Doctor Robert Willan was the first to accurately describe the different types of psoriasis in the early 1800s. In the early 1960s, experts found that psoriasis was an autoimmune disorder, and modern treatment began in the mid-1900s.

In 1809, the English doctor Robert Willan was the first to develop an accurate description of the different types of psoriasis. While doctors learned more about the condition over the years, a pivotal finding emerged in 1963, when E. J. Van Scott found that psoriasis was an autoimmune disorder.

Modern treatment for this condition became available in the mid-1900s, and doctors still use these treatments today. Options include ultraviolet light and medications to reduce inflammation and suppress the immune system.

This article discusses the history and discovery of psoriasis and how treatment has changed.

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According to the Psoriasis and Psoriatic Arthritis Alliance, people were aware of psoriasis as early as ancient Greece. Hippocrates wrote some of the first descriptions of skin conditions. However, he classified psoriasis in the same category as leprosy (Hansen’s disease).

People continued to classify psoriasis in the same category as Hansen’s disease for several centuries, and as a result, people with psoriasis often experienced stigma and were outcasts from society.

During the Renaissance period, several people wrote books further categorizing skin conditions. Two Italian authors, Girolamo Mercuriale and Bernardino Ramazzini, began to describe different skin conditions, including psoriasis, in their books De Morbius Cutaneis and De Morbis Artificum.

In 1809, the English doctor Robert Willan also categorized skin conditions. He was the first person to provide a description of different types of psoriasis, and he wrote about the progression of the condition.

While Robert Willan was the first person to investigate psoriasis as a separate condition, he still used the term “lepra vulgaris,” which contributed to people associating psoriasis with leprosy.

In the 1800s, the Austrian physician Ferdinand von Hebra was the first to use modern research techniques to study skin conditions. He also removed “lepra” from the description of psoriasis.

During this century, French doctors discovered the connection between psoriasis and a form of arthritis called psoriatic arthritis.

Other medical professionals of the time continued to make discoveries that led to later research subcategorizing psoriasis. For example, Australian dermatologist William J. Munro discovered mico-abscesses in the top layer of the skin in people with this condition. Later research would find that these abscesses are part of psoriasis vulgaris, a common form of this condition.

Heinrich Köbner made an important discovery during the 19th century. He found that people with psoriasis may also develop psoriatic lesions in previously unaffected areas that have experienced trauma, such as a cut, burn, or bruise. Doctors still use the Köbner phenomenon as a diagnostic tool today.

The 20th century saw various advancements in the classification of psoriasis and its symptoms.

In 1910, Leo von Zumbusch was the first to describe pustular psoriasis, a rare type of psoriasis that causes pustules, blisters, fever, and fatigue.

In 1926, Dr. Woronoff discovered that people with psoriasis may have a pale ring of skin around healing lesions. This halo, or Woronoff ring, is another diagnostic tool that medical professionals use. The appearance of a Woronoff ring may be a sign that psoriasis lesions are healing.

In 1963, E. J. Van Scott found that people with psoriasis have a rapid turnover of cells, which is a marker of an autoimmune condition. This discovery that psoriasis is an autoimmune condition affected the way doctors treated this condition.

A 1973 paper by John M. Moll and Verna Wright linked psoriasis to psoriatic arthritis. This was one of the first research papers to distinguish psoriatic arthritis from rheumatoid arthritis.

The understanding that psoriasis is an autoinflammatory condition rather than a skin disease has led to advances in treatment. In auto-inflammatory conditions, the immune system attacks healthy tissue and cells in the body.

Within the last decade, discoveries in genetics and molecular science have led to a greater understanding of how psoriasis affects people. Researchers now know that the cause is a complex interaction between immunological, environmental, cellular, and genetic factors.

Psoriasis treatment over the years

One of the earliest treatments for psoriasis was coal tar. Medical professionals may still recommend using coal tar as a first-line treatment in cases of mild plaque psoriasis. And they may recommend it in combination with other medications for cases of moderate or severe plaque psoriasis.

In the 1920s, William Goeckerman developed Goeckerman therapy, which combined UVB light with coal tar to treat psoriasis. Doctors still use this treatment today for moderate or severe psoriasis.

Throughout the 1900s, experts created several new treatments, such as:

  • Corticosteroids: This treatment involves using inflammation-reducing drugs, such as amcinonide.
  • Psoralen with ultraviolet A (PUVA): This therapy consists of taking a light-sensitizing drug, such as methoxsalen (Oxsoralen), and then exposing the skin to long-wave ultraviolet light.
  • Methotrexate (Otrexup) and Cyclosporine (Gengraf): These drugs help suppress overactive immune systems.
  • Vitamin D3: There is an association between low vitamin D levels and psoriasis. D3 is the ingredient in the topical medication calcipotriene (Dovonex).
  • Narrowband UVB phototherapy: This therapy is the most common type of phototherapy for skin conditions.

Biologic drugs are the most recent development in the treatment of psoriasis. These drugs interrupt the immune process of the condition, which can help ease its symptoms. A 2018 study reports that biologics are highly effective and lead to dramatic improvements in 80–90% of people with psoriasis.

Healthcare professionals may also prescribe topical and oral retinoids, such as acitretin (Soriatane). Experts are also investigating the effectiveness of Janus kinase (JAK) inhibitors, which healthcare professionals already use in the treatment of rheumatoid arthritis and psoriatic arthritis.

People have been aware of psoriasis for centuries and often grouped this condition with leprosy (Hansen’s disease). Over time, experts began to recategorize this condition and learn more about how it affects the body, eventually discovering it is an autoimmune condition.

Similarly, treatment has evolved over time to become more effective. There are now several options that a doctor may recommend, many of which were first discovered in the 1900s.