Current Research

Dr Sizheng Steven Zhao, University of Manchester

Lay summary of research:

Psoriasis can affect more than the skin and joints. People with psoriatic disease are more likely to have other long-term health problems such as heart disease and depression. We still do not know clearly which conditions are most common, which tend to occur together, or how these patterns differ between ethnic groups, because most research has focused on single conditions and mainly on people of white European background. This project will use two large health studies – Our Future Health in the UK and All of Us in the United States – which link medical records, questionnaires and genetic information from people from diverse backgrounds.

First, we will identify people with psoriasis and psoriatic arthritis and describe how common 40 important long-term conditions are, and which ones tend to cluster together, compared with people without psoriatic disease. Second, we will follow people over time to find out which new health problems people with psoriasis or psoriatic arthritis are more likely to develop, and whether this varies by ethnicity. Third, we will use genetic methods to explore whether some conditions are more likely to cause psoriatic disease, to be caused by it, or mainly to share common risk factors.

This research directly addresses key questions from people with psoriasis and psoriatic arthritis about their chances of developing other health problems, which ones they are at risk of and why, providing the evidence needed for better screening, better-informed treatment decisions and fairer, more personalised care.

Professor Wendy Hall, Kings College London

Lay Summary of Research:

Many people with psoriasis are interested in lifestyle changes that could help them feel better. Time-restricted eating (TRE), a daily meal timing strategy where all meals are kept within a consistent 6-10 hour window, aligns food intake with the body’s natural 24-hour circadian clock that helps regulate sleep, hormones and metabolism. Sometimes called “intermittent fasting”, TRE should not be confused with the 5:2 diet or alternate day fasting, involving very low calorie intakes on some days. TRE only changes the timing of meals across the day. TRE has been shown to improve metabolic health (blood sugars and fats) and reduce inflammation in different groups. What we don’t yet know is whether TRE can also improve skin-related quality of life in psoriasis. This PhD project will explore the potential of TRE in the management of psoriasis in two broad stages: Preparatory stage. A qualitative study using interviews to understand experiences, motivations and barriers to following TRE among people starting treatment for psoriasis. This will inform intervention co-design with patient representatives. Experimental stage. A clinical trial, carried out entirely online to make participation easier, will compare two groups of adults with psoriasis starting methotrexate treatment (tablets or injections): one group will follow TRE with video-call support and digital resources, while the comparison group will receive the same scheduled check-ins and an Eatwell Guide leaflet but no TRE advice. Findings will provide important new evidence on whether this eating approach can improve skin-related quality of life and response to medical treatment.

Dr Oras Alabas, University of Manchester

Lay Summary of research:

Psoriasis is a long-term skin condition affecting around 60 million people worldwide. It causes red, scaly patches on the skin and can be painful, itchy, and emotionally distressing. But psoriasis doesn’t just affect the skin; it is also linked to other health problems, particularly heart disease, the leading cause of death globally.

Some studies suggest that people with psoriasis may be more likely to develop heart disease compared with those without the condition, while others have found no clear link. Modern treatments, especially biologic medicines, have greatly improved skin symptoms by targeting the immune system. However, it remains unclear whether these treatments protect against or increase long-term heart risks.

This project will use two large UK health databases to address these questions. The first, BADBIR, follows over 20,000 patients with moderate-to-severe psoriasis receiving systemic treatments. The second, the SAIL Databank, contains detailed health records from general practices across Wales.

By analysing these databases, we will compare heart disease risk across treatments and psoriasis severity. We will also test and refine a heart disease risk calculator to help doctors identify psoriasis patients at greater risk. This tool could support earlier detection and better prevention of heart problems, improving the health and quality of life of people living with psoriasis. It could also help patients and dermatologists engage in more meaningful discussions about cardiovascular risks, conversations that do not always occur. With better awareness, patients can make more informed treatment decisions that reflect their priorities for managing both psoriasis and cardiovascular disease.

Dr Ali Al-Janabi, University of Manchester

Lay summary of research:

Psoriasis is a chronic skin condition affecting 3% of the population that profoundly affects physical and mental well-being. Up to 30% of patients with psoriasis also develop inflammation of their joints and arthritis causing joint pain and swelling affecting day to day activities, called psoriatic arthritis. Both diseases are due to the immune system attacking the body.

Advanced biologic treatments, such as tumour necrosis factor (TNF) inhibitors, target proteins of the immune system to control both diseases but fail to control the disease in up to 40% of patients. Treatment selection is based on a trial-and-error approach where it is not guaranteed that the disease will be controlled. Our DNA is unique and forms genes which, when turned on, code proteins which control our body functions including the immune system. This study will measure proteins in the blood of patients with psoriasis or psoriatic arthritis before and after starting a TNF inhibitor to predict which patients will respond to this treatment. We will be able to compare whether these protein predictors are the same in psoriasis and psoriatic arthritis.

We will create a model combining protein levels with clinical information such as age to find out if proteins can guide which patients should receive TNF inhibitors. The development of such a model would pave the way to support proactive prescribing, rather than the trial-and-error approach, for treatment of these common diseases.

