Management Of Psoriasis Research Articles

Management of moderate to severe psoriasis with brodalumab-Real-world evidence from the LIBERO study.

Brodalumab, a fully human monoclonal immunoglobulin IgG2 antibody that binds the human interleukin 17 receptor subunit A, is available for the treatment of moderate-to-severe plaque psoriasis in Europe since September 2017, but so far there are only a few studies on its use in real-world conditions. To assess the management of moderate-to-severe psoriasis with brodalumab 210 mg in daily practice after 12 and 52 weeks (W). In addition, patient profiles and treatment pathways are described. LIBERO is a prospective, multicenter, non-interventional study including adult patients with plaque psoriasis treated with brodalumab 210 mg. In total, 638 patients (65% male, mean age: 49.3 ± 14.4 years) from 148 sites in Germany were enrolled. The majority suffered from severe (51.1%) or very severe (13.1%) psoriasis according to physician global assessment (PGA0-5). When starting with brodalumab, 58.5% were biologic naïve and 41.5% were previously treated with another biologic, mainly adalimumab (18.5%) and secukinumab (17.9%). About 74.0% of patients met the primary endpoint of an absolute PASI ≤3 at ~W12 (n = 618, LOCF). The mean PASI was reduced significantly as of ~W2 from 17.2 (±11.7) to 9.7 (±8.8) and improved further to 3.3 (±6.3) at ~W12 (p < 0.001). At ~W52 85.5% of patients reached a PGA0/1-response (primary endpoint) and 54.1% patients were assessed as completely clear (PGA0) (both n = 399, as observed). Effectiveness of brodalumab was confirmed in relevant subgroup analysis by previous treatment regimen. Most frequently reported adverse events were nasopharyngitis (4.6%), psoriasis (4.6%) and arthralgia (4.1%), new safety signals were not detected. This representative, non-interventional study confirms the short- and long-term effectiveness and safety profile of brodalumab in the management of psoriasis in daily practice as well as in relevant treatment pathways.

The Role of Interleukin 23/17 Axis in Psoriasis Management: A Comprehensive Review of Clinical Trials.

Psoriasis pathogenesis is influenced by genetic factors and characterized by a complex interplay between genetic predisposition and various environmental triggers. These triggers set off metabolic processes involving inflammation, cell signaling, immune response dysregulation, and antigen presentation. Several types of innate and adaptive immune cells are involved in psoriasis. Among the cytokine cascade which leads to psoriasis development, the interleukin (IL)-23/Th17 axis, especially IL-17 production, emerges as crucial. Recognizing the pivotal role of this axis has facilitated the development of selective and effective biological drugs, such as anti-IL17 and anti-IL23 monoclonal antibodies. These drugs aim to achieve the complete or near-complete disappearance of psoriatic lesions, as indicated by PASI100 and PASI90 responses, respectively. In this context, the aim of our review was to delve into the functioning of the IL-23/Th17 axis, its dysregulation in psoriasis pathogenesis, and the therapeutic potential of its inhibition. Currently, 4 anti-IL17 (secukinumab, ixekizumab, bimekizumab and brodalumab) and 3 anti-IL23 (guselkumab, risankizumab and tildrakizumab) have been approved. All these drugs showed high levels of effectiveness in both clinical trials and real-life experiences, with an excellent profile in terms of safety. Certainly, furthers studies will allow for better characterization of biologics' profile, in order to administer the right drug for the right patients at the right moment.

