might be a controversial statement to make, because our systemic therapies are doing a pretty good job of getting skin clear and keeping it clear. I think personalized medicine comes into play, at least for me, where a patient has had an inadequate response to a systemic therapy I'd expect to work for a majority of my patients, or if they've cycled through multiple biologics over the course of their treatment and lost response to every systemic therapy over time. Maybe in that scenario personalized medicine would make sense, but I think we're many years away from it.

HCPLive: What is the one message you most want patients to hear this Psoriasis Awareness and Action Month?

Khattri: If there's one thing I want patients to hear this Awareness Month, especially those who tried a treatment years ago and it didn't work, and they maybe gave up, it's this: don't let that past experience define what's possible today. We have excellent systemic therapies with great safety, durability, and efficacy, and newer molecules and orals on the horizon with fabulous efficacy and safety.

If you've had an experience in the past where things didn't work, perhaps it's time to go back and talk to your dermatologist, because we have excellent systemic medications that will clear your psoriasis and keep it clear. The landscape has changed, and it's worth having another conversation with your dermatologist. Don't let that past experience define your present.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

References

1. Wong JH, Garg KS, Bui JK, Huang JM, Greer ME, Hussain A. Mental health burden in dermatologic conditions: a scoping review of anxiety and depression prevalence in adults. JAAD Rev. 2025;4:123-125. doi:10.1016/j.jdrv.2025.03.013.

2. 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.