Efficacy and safety of epidural block with lidocaine for refractory severe plaque psoriasis: An open‐label pilot study in real world setting

Abstract

Epidural block using lidocaine, a non‐selective blocker of voltage‐gated sodium channels (Nav), has demonstrated efficacy in the treatment of severe plaque psoriasis in a limited number of cases. This study aimed to evaluate the effectiveness and safety of epidural lidocaine block in adult patients with severe, treatment‐resistant plaque psoriasis. This was an open‐label pilot study. Patients with severe plaque‐type psoriasis unresponsive to at least one systemic treatment were enrolled for a 1‐week epidural lidocaine block and followed up for 48 weeks. Thirty‐six patients participated, with 32 completing the study. At the 12‐week mark, there was a remarkable 59% improvement in the mean Psoriasis Area Severity Index (PASI) score (P < 0.001). By week 48, 28 out of 32 patients (87%) achieved PASI 75, while 18 out of 32 (56%) reached PASI 90. Within 7 days, 20 out of 21 patients (95%) reported a reduction in itch, with a mean itch reduction of 82% at day 1 and 94% at day 7. Notably, no severe side effects were observed. Epidural lidocaine block proved to be an effective and safe long‐term treatment option for individuals with refractory severe plaque psoriasis.