latest research psoriasis treatment

Recent Advances in Psoriasis Therapy: Trends and Future Prospects

Affiliation.

• 1 Department of Pharmacy, IIMT College of Medical Sciences, IIMT University Meerut, Uttar Pradesh 250001, India.
• PMID: 33461464
• DOI: 10.2174/1389450122666210118103455

Background: Psoriasis is a challenging skin disorder due to its chronicity, high rate of prevalence, disability, comorbidity and disfiguration. It is a multi-system disorder that includes joints and metabolic syndromes. Psoriasis is a condition of pathologic interaction among immune cells, biological signaling molecules and skin cells. Several contributing factors are responsible for the exacerbation and onset of psoriasis, i.e. genetic factors and environmental factors such as medications, infectious diseases and lifestyle.

Objectives: To study the new insights in the treatment of psoriasis and future prospects.

Methods: This review article gives an insight on the current concepts of psoriasis and deals with discussing the initiation and development of the diseases. We described the pathogenetic pathway for psoriasis. The article focuses on the treatment approaches for psoriasis that have arisen from the dissection of the inflammatory psoriatic pathways.

Results: We aimed to highlight the novel therapies and drugs used in the treatment of psoriasis, including food and drug administration (FDA) approved drugs and drugs under clinical trials. The treatment can be initiated for mild to the moderate diseased condition employing vitamin D3 analogues, corticosteroids and a combination of products as first-line therapy.

Conclusion: Psoriasis can be managed by a proper understanding of the immune function. We have also discussed medicinal herbs used for psoriasis based on their ethnopharmacological knowledge and reported work of researchers.

Keywords: Psoriasis plaque; T-cell; herbs; immunity.; inflammatory cascade.

Copyright© Bentham Science Publishers; For any queries, please email at [email protected].

Publication types

• Adrenal Cortex Hormones / therapeutic use
• Cholecalciferol / analogs & derivatives
• Plant Preparations / therapeutic use
• Plants, Medicinal
• Psoriasis* / drug therapy
• Psoriasis* / epidemiology
• Psoriasis* / immunology
• Adrenal Cortex Hormones
• Plant Preparations
• Cholecalciferol

Treat psoriasis with traditional and novel topical therapies

• Practical Issues and Updates
• Published: 05 August 2022
• Volume 38 , pages 400–405, ( 2022 )

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• Caroline Fenton 1 &
• Connie Kang 1  

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The mainstay topical treatments for psoriasis are corticosteroids and/or vitamin D analogues, with retinoids, calcineurin inhibitors, salicylic acid and other agents used for decades. These agents target abnormal cytokine activity and keratinocyte proliferation and differentiation. New research areas include intracellular signalling pathways, with tapinarof being the first aryl hydrocarbon receptor (AhR) modulator to gain approval. Other promising topical agents include additional AhR modulators, phosphodiesterase type 4 inhibitors and janus kinase pathway inhibitors.

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Lé AM, Torres T. New topical therapies for psoriasis. Am J Clin Dermatol. 2022;23(1):13–24.

Article   Google Scholar  

Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84(2):432–70.

Bissonnette R, Stein Gold L, Rubenstein DS, et al. Tapinarof in the treatment of psoriasis: a review of the unique mechanism of action of a novel therapeutic aryl hydrocarbon receptor-modulating agent. J Am Acad Dermatol. 2021;84(4):1059–67.

Article   CAS   Google Scholar  

Dermavent Sciences. FDA approves Dermavant’s VTAMA ® (tapinarof) cream, 1% for the treatment of plaque psoriasis in adults: first topical novel chemical entity launched for psoriasis in the U.S. in 25 years [media release]. 24 May 2022. https://www.dermavant.com .

Hosking AM, Juhasz M, Mesinkovska NA. Topical Janus kinase inhibitors: a review of applications in dermatology. J Am Acad Dermatol. 2018;79(3):535–44.

Bissonnette R, Bolduc C, Maari C, et al. Efficacy and safety of topical WBI-1001 in patients with mild to moderate psoriasis: results from a randomized double-blind placebo-controlled, phase II trial. J Eur Acad Dermatol Venereol. 2012;26(12):1516–21.

PubMed   CAS   Google Scholar  

Rudnicka L, Olszewska M, Mohamad Goldust M, et al. Efficacy and safety of different formulations of calcipotriol/betamethasone dipropionate in psoriasis: gel, foam, and ointment. J Clin Med. 2021;10(23):5589.

Mason AR, Mason J, Cork M, et al. Topical treatments for chronic plaque psoriasis. Cochrane Database Syst Rev. 2013(3):CD005028.

Ingenus Pharmaceuticals LLC. Betamethasone aerosol, foam: US prescribing information. 2021. https://dailymed.nlm.nih.gov . Accessed 31 May 2022.

Padagis Israel Pharmaceuticals Ltd. Fluocinolone acetonide topical oil, 0.01% (Scalp Oil): US prescribing information. 2021. https://dailymed.nlm.nih.gov . Accessed 31 May 2022.

Sandoz Ltd. Calcipotriene and betamethasone dipropionate ointment: US prescribing information. 2019. https://dailymed.nlm.nih.gov . Accessed 31 May 2022.

Allergan Inc. Tazorac - tazarotene cream. 2017. https://dailymed.nlm.nih.gov . Accessed 31 May 2022.

Stein Gold L, Bhatia N, Tallman AM, et al. A phase 2b, randomized clinical trial of tapinarof cream for the treatment of plaque psoriasis: secondary efficacy and patient-reported outcomes. J Am Acad Dermatol. 2021;84(3):624–31.

Dermavent Sciences. Dermavant showcases new long-term data from phase 3 PSOARING 3 trial of tapinarof in patients with plaque psoriasis at the 30th EADV Virtual Congress [media release]. 30 Sept 2021. https://www.dermavant.com .

Cai L, Chen G, Lu Q, et al. A double-blind, randomized, placebo- and positive-controlled phase III trial of 1% benvitimod cream in mild-to-moderate plaque psoriasis. Chin Med J (Engl). 2020;133(24):2905–9.

Lebwohl M, Kircik LH, Moore A, et al. Once-daily roflumilast cream 0.3%, a potent phosphodiesterase-4 inhibitor, provided safe and effective treatment of psoriasis in the DERMIS-1 and DERMIS-2 phase 3 trials [poster]. SKIN J Cutan Med. 2010;5(6):s42.

Gooderham MJ, Alonso-Llamazares J, Bagel J, et al. Roflumilast cream 0.3% improved the severity and impact of itch in patients with chronic plaque psoriasis in the phase 3 DERMIS-1 and DERMIS-2 studies [poster]. SKIN J Cutan Med. 2021;5(6):s41.

Hashim PW, Chima M, Kim HJ, et al. Crisaborole 2% ointment for the treatment of intertriginous, anogenital, and facial psoriasis: a double-blind, randomized, vehicle-controlled trial. J Am Acad Dermatol. 2020;82(2):360–5.

Punwani N, Burn T, Scherle P, et al. Downmodulation of key inflammatory cell markers with a topical Janus kinase 1/2 inhibitor. Br J Dermatol. 2015;173(4):989–97.

Pfizer Inc. Immunology & inflammation: autoimmune pipeline & trials. 2022. https://www.pfizer.com . Accessed 31 May 2022.

Kang EG, Wu S, Gupta A, et al. A phase I randomized controlled trial to evaluate safety and clinical effect of topically applied GSK2981278 ointment in a psoriasis plaque test. Br J Dermatol. 2018;178(6):1327–9.

Thorley J. FDA expands JAK inhibitors warning: going beyond the data? Lancet Rheumatol. 2021;3(11): e757.

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Fenton, C., Kang, C. Treat psoriasis with traditional and novel topical therapies. Drugs Ther Perspect 38 , 400–405 (2022). https://doi.org/10.1007/s40267-022-00936-4

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Editorial article, editorial: therapeutic advancements in psoriasis and psoriatic arthritis.

• Department of Dermatology, Belle Vue Clinic, Kolkata, India

Editorial on the Research Topic Therapeutic Advancements in Psoriasis and Psoriatic Arthritis

Psoriasis and psoriatic arthritis are complex autoimmune diseases affecting about 2–3% of world population. With the advancement in translational research, the pathogenesis of these diseases is better known now compared to a decade ago. New therapeutic targets have been identified, and subsequently more effective therapies are now available for these patients. With these new therapies, psoriatic diseases are much better controlled, and quality of life has improved greatly. Most of these newer therapies are targeting the immune system and their molecular signaling pathways. In this Research Topic, we had planned to gather articles on new therapeutic strategies for psoriatic disease, their limitations and future directions.

We present here a gleaning of contemporary research in this area, encapsulated in 9 articles written by 60 authors. In one of the 3 original articles, Liu et al. explores a novel mechanism of action of acitretin via promoting the differentiation of myeloid-derived suppressor cells (MDSC). It is known that increased number of MDSCs are involved in the pathogenesis of psoriasis. Though the role of acitretin as a regulator of keratinocyte proliferation and differentiation is well-known, its effect on immune cells has been less well-understood. This work throws new light on a largely unexplored area.

In another study in this section, Bauer et al. explores epidermal drug delivery through fractional ablative (Er:YAG) laser microporation in a phase I study on plaque-type psoriasis. Topical delivery of etanercept solution to psoriatic plaques via laser-generated micropores was found to be generally well-tolerated and safe. The study opens the door to future follow-up studies to find out clinical benefit of this drug delivery system.

Rattanakaemakorn et al. compared a combination of liquid coal tar (liquor carbonis detergens) and 308-nm Excimer lamp with Excimer lamp alone in scalp psoriasis. The combination appeared to have a synergistic effect. This is an important finding in a particularly treatment-resistant site, that not only underscores the importance of an age-old modality like coal tar, but also situates the role of a novel light therapy.

