Abstract
Psoriasis is a chronic inflammatory condition with genetic, immunological, and metabolic etiology. The link between psoriasis and diabetes mellitus has been shown in genetic predisposition, environmental influences, inflammatory pathways, and insulin resistance, resulting in end-organ damage in both conditions. Because comorbidities often accompany psoriasis, the therapeutic management of the disease must also take into consideration the comorbidities. Given that metformin’s therapeutic role in psoriasis is not yet fully elucidated, we raised the question of whether metformin is a viable alternative for the treatment of psoriasis. We conducted this scoping review by searching for evidence in PubMed, Cochrane, and Scopus databases, and we used an extension for scoping reviews (PRISMA-ScR). Current evidence suggests that metformin is safe to use in psoriasis. Studies have shown an excellent therapeutic response to metformin in patients with psoriasis and comorbidities such as diabetes, metabolic syndrome, and obesity. There is no clear evidence supporting metformin monotherapy in patients with psoriasis without comorbidities. There is a need to further evaluate metformin in larger clinical trials, as a therapy in psoriasis.
Highlights
Diabetes mellitus is a chronic disease affecting over 22 million people worldwide and has metabolic, inflammatory, and pathological genetic mechanisms [1,2]
The good results obtained with metformin as the first-line treatment of type 2 diabetes have led to its successful use in many other conditions, such as cancer, nonalcoholic fatty liver disease, chronic kidney disease, metabolic syndrome, obesity, coronary artery disease, polycystic ovary syndrome, and acne
One randomized placebo-controlled study published in 2016 was the first to measure psoriasis progression in patients with metabolic syndrome; this study showed that metformin causes a significant improvement in Psoriasis Area Severity Index (PASI) score compared to placebo, and a complete improvement in metabolic syndrome
Summary
Diabetes mellitus is a chronic disease affecting over 22 million people worldwide and has metabolic, inflammatory, and pathological genetic mechanisms [1,2]. The good results obtained with metformin as the first-line treatment of type 2 diabetes have led to its successful use in many other conditions, such as cancer (breast, endometrial, colorectal, prostate, various other tumors), nonalcoholic fatty liver disease, chronic kidney disease, metabolic syndrome, obesity, coronary artery disease, polycystic ovary syndrome, and acne. It has anti-aging effects and improves the efficiency of in vitro fertilization; some studies have demonstrated the benefits of metformin in patients with psoriasis [5,6,7,8,9,10,11,12,13,14,15]. These may vary by country, by associated comorbidities, and by severity of disease
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