Remission in Dermatology: What Does "Clear" Really Mean for Psoriasis and Atopic Dermatitis?
The bar for treating psoriasis has moved dramatically—from PASI 50 to PASI 75 to complete clearance—and the field is now seriously asking whether remission is an achievable clinical goal, not just an aspirational one. In this episode, Dr Joseph Merola and Dr Alice Gottlieb break down how remission is currently defined in dermatology, where those definitions came from, and what they actually mean for patients in the clinic.
The conversation covers the National Psoriasis Foundation's recently published on-treatment remission criteria for plaque psoriasis, the concept of the molecular scar—what's still happening under visibly clear skin—and why tissue-resident memory T cells may be the reason patients who stop therapy don't always get back to where they were. Dr Merola also presents new American Academy of Dermatology data applying remission definitions to real-world trial outcomes with bimekizumab and guselkumab, including how many patients sustained on-treatment remission at three and five years.
From there, the discussion expands to atopic dermatitis, where Dr Merola led the International Eczema Council consensus on low disease activity and remission—now in press at JAMA Dermatology—and to psoriatic arthritis, where a similar framework is actively in development. Dr Gottlieb draws on her rheumatology background to examine what dermatology should borrow from rheumatoid arthritis and psoriatic arthritis remission models, and where the analogy breaks down.
The episode closes on the question of cure—what it would actually require, what early-intervention data in guttate psoriasis suggests, and how far off a true immune reset really is.
Hosted by Masterclasses in Dermatology Saturday Morning Live, a free virtual education series for dermatologists, nurse practitioners, and physician associates.
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