The emergence of proteomics as a technology allows us to have a panoramic view of all potential peptides involved in the interactive pathways operating between cutaneous psoriasis and psoriatic arthropathy, and provides helpful clues as to why a certain subset of cutaneous psoriasis develops arthropathy. Qi et al. has elucidated this aspect in an important mini-review that summarizes the application of proteomics in the development of biomarkers in psoriatic arthritis and identifies possible clinical risk factors in the evolution of psoriatic arthropathy in patients with cutaneous psoriasis.

The role of oxidative stress and that of reactive oxygen species in the pathogenesis of psoriasis is well-known. In an illuminating narrative review, Campione et al. explore the role of dimethyl fumarate (DMF) and its metabolite, monomethyl fumarate, in modulation of pro-inflammatory transcription factors. The comparatively recent association of psoriasis with metabolic syndromes has brought the focus to glutathione-S-transferase dysregulation that is present in obesity, diabetes and cardiovascular disorders. The increase of this enzymatic activity in psoriatic epidermis and its reduction by DMF through formation of covalently linked conjugates is one of the highlights of this review.

In second of the two reviews, Thakur and Mahajan elucidate the therapeutic targets in psoriasis and the novel agents being developed to selectively block or inhibit those targets. Their discussion on the interplay of different epigenetic pathways in pathogenesis of psoriasis and the enzyme inhibitors acting on these pathways make for an illuminating discussion on the novel therapeutic targets in psoriasis.

In an interesting systematic review, Arora et al. deal with the very important issue of combination therapies and manage to come up with some recommendations. They discuss combinations of every kind that have been described in the literature, involving new therapeutic agents (small molecules, biologics), conventional agents and phototherapy.

Gómez-García et al. have done a scoping review of the inhibitors of the Janus kinase–signal transducer and activator of transcription (JAK/STAT) pathway in psoriasis. The application of this class of agents in dermatological disorders is in its infancy. They advocate caution in the interpretation of early phase trials, most of which have been industry-sponsored with a high risk of bias. They also suggest the use of standardized psoriasis-specific outcome measures, which would help reach better decisions.

The last of the three systematic reviews by Zhang et al. is on systematic treatment in nail psoriasis. They recommend to prioritize the use of anti-IL-17 agents in this situation.

To conclude: This Research Topic is a collection of diverse articles providing a gleaning on therapeutic advances in psoriasis and psoriatic arthritis. Through 3 original articles, 1 mini-review, 2 reviews and 3 systematic reviews, a whole lot of new ground, covering pathogenesis of the disease, the interlinking of pathogenetic pathways between cutaneous psoriasis and psoriatic arthritis, new drug delivery systems, systematic reviews of JAK-STAT inhibitors, to name just a few, have been covered by the authors. Many of these subjects are relatively new and/or unexplored, like the role of acitretin in the differentiation of MDSCs, and the role of the latter in the development of severe disease; fractional laser-delivered microporation as a new drug delivery technique in plaque psoriasis; the utilization of proteomics in identifying biomarkers that might be helpful in understanding the subset of cutaneous psoriasis patients who would be at risk for developing psoriatic arthritis, etc. Another important, yet a relatively virgin field of research, highlighted in one of the reviews, is the epigenetic pathways in the pathogenesis of the disease. New light has been thrown on possible mechanisms of action of some agents that are not so new, like fumarates and acitretin. All in all, this bouquet of articles will whet the appetite of anyone who wishes to have a panoramic view of new developments of all aspects of therapy of psoriasis and psoriatic arthritis, particularly if read in conjunction with novel findings in the pathogenesis of both the conditions.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

Conflict of Interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Keywords: psoriasis, psoriatic arthritis, therapy, epigenetics, acitretin

Citation: Panda S (2022) Editorial: Therapeutic Advancements in Psoriasis and Psoriatic Arthritis. Front. Med. 9:888648. doi: 10.3389/fmed.2022.888648

Received: 03 March 2022; Accepted: 04 March 2022; Published: 29 March 2022.

Edited and reviewed by:

Copyright © 2022 Panda. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Saumya Panda, saumyapan@gmail.com

This article is part of the Research Topic

Therapeutic Advancements in Psoriasis and Psoriatic Arthritis

• Patient Care & Health Information
• Diseases & Conditions

Your health care provider will ask questions about your health and examine your skin, scalp and nails. Your health care provider then might take a small sample of skin (biopsy) for examination under a microscope. This helps determine the type of psoriasis and rule out other disorders.

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Psoriasis care at Mayo Clinic

• Skin biopsy
• Psoriasis: What to share with your doctor

Psoriasis treatments aim to stop skin cells from growing so quickly and to remove scales. Options include creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medications.

Which treatments you use depends on how severe the psoriasis is and how responsive it has been to previous treatment and self-care measures. You might need to try different drugs or a combination of treatments before you find an approach that works. Even with successful treatment, usually the disease returns.

Topical therapy

Corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They are available as oils, ointments, creams, lotions, gels, foams, sprays and shampoos. Mild corticosteroid ointments (hydrocortisone) are usually recommended for sensitive areas, such as the face or skin folds, and for treating widespread patches. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends during remission.

Your health care provider may prescribe a stronger corticosteroid cream or ointment — triamcinolone (Trianex) or clobetasol (Cormax, Temovate, others) — for smaller, less-sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can thin the skin. Over time, topical corticosteroids may stop working.

• Vitamin D analogues. Synthetic forms of vitamin D — such as calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical) — slow skin cell growth. This type of drug may be used alone or with topical corticosteroids. Calcitriol may cause less irritation in sensitive areas. Calcipotriene and calcitriol are usually more expensive than topical corticosteroids.

Retinoids. Tazarotene (Tazorac, Avage, others) is available as a gel or cream. It's applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light.

Tazarotene isn't recommended when you're pregnant or breastfeeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — calm the rash and reduce scaly buildup. They can be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are irritating or harmful.

Calcineurin inhibitors aren't recommended when you're pregnant or breastfeeding or if you intend to become pregnant. This drug is also not intended for long-term use because of a potential increased risk of skin cancer and lymphoma.

• Salicylic acid. Salicylic acid shampoos and scalp solutions reduce the scaling of scalp psoriasis. They are available in nonprescription or prescription strengths. This type of product may be used alone or with other topical therapy, as it prepares the scalp to absorb the medication more easily.

Coal tar. Coal tar reduces scaling, itching and inflammation. It's available in nonprescription and prescription strengths. It comes in various forms, such as shampoo, cream and oil. These products can irritate the skin. They're also messy, stain clothing and bedding, and can have a strong odor.

Coal tar treatment isn't recommended when you're pregnant or breastfeeding.

• Anthralin. Anthralin is a tar cream that slows skin cell growth. It can also remove scales and make skin smoother. It's not intended for use on the face or genitals. Anthralin can irritate skin, and it stains almost anything it touches. It's usually applied for a short time and then washed off.

Light therapy

Light therapy is a first line treatment for moderate to severe psoriasis, either alone or in combination with medications. It involves exposing the skin to controlled amounts of natural or artificial light. Repeated treatments are necessary. Talk with your health care provider about whether home phototherapy is an option for you.

• Sunlight. Brief, daily exposures to sunlight (heliotherapy) might improve psoriasis. Before beginning a sunlight regimen, ask your health care provider about the safest way to use natural light for psoriasis treatment.
• Goeckerman therapy. An approach that combines coal tar treatment with light therapy is called the Goeckerman therapy. This can be more effective because coal tar makes skin more responsive to ultraviolet B (UVB) light.
• UVB broadband. Controlled doses of UVB broadband light from an artificial light source can treat single psoriasis patches, widespread psoriasis and psoriasis that doesn't improve with topical treatments. Short-term side effects might include inflamed, itchy, dry skin.
• UVB narrowband. UVB narrowband light therapy might be more effective than UVB broadband treatment. In many places it has replaced broadband therapy. It's usually administered two or three times a week until the skin improves and then less frequently for maintenance therapy. But narrowband UVB phototherapy may cause more-severe side effects than UVB broadband.

Psoralen plus ultraviolet A (PUVA). This treatment involves taking a light-sensitizing medication (psoralen) before exposing the affected skin to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe psoriasis. Short-term side effects might include nausea, headache, burning and itching. Possible long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

• Excimer laser. With this form of light therapy, a strong UVB light targets only the affected skin. Excimer laser therapy requires fewer sessions than does traditional phototherapy because more-powerful UVB light is used. Side effects might include inflammation and blistering.

Oral or injected medications

If you have moderate to severe psoriasis, or if other treatments haven't worked, your health care provider may prescribe oral or injected (systemic) drugs. Some of these drugs are used for only brief periods and might be alternated with other treatments because they have potential for severe side effects.

• Steroids. If you have a few small, persistent psoriasis patches, your health care provider might suggest an injection of triamcinolone right into them.
• Retinoids. Acitretin and other retinoids are pills used to reduce the production of skin cells. Side effects might include dry skin and muscle soreness. These drugs are not recommended when you're pregnant or breastfeeding or if you intend to become pregnant.

Biologics. These drugs, usually administered by injection, alter the immune system in a way that disrupts the disease cycle and improves symptoms and signs of disease within weeks. Several of these drugs are approved for the treatment of moderate to severe psoriasis in people who haven't responded to first line therapies. Options include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), risankizumab-rzaa (Skyrizi) and ixekizumab (Taltz). Three of them — etanercept, ixekizumab and ustekinumab — are approved for children. These types of drugs are expensive and may or may not be covered by health insurance plans.

Biologics must be used with caution because they carry the risk of suppressing the immune system in ways that increase the risk of serious infections. People taking these treatments must be screened for tuberculosis.

Methotrexate. Usually administered weekly as a single oral dose, methotrexate (Trexall) decreases the production of skin cells and suppresses inflammation. It's less effective than adalimumab and infliximab. It might cause upset stomach, loss of appetite and fatigue. People taking methotrexate long-term need ongoing testing to monitor their blood counts and liver function.