Management of Plaque Psoriasis through Agadatantra Principles – A Case Report

Psoriasis is a chronic, relapsing dermatological disorder characterized by the presence of pink to erythematous plaques with overlying silver hyperkeratotic plaques, distributed on the scalp, postauricular skin, elbows, gluteal cleft etc. Plaque psoriasis is one among the common variety of psoriasis. Though it is manageable with difficulty, its relapsing nature remains a threat to the present management strategies. On the contrary in Ayurveda, a thorough analysis of condition, purification, rasayana and samana medicines proves to be effective in such conditions. A single case report of 42 year old male consulted in the Vaidyaratnam Ayurveda College OPD with presenting complaints as dry itchy and scaly silvery white lesions on chest, lower back, scalp and beard upon reddish patches with duration of two years. He was allergic to dantappala (Wrightia tinctoria) also. On examination the case was having positive candle grease and Auspitz sign with PASI score as 20.8 and DLQI as 21. The case was doignosed as ekakushta associated with severe pitta dushti and poor satva bala. The Doosheevisha chikitsa along with snehapana, svedana, vamana, virechana, takradhara, Shashtika annalepa and rasayana was done with proper medicines. The condition of the patient improved considerably by reducing the symptoms like erythema, dryness, itching, scaling and pain. The PASI score reduced to 2.3 and DLQI reduced to almost zero at the time of discharge. The further follow up has not reported any recurrence of the disease since two years.The proper understanding of the pathology through dasa vidha pareeksha and tracing out the vishaja nidanas can lead to a proper treatment plan. This will give successful management of similar conditions along with the enhancement of immunity to prevent or reduce the recurrence of the disease through principles of Agadatantra.

Adalimumab in the management of psoriasis and psoriatic arthritis: Results from a Delphi investigation.

Psoriasis (PsO) and psoriatic arthritis (PsA) are often undertreated and require a multidisciplinary approach. In recent years, patent expiration has allowed the introduction of tumor necrosis factor inhibitor (anti-TNF) biosimilars, which have stimulated a significant increase in the use of biological therapies. This article reports the findings of a multidisciplinary approach to achieve a consensus on the use of adalimumab in patients with PsO or PsA. A voting panel of 36 Italian dermatologists and rheumatologists were chosen by eight Italian clinicians (the Board), to provide a consensus on the real-world management of PsO and PsA with adalimumab using the Delphi Method, comprising three survey rounds. Twelve statements were defined by the Board and submitted to the panel (rating scale 1-7). Clinicians reached a wide consensus on the effectiveness (score 6-7: 67%) and long-term efficacy (6-7: 100%) of adalimumab in all clinical forms of PsO and PsA, including pediatric patients (6-7: 85%). Considering cost-effectiveness and safety, adalimumab is suggested as a first-line treatment in patients with enthesitis, predominant peripheral arthritis, axial involvement or associated inflammatory bowel disease (IBD) or uveitis. Adalimumab can be also considered after failure of etanercept (6-7: 94%). Results from this Delphi study clearly show an overall consensus on the use of adalimumab in the management of PsO and PsA, particularly as first-choice for specific subpopulations (uveitis, IBD, hidradenitis suppurativa). Considering the cost-effectiveness of biosimilars within Italy, adalimumab may represent an effective and safe first-line treatment for patients with moderate-to-severe PsO or PsA, and a valid choice for switching after failure.

Development and Characterization of Transdermal Patches Using Novel Thymoquinone-L-Arginine-Based Polyamide Nanocapsules for Potential Use in the Management of Psoriasis

Thymoquinone (TQ) is a phytochemical compound present in Nigella sativa and has potential benefits for treating dermatological conditions such as psoriasis. However, its clinical use is limited due to its restricted bioavailability, caused mainly by its low solubility and permeability. To overcome this, a new transdermal drug delivery system is required. Nanoparticles are known to enhance material solubility and permeability, and hence, this study aimed to synthesize TQ-loaded L-arginine-based polyamide (TQ/Arg PA) nanocapsules incorporated into transdermal patches for prolonged delivery of TQ. To achieve this, Eudragit E polymer, plasticizers, and aloe vera as penetration enhancer were used to develop the transdermal patch. Furthermore, novel TQ/Arg-PA was synthesized via interfacial polymerization, and the resultant nanocapsules (NCs) were incorporated into the matrix transdermal patch. The Arg-PA NCs’ structure was confirmed via NMR and FTIR, and optimal TQ/Arg-PA NCs containing formulation showed high entrapment efficiency of TQ (99.60%). Molecular and thermal profiling of TQ/Arg-PA and the transdermal patch revealed the effective development of spherical NCs with an average particle size of 129.23 ± 18.22 nm. Using Franz diffusion cells and synthetic membrane (STRAT M®), the in vitro permeation profile of the prepared patches demonstrated an extended release of TQ over 24 h, with enhanced permeation by 42.64% when aloe vera was employed. In conclusion, the produced formulation has a potential substitute for corticosteroids and other drugs commonly used to treat psoriasis due to its effectiveness, safety, and lack of the side effects typically associated with other drugs.Graphical

