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Currently, psoriasis occupies a leading position in the structure of chronic recurrent dermatological diseases. The modern view on the etiopathogenesis of psoriasis allows us to consider this disease as a systemic, genetically determined, immune-mediated process, which manifests itself not only in the form of damage to the skin, but also leads to the development of various comorbid conditions (lesion of the musculoskeletal system, cardiovascular system, excretory system , metabolic disorders, etc.). This fact radically changes the approach to the treatment of patients with psoriasis, to the selection of a systemic drug. The main points in the management of patients with psoriasis, especially of moderate and severe course: interdisciplinary examination of the patient, prevention of the development of comorbid conditions and irreversible (sometimes disabling) changes in internal organs and systems, timely administration of systemic therapy. The article presents modern aspects of the etiopathogenesis of psoriatic disease, the advantages of genetically engineered biological therapy, and a clinical case of treating a patient with severe psoriasis. A 48-old-patient E. who had been suffering from extensive psoriasis vulgaris for 16 years, which manifested after pregnancy and childbirth, was proscribed the systemic therapy. In July 2022, the patient reported oedema that developed in the lower extremities and face while taking methotrexate, and was examined by a nephrologist. Microalbuminuria nephropathy was diagnosed, which served as a reason for adjusting the systemic therapy for psoriasis. The patient had to be switched to the genetically engineered biological therapy. After 3 subcutaneous injections of netakimab at a dose of 120 mg/week, psoriasis went into a steady-state showing the trend towards a regressing stage. The psoriasis severity index scores decreased by the end of the initiating course of therapy.

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The article presents a modern view on the pathogenesis of psoriasis, considers an approach to management of patients with extensive moderate to severe psoriasis, sets out the key features of treatment with genetically engineered biological drugs of different groups: TNF-alpha, IL-17, IL-23 inhibitors. Literature data on the key features, indications, contraindications, and side effects associated with the use of genetically engineered drugs have also been analysed. The experience of using therapies described in domestic and foreign research publications was examined. Approaches to the treatment of patients with moderate to severe psoriasis combined with concomitant comorbid pathologies were discussed, and the features of treatment with genetically engineered biological drugs of different groups were also evaluated. In addition, the publication contains the results of our own observations obtained in the treatment of patients with extensive psoriasis and concomitant comorbid pathology using such biological drugs as secukinumab (10 patients), netakimab (5 patients), guselcumab (7 patients). The schemes of patient investigation, dosage regimens for each drug are given, their efficacy and tolerability are evaluated, and complications acquired during treatment with each drug are analysed, the speed and stability of the therapeutic effect provided by each of them are evaluated. In connection with the emergence of new data on the pathogenesis and treatment of psoriasis, patients have increasing opportunities to receive timely care, maintain disease remission for a long time and improve the quality of life regardless of the severity and stage of the pathological process, as well as of the history and presence of comorbid conditions.