People need to stop taking methotrexate at least three months before attempting to conceive. This drug is not recommended for those who are breastfeeding.

Cyclosporine. Taken orally for severe psoriasis, cyclosporine (Gengraf, Neoral, Sandimmune) suppresses the immune system. It's similar to methotrexate in effectiveness but cannot be used continuously for more than a year. Like other immunosuppressant drugs, cyclosporine increases the risk of infection and other health problems, including cancer. People taking cyclosporine long-term need ongoing testing to monitor their blood pressure and kidney function.

These drugs aren't recommended when you're pregnant or breastfeeding or if you intend to become pregnant.

• Other medications. Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when you can't take other drugs. Talk with your health care provider about possible side effects of these drugs.

Treatment considerations

You and your health care provider will choose a treatment approach based on your needs and the type and severity of your psoriasis. You'll likely start with the mildest treatments — topical creams and ultraviolet light therapy (phototherapy). Then, if your condition doesn't improve, you might move on to stronger treatments.

People with pustular or erythrodermic psoriasis usually need to start with stronger (systemic) medications.

In any situation, the goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

Alternative medicine

Some studies claim that alternative therapies (integrative medicine) — products and practices not part of conventional medical care or that developed outside of traditional Western practice — ease the symptoms of psoriasis. Examples of alternative therapies used by people with psoriasis include special diets, vitamins, acupuncture and herbal products applied to the skin. None of these approaches is backed by strong evidence, but they are generally safe and might help reduce itching and scaling in people with mild to moderate psoriasis.

• Aloe extract cream. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce scaling, itching and inflammation. You might need to use the cream several times a day for a month or more to see any improvement in your skin.
• Fish oil supplements. Oral fish oil therapy used in combination with UVB therapy might reduce the extent of the rash. Applying fish oil to the affected skin and covering it with a dressing for six hours a day for four weeks might improve scaling.
• Oregon grape. Oregon grape — also known as barberry — is applied to the skin and may reduce the severity of psoriasis.

If you're considering alternative medicine to ease the signs and symptoms of psoriasis, talk with your health care provider about the pros and cons of these approaches.

• Psoriasis and clinical trials
• Psoriasis treatment options
• Photodynamic therapy
• Psoriasis: Get the most out of your treatment

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Try these self-care measures to better manage your psoriasis:

• Take daily baths. Wash gently rather than scrubbing your skin in the shower or bath. Use lukewarm water and mild soaps that have added oils or fats. It might help to add bath oil, Epsom salts or oatmeal to bathwater and soak for at least 15 minutes.

Keep your skin moist. Apply moisturizer daily. If you're moisturizing after bathing, gently pat dry and apply your preferred product while your skin is still moist. For very dry skin, oils or heavy ointment-based moisturizers may be preferable — they stay on the skin longer than creams or lotions do. If moisturizing seems to improve your skin, apply the product more than once a day.

If the air where you live is very dry, use a humidifier to add moisture to the air.

• Cover the affected areas overnight. Before going to bed, apply an ointment-based moisturizer to the affected skin and wrap with plastic wrap. When you wake, remove the plastic and wash away scales.
• Expose your skin to small amounts of sunlight. Ask your health care provider about the best way to use natural sunlight to treat your skin. A controlled amount of sunlight can improve psoriasis, but too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. Log your time in the sun, and protect skin that isn't affected by psoriasis with a hat, clothing or sunscreen with a sun protection factor (SPF) of at least 30.
• Avoid scratching. It might help to apply a nonprescription anti-itch cream or ointment containing hydrocortisone or salicylic acid. If you have scalp psoriasis, try a medicated shampoo that contains coal tar. Keep your nails trimmed so that they won't hurt your skin if you do scratch. Wear soft fabrics that don't contribute to itchiness.
• Avoid psoriasis triggers. Notice what triggers your psoriasis, and take steps to prevent or avoid it. Infections, injuries to your skin, smoking and intense sun exposure can all worsen psoriasis.
• Stay cool. Being too hot can make your skin feel itchy. Wear light clothing if you're outside on hot days. If you have air conditioning, use it on hot days to keep cool. Keep cold packs in your freezer and apply them to itchy spots for a few minutes of relief. You might try storing your moisturizing lotion in the refrigerator to add a cooling effect when you apply it
• Strive to maintain a healthy lifestyle. Try practicing other healthy-living habits to help manage psoriasis. These include being active, eating well, limiting or avoiding alcohol consumption, and maintaining a healthy weight.
• 6 ways to manage itchy skin when you have psoriasis
• Ease stress to reduce your psoriasis flares
• Psoriasis and intimacy
• Can psoriasis make it hard to sleep?
• Gluten sensitivity and psoriasis: What's the connection?
• Is the Mediterranean diet good for psoriasis?
• Psoriasis: How can I protect my skin during a workout?
• What's the best way to manage scalp psoriasis?

Coping and support

Coping with psoriasis can be a challenge, especially if the affected skin covers a large area of your body or is visible to other people. It can cause discomfort and embarrassment. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you live with psoriasis and feel more in control:

• Learn more about psoriasis. Find out as much as you can about the disease, and research your treatment options. Understand possible triggers of the disease so that you can better prevent flare-ups. Educate those around you — including family and friends — so that they can recognize, acknowledge and support your efforts in dealing with the disease.
• Follow your health care provider's recommendations. Try to adhere to medical advice about treatment and lifestyle changes. Ask questions if anything is unclear.
• Find a support group. Consider joining a support group of people who have the disease. Some people find comfort in sharing their experiences and meeting people who face similar challenges. Ask your health care provider for information on psoriasis support groups in your area or online.
• Use cover-ups as needed. On those days when you feel particularly self-conscious, cover the psoriasis with clothing or use cosmetic cover-up products, such as body makeup or a concealer. These products might irritate the skin, so don't use them on open sores, cuts or unhealed patches.
• Reduce stress. The relationship between stress and psoriasis is unclear and needs further study. But it's possible that easing stress in your life might help reduce psoriasis flares and itchiness. Try doing things you enjoy and activities that focus your mind on something other than your stresses. Consider meditation, tai chi, yoga, and spending time with friends and loved ones.

Preparing for your appointment

You'll likely first see your primary care provider. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here's some information to help you prepare for your appointment and know what to expect from your health care provider.

What you can do

Make a list of the following:

• Symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment
• All medications, vitamins and herbs you take, including doses
• Questions to ask your health care provider

For psoriasis, some basic questions you might ask include:

• What might be causing my signs and symptoms?
• Do I need diagnostic tests?
• What treatments are available, and which do you recommend for me?
• What types of side effects can I expect?
• Will the treatment you recommended cause a remission in my symptoms?
• How quickly can I expect results?
• What are the alternatives to the primary approach you're suggesting?
• I have other medical conditions. How can I manage these conditions together?
• What skin care routines and products do you recommend to improve my symptoms?

What to expect from your doctor

Your health care provider is likely to ask you several questions, such as:

• When did you begin having symptoms?
• How often do you have these symptoms?
• Have your symptoms been continuous or occasional?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• AskMayoExpert. Psoriasis. Mayo Clinic; 2021.
• Dinulos JGH. Psoriasis and other papulosquamous diseases. In: Habif's Clinical Dermatology. 7th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed March 5, 2020.
• Psoriasis clinical guideline. American Academy of Dermatology. https://www.aad.org/member/clinical-quality/guidelines/psoriasis. Accessed March 5, 2020.
• Aloe. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 6, 2020.
• Bolognia JL, et al., eds. Psoriasis. In: Dermatology. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed March 5, 2020.
• Richard EG. Psoralen plus ultraviolet A (PUVA) photochemotherapy. https://www.uptodate.com/contents/search. Accessed March 16, 2020.
• Feldman SR, et al. Treatment of psoriasis in adults. https://www.uptodate.com/contents/search/. Accessed March 16, 2020.
• Aromatherapy. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 6, 2020.
• Fish oil. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 6, 2020.
• Kermott CA, et al., eds. Psoriasis. In: Mayo Clinic Book of Home Remedies. 2nd ed. Time; 2017.
• Oregon grape. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed March 16, 2020.
• Bolognia JL, et al., eds. Ultraviolet therapy. In: Dermatology. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed March 5, 2020.
• Bolognia JL, et al., eds. Systemic immunomodulators. In: Dermatology. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed March 5, 2020.
• Psoriasis: Causes. American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/insider/diet. Accessed March 17, 2020.
• Healthy diet and other lifestyle changes that can improve psoriasis. American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/insider/diet. Accessed March 17, 2020.
• Gibson LE (expert opinion). Mayo Clinic. March 26, 2020.
• Sokumbi O (expert opinion). Mayo Clinic. Nov. 1, 2021.
• Kelly AP, et al. Psoriasis. In: Taylor and Kelly's Dermatology for Skin of Color. 2nd ed. McGraw Hill; 2016. https://accessmedicine.mhmedical.com. Accessed Sept. 13, 2021.
• Menter A, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. Journal of the American Academy of Dermatology. 2018; doi:10.1016/j.jaad.2018.11.057.
• Office of Patient Education. Psoriasis. Mayo Clinic; 2008.
• Managing itch. National Psoriasis Foundation. https://www.psoriasis.org/life-with-psoriasis/managing-itch. Accessed Nov. 12, 2019.
• High WA. Special considerations in skin of color. In: Dermatology Secrets. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 5, 2021.
• Griffiths CEM, et al. A multidimension assessment of the burden of psoriasis: Results from a multinational dermatologist and patient survey. British Journal of Dermatology. 2018; doi:10.111/bjd.16332.
• Feldman SR, et al. Psoriasis: Epidemiology, clinical manifestations, and diagnosis. https://www.uptodate.com/contents/search/. Accessed Sept. 15, 2021.
• Nogueira M, et al. Targeted therapy for pediatric psoriasis. Paediatric Drugs. 2021; doi:10.1007/s40272-021-00443-5.
• Elmets CA, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. Journal of the American Academy of Dermatology. 2021; doi.10.1016.j.jaad.2020.07.087.
• Dietary modifications. National Psoriasis Foundation. https://www.psoriasis.org/dietary-modifications/. Accessed Oct. 20, 2021.
• Ford AR, et al. Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the National Psoriasis Foundation: A systematic review. JAMA Dermatology. 2018; doi:10.1001/jamadermatol.2018.1412.
• 5 signs a psoriasis support group is right for you
• Alternative psoriasis treatments
• Erythrodermic psoriasis
• Guttate psoriasis
• How psoriasis develops
• Identifying what worsens your psoriasis
• Inverse psoriasis
• Nail psoriasis
• Plaque psoriasis
• Pregnancy and breastfeeding when you have psoriasis
• Psoriasis and your self-esteem
• Psoriasis: What if I get psoriatic arthritis, too?
• Psoriasis-related health risks
• Pustular psoriasis
• Scalp psoriasis
• Scalp psoriasis vs. seborrheic dermatitis
• Types of psoriasis
• What are the risks of vaccinations for people living with psoriasis?