Evaluating the Efficacy and Safety of Bimekizumab for Plaque Psoriasis and Psoriatic Arthritis: An Expert Consensus Panel Report

Background: While there are numerous effective therapies for psoriasis, there remains an unmet need as some patients still suffer from inadequate response with available medications. Bimekizumab is a first-in-class monoclonal antibody that inhibits both interleukin (IL)-17A and IL-17F and was recently approved by the Food and Drug Administration. The aim of this study was for a panel of experts in psoriasis management to review the available data on bimekizumab and create consensus statements on its use in clinical practice.&#x0D; Methods: A comprehensive literature search of PubMed, Scopus, and Google Scholar was conducted for English-language original research articles, systematic reviews, and meta-analyses discussing the safety and efficacy of bimekizumab for moderate to severe plaque psoriasis and psoriatic arthritis. A panel of nine dermatology physician assistants and one dermatology nurse practitioner with significant expertise in the management of psoriasis convened virtually on December 16, 2023, to review the studies and create recommendations for their peers on the use of bimekizumab. A modified Delphi process was implemented to reach a consensus on these statements and the Strength of Recommendation Taxonomy was used to assign each one a strength of recommendation.&#x0D; Results: The literature search resulted in 92 articles that met search criteria. After a thorough screening of these studies for relevance to the discussion questions, 20 articles remained and were distributed to each panelist prior to the meeting. The panel unanimously voted to adopt 10 consensus recommendations and assigned all 10 statements a strength of recommendation of “A.”&#x0D; Conclusion: Bimekizumab has a very high efficacy in the treatment of moderate to severe psoriasis and psoriatic arthritis. It also has a favorable safety profile that is consistent with that of other biologics, except for an increased risk of oral candidiasis.

Therapeutic landscape of natural products and emulgel in psoriasis

Psoriasis, characterized by immune-mediated inflammation triggered by dysfunctions in the immune system, manifests in various skin areas with elevated plaques presenting as common symptoms. Traditional psoriasis treatments often incorporate plant-based remedies, which, although safer, are predominantly hydrophobic, limiting their permeation and absorption into the skin. To address these challenges, researchers have turned to emulgels as drug delivery systems. Emulgels, combining the properties of both emulsions and gels, effectively solubilize hydrophobic drug molecules, enhancing their absorption through the skin. Emulgels shows several advantages including easy application and removal, emollient properties, non-greasiness, cosmetic appeal, and excellent penetration capabilities.This review emphasizes the significance of herbal drugs in psoriasis therapeutics and explores the utilization of emulgels as a delivery system for herbal extracts and constituents in psoriasis treatment. By highlighting the potential of emulgels in enhancing the delivery of herbal remedies for psoriasis management, this review offers insights into novel approaches to address the challenges associated with traditional psoriasis treatments.

Development of Betulin-Loaded Nanostructured Lipid Carriers for the Management of Imiquimod-Induced Psoriasis.