We plan to use the results of this work to undertake further research, including examining whether genetic differences can predict treatment response, and aiming to predict treatment outcomes for different drug classes used for psoriasis and psoriatic arthritis.

Lead researcher: Dr Helen Young

Lay abstract: The aim of the Psoriasis Priority Setting Partnership (PSP) in 2018 was to find out what matters most about psoriasis to patients, their families and clinicians.  It was commissioned and funded by Psoriasis UK and led by Dr Helen Young from The University of Manchester, who is the lead researcher for this new study.  Critically the Psoriasis PSP identified the “MOST IMPORTANT” research priorities in psoriasis / psoriatic arthritis and reported these in November 2018. 

In this new study, the team in Manchester working closely with Psoriasis UK, will investigate how effective the original Psoriasis PSP has been in: i) encouraging the research community to find answers to the priorities identified as “MOST IMPORTANT” and ii) facilitating the views of those with lived-experience and their healthcare providers to set the research agenda for psoriasis in the UK. 

The research team anticipate that through this work they can further enhance patient care and drive further investment in psoriasis focused research. 

Dr Satveer Mahil, King’s College London

Powerful injection treatments that affect the immune system (‘biologics’) have revolutionised lives of people with psoriasis and are available for those with severe disease. Rising numbers achieve clear skin (‘remission’) within weeks but continue treatment indefinitely. This is costly and burdensome (infections/adverse events risk). When treatment is paused, psoriasis may not recur for some time, and then it recurs in the same location. This suggests skin retains an ‘inflammatory memory’, but this is underexplored. If we can monitor cellular/molecular signals before psoriasis re-appears, individuals could take treatment ‘as needed’.

We will:

Identify cell types in skin that underpin inflammatory memory in remission.
We profiled skin biopsies from patients in remission on biologics using high-resolution ‘single-cell’ sequencing. Our analysis will characterise how each cell works and communicates with other cells during remission.

Understand cellular and molecular events in skin leading to recurrence.
We profiled serial biopsies collected from the same patients after pausing biologics using single-cell sequencing. We will define the changes in skin that culminate in recurrence.

Investigate how the skin’s immune response could be monitored in blood for ‘as needed’ treatment.
We will use blood samples (taken alongside skin samples) from the same patients and another group pausing biologics in our ongoing clinical trial. We will apply experimental techniques to detect events defined in (2) within blood.

Our research may inform personalised ‘as needed’ biologics use. This may reduce burden and cost of long-term treatment, enabling biologics access for more people with psoriasis for major health and quality-of-life benefits.

Dr Zenas Yiu, University of Manchester

Biologic therapies, which are treatments made from lab-engineered proteins, have helped many people with psoriasis achieve significant skin clearance and have been recommended as cost-effective treatments through a robust evaluation process. Recently, biosimilars—near-identical copies of biologic medicines—have been developed, offering the same effectiveness at a lower cost. However, the evaluation of the cost and benefits of these therapies have not been updated, leaving healthcare providers unsure whether they are using these treatments in the most cost-effective way.

This research aims to fill these gaps by evaluating the cost-effectiveness of systemic therapies, including non-biologic, biologics and biosimilars for psoriasis. Using data from existing clinical trials and from the British Association of Dermatologists Biologics and Immunomodulator Register, a large multicentre registry of people with psoriasis based in the UK and the Republic of Ireland, we’ll study the orders of how these treatments are used over time, how effective they are at different stages of disease, and what happens when people switch from one treatment to another. We’ll also look at how factors like age or other health conditions might influence treatment success.

Finally, the project will develop a cost-effectiveness model to investigate which strategies for using systemic therapies provide the best value for money. This tool will help healthcare providers and policymakers decide which treatments should come first and which should follow. This will allow healthcare systems to allocate resources more efficiently while ensuring that people with psoriasis get the most effective care at the earliest time.

Dr Satveer Mahil, King’s College London (Cecil King Memorial Fund Award)

Scientific research has delivered increasingly powerful injection drugs for psoriasis called biologics. These treatments are life-changing: more than half of patients receiving newer biologics achieve remission (i.e. clear skin) within a year. If treatment is started early, chances of achieving remission, and ultimately cure, are even higher. However, access to healthcare is poor and inequitable due to outdated, unsustainable hospital-centred healthcare models, which are not driven by the needs of affected individuals.

We will build on our existing co-developed self-report mySkin online platform (mySkin.org, >920 participants to date) and our ‘skin research inclusion toolkit’ (Choy et al, JEADV Clin Pract 2024; doi.org/10.1002/jvc2.516), to create a patient-centred digital healthcare tool (the mySkin app) for early, inclusive self-diagnosis, -monitoring and -management, which promises to transform healthcare efficiency and outcomes for everyone with psoriasis. We will deliver personalised evidence-based educational resources via the mySkin app on topical treatments (creams/ointments), and prevention and optimisation of associated health conditions for everyone with psoriasis. We will later assess feasibility of using the mySkin app for expedited face-to-face specialist review for those in need.