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• Mayo Clinic Minute: Psoriasis of the scalp Oct. 10, 2023, 03:00 p.m. CDT
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Home / Living Well / More than skin deep with Dr. V.: Flake-free living with psoriasis

More than skin deep with Dr. V.: Flake-free living with psoriasis

Psoriasis is one of the most common skin conditions in the world.

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“I hate how my scalp psoriasis causes flaking; it looks like I have dandruff all the time. It is so itchy!” said my friend Jasmine. Topical medicines had been challenging for her to consistently use, which made her scalp and body psoriasis difficult to treat.

But now medications known as biologics are revolutionizing the treatment of psoriasis by modulating the immune system. And they are giving people like Jasmine new options for living flake-free.

What is psoriasis?

Psoriasis is one of the most common skin conditions in the world, affecting an estimated 2% to 3% of the United States population. It is a chronic and inflammatory condition that primarily affects the skin but can be associated with manifestations in other parts of the body, including the joints. This condition has a preference for the skin on the front of the knees, back of the elbows, scalp and cleft at the top of the buttocks but can occur anywhere.

Psoriasis most commonly develops in adulthood, often between ages 30 and 39 or between ages 50 and 69. Psoriasis tends to affect men and women equally. Healthcare professionals often diagnose psoriasis by a physical exam, but a biopsy of the skin may be needed.

What causes psoriasis?

Psoriasis is an autoimmune disorder. Its cause is not completely understood. The mechanism is due, at least in part, to an issue with the immune system. The hallmark of psoriasis is inflammation that drives uncontrolled production and aging of skin cells that build up into thick plaques on the skin.

Factors that play a role in an individual’s risk for developing psoriasis or worsening severity of their psoriasis include:

• Genetic predisposition.
• Alcohol use.
• Infections — Infections can rev up the immune system, which can trigger a psoriasis flare.

It is estimated that 35% of individuals who develop psoriasis have a family history of the condition. One study of twins found that in 80% of cases, if one twin had psoriasis, both did.

What does psoriasis look like?

There are multiple forms of psoriasis: plaque, erythrodermic, guttate, pustular, inverse and nail psoriasis.

Lesions develop in response to trauma at the site where the trauma occurred. This is known as the Koebner phenomenon. For this reason, psoriatic lesions can be found at the belt line, where clothing rubs or at places that are commonly bumped during daily activities.

What is plaque psoriasis? What causes scalp psoriasis?

Plaque psoriasis is the most common type of psoriasis, representing over 90% of cases of psoriasis. This type of psoriasis is characterized by well-defined raised, red lesions that are rough to the touch and topped with a fine silvery-white scale. In darker skin tones, psoriatic plaques tend to appear more brown or violet in color and are topped with gray scale. It tends to present equally on both sides of the body on the scalp, knees, elbows and between the buttocks.

Scalp psoriasis can be confused with dandruff (seborrheic dermatitis). However, there is a form of plaque psoriasis that affects individuals’ scalps. The most common complaints of scalp psoriasis include itching and flaking. Psoriasis also can cause areas of hair loss.

How do you treat psoriasis?

There is no cure for psoriasis. Therapies are individualized based on the severity of the disease, patient preferences and other concurrent conditions such as psoriatic arthritis. Treatment can be applied to the affected area (topical) or throughout the whole body (systemic). For limited or mild disease, topical therapies are used. For moderate-to-severe disease, systemic agents are more common.

 Topical therapies include:

• Moisturizers.
• Vitamin D analogs.
• Immunosuppressants.

Systemic therapies can include:

• Phototherapy (a fancy term for exposure to light).
• Oral immunosuppressants.
• Oral, infused or injected immunomodulating agents often called biologics.

Lifestyle changes also could help with scalp psoriasis. You can try:

• Washing hair more frequently.
• Frequently brushing hair to remove scale.
• Using special topical oils and ointments that contain salicylic acid to help break down built-up scale.

How are psoriasis and mood related?

The association between psoriasis and mood is startling, and reflective of the toll skin disease can take on quality of life. People with psoriasis have higher rates of anxiety and depression than those without psoriasis. Social stigmatization is commonly reported. Further, psoriasis can be severe and disabling for some individuals, even impacting their financial security. If you or a loved one are affected, connect with peers affected by psoriasis through the National Psoriasis Foundation for support.

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Everything You Need to Know About Psoriasis, Including Signs, Causes & Treatment

I f you've ever noticed inflamed, scaly patches on your body and wondered what they were (and what you should do about them), psoriasis , an autoimmune disorder that causes scaly rashes on the skin, may be the cause.

While there are a number of treatment options available for psoriasis, the scaly patches that can develop all over your body can be a bit scary. We get it, which is why we spoke with a slew of skin experts on all things psoriasis, including what you should (and definitely should not) do if you suspect you might have it.

Meet The Experts:

• Joshua Zeichner , MD, is a board-certified dermatologist and Associate Professor of Dermatology and the Director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital in New York City.
• Tsippora Shainhouse , MD, is a board-certified dermatologist in Beverly Hills and a clinical instructor at the University of Southern California.
• Nava Greenfield , MD, is a board-certified dermatologist in Brooklyn, New York.

In This Story:

What is psoriasis, what does psoriasis look like, what do you do about it.

• What you should not do about it.

Joshua Zeichner , the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, explains it in the simplest terms: "Psoriasis is a condition in which the immune system gets angry at the skin, leading to red, scaly plaques," he says. Usually, you'll see these plaques on the elbows and knees, but psoriasis can appear anywhere, including the scalp, lower back, nails, and even the genitals.

Want to get even more specific? Psoriasis "is a genetic, autoimmune, inflammatory condition in which your skin cells divide too quickly and do not shed quickly enough," says Tsippora Shainhouse, a board-certified dermatologist in Beverly Hills and a clinical instructor at the University of Southern California. These extra cells (that don't get shed fast enough) are what create the inflamed, scaly plaques on the surface of the skin. Psoriasis is considered to be a common and chronic condition , meaning that it's usually a lifelong disease and that flare-ups can come and go at any time.

Even though symptoms mainly manifest on the skin, the condition isn't only skin deep — it is an autoimmune disorder. Having psoriasis can also make you more susceptible to developing other diseases. According to Shainhouse, psoriasis is often associated with psoriatic arthritis , metabolic syndrome, elevated triglycerides, increased risk for heart disease, and obesity. So, if the superficial aspect of psoriasis isn't enough to get you to a doctor, all of the aforementioned reasons should be.

You can generally tell that it's psoriasis, thanks to the main symptom: dry, raised, scaly plaques that can be pink, white, or even silver in color. Sometimes these plaques will itch or crack and possibly even bleed. Psoriasis patches can range in size from small spots or dandruff-like flakes to large plaques that cover large areas of the body and they can also erupt in waves or flare-ups for weeks or even months at a time.

Unfortunately, even when the plaques are visibly in remission, they're lying dormant and could appear at any moment. This is why psoriasis is a chronic disorder and for many people (including Kim Kardashian ), keeping flare-ups at bay can be a lifelong battle.

Under the overarching psoriasis umbrella, there are also many different types of the condition. All forms of psoriasis are characterized by plaques, but the size, pattern, and location can differ. The most common kinds are plaque psoriasis, guttate psoriasis, and inverse psoriasis, explains Nava Greenfield , a board-certified dermatologist in Brooklyn. Of these, plaque psoriasis is considered to be the most common form.

"Plaque will typically be on the elbows, knees, scalp, and trunk," Greenfield explains. "Guttate lesions are smaller and usually [occur] mostly on the trunk, and inverse appears on sensitive areas such as axilla [armpits] and the groin."

"Fun" fact about guttate psoriasis: It's actually "named after raindrops because you get a sudden eruption of small, pink, scaly spots all over the trunk, usually after exposure to strep throat," Shainhouse says.

Don't just go to Google images and try to diagnose yourself. A dermatologist will have to examine your skin in order to make a diagnosis and determine which form of the disorder you have. Once you've been diagnosed, you can discuss treatment plans. There are now many options available, including topical creams, injections , and lifestyle alterations.

"With the right medication, most patients can achieve complete or near-complete clearance" of symptoms, explains Gary Goldenberg, a board-certified dermatologist in New York City.

According to Zeichner and Goldenberg, the proper treatment regimen will depend upon how mild or severe your case is, as well as what kind of psoriasis you have. "For mild cases, skin care is important," Goldenberg says. "I usually recommend [full-body] moisturizers [and] topical steroids are also useful for itching and inflammation."

Other topical options for mild cases include cortisones and vitamin D creams, Zeichner says. "More severe cases may require systemic medications like pills or shots to keep the inflammation calm."