Psoriasis is a complex and persistent autoimmune skin disease. The present research focused on the therapeutic evaluation of betulin-loaded nanostructured lipid carriers (BE-NLCs) towards managing psoriasis. The BE-NLCs were synthesized using the emulsification cum solidification method, exhibiting a spherical shape with a particle size of 183.5±1.82nm and a narrow size distribution window (PDI: 0.142±0.05). A high zeta potential -38.64±0.05mV signifies the relative stability of the nano-dispersion system. BE-NLCs show a drug loading and entrapment efficiency of 47.35±3.25% and 87.8±7.86%, respectively. In vitro release study, BE NLCs show a cumulative percentage release of 90.667±5.507% over BE-sol (57.334±5.03%) and BD-oint (42±4.58%) for 720min. In an ex vivo 24-h permeation study, % cumulative amount permeated per cm2 was found to be 55.667±3.33% from BE-NLCs and 32.012±3.26% from BE-sol, demonstrating a better permeability of 21.66% when compared to the standard formulation BD-oint. The in vivo anti-psoriatic activity in the IMQ-induced model shows topical application of BE-sol, BE-NLCs, and BD-oint resulted in recovery rates of 56%, 82%, and 65%, respectively, based on PASI (Psoriasis Area and Severity Index) score. Notably, BE-NLCs demonstrated a more significant reduction in spleen mass, indicating attenuation of the local innate immune system in psoriatic mice. Reductions in TNF-α, IL-6, and IL-17 levels were observed in both BE-sol and BE-NLCs groups compared to the disease control (DC) group, with BE-NLCs exhibiting superior outcomes (74.05%, 44.76%, and 49.26% reduction, respectively). Soy lecithin and squalene-based NLCs could be better carrier system for the improvement of the therapeutic potential of BE towards management of psoriasis.

Burden of Topical Treatments in Psoriasis and Preferred Criteria of Choice: A Survey-Based Evaluation of Patients in Europe.

Topical treatments (TT) are widely used in psoriasis management. While psoriasis itself has been associated with diminished quality of life and mental well-being, the impact of TT remains underexplored. This study aimed to evaluate the burden of TT on the daily lives of patients with psoriasis, the convenience of the TT, and the choice criteria. Patients were recruited across five countries (France, Germany, Italy, Spain, UK) by Wefight and the International Federation of Psoriasis Associations (IFPA) to complete a 29-item online survey. A total of 766 patients completed the survey (54% female, mean age of 53years). The mean body surface area covered by psoriasis was 7%, predominantly on the scalp and elbows. Participants had been living with psoriasis for a mean duration of 18years. Of the respondents, 34% reported feeling affected by their TT in their daily routines and activities. Those feeling affected were more likely to have a more complex disease, be using more treatments, or be diagnosed more recently compared to those less affected. Among those most affected by their TT, 27% reported a strong impact on mental health, 30% on sexual life, and 25% on physical activities, compared to 7%, 6% and 4% in those least affected, respectively. Both cohorts considered tolerability factors such as "does not cause itching/burning" and "good tolerability" as most important when choosing a topical. However, only least affected participants regarded convenience factors such as "does not run off," "ease of application," "does not leave stains" among others equally as important. Overall, one-third of patients report a significant burden of TT on their daily lives. These patients have different criteria of choice, highlighting the importance of communication between physicians and patients to tailor treatment to individual preferences, thereby enhancing adherence and treatment outcomes.

Multiple environmental antigens may trigger autoimmunity in psoriasis through T-cell receptor polyspecificity.

