Is Metformin a Possible Beneficial Treatment for Psoriasis? A Scoping Review

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.

The Effect of Metformin and Biological Therapy on Insulin Resistance in Iraqi Psoriatic Patients

“…In addition, a reduction in PASI score is achieved after 12 weeks of follow-up. Psoriasis refers to a long-term inflammation disorder associated with hyper proliferation and inflammation of the keratinocyte (15)(16)(17)(18). Such a multisystem chronic disease is usually associated with comorbidities such as obesity, diabetes, metabolic syndrome and arthritis.…”

“…10,15 Also, oxidative stress is majorly involved in disease development. 16,[19][20][21] Metformin is used as a first-line antidiabetic medication in the treatment of diabetes mellitus (DM). It does not produce hypoglycemia; instead, it lowers serum glucose level by inhibiting hepatic glucose synthesis and improving peripheral tissue sensitivity to insulin.…”

Killing Two Birds with One Stone: Potential Therapies Targeting Psoriasis and Atherosclerosis at the Same Time

“…Regarding psoriasis, metformin showed improvement in PASI and some metabolic parameters [ 91 , 94 ]. Furthermore, in patients with diabetes, it could reduce the risk of developing psoriasis [ 94 ].…”

“…Regarding psoriasis, metformin showed improvement in PASI and some metabolic parameters [ 91 , 94 ]. Furthermore, in patients with diabetes, it could reduce the risk of developing psoriasis [ 94 ]. In a randomized controlled trial, an improvement in psoriasis was observed in metformin-treated patients compared to placebo [ 95 ].…”

“…However, current evidence suggests that metformin is safe for use in psoriasis. Furthermore, with respect to its beneficial anti-inflammatory and other pleiotropic effects, it could prove especially useful as an additional treatment in patients with psoriasis with metabolic comorbidities, such as obesity, metabolic syndrome, and insulin resistance or diabetes [ 94 ].…”