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If you have scalp psoriasis , Zeichner also suggests using over-the-counter tar shampoos to help relieve dandruff and itching. Phototherapy could also be a viable option: "UV light is generally a no-no in dermatology since we know that too much can be associated with the development of skin cancer and melanoma," Shainhouse explains. "However, it has an anti-inflammatory effect in psoriatic skin, and is a very useful option for reducing skin disease and symptoms."

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Dove Beauty Dermacare Anti-Dandruff Shampoo

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And what you definitely should not do about it...

When it comes to psoriasis, certain lifestyle choices can greatly affect and even trigger flare-ups. "Lifestyle is very important," Goldenberg explains. "I usually recommend an anti-inflammatory diet that's rich in fruits, vegetables, and fish, probiotics, and vitamin D supplements. Alcohol in excess and smoking can also make psoriasis worse." In addition to alcohol and smoking, stress can also exacerbate symptoms, Greenfield says.

One thing that can significantly worsen your psoriasis symptoms (although it may be even more tempting than an extra glass of wine with dinner): Picking at your scaly skin is the last thing you should do. "Rubbing and picking at the skin will actually worsen the spots," Shainhouse says. "Psoriasis tends to develop in sites of skin trauma, including cuts and scratches."

This is called the Koebner phenomenon. So, no matter how itchy or irritated your plaques may feel, try to keep your hands off and enlist the help of a professional, ASAP.

If you suspect you might have psoriasis, the best thing to do is make an appointment with your dermatologist and remain diligent about following through with the prescribed protocol — even if that means no more wine with dinner.

This story is part of Survivor's Guide , a series on navigating the impact of psoriasis through beauty and self-care.

In case that wasn't quite comprehensive enough:

• Kim Kardashian's Fans Are Praising Her for Sharing a Photo of Her Psoriasis Flare-Up
• We Answer Cara Delevingne's Skin S.O.S.: Psoriasis
• The Winter Skin Problem You Might Not Know You Have

Done reading? Watch psoriasis advocate Nitika Chopra walk us through her day:

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Comprehensive Guide to Psoriasis: Understanding Types, Treatment, and Care

Try our free symptom checker

Get a thorough self-assessment before your visit to the doctor.

Psoriasis is a long-lasting, noncontagious autoimmune disease that manifests as red, pink, or purple, dry, itchy, and scaly patches on the skin. These patches vary in severity, from minor localized areas to complete body coverage. The condition is marked by an accelerated turnover of skin cells, accumulating these cells on the skin's surface, forming what are known as plaques. While primarily a concern in dermatology, psoriasis also intersects with immunology, rheumatology, and other medical disciplines due to its systemic nature and the array of complications it can entail​​​​.

Globally, psoriasis affects an estimated 79.7 million people , making it a relatively common condition. It can occur at any age but usually starts in adulthood. There's no gender bias in its occurrence; it affects men and women equally. The causes of psoriasis are multifaceted, involving genetic predisposition and environmental triggers, contributing to its complexity and the variety of ways it can present itself.​

In this article, you will learn about the types of psoriasis, symptoms, diagnosis, causes and triggers, treatment and management, and the associated complications. It will conclude with a discussion of the importance of comprehensive care and support for individuals affected by psoriasis.

📒 Related Articles

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• Scalp Psoriasis vs Dandruff
• Shingles vs. Psoriasis

1. Types of Psoriasis

Psoriasis manifests in various forms, each with distinct characteristics and areas of the body affected. Understanding these types is crucial for effective diagnosis and treatment.

• Plaque Psoriasis (Psoriasis Vulgaris): The most prevalent form, accounting for about 90% of cases , is characterized by raised, red patches covered with a silvery-white buildup of dead skin cells or scale. These patches are typically found on the scalp, elbows, knees, and lower back​​.
• Guttate Psoriasis: This type primarily affects young adults and children and is often triggered by a bacterial infection, such as streptococcal throat infection. Small, drop-shaped, scaling lesions on the trunk, arms, or legs characterize it​​​​.
• Inverse Psoriasis: Also known as flexural psoriasis, this type affects skin folds, such as those under the breasts, in the armpits, or around the groin and genitals. Inverse psoriasis causes smooth patches of red, inflamed skin that worsen with friction and sweating​​​​.
• Pustular Psoriasis: Less common, pustular psoriasis is marked by white blisters of noninfectious pus surrounded by red skin. It can occur on any body part but most often affects the hands and feet​​​​.
• Erythrodermic Psoriasis: The least common type of psoriasis, erythrodermic psoriasis is a severe form that can cover large areas of the body with a red, peeling rash that can itch or burn intensely. This type can be life-threatening and requires immediate medical attention​​​​.
• Nail Psoriasis: Psoriasis can affect fingernails and toenails, leading to pitting, abnormal nail growth, discoloration, and lifting from the nail bed. In severe cases, the nail may crumble.​

2. Symptoms

The symptoms of psoriasis extend beyond the well-known red, itchy, and scaly patches. These symptoms can vary widely among individuals and may include:

• Cracked, dry skin that may bleed
• Burning or soreness around the patches
• Thickened or ridged nails
• Swollen and stiff joints

The severity of the symptoms can fluctuate with flare-ups often triggered by various factors such as stress , weather changes, or medications​​​​.

3. Causes and Triggers

Psoriasis is a complex condition whose exact cause remains not fully understood. However, it is widely acknowledged as an immune system problem tied to genetics and triggered by environmental factors.

In individuals with psoriasis, the immune system mistakenly attacks healthy skin cells, accelerating their growth cycle dramatically. This rapid turnover leads to the buildup of cells on the skin's surface, resulting in the characteristic psoriasis plaques​​​​.

Genetic Factors

A strong genetic predisposition to psoriasis suggests it can run in families. If one parent has psoriasis, the chance of their child developing the condition increases, and the likelihood is even higher if both parents are affected​​.

Environmental Triggers

Various environmental factors can trigger psoriasis flare-ups in individuals who are genetically predisposed. These triggers can include:

• Skin injuries, such as cuts, scrapes, or sunburns , known as the Koebner phenomenon.
• Infections, particularly streptococcal infections, which are closely linked with guttate psoriasis.
• Stress, which can exacerbate or trigger psoriasis in some people.
• Certain medications, including beta-blockers, lithium, and antimalarial drugs, have been implicated in triggering psoriasis.
• Weather, especially cold and dry conditions, which can lead to dry, cracked skin that may trigger a psoriasis flare-up​​​​.

4. Diagnosis

Diagnosing psoriasis typically involves a physical examination of the skin, nails, and scalp by a healthcare provider or dermatologist. A detailed medical history is also considered to identify any family history of psoriasis, which can predispose an individual to the condition.

While the appearance of the skin usually suffices for diagnosis, a skin biopsy may be performed to rule out other skin disorders. This involves removing a small sample of skin tissue and examining it under a microscope​​​​.

In cases of joint pain, healthcare providers may conduct evaluations for psoriatic arthritis , a related condition that can cause joint damage and pain. This may involve imaging tests such as X-rays or MRIs to assess the extent of joint involvement.

5. Treatment and Management

The management of psoriasis involves a combination of lifestyle adjustments, topical treatments, and, in more severe cases, systemic medications. Treatment aims to reduce inflammation, slow down the rapid skin cell growth, and clear the plaques. Treatment plans are highly individualized, considering the type of psoriasis, its severity, and the patient's overall health and lifestyle.

Topical Treatments

Topical treatments are often the first line of defense for mild to moderate psoriasis. These include:

• Steroid creams to reduce inflammation and itching.
• Moisturizers for dry skin to help prevent cracking and peeling.
• Vitamin D analogues which slow skin cell growth.
• Coal tar, which can reduce scaling, itching, and inflammation.
• Topical retinoids that can help to control skin cell growth​​​​.

Phototherapy

For moderate to severe cases, or when topical treatments are not enough, phototherapy (light therapy) may be recommended. This involves exposing the skin to ultraviolet (UV) light under medical supervision, which can slow down the growth of skin cells​​​​.

Systemic Treatments

Systemic treatments may be necessary for more severe psoriasis or psoriatic arthritis. These are drugs that work throughout the entire body and include:

• Oral medications like methotrexate or cyclosporine, which suppress the immune system to reduce inflammation and skin cell turnover.
• Biologics, a newer class of drugs that target specific parts of the immune system. They are typically used when other treatments have failed and are administered via injection or intravenous infusion​​​​.

Lifestyle and Home Remedies

In addition to medical treatments, lifestyle adjustments can significantly impact the management of psoriasis. These include:

• Stress management, as stress can trigger flare-ups.
• Maintaining a healthy weight, as obesity can worsen psoriasis symptoms.
• Avoiding smoking and excessive alcohol consumption, as both can trigger psoriasis and reduce the effectiveness of treatments​​.

6. Complications and Associated Conditions

Managing psoriasis involves treating the skin symptoms and being vigilant about potential complications and associated conditions. Psoriasis, especially when severe, is linked to several other health issues, highlighting the importance of comprehensive care.

• Psoriatic Arthritis: Up to 30% of individuals with psoriasis may develop psoriatic arthritis, a type of arthritis that causes joint pain, stiffness, and swelling. Those with psoriasis must be aware of these symptoms and seek medical evaluation, as early treatment can prevent joint damage​​​​.
• Cardiovascular Disease: Research suggests a higher risk of cardiovascular problems, including heart disease and stroke, in people with psoriasis, particularly those with severe forms of the disease. The inflammation associated with psoriasis may contribute to these risks, underscoring the need for heart-healthy lifestyle choices and regular medical check-ups​​​​.
• Mental Health Issues: The impact of psoriasis extends beyond physical symptoms, with many individuals experiencing mental health challenges such as depression and anxiety. The visible nature of psoriasis can affect self-esteem and social interactions, making mental health support an essential component of comprehensive care​​​​.
• Other Autoimmune Diseases: Individuals with psoriasis may be at an increased risk for other autoimmune diseases, such as Crohn's and celiac diseases . The shared underlying immune system dysfunctions may contribute to this increased susceptibility​​.
• Metabolic Syndrome: Psoriasis is also associated with metabolic syndrome, a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. These conditions include high blood pressure, elevated blood sugar levels, abnormal cholesterol or triglyceride levels, and obesity​​​​.