Psoriasis is a T-cell mediated autoimmune skin disease. HLA-C*06:02 is the main psoriasis-specific risk gene. Using a Vα3S1/Vβ13S1 T-cell receptor (TCR) from a lesional psoriatic CD8+ T-cell clone we had discovered that, as an underlying pathomechanism, HLA-C*06:02 mediates an autoimmune response against melanocytes in psoriasis, and we had identified an epitope from ADAMTS-like protein 5 (ADAMTSL5) as a melanocyte autoantigen. The conditions activating the psoriatic autoimmune response in genetically predisposed individuals throughout life remain incompletely understood. Here, we aimed to identify environmental antigens that might trigger autoimmunity in psoriasis because of TCR polyspecificity. We screened databases with the peptide recognition motif of the Vα3S1/Vβ13S1 TCR for environmental proteins containing peptides activating this TCR. We investigated the immunogenicity of these peptides for psoriasis patients and healthy controls by lymphocyte stimulation experiments and peptide-loaded HLA-C*06:02 tetramers. We identified peptides from wheat, Saccharomyces cerevisiae, microbiota, tobacco, and pathogens that activated both the Vα3S1/Vβ13S1 TCR and CD8+ T cells from psoriasis patients. Using fluorescent HLA-C*06:02 tetramers loaded with ADAMTSL5 or wheat peptides, we find that the same CD8+ T cells may recognize both autoantigen and environmental antigens. A wheat-free diet could alleviate psoriasis in several patients. Our results show that due to TCR polyspecificity, several environmental antigens corresponding to previously suspected psoriasis risk conditions converge in the reactivity of a pathogenic psoriatic TCR and might thus be able to stimulate the psoriatic autoimmune response against melanocytes. Avoiding the corresponding environmental risk factors could contribute to the management of psoriasis.

Topical co-delivery of tacrolimus and calcipotriol loaded nanostructured lipid carrier: a potential and synergistic approach in the management of psoriasis

The focus of this study was to develop a Vitamin-D3 (Calcipotriol)-based Tacrolimus (TAC)-loaded nanostructured lipid carrier (NLC) for topical application to treat psoriasis. The sonication technique followed by melt emulsification was used to formulate TAC-NLC, in which Precirol ATO-5, Calcipotriol, and Solutol HS-15 were used as excipients. Based on the analysis of particle size, PDI, and entrapment efficiency of various TAC-NLCs using Box-Behnken Design, an optimized NLC was selected. The selected nanocarrier was further transformed into the gel and then characterized for in vitro release, in vitro and ex vivo permeation, and dermatokinetic, including in vitro characterization studies. The optimized TAC-NLC had a particle size of 231 ± 1.52 nm with a narrow PDI of 0.40 ± 0.001 along with high entrapment efficiency (84.04 ± 1.36%) and drug loading (12.61 ± 0.20%)”. The in vitro release showed sustained release throughout 12 h. Moreover, dissimilarity (f1:52) and the similarity factor (f2:37) showed a lack of any similarity in the evaluation of drug release from TAC-NLC formulation and Conventional formulation. The time requisite to release 50% (T50), 30% (T30), and 20% (T20) of the drug is also calculated. The flux and permeability coefficients were found to be 11.59 µg/cm2/h and 0.0386 cm/h. A dermatokinetic study of TAC-NLC indicated a remarkable rise in AUC0-12h and CSkin max compared to conventional formulation (p < 0.005). Further, the vitro studies indicated higher cell viability (85%-80%) on melanoma cells than aqueous suspension of the drug (60–70%). The study indicated that the topical application of TAC-NLC nanogel was found potentially useful for the management of psoriasis.

Efficacy and safety of tildrakizumab in elderly patients: real-world multicenter study (ESTER – study)

Purpose of the article: Interleukin-23 inhibitors, such as tildrakizumab, have emerged as safe and effective options for the management of psoriasis. Yet their efficacy in elderly patients (aged 65 years or more), particularly in those with difficult-to-treat areas involvement, remains insufficiently explored. We conducted this real-life retrospective multicentric observational study to assess the effectiveness of tildrakizumab in elderly patients with moderate-to-severe psoriasis, with involvement of difficult-to-treat areas.Materials and methods: We enrolled forty-nine patients aged 65 years old or more (mean age 73.1 ± 6.0), all treated with tildrakizumab for at least 28 weeks. The effectiveness of tildrakizumab was assessed by Static Physician’s Global Assessment of Genitalia (sPGA-G), fingernail-PGA (f-PGA), palmoplantar PGA (pp-PGA), scalp-specific PGA (sc-PGA), and Psoriasis Area and Severity Index (PASI) scores.Results: Significant improvements in PASI scores were observed within 28 weeks of treatment, with 77.5%, 60%, and 45.2% of patients achieving PASI75, PASI90, and PASI100, respectively. The mean PASI decreased significantly from baseline (13.6 ± 9.9) to 1.3 ± 1.7 at week 28. More than 90% of patients had clear sPGA-G and pp-PGA scores and over 70% had clear f-PGA and sc-PGA scores after 28 weeks.Conclusions: Our findings suggest that tildrakizumab could be a valuable option for the treatment of elderly patients, including those with difficult-to-treat areas involvement.

