A genetic biomarker is described as a known DNA sequence that causes disease or is associated with susceptibility to disease. Using genetic biomarkers to predict the severity of a skin condition for a person as well as how that person is likely to respond to treatment would tremendously improve our ability to manage the disease for that patient. Precision health is about prescribing an individual patient with the right drug, at the right dose, at the right time. This would allow for earlier intervention and the increased potential to slow progression.
Although the mechanisms that lead to someone developing an inflammatory skin condition are not fully understood, gene-environment interactions in genetically susceptible individuals is thought to play a central role. Inflammatory skin conditions are not passed directly from parents to their children, although the risk may be increased if one or both parents are affected. Genome-wide association studies (GWAS) have identified a number of gene variants (changes) that are associated with specific conditions.
Some conditions have been explored more extensively than others, and one of the aims of this research programme is to expand our understanding of gene variants and their role in atopic dermatitis, acne vulgaris, hidradenitis suppurativa, plaque psoriasis, and chronic hives. Environmental and lifestyle factors have been associated with certain conditions. For example, smoking, obesity or stress, are strong risk factors associated with skin conditions and may also be risk factors for developing more severe forms of the disease.
There are a range of treatments available for skin conditions, and these vary depending on the specific condition and the severity of symptoms. Not all treatments work effectively for every individual and developing more effective therapies for inflammatory skin diseases will require understanding the genetic and biological drivers of each condition. Self-care steps, such as regular skin washing, and moisturising are important parts of management. Creams and ointments (topical therapy) that control symptoms, such as corticosteroid creams to control itching and help repair the skin, are also frequently used. In more severe cases of some
conditions, oral corticosteroids are effective but can’t be used long term due to potential side effects. Antibiotics can be prescribed if the skin has a bacterial infection. Light therapies (phototherapy) use natural or artificial light to treat conditions such as psoriasis. Other powerful medications may be suitable for severe forms of certain skin conditions that do not respond to other treatments, for example, isotretinoin in severe acne or biologics in severe psoriasis. However, these treatments may not be suitable for everyone.
Inflammatory skin disease is an umbrella term that includes many distinct conditions. Within each of these, there is a spectrum of severity ranging from mild to severe. Many skin conditions typically go through periods of flare-up when symptoms are worsened, and periods of relative control of symptoms.
While inflammatory skin conditions manifest in the skin, over time they can have a wider effect on the body. For example, approximately one in three people with psoriasis will also develop pain and structural changes in their joints. Understanding why some people develop more extensive forms of the condition needs further investigation.
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