Final Words

Managing psoriasis is a lifelong journey that requires a comprehensive approach encompassing medical treatments, lifestyle adjustments, and mental health support. Advances in understanding psoriasis and its associated conditions have led to more effective treatments and management strategies, significantly improving the quality of life for those affected.

Continued research and patient education are crucial in addressing the complexities of psoriasis, reducing stigma, and enhancing outcomes. Collaboration between patients and healthcare providers is key to developing personalized treatment plans that address both the physical and psychological aspects of living with psoriasis.

Frequently Asked Questions

Is psoriasis contagious.

Psoriasis is not contagious and cannot spread from person to person. It's an autoimmune condition that affects the skin and sometimes joints, but an infectious agent does not cause it​​​​.

Can Psoriasis be cured?

While no definitive cure for Psoriasis exists, many treatments can temporarily clear the symptoms. Treatment success varies by individual, and symptoms can be managed effectively with the right approach​​.

What triggers Psoriasis?

Triggers vary but often include stress, skin injury, certain medications, and infections. The condition is linked to the immune system and genetic factors, with environmental elements playing a significant role in flare-ups​​.

Can lifestyle changes improve Psoriasis?

Yes, lifestyle changes like stress management, maintaining a healthy weight, and avoiding smoking and excessive alcohol can impact Psoriasis positively. Each person may find different triggers, so identifying and avoiding personal triggers is helpful​​​​.

Is it necessary to treat Psoriasis even if I have learned to live with it?

Treating Psoriasis is important as leaving it untreated could increase the lesions and potentially affect the joints and nails. Medical intervention is recommended to manage the condition effectively.​

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🌍✨ Welcome to a US-Canada Acne Dialogue Where we Unpack the Art of Acne Treatment Customization and Master Practical Clinical Pearls.🎙️🍁🇺🇸 🌉🔬Skin and Joints Podcast Faculty Dermatologist duo, Dr.Linda Stein Gold and Dr. Mimi Tran, converge to unravel a MasterClass on the latest in acne management, distilled straight from the AAD with a focus on defining the role and place of a new topical hormonal anti-androgen agent and why all isotretinoin options are not the same 🌞 🎯Learning Objectives: Advances in Acne Care Innovation: Gain practical insights into the newly released AAD acne guidelines, how they should be used for the patient in front of you, straight from one of the Faculty members that helped create it! Dr.Stein Gold deep dives into the critical balance between guideline recommendations and the nuanced needs of individual patients, highlighting the importance of cost considerations, treatment efficacy, and the patient-practitioner partnership in dermatology. Dive into the world of new acne therapies, including the groundbreaking topical androgen receptor blocker and its role in reducing sebum production. A leap forward in topical acne treatment! 🆕💡 Beyond the Surface: Learn about the significance of vehicle design in topical medications — a crucial factor for efficacy, tolerability, and patient satisfaction. It's not just what's inside that counts, but how it's delivered. 🚚💊 The Isotretinoin Evolution: Explore the latest advancements in isotretinoin formulations that promise enhanced absorption without the need for fatty meals, paving the way for more effective and flexible treatment options. 🍽️➡️💧 Empowering Patients: Embrace the power of visual progress tracking with baseline and follow-up photographs, fostering patient engagement and adherence. A picture is worth a thousand words, especially in acne treatment! 📸📈 🌟 Stay tuned #HealthcareCrossroads #AcneInnovation #USCanadaConnection 🎧💬 EPISODE Supported by SUN Pharma ABOUT Dr.Linda F Stein Gold, MD, FAAD Dermatologist, Detroit, MI Linda Stein Gold, MD, is Director of Dermatology Clinical Research at Henry Ford Health System in Detroit, Michigan, as well as Division Head of Dermatology at Henry Ford Health System in West Bloomfield, Michigan. Dr. Stein Gold earned her undergraduate degree at the Wharton School of the University of Pennsylvania and her medical degree from the University Of Pennsylvania School Of Medicine in Philadelphia and completed her residency in dermatology at Henry Ford Hospital in Detroit. Dr. Stein Gold is very active in clinical research on a variety of dermatologic conditions, including the treatment of chronic plaque-type psoriasis, actinic keratosis, atopic dermatitis, acne vulgaris, seborrheic dermatitis, and rosacea. She has published articles in journals such as the Journal of the American Academy of Dermatology, Cutis, the Journal of Drugs in Dermatology among others. She is a frequent national and international lecturer on acne, rosacea, psoriasis, actinic keratosis, alopecia, viral infections, atopic dermatitis, and fungal infections, at grand rounds and medical society meetings. She is also the treasurer of the National Acne and Rosacea Society and a member of the National Psoriasis Foundation Medical Board. ABOUT Dr. Mimi Tran MD, FRCPC Dermatologist, Winnipeg, MB Dr Mimi Tran is a dual board-certified Dermatologist in Canada and the USA. After graduating from medical school at the University of Calgary, she pursued a rigorous Dermatology residency at the University of British Columbia. She has trained in centres across Canada. With her extensive experience from practicing in Vancouver, Dr Tran decided to bring her exceptional skills and expertise back to her hometown of Winnipeg. Dr. Tran practices in both Medical and Cosmetic Dermatology. She has a particular interest in Skin Cancer, Acne,

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• v.22(3); 2021 Sep

Experimental research in topical psoriasis therapy (Review)

Diana ana-maria nițescu.

1 Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania

Alina Mușetescu

2 Department of Dermatovenereology, ‘Dr. Victor Babes’ Clinical Hospital for Infectious and Tropical Diseases, 030303 Bucharest, Romania

3 Department of Dermatovenereology, Faculty of Medicine, ‘Titu Maiorescu’ University, 040051 Bucharest, Romania

Maria Nițescu

4 Department of Hygiene and Medical Ecology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania

Monica Costescu

5 Department of Dermatovenereology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania

Oana-Andreia Coman

Associated data.

Not applicable.

Psoriasis, one of the most prevalent inflammatory diseases in dermatologic pathology, remains a challenge in regards to the therapeutic approach. Topical therapy for psoriasis is a current trending subject as it implies good compliance for the patient, few adverse systemic reactions and a targeted effect. Numerous substances are now being tested, from natural to synthetic compounds and already known substances in improved formulas such as vesicular systems. The aim of this article was to conduct a literature review regarding the topical therapy of psoriasis in animal models, between June, 27, 2019 and July 9, 2020. For this article, the authors conducted extensive research in PubMed with the following keywords: Psoriasis AND (topical OR local) and (therapy OR treatment) AND (mice OR rats). The main new studied substances included lycopene, sodium butyrate, salvianolic acid B, small interfering RNAs (siRNAs) in ionic liquids, albendazole, phosphodiesterase inhibitors, biomimetic reconstituted high-density lipoprotein nanocarrier gel containing microRNA (miRNA)-210 antisense, thymoquinone in ethosomal vesicle, Sea buckthorn oil ( Hippophae rhamnoides ), nitidine chloride, Melissa officinalis spp. Altissima extract and [1-(4-chloro-3-nitrobenzenesulfonyl)-1H-indol-3-yl]-methanol (CIM). New formulas of already known anti-psoriasis substances such as: Cyclosporine, methotrexate, calcipotriol, tazarotene, protein kinase p38 and integrin α5β1 as a target, are also reviewed. Recent research in topical psoriasis underlines the importance of animal experimental research in dermatology, providing a starting point for developing new therapeutic approaches in one of the most frequently diagnosed chronic dermatologic diseases. Vesicular systems are now providing the best vehicle for topical therapy, thus easing the action of the active substances at their target sites.

1. Introduction

Psoriasis represents a chronic, incurable, immune-mediated disease, being a combination between polygenic predisposition and external triggers (trauma, microorganism, drugs) or internal triggers (stress) ( 1 ). Psoriasis is one of the most prevalent dermatological diseases and a continuous challenge in regards to therapeutic approach.

The key in initiating the characteristic lesions of psoriasis is dendritic cell stimulation by Toll-like receptors (TLRs) with interferon (IFNα and IFNβ) production, followed by regional ganglia migration and tumor necrosis factor (TNF α, interleukin (IL)-23 and IL-12 production. The latter (IL-23 and IL-12) stimulate LTh17 and LTh1 subtype differentiation. In the steady phase, adaptative immune system is activated with Th-17 cytokine secretion (IL-17, IL-21, IL-22) and dermal proliferation. Therefore, the TNFα/IL-23/Th-17 axis is characteristic for psoriasis vulgaris and psoriatic arthritis ( 2 ). Intracellular activated kinases through this way include: Extracellular signal-regulated kinase (ERK), p38 MAPK (mitogen-activated protein kinases), transforming growth factor (TGF)-β-activated kinase 1 (TAK1), IκB kinase (IKK), and glycogen synthase kinase 3β (GSK-3β). These kinases enable nuclear factor (NF)-κB, AP-1, and C/EBP transcription of pro-inflammatory cytokines, chemokines, and antimicrobial peptides ( 3-6 ).

Currently, along with evolving systemic therapy, biological treatment has revolutionized severe psoriasis management. Topical treatment is especially recommended for localized and moderate forms of psoriasis and aims to decrease the severity of hyperkeratosis (preparations with tar, dioxyanthranol, salicylic acid) and decrease keratinocyte proliferation (topical retinoids, vitamin D3 analogues). Dermatocorticoids are first-line active agents in the topical treatment of psoriasis with important local side effects such as atrophy, hypopigmentation, and superinfections.

The experimental models used to evaluate psoriasis changes in laboratory animals are mainly the imiquimod (IMQ) mouse model, the mouse tail model, and the carrageenan and TPA (12- O -tetradecanoylphorbol-13-acetate) inflammation induction models.

