Psoriasis is a chronic, inflammatory, immune-mediated skin disease affecting 3% of the population, Psoriasis involves an extremely complex immunologic pathogenesis of both the innate and adaptive immune systems. characterized by well-demarcated, erythematous plaques with silver scales, it is associated with many comorbidities conditions, including the metabolic syndrome and cardiovascular disease and decreased quality of life including impairment in physical and mental functioning, psychological well-being, and work productivity.
Plaque psoriasis, the most common variant of psoriasis, Although the etiology still unknown, multiple environmental factors, T cells, dendritic cells, numerous cytokines, and 45 identified gene loci, all interact to create the systemic psoriatic. Impaired T-cell activity contributes to hyper proliferation and abnormal differentiation of keratinocytes. The keratinocytes then recruit dendritic cells to release interleukin (IL)-12 and 23 ,which activate type 1 T helper (Th1) and type 17 T helper (Th17) cell, which release the psoriatic cytokines IL-17, interferon (IFN)-?, tumor necrosis factor (TNF)-?, and IL-22. IL-23 is a pro-inflammatory cytokine such as IL-17 and IL-22that mediate the inflammation and Epidermal hyperplasia of psoriasis, IL-23 is heterodimer of a p40 subunit, the major regulator of the Th17 pathway in treating psoriasis .IL-23 is primarily produced by antigen-presenting cells and stimulates the differentiation of T cells to Th17 and Th22 cells, the stimulation leads to an increase in the release of IL-17 and IL-22 that mediate the inflammation and epidermal hyperplasia of psoriasis.
IL-23 antagonism inhibit the effect of cytokines that play an important role in regulation of the adaptive and innate immune systems also develop the treatment of moderate-to-severe plaque psoriasis such as such as IL-17A, IL-17F, IL-22 and TNF secreted by T cells, natural killer cells, type 3 innate lymphoid cells, neutrophils, and mast cells. Drugs targeting IL-23 include BI 655066, briakinumab, guselkumab, tildrakizumab, andustekinumab