Analysis of Clinical and Genetic Factors of Obesity and Psoriasis Concomitance-The Influence of Body Mass Composition, Prevalence of Mood Disorders, Environmental Factors and FTO Gene Polymorphisms (rs9939609, rs1558902).

The study enrolled 30 overweight or obese adult patients with chronic plaque psoriasis and 30 overweight or obese volunteers (northern Poland region, Caucasian population). Mood disorders, body mass composition by using bioelectrical impedance analysis (BIA) and FTO gene polymorphisms (rs9939609, rs1558902) by tetra-primer amplification refractory mutation system PCR (T-ARMS-PCR) were assessed. Results revealed significantly higher visceral adipose tissue levels in psoriatic patients (5.23 ± 2.29 [L] vs. 3.41 ± 1.86 [L]), p = 0.001), especially among men, along with elevated rates of moderate and severe depression (26.67% vs. 6.67% and 13.33% vs. 3.33%, p = 0.048 respectively). Additionally, FTO gene polymorphisms correlated with waist-hip ratio differences in both groups. The study highlights the importance of evaluating body composition beyond body mass index, recognizing its influence on psoriasis and associated conditions like depression. The FTO gene may serve as a potential genetic link between psoriasis and obesity, warranting further research for validation. Adiposity emerges as a key and modifiable risk factor, underscoring the clinical implications of body composition complexities in psoriasis management.

Stem cell secretome-mediated alleviation of scalp psoriasis: A case report

Scalp psoriasis, a skin condition characterized by red, thickened (erythematous), well-demarcated patches or plaques with overlying silvery-white scales, affecting part or all of the scalp, is an autoimmune disease accompanied by itchy skin. The disease is associated with faulty functioning of adaptive and innate components of immune systems. The key proinflammatory cytokines mediating immunopathology of psoriasis are IL-17 and IL-23 which promote proliferation of Th 17 cells which in turn induce proliferation of keratinocytes leading to the disease. Standard management of psoriasis primarily targets the disease by suppression of inflammation using steroid based drugs. However, these are not enough to cure the disease. In recent years researchers have demonstrated the use of mesenchymal stem cells (MSCs) in treating autoimmune disorders and skin disorders. MSCs mediate skin regeneration by a plethora of mechanisms including immune modulation, angiogenesis, proliferation of mediator cells like fibroblasts, and by inhibition of proinflammatory pathways. The paracrine factors secreted by MSCs in surrounding environment like growth factors, cytokines, chemokines, and other signaling and regulatory molecules, act as key molecules in mediating anti-inflammatory responses. Here we describe a case report following the treatment of a patient suffering from scalp psoriasis using MSC- secreted molecules in the conditioned media. Both silvery scales and plaques on the scalp were significantly reduced within 4 weeks of topical application of the conditioned media. The patient remained disease free for 3 years of follow up. Our current results are in good agreement with those of our previous report where we reported complete amelioration of scalp psoriasis following the topical application of the conditioned media.

Review of Integrative Medical Therapies for Psoriasis: The Microbiome, Probiotics, Diet, and Mindfulness

Background Psoriasis is a chronic inflammatory condition with cutaneous and systemic involvement. Although many efficacious treatment options are available, concerns regarding costs and duration of treatment have expanded interest in the role of integrative medical therapies for psoriasis. Objective In this review, we aim to provide evidence for the use of integrative medical approaches in the management of psoriasis, namely approaches utilizing the microbiome, probiotics, diet, and mindfulness. Methods PubMed/Medline and Google Scholar databases were searched from inception up to 16 August 2023 to identify clinical studies that evaluated how integrative medical therapies affect psoriasis severity. Search terms combined “psoriasis” or “psoriatic arthritis” with terms related to the microbiome, diet, and lifestyle. Results Multiple clinical studies have shown that integrative approaches can reduce psoriasis severity. Probiotic supplementation in psoriatic patients decreased PASI scores, decreased inflammatory markers, increased quality of life, and reduced the risk of disease relapse. Intermittent fasting, in the context of Ramadan, decreased PASI scores and plasma CRP levels. Low-calorie diets and low-calorie ketogenic diets have been shown to reduce psoriasis severity. Notably, combining low-calorie diets with biologics and cyclosporine synergistically improved psoriasis to a greater extent than pharmaceutical therapy alone. A gluten-free diet improved psoriasis and reduced antigliadin antibodies in those with hypersensitivity. Mindfulness therapies also improved psoriasis severity with and without phototherapy. Conclusion Several studies show that integrative medicine can be used to manage psoriasis. Specifically, probiotic supplementation, diets that promote weight loss or modulate antigliadin antibodies, and mindfulness therapies may improve disease severity.

Effects of topical Ivermectin on imiquimod-induced Psoriasis in mouse model – Novel findings

Aim: investigate the possible anti-psoriatic effect of ivermectin in mice based on observational and histopathological outcomes and biomarkers. Methods: Sixty male Swiss Albino Mice were divided into six groups (Groups I–VI); each group contained ten mice with shaved dorsal skin. The clinical, pathological, and laboratory effects were measured. Results: Topical Ivermectin significantly decreased vascular endothelial growth factor levels. At the same time, the combination of ivermectin plus Clobetasol showed a more significant reduction in tumor necrosis factor-alpha (TNF-α) and Interleukin-17 (IL-17) levels. Regarding the Interleukin-10 (IL-10) level, the Ivermectin and Ivermectin/Clobetasol combination groups showed a significant increase in IL-10. Conclusion: Topical Ivermectin’s anti-psoriasis activity increases IL-10 levels and could be used efficiently to alleviate psoriatic symptoms. Its combination treatment with Clobetasol holds promise for the management of psoriasis.

A CLINICAL STUDY TO EVALUATE THE EFFECT OF VIRECHANA WITH TRIPHALADI CHOORNA IN THE MANAGEMENT OF PSORIASIS

Virechana is among the Pancha Shodhana and Panchakarma, as explained by Acharyas in the classics. Virechana is the procedure in which the orally administered Dravyas act on internally vitiated Doshas, specifically Pitta, and expels them through Gudamarga. Psoriasis is a chronic, recurrent, inflammatory disease of the skin of unknown origin, characterised by well-circumscribed erythematous, dry plaques of various sizes covered with scales. The Prevalence of Psoriasis varies across countries, ranging from 0.09-11.43%. Globally, it is estimated that at least 100 million individuals are affected by Psoriasis. In India, the reported incidence varies from 0.44- 2.8% among skin disorders, with an overall incidence of 1.02%. In Ayurveda, various skin diseases are classified under the broad category of Kushta. Features of Psoriasis resemble multiple types of Kushta. Hence, this clinical study of Virechana with Triphaladi Choorna was taken to assess its efficacy in this disease. The assessment used parameters like PASI Score, Auspitz sign, and Candle grease sign. Objectives: To evaluate the effect of Virechana with Triphaladi Choorna in the management of Psoriasis. Methods: This is an open-label clinical study with pre-test and post-test design wherein 20 patients diagnosed with Psoriasis and fulfilling the selection criteria in the age group of 18 – 70 years of either gender were selected from the OPD/IPD. Results: The study showed a statistically significant result in decrement in PASI Score with a change from before treatment to after follow-up. Interpretation and Conclusion: Hence, Virechana Karma with Triphaladi Choorna was found to be effective in reducing signs and symptoms of Psoriasis

Pioglitazone attenuate level of myeloperoxidases and nitic oxide in psoriatic lesion: a proof-of-concept study in a imiquimod induced psoriasis model in rat.

