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Hernandez-Nicols BF, Robledo-Pulido JJ, Alvarado-Navarro A. Etiopathogenesis of Psoriasis: Integration of Proposed Theories. Immunol Invest 2024; 53:348-415. [PMID: 38240030 DOI: 10.1080/08820139.2024.2302823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Psoriasis is a chronic inflammatory disease characterized by squamous and erythematous plaques on the skin and the involvement of the immune system. Global prevalence for psoriasis has been reported around 1-3% with a higher incidence in adults and similar proportions between men and women. The risk factors associated with psoriasis are both extrinsic and intrinsic, out of which a polygenic predisposition is a highlight out of the latter. Psoriasis etiology is not yet fully described, but several hypothesis have been proposed: 1) the autoimmunity hypothesis is based on the over-expression of antimicrobial peptides such as LL-37, the proteins ADAMTSL5, K17, and hsp27, or lipids synthesized by the PLA2G4D enzyme, all of which may serve as autoantigens to promote the differentiation of autoreactive lymphocytes T and unleash a chronic inflammatory response; 2) dysbiosis of skin microbiota hypothesis in psoriasis has gained relevance due to the observations of a loss of diversity and the participation of pathogenic bacteria such as Streptococcus spp. or Staphylococcus spp. the fungi Malassezia spp. or Candida spp. and the virus HPV, HCV, or HIV in psoriatic plaques; 3) the oxidative stress hypothesis, the most recent one, describes that the cell injury and the release of proinflammatory mediators and antimicrobial peptides that leads to activate of the Th1/Th17 axis observed in psoriasis is caused by a higher release of reactive oxygen species and the imbalance between oxidant and antioxidant mechanisms. This review aims to describe the mechanisms involved in the three hypotheses on the etiopathogeneses of psoriasis.
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Affiliation(s)
- Brenda Fernanda Hernandez-Nicols
- Centro de Investigación en Inmunología y Dermatología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Juan José Robledo-Pulido
- Centro de Investigación en Inmunología y Dermatología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Anabell Alvarado-Navarro
- Centro de Investigación en Inmunología y Dermatología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
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Ganguly R, Kumar S, Soumya M, Khare A, Bhainsa KC, Aswal VK, Kohlbrecher J. Structural and therapeutic properties of salicylic acid-solubilized Pluronic solutions and hydrogels. SOFT MATTER 2024; 20:2075-2087. [PMID: 38345756 DOI: 10.1039/d4sm00079j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Salicylic acid (SA) finds extensive applications in the treatment of rheumatic and skin diseases because of its analgesic, anti-inflammatory and exfoliating properties. As it is lipophilic in nature, there is a need for appropriate delivery systems to harness these properties for different applications. Herein, we examined the suitability of Pluronic P123/F127 micellar systems as delivery media by investigating the structural, flow and antimicrobial properties of P123/F127-SA solutions and hydrogels using DLS, SANS, rheological and zone inhibition measurement techniques. SA modulates the aggregation characteristics of these surfactant systems and brings about spherical-to-worm-like micelle-to-vesicular structural transitions in the hydrophobic Pluronic P123 system, a spherical-to-worm-like micellar transition in the mixed P123/F127 system and an onset of inter-micellar attraction in the hydrophilic Pluronic F127 system. SA-solubilized systems of both hydrophobic and hydrophilic Pluronics inhibit the growth of Gram-positive and Gram-negative bacteria with comparable MIC values. This suggests that the interaction of SA molecules with the bacterial cell membrane remains unobstructed upon encapsulation in Pluronic micelles. F127 hydrogel-based SA formulations with rheological properties suitable for topical applications and up to 15% SA loading were prepared. These will be useful SA ointments as F127 is an FDA-approved excipient for topical drug delivery applications. The results indicate that Pluronics remain effective as delivery agents for SA and exhibit interesting structural polymorphism upon its solubilization.
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Affiliation(s)
- R Ganguly
- Chemistry Division, Bhabha Atomic Research Centre, Mumbai-400085, India.
| | - S Kumar
- Solid State Physics Division, Bhabha Atomic Research Centre, Mumbai-400085, India
| | - M Soumya
- Nuclear Agriculture & Biotech Division, Bhabha Atomic Research Centre, Mumbai-400085, India
| | - A Khare
- Radiation Biology & Health Sciences Division, Bhabha Atomic Research Centre, Mumbai-400085, India
| | - K C Bhainsa
- Nuclear Agriculture & Biotech Division, Bhabha Atomic Research Centre, Mumbai-400085, India
| | - V K Aswal
- Solid State Physics Division, Bhabha Atomic Research Centre, Mumbai-400085, India
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Chandy RJ, Dao DPD, Rivis CC, Shan DM, Feldman SR. Noncorticosteroid Topical Therapies for the Treatment of Plaque Psoriasis: A Narrative Review. J Pharm Technol 2023; 39:247-255. [PMID: 37745732 PMCID: PMC10515967 DOI: 10.1177/87551225231193057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective: The objective was to compare the safety and efficacy of noncorticosteroid topical treatments for plaque psoriasis. Data Sources: A literature search of the PubMed database was performed (January 1978 to May 2023) using the keywords plaque psoriasis, tapinarof, benvitimod, Vtama, roflumilast, Zoryve, pimecrolimus, tacrolimus, tazarotene, tacalcitol, calcitriol, Vectical, calcipotriene, Dovonex, tacalcitol, vitamin D analogs, salicylic acid, non-corticosteroid topical, Investigator's Global Assessment, and Physician's Global Assessment. Study Selection and Data Extraction: Relevant English-language articles and clinical trial data were considered. Data Synthesis: Six noncorticosteroid topical classes for the treatment of plaque psoriasis were selected. The percentage of patients with plaque psoriasis who achieved Investigator's Global Assessment (IGA) success after 8 weeks of treatment with tacalcitol, calcipotriene/betamethasone dipropionate compound, tazarotene/halobetasol propionate, and roflumilast was 17.9%, 39.9%, 40.7%, and 42.4%, respectively. For 12-week trials of tapinarof and coal tar, 37.4% and 58.2% of patients achieved IGA success, respectively. There were 48% and 71.4% reductions in IGA scores with salