Oral Therapies and the Future of Psoriasis Care

In this Experiences episode of Topical Conversations, Mona Shahriari, MD, Associate Clinical Professor of Dermatology at Yale University, and Jason Hawkes, MD, Chief Scientific Officer and investigator at the Oregon Medical Research Center, explore the evolution of oral therapy in psoriasis care, from the early days of apremilast to the growing impact of selective TYK2 inhibition.

Together, they trace how the field has moved from broad, nonspecific PDE4 blockade to the more targeted, allosteric TYK2 mechanism that bridges IL-23 and IL-17 signaling. Dr Hawkes outlines how TYK2 inhibition can influence downstream pathways, including IL-12 and type I interferons, potentially extending benefits beyond skin disease. The discussion also highlights recent data in psoriatic arthritis and real-world safety outcomes, with consistent tolerability and durable efficacy across challenging sites like scalp, nails, and palms.

Both clinicians emphasize practical considerations—how to identify appropriate candidates for oral therapy, manage expectations around treatment onset, and communicate the distinct safety profile and monitoring needs of TYK2 inhibitors. They close by looking ahead to next-generation orals, including second-generation TYK2 inhibitors and oral IL-23 receptor blockers, which are narrowing the gap between biologic and oral efficacy.

A grounded, forward-looking conversation on how oral innovation continues to reshape the psoriasis treatment landscape.