The mySkin app promises to deliver rapid reassurance and inform self-directed management when specialist review is not required, while releasing critical NHS capacity for review of those in need. Our work will ultimately drive a paradigm shift to inclusive, equitable data-driven patient-empowering care of psoriasis to transform health, quality-of-life and cost outcomes for all.

Professor Darren Ashcroft, University of Manchester

Psoriasis is a skin condition, resulting from abnormal activity of the immune system (immune-mediated), which causes inflammation of the skin and sometimes joints. It typically causes a rash with itchy, scaly patches on the skin most commonly on the scalp, elbows and knees, Symptoms of psoriasis can change over time and various factors can cause it to flare-up. There are a range of treatments that can improve symptoms and the appearance of skin patches.

Our previous studies have shown psoriasis affects 2-3% of the UK population and it can either begin before the age of 40 years, categorised as early onset psoriasis, or after 40 years of age known as late-onset psoriasis. We have also shown that, although life expectancy for people with psoriasis is improving, it is still lower compared with people without psoriasis.

This study will provide an update to our previous work examining changes in the number of people with psoriasis and life expectancy between 1999 and 2013, covering a much longer time-period. We will examine for the first time how the number of new cases of psoriasis and the total of people with the disease varies by ethnicity (using the CPRD Ethnicity Record). We will also investigate whether the number of psoriasis diagnoses has been impacted by the COVID-19 pandemic, and whether there have been further changes in life expectancy for people with psoriasis. The findings from this study will inform future policy and clinical practice to help people living with psoriasis across the UK.

Dr Esther Burden-Teh, University of Nottingham

“They couldn’t decide whether it was a fungal infection.”

“I had psoriasis for about six and a half months before someone correctly diagnosed me.”

These are the experiences of some children and young people who have psoriasis who took part in the healthtalk.org project. They found the delay in getting a diagnosis to be frustrating and upsetting.

Psoriasis is a skin condition that can cause red, flaky patches on any part of the body including the face, scalp, hands and genitals. Psoriasis can affect adults and children, but psoriasis in children is often confused with other common skin diseases.

Diagnostic criteria can help doctors make a diagnosis. Criteria are a list of skin changes to look for and questions to ask when the patient is seen in clinic. We have developed a version that patients can complete themselves but we don’t know how well it works so we need to test it.

Before starting a large study across several hospitals, it is important to test the design. Therefore, a practice study, called a pilot study, will take place first.

In this practice study, one hundred children and young people will be invited to complete an online diagnostic criteria questionnaire before they have their dermatology appointment. We will compare their responses to the diagnosis given by the doctor. We will also collect information on what makes them more, or less, likely to fill in the questionnaire.

Dr Ella Guest, University of the West of England

Individuals with psoriasis can experience negative attitudes and discrimination from the general population, which can affect their psychological wellbeing (e.g., low mood, anxiety, depression, appearance concerns) and life engagement (e.g., avoidance of activities that draw attention to their skin, romantic relationships) and make it more difficult to manage their condition. Given that most of these challenges stem directly from the attitudes and behaviours of society, which are influenced by the (mis)representation of psoriasis in the media, it is important that charitable organisations have tools to raise awareness of psoriasis, increase knowledge of the condition, and reduce misconceptions towards it. Social media provides a cost-effective and wide-reaching platform for population-level campaigns and is regularly used by Psoriasis UK; however, the effectiveness of current campaigns has not been assessed. Limited current research suggests including personal stories, educational information, and presenting psoriasis in a positive light may effectively reduce negative attitudes; however, this research is in its infancy. Therefore, further evidence-based research is needed to target negative attitudes towards psoriasis and develop an effective social media campaign intervention. Therefore, in collaboration with adults with psoriasis, this PhD would use a mixed-methods approach to understand experiences of misconceptions and negative attitudes using qualitative interviews and co-produce and evaluate a social media intervention that Psoriasis UK can use to improve the lives of people with psoriasis by targeting the general public.

Dr Paola Di Meglio, King’s College London

The focus of this proposal is a cellular protein called Aryl Hydrocarbon Receptor (AHR) which responds to dietary, light and microbial stimulation by switching off inflammation in the skin. Importantly, a compound called tapinarof, which works by instructing AHR to switch off inflammation, has been tested as topical medication in people with psoriasis, with good efficacy in around 50% of them. However, it is currently unclear how much AHR there is in the skin of people with psoriasis, what determines the amount, and whether that amount is enough for tapinarof to work as an anti-inflammatory drug. Moreover, some evidence suggests that the amount of AHR in the skin may differin people of different ethnicities. We aim to study the skin of people with and without psoriasis who define their ethnicity according to the UK Census 2021 categories as Asian or White to find out:1)What affects the amount of AHR present in skin cells and whether it varies according toethnicity2)How much AHR is present in their skin3)If the anti-inflammatory effect of tapinarof depends on the amount of AHR present in the skin and whether it varies according to ethnicity. Taken together, these experiments will enhance our understanding of how environmental factors influence psoriasis and treatment in people of different ethnic groups. Moreover, they can provide further opportunities to find novel effective medications or lifestyle intervention to improve the lives of people living with psoriasis.