title: Current challenges and emerging drug delivery strategies for the treatment of psoriasis.
abstract: BACKGROUND
  Psoriasis is a common skin disorder associated with physical, social, psychological and financial burden. Over the past two decades, advances in our understanding of pathogenesis and increased appreciation for the multifaceted burden of psoriasis has led to new treatment development and better patient outcomes. Yet, surveys demonstrate that many psoriasis patients are either undertreated or are dissatisfied with treatment. There are many barriers that need be overcome to optimize patient outcomes and satisfaction.
  
  
  METHODS
  This review covers the current challenges associated with each major psoriasis treatment strategy (topical, phototherapy, oral medications and biologics). It also reviews the challenges associated with the psychosocial aspects of the disease and how they affect treatment outcomes. Patient adherence, inconvenience, high costs, and drug toxicities are all discussed. Then, we review the emerging drug delivery strategies in topical, oral, and biologic therapy.
  
  
  CONCLUSIONS
  By outlining current treatment challenges and emerging drug delivery strategies, we hope to highlight the deficits in psoriasis treatment and strategies for how to overcome them. Regardless of disease severity, clinicians should use a patient-centered approach. In all cases, we need to balance patients' psychosocial needs, treatment costs, convenience, and effectiveness with patients' preferences in order to optimize treatment outcomes.
authors.affiliation: a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Hoffman
authors.affiliation: a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.
authors.forename: Dane
authors.initials: D
authors.lastname: Hill
authors.affiliation: a Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , NC , USA.|b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA.|c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D001688:Biological Products / Q000008:administration & dosage; D001691:Biological Therapy / Q000379:methods; D003879:Dermatologic Agents / Q000008:administration & dosage*; D016503:Drug Delivery Systems; D006801:Humans; D010349:Patient Compliance; D010789:Phototherapy / Q000379:methods; D011565:Psoriasis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D001688:Biological Products; D003879:Dermatologic Agents
keywords: Treatment adherence; biologics; biosimilars; compliance; phototherapy; small molecule agents; systemics