Abstract In the 19th century when arsenic was the recommended treatment for psoriasis, little consideration was given to the toxic side-effects of the potent carcinogen. Thomas Girdlestone, an English physician, is said to have been the first to advocate for the use of arsenic to treat psoriasis. Girdlestone prescribed Fowler’s solution, a solution of potassium arsenite 1%. In 1876, Alexander John Balmanno Squire inadvertently discovered dithranol, a known treatment for ringworm, to be efficacious in treating psoriasis. However, it was Eugen Galewsky, in 1916, who then went on to synthesize anthralin, a synthetic form of dithranol, to target psoriasis. A key historical figure was William H. Geockerman, an American dermatologist, who developed Goekerman therapy—a regimen that combined the use of coal tar and ultraviolet (UV) light to treat moderate-to-severe plaque psoriasis. In 1953, John Ingram, an English dermatologist, discovered that the beneficial effects of dithranol paste could be enhanced by adding it to coal tar and UV light—later coined the ‘Ingram regimen’. Philip Showalter Hench, Edward Calvin Kendall and Tadeus Reichstein received the Nobel Prize in Medicine and Physiology for the development of cortisone; it proved to be useful in topically treating many skin diseases, but it had a limited effect on psoriasis. The production of synthetic corticosteroids soon followed, which, conversely, proved to be successful in treating psoriasis. However, the daunting side-effects of corticosteroids limited their long-term use. In 1951, a patient with rheumatoid arthritis showed dramatic improvement in their psoriasis when treated with aminopterin, as recorded by Richard Gubner, a New York cardiologist. PUVA was developed in the 1970s—a photochemotherapy for psoriasis that combined psoralen with UVA radiation to clear skin lesions. Interestingly, in 1500 Bc, the ancient Egyptians were known to use a combination of psoralen and sunlight to treat vitiligo. Furthermore, in the 1980s, researchers noted complete clearance of psoriasis in a patient with osteoporosis who was prescribed an oral form of vitamin D. This chance observation then led to the development of topical vitamin D analogues for the treatment of psoriasis that work by encouraging normal skin growth and slowing down overproduction of skin cells. Finally, in 2003, the first biologic treatments were approved for psoriasis by the US Food and Drug Administration—a significantly safer and more efficacious alternative to the controversial arsenic treatments that were used over 200 years ago.
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