The present trend is to discover either new effective or already approved substances conditioned in superior formulas in regards to absorption and efficacy and new mechanisms with anti-psoriasis potential.

2. Research methods

The aim of this article was to conduct a literature review regarding research on the topical therapy of psoriasis in animal models, between June, 27, 2019 and July 9, 2020.

For this article, the authors conducted extensive research in PubMed with the following keywords: Psoriasis AND (topical OR local) AND (therapy OR treatment) with publication dates January 1, 1995 to July 15, 2020 for search 1 and also psoriasis AND (topical OR local) AND (therapy OR treatment) AND (mice OR rats) for search 2.

The first search was made in order to assess the scientific interest in the topic. The second search had the following steps: Introduction of words and limits in PubMed with first step exclusion criteria for articles that did not refer to a potential substance for topical therapy, formulas from traditional medicine that did not specify the active ingredient ( 7-17 ). The second step exclusion criterion was if the substance of interest was not administered topically. The search was performed by two authors in the PubMed database and the results were mediated.

The data extracted from each article referred to newly tested substance or known substance with a new pharmaceutical form (dosage, pharmaceutical form, concentration), the experimental model used and the mechanism of action involved.

3. Summary and discussion of the new topical treatment strategies

Interest in topical psoriasis therapy has increased over time. Regarding the number of articles between 1951 and 2020, the first keywords were used (see search 1).

The total number of articles was 6,052 (4,572 between 1995 and 2020) until July 9, 2020. In the last 25 years, the interest has increased with a peak in 2018 and a slight decrease over the last 2 years ( Fig. 1 ). The trendline is at an average of 5 years. In the last year (June 27, 2019 to July 9, 2020), 41 articles were found and 23 were deemed articles of interest ( Fig. 2 ) and are summarized as follows in Tables I and ​ andII II .

Interest in topical anti-psoriasis therapy over the last 25 years.

Criteria of inclusion/exclusion used in regards to the literature studies.

New substances and improved formulas in topical psoriasis treatment.

New tested substances in experimental model research.

IMQ, imiquimod; PASI, Psoriasis Area Severity Index; H&E, hematoxylin and eosin; GO, graphene oxide; TPA, 12-O-tetradecanoylphorbol-13-acetate; Tregs, T regulatory cells; Sal. B, salvianolic acid B; O, oil phase; S, surfactant phase; W, water phase; DXM, dexamethasone; CAGE, choline-geranic acid ionic liquid; BDOA, benzyl dimethyl octyl ammonium; FTIR, Fourier Transform Infrared Spectroscopy; ELISA, enzyme-linked immunosorbent assay; {"type":"entrez-nucleotide","attrs":{"text":"DC591017","term_id":"179677392"}} DC591017 , ((1S)-6,7-dimethoxy-1-[2-(6-methyl-1H-indol-3-yl)ethyl]-3,4-dihydroisoquinoline-2(1H)-carbaldehyde); EPS, exopolysaccharides; CPT, calcipotriol; TQ, timoquinone; Ok, Orthokeratosis; EV, ethosomal vesicle; SBKT, sea buckthorn oil; T.A., topical application; INDO, indomethacin; TEWL, transepidermal water loss; MTX, methotrexate.

In a study by Shih et al lycopene, a terpenoid carotenoid, was administered orally at a dose of 0.06 and 0.12 mg/kg/day and topically at a dose of 0.06 and 0.12 mg/ml of ointment in the imiquimod (IMQ) model. The results revealed a dose-dependent decrease in the Psoriasis Area Severity Index (PASI), epidermal hyperplasia and cell adhesion on HaCaT cultures stimulated by TNFα, demonstrating the anti-psoriasis effect ( 18 ) ( Table II ).

In a study by Li et al graphene oxide in hydrogel was used as a nano-carrier in order to increase the permeability and retention of cyclosporine in tissue. Efficacy evaluation was performed ex vivo on goatskin and modified Franz cells (diffusion area 1 cm 2 ) and in vivo on rabbits for evaluation of irritant effect and on a TPA model in mice. The results demonstrated an increase in the permeability and tissue retention of cyclosporine while avoiding the effects of systemic administration ( 19 ) ( Table II ).

Mometasone furoate, a widely used corticosteroid in dermatological pathology with a certain anti-psoriasis effect, has recently been conditioned as an apasomal gel used topically against psoriasis. In a study by Shinde et al compared to the available cream that has a 5-h release, the release of the new formula took place over 24 h ( 20 ) ( Table II ).

Short-chain fatty acids in the colon induce regulatory T cell (Treg) generation. Schwarz and colleagues studied the effect of topically applied sodium butyrate using the IMQ model. The results revealed a IL-17 decrease and IL-10 and Foxp3 increased transcription. The data thus demonstrated that a Treg imbalance occurs in psoriasis that can be ameliorated by sodium butyrate ( 21 ) ( Table II ).

In a study by Guo et al salvianolic acid B with anti-inflammatory, antioxidant and antitumoral properties was investigated using the IMQ model for psoriasis. Salvianolic acid B in microemulsion was shown to reduce acanthosis, epidermal proliferation, inhibit cytokine IL-23/IL-17 axis and increase skin hydration, having anti-psoriasis potential ( 22 ) ( Table II ).

Small interfering RNAs (siRNAs) can be used to suppress gene-specific alleles for various diseases such as psoriasis, lupus, hyperhidrosis, and neoplasms. For this purpose, the topical administration in the form of ionic liquids capable of forming non-covalent bonds with siRNA and achieving adequate absorption was attempted in a study by Dharamdasani et al Hydrophobic cations were used to bind RNA and ionic liquid of choline-geranic acid to increase permeability. The experiments were performed in vitro on pig skin and in vivo on SKH-1E mice ( 23 ) ( Table II ).

Phosphodiesterase, an intracellular enzyme that hydrolyzes cGMP, is involved in multiple physiological processes. {"type":"entrez-nucleotide","attrs":{"text":"DC591017","term_id":"179677392"}} DC591017 , a PDE4 (phosphodiesterase 4) inhibitor, was studied by Li et al in vivo and in vitro for its anti-psoriasis effect, and was found to decrease the inflammatory infiltrate and epidermal thickness. The IMQ and carrageenan models were used for this purpose ( 24 ) ( Table II ).

In a study by Di Fusco et al albendazole, an anthelmintic drug, was investigated in topical administrations using the experimental model of imiquimod in mice, with decreased keratinocyte proliferation, reduced keratin (K)6/K16 expression, reversibly inhibiting cell cycle by S-phase cell accumulation. Using this model, albendazole was shown to inhibit the protein kinase receptor (PKR), increase eukaryotic initiation factor 2 (eIF2α) phosphorylation and reduce CDC25A expression thus demonstrating an anti-psoriasis effect ( 25 ) ( Table II ).

Calcipotriol (CPT), a first-line topical drug in psoriasis vulgaris, was tested as an improved formula in regards to transdermal administration, avoiding adverse skin reactions due to loss of hydration in the epidermis. Bacillus amyloliquefaciens (named ZWJ strain) was identified as a producer of high- emulsification exopolysaccharides (EPS). The effect of the formula was tested by animal experiments, providing a scientific basis for future usage ( 26 ) ( Table II ).

In a study by Lee et al CO 2 fractional laser was used to increase the permeability of the substance in the psoriatic plaque. A 64% decrease in IL-6 expression in the psoriatic plaque was demonstrated with topical application of IL-6 siRNA using the imiquimod psoriasis induction model. The conventional route of siRNA delivery for dermatological treatment is injection, with adverse reactions such as pain and difficult administration ( 27 ) ( Table II ).

After Feng et al ( 28 ) demonstrated in a previous study the involvement of microRNAs (miRNAs/miRs) in the pathogenesis of psoriasis, an anti-psoriasis effect was obtained after topical administration of antisense miRNA-210 in a reconstituted high-density lipoprotein nano-transporter gel. The formula decreased the level of miRNA-210 with reduction of erythema, scales, acanthosis, dermal infiltrate and of IL-17A, using the IMQ model ( 28 ) ( Table II ).

Thymoquinone, a liposoluble benzoquinone is the major substance in the volatile oil of Nigella sativa and has an anti-psoriasis effect. However, being practically insoluble in water and photosensitive, topical application in conventional formulas does not provide benefits. Thus, research using thymoquinone-loaded ethosomal vesicles in hydrogels was tested using the tail model for psoriasis. The study showed promising results in terms of anti-psoriasis effect of thymoquinone ( 29 ) ( Table II ).

Sea buckthorn oil extracted from Hippophae rhamnoides , which contains 16 types of monounsaturated and polyunsaturated fatty acids, was tested for its anti-psoriasis effect in vitro using human THP-1 cells, in vivo in systemic and topical administration in the model of paw edema in mice with carrageenan and on a CD-1 model of psoriasis in mice with TPA. The results of these studies were the reduction of reactive nitrogen species and NF-κΒ expression, depending on the concentration of the substance under investigation, along with pro-inflammatory cytokines IL-1β, IL-6, inflammation and epidermal thickness reduction ( 30 ) ( Table II ).

Nitidine is a natural alkaloid extracted from Zanthoxylum nitidum (Roxb), with anti-proliferative properties using the ERK signaling pathway with antitumor potential in colorectal cancer ( 31 ) and a potent inhibitor of HaCaT keratinocyte proliferation in vitro , with decreased DNA synthesis, decrease in Ki67, cyclin A and D1 levels and with p53 protein increase. On experimental models with imiquimod/TPA topical application, epidermal thickness, edema and pro-inflammatory cytokine levels were decreased ( 32 ) ( Table II ).

Indole-3-carbinol (I3C) is a natural compound with anti-neoplastic effect. [1-(4-Chloro-3-nitrobenzenesulfonyl)-1H-indol-3-yl]-methanol is a new I3C derivative. Upon topical application in the IMQ model, the latter compound decreased hyperplasia and inflammation, with suppression of cytokines specific to the MAPK, NF-κB and AP-1 pathways ( 33 ) ( Table II ).