Psoriasis is a persistent autoimmune inflammatory condition that is primarily affecting the skin. Pioglitazone (PGZ), a peroxisome proliferator activated receptor gamma (PPARγ) agonist, has been reported to have anti-inflammatory effects. However, the role of PGZ in psoriatic disease remains unclear. In this study, we aimed to repurpose the use of the PGZ for the treatment of psoriasis. To investigate its efficacy, we employed an imiquimod (IMQ)-induced rat model. Wistar rats are randomly allocated to four different groups. Group, I served as a negative control, Group II IMQ control, Group III was treated with pioglitazone hydrogel and Group IV received standard drug betamethasone cream. PASI score was monitored on every alternative day and on day 7 animals were sacrificed and histopathology of skin was performed. Level of nitric oxide (NO) and myeloperoxidase (MPO) was also performed using established methods. The results of the experiment revealed that treatment with PGZ significantly (p<0.05) reduced redness, scaling, and skin thickening, surpassing the effectiveness of standard drugs. Our result also indicates that PGZ significantly (p<0.05) inhibits the release of both MPO and NO from the psoriatic lesions. PGZ effectively reduces the severity of psoriasis possibly by inhibiting the accumulation of neutrophil at the psoriatic area which indirectly regulates the release of NO in the affected area. Our study showed we can repurpose the PGZ for the management of psoriasis.

Unlocking the Potential of Herbal Therapies in the Management of Psoriasis: Prospects and Challenges

Background:: Psoriasis is a severe chronic skin disease with no permanent cure, caused by inherited, immunologic, and environmental factors, like trauma, medications, infection, humidity, and stress. It can have a devastating impact on people's lives and is often associated with systemic conditions, like arthritis. The exact cause of psoriasis remains unclear, but it involves the activation of cytokines, chemokines, and growth factors, playing a major role in Th1/Th17 regulation. Methods:: The PubMed and Google Scholar search engines were used to conduct the literature review. The search terms included "psoriasis and classification," "therapeutic strategies and psoriasis," "herbal medicine and psoriasis," and "herbal nanocarrier and psoriasis." An attempt was made to compile relevant material with a focus on only herbal treatments for psoriasis management. Results:: An extensive literature search showed that herbal treatments that constitute plant-based therapies have been largely utilized to treat infections. Natural medicines have been gaining tremendous momentum in the recent decade due to minimal side effects. Approximately 75-80% of the global population in developing countries consume natural remedies. Conclusion:: Psoriasis remains a severe chronic skin disease without a permanent cure, influenced by inherited, immunologic, and environmental factors. Herbal treatments show promise in managing psoriasis with minimal side effects, offering hope for improved quality of life. This report has highlighted the potential of plant-based therapies and their role in treating psoriasis.

Ayurvedic management of Plaque Psoriasis - A Case Study

Psoriasis is a chronic inflammatory disease affecting mainly in skin and joint. In Ayurveda, under the umbrella of Kushtha all skin diseases are described. In management of Psoriasis Ayurvedic system of medicine is giving good results. The main line of treatment of skin diseases in Ayurveda is repeated Samshodhana (purificatory therapies) along with Samshamana (palliative therapies). Three assessments were done before and after treatment on scoring of Dermatology Life Quality Index (DLQI), Psoriasis Disability Index (PDI) and PASI score. Score of the patient was 83% before treatment and 16% after treatment and 10% after follow up on Dermatology Life Quality Index (DLQI), 86% before treatment and 65% after treatment and 41% after follow up on Psoriasis Disability Index (PDI) and 35.5% before treatment, 10.2% after treatment and 8% after follow up in PASI (Psoriasis Area and Severity Index). This case study wants to substantiate the effectiveness of Ayurvedic treatment in the management of Plaque psoriasis.