Classical to Current Approach for Treatment of Psoriasis: A Review

Abstract

Psoriasis is a genetic predisposition with T-cell mediated autoimmune inflammatory skin disorder, characterized by cutaneous inflammation, increased epidermal proliferation, hyperkeratosis, angiogenesis, and abnormal keratinization that affects up to 2 - 3% of the population worldwide. Common therapies that are used for the treatment of psoriasis include topical, systemic, phototherapy, combination, herbal therapy and novel molecules. Topically used agents include Vit D, calcipotriol, corticosteroids, dithranol and retinoids etc. Systemically used agents include methotrexate and cyclosporine etc. Phototherapy includes UV-B, Psoralen plus ultraviolet therapy and excimer laser etc. These therapies have a number of potential problems, such as limited in efficacy, inconvenience, organ toxicity, carcinogenic and broadband immunosuppression. In natural treatment a variety of natural agents such as methanolic extracts of duzhong (Eucommia ulmoides Oliv.), yerba mate (Ilex paraguariensis,) linseed oil, fish oil, and Indigo naturalis etc., that modulates T cell and cytokine action at various steps along with the pathogenic sequence have been developed. But till now there is no more in vivo, dose and its efficacy data has been established. Current therapy includes biologicals, small molecules inhibitor and enzyme inhibitors etc, which serve as novel therapeutic options for psoriasis treatment. All these avoid the side effects of the prebiologically developed systemic agents including hepatotoxicity, nephrotoxicity, and bone marrow suppression. Currently, Denilukin diftitox, Efalizumab, Alefacept, Ustekinumab and Etanercept are approved by the FDA, and others molecules are at clinical stage. Patents issued by the US office are also included in current psoriasis treatment scenario. In the United States, biologicals are widely used for moderate-to-severe psoriasis. But because of the high cost of medication and their availability in injection form, it remains to be seen how widely these agents will be utilized worldwide. Still, developing countries prefer conventional drugs.

Enhancement of physicochemical properties of nanocolloidal carrier loaded with cyclosporine for topical treatment of psoriasis: in vitro diffusion and in vivo hydrating action

“…1 As for psoriatic skin, the mitotic activity of basal keratinocytes is 50-fold compared to normal skin activity. Therefore, keratinocytes of psoriatic skin have only 3-5 days to be removed from the basal layer to the cornified layer (28-30 days for normal skin).…”

“…Nanoemulsion systems containing the oil phase carrying lipophilic molecules that act as polar lipids would help in maintaining the barrier integrity of the stratum corneum and thus make penetration through the skin barrier easier. 21 Even though cyclosporine is a highly hydrophobic molecule, its large molecular weight (1,202.64 Da) would restrict entrance through the skin barrier. Therefore, a nanoemulsion could overcome this restriction with extremely small vehicles.…”

Calcipotriol Inhibits Proliferation of Human Keratinocytes by Downregulating Stat1 and Stat3 Signaling

“…Psoriasis affects ∼0.1–3% of the population worldwide 2. Common treatments for psoriasis include topical, systemic, phototherapy, combination, and herbal therapy treatments that inhibit excessive keratinocyte proliferation 3. Despite the fact multiple psoriasis therapies are available, no cure has been developed to date, and the relapsing–remitting nature of psoriasis adversely effects patient quality of life 4 5…”

MicroRNA‑520a suppresses the proliferation and mitosis of HaCaT cells by inactivating protein kinase B

“…Characteristics of the disease include altered differentiation of keratinocytes and hyperplasia of the skin (1). Common treatments for psoriasis include herbal therapy and systemic, topical, combination and phototherapy treatments, which inhibit excessive keratinocyte proliferation (3). Although there are a variety of therapies available to treat psoriasis, no cure has been developed and the relapsing-remitting nature of psoriasis continues to adversely affect patient quality of life (4,5).…”