In a study by Chandra et al the combination of methotrexate with salicylic acid in ethosomal gel with a particle size of 376.04±3.47 nm was tested in the IMQ model and then compared to methotrexate solution. The results showed a 43% retention study for the gel compared to 13% for the solution, with decreased PASI and normalization of psoriatic plaques ( 34 ) ( Table II ).

In a study by Dimitris et al Melissa officinalis spp. Altissima extract (lemon balm) was tested using the IMQ model. Chemical analysis was performed to detect active metabolites. From the dichloromethane extract, seven triterpenes were isolated, i.e. ursolic acid, 2α-hydroxy-ursolic acid, pomolic acid, 3β-stearyloxy-urs-12-ene, oleanolic acid, noropacursane and campesterol. The methanol extract yielded two phenolic acids (rosmarinic acid and methyl rosmarinate), which seem to be the major compounds of the total methanol extract. In addition, from the decoction, three phenolic acids were isolated: Caffeic acid, 3-(3,4-dihydroxyphenyl) lactic acid and rosmarinic acid. Extracts with dichloromethane and methanol and decoction were used. Triterpene derivatives of the dichloromethane extract were shown to be responsible for the anti-psoriasis effect. The polyphenols in the decoction were responsible for the strong antioxidant effect, with the strongest anti-psoriasis effect ( 35 ) ( Table II ).

Topical methotrexate embedded in deformable liposomes with phosphatidylcholine and oleic acid in concentrations of 0.05 and 0.1% demonstrated significant anti-psoriasis effect in the model of psoriasis with IMQ ( 36 ), without significant toxicity as in systemically administrated methotrexate ( 37-39 ). Methotrexate has low skin permeability due to high molecular weight and hydrophobicity, thus the liposomal form is optimal for increasing bioavailability ( Table II ).

The involvement of p38 protein kinase in the pathogenesis of psoriasis was investigated using the IMQ model. Anisomycin, a murine p38 activator with psoriasis-producing effect and BIRB796, a p38 inhibitor with anti-psoriasis effect, were used ( 40 ) ( Table II ).

Tazarotene is a synthetic topical retinoid used in the treatment of psoriasis but with a lipophilic structure causing irritating side effects. Recent in vitro and ex vivo research conducted by Elmowafy et al ( 41 ) regarding nanovesicles enriched with 1% cineole recorded a significant loading of tazarotene with a total of 81.51% in all epidermal layers. Statistically significant results were obtained in terms of PASI score, dermoscopic appearance, anti-psoriasis effect compared to the commercial reference product used ( 41 ).

MnTE-2-PyP (BMX-010) (manganese porphyrin) in topical applications is a new anti-psoriatic agent with anti-pruritic effect in nonspecific idiopathic prurigo and atopic dermatitis. Phase I study in 64 patients did not show any significant adverse reactions. The only toxic adverse reaction to maximum concentration in mice was reversible hypertension ( 42 ).

Celastrole, a triterpenoid extracted from Tripterygium , was developed in a new therapeutic formula, respectively in 147-nm niosomes. Results revealed erythema and scaly relief in the IMQ psoriasis model, with decreased IL-22, IL-23 and IL-17 levels, with an in vivo demonstrated increase in skin absorption ( 43 ) ( Table II ).

Integrin α5β1, as a fibronectin receptor, is expressed in excess in the non-lesional epidermis of psoriasis. In order to investigate whether this integrin is a potential target in psoriasis treatment, an antagonist ligand peptide called C16, was used. Using the IMQ model, Ho et al showed that topically administered C16 reduced epidermal hyperplasia, neutrophilic infiltrate and expression of pro-inflammatory mediators. Thus, α5β1 integrin is a potential target for anti-psoriasis therapy ( 44 ) ( Table II ).

4. Discussion

After studying the scientific literature from the last current year regarding the topical therapy of psoriasis, it was observed that the subject is of great interest, with multiple experimental research studies of new therapies or mechanisms of action of already known substances included in superior formulas, with increased skin absorption and penetrability.

Imiquimod (IMQ) can aggravate and even trigger psoriasis both at the site of application and remotely. The application of imiquimod to laboratory mice causes IL-23/IL-17 axis-dependent changes, with influx of immune cells and cytokines such as IL-1α, IFN-α, IL-23 and IL-6. On the other hand, the application of IMQ causes, possibly through a cAMP-dependent mechanism, epidermal hyperplasia, thus resulting in phenotypic and histological changes of psoriasis (45, 46). This model was initially reported in 2009 and has been used most frequently in anti-psoriasis therapy research ever since. It consists of the topical application of IMQ to the ear and back of the laboratory mouse on day 0 of the experiment demonstrating the characteristic changes of psoriasis: Erythema, scale, and altered keratinocyte differentiation. The best results have been obtained by using B6/C57BL mice ( 47 ).

The current trend regarding the therapy of psoriasis is to use vehicles such as vesicular systems (liposomes and ethosomes). Liposomes are artificial spherical vesicles composed of cholesterol and natural phospholipids. They are hydrophobic and hydrophilic, biocompatible, non-immunogenic and increase the therapeutic index and efficacy of the active substance. The properties of liposomes differ depending on composition, size (from 0.025 to 2.5 µm) and preparation methods ( 48 ).

Liposomes are used with promising results for intracellular release systems: Antisense molecules, ribosomes, proteins, and DNA ( 48 ). Ethosomes are phospholipid elastic nanovesicles with a high ethanol content (20-45%). Ethanol increases permeability and by interacting with the lipid polar end decreases the melting point of lipids in the stratum corneum, thus increasing cellular fluidity and permeability. Ethosomal systems are much more efficient in delivering the substance in terms of quantity and depth than liposomes and hydroalcoholic solutions ( 49 ). Niosomes are vesicles with non-ionic surfactant, lamellar structures formed by the combination of alkyl-polyglycerol surfactant with cholesterol. The concentration of cholesterol in liposomes is higher than that in niosomes so that the binding efficiency of the active substance is lower in the case of liposomes, which are less stable but also more expensive ( 50 ).

There were additional articles that did not meet the chosen criteria but were significant in regards to novel methods in psoriasis therapy.

Stress as an aggravating factor of psoriasis was analyzed using the imiquimod model in laboratory mice using a bottle emptying as a stressor stimulation. Thus, it was shown that stress worsened and prolonged imiquimod-induced psoriasis dermatitis, with increased levels of neurotransmitters such as substance P and IL-1β and IL-23p40 upregulation ( 51 ).

Estrogen receptors have been studied in relation to the development of psoriatic dermatitis in the IMQ model in laboratory mice. In one study, from day 2 of IMQ application, estrogenic agonists were administered orally: Either ERα selective agonist [propylpyrazoletriol (PPT) 2.5 mg/kg] or ERβ selective agonist [diarylpropionitrile (DPN) 2.5 mg/kg]. Administration of PPT induced pruritic behavior and proinflammatory response, increasing the levels of IL-17 and IL-22, while DPN did not influence these aspects in any way. In addition, PPT also increased IL-23 levels by stimulating dendritic cells. This research concluded that the stimulation of α and not β estrogen receptors is associated with pruritic and proinflammatory behavior in the IMQ model ( 52 ).

The IMQ psoriasis induction model was used to study the mechanism of TNF-α induction by FGF-7, using a specific anti-FGF-7 antibody called F-9 which decreased inflammation and PASI. It has thus been shown that a potential therapeutic target in anti-psoriasis therapy is the FGF-7 pathway ( 53 ). Recent research by Borek et al ( 54 ) showed that TGF-β-dependent factors in psoriasis plaque act mainly through the bone morphogenic protein (BMP) cascade with the influence of Langerhans cell subtype, promoting the classic changes in psoriasis. In vivo experimental models with Junf/fJunBf/fK5cre-ERT mice were used for this purpose. Thus, it can be concluded that by using the BMP pathway as a therapeutic target, the mechanism of psoriasis production can be suppressed ( 54 ).

Microglial healing peptide-1 (MHP1-AcN) inhibits Toll-like receptor (TLR)-related inflammation by RANK/RANK-L signaling in microglia and macrophages without activating osteoclasts. Inhibition of TLR is a feasible treatment strategy for psoriasis. Using the IMQ model, the effect of this substance was studied. The results were more than promising. In addition to a reduction in erythema and scales, there were significant decreases in IL-6, IL-23, and IL-17A ( 55 ).

Kaempferol, a natural flavonoid, was found to attenuate inflammation in the imiquimod model, decreasing the proinflammatory cytokines IL-6, IL-17-A, TNF-α, inhibiting the NF-κB pathway, suppressing T lymphocytes in vitro and demonstrating anti-psoriasis potential ( 56 ).

5. Conclusions

Recent studies in topical psoriasis underline the importance of animal experimental research in dermatology, providing a starting point for developing new therapeutic approach in one of the most frequently diagnosed chronic diseases. Two trends can be found from the review. One trend is represented by the discovery of new topical active substances with potential anti-psoriasis effect: Lycopene, sodium butyrate, salvianolic acid B, albendazole, phosphodiesterase 4 inhibitors, thymoquinone, and nitidine chloride. Another trend is represented by the research of new mechanisms of action for some active substances, already used in the topical therapy of psoriasis but in superior topical formulations in order to increase their topical biodisponibility. Vesicular systems are now providing the best vehicle for topical therapy, thus easing the action of the active substances at the target site.

Acknowledgements

Funding statement.

Funding: No funding was received.

Availability of data and materials

Authors' contributions.

DAMN analyzed the data from the literature regarding substances and their mechanism of action. MN analyzed the results. AM designed the final aspect of the manuscript. MC analyzed the clinical implications of the new formulas researched. OAC analyzed all of the data and wrote the conclusions. All the authors critically revised the manuscript and read and approved its final version.

Ethics approval and consent to participate

Patient consent for publication, competing interests.

The authors declare that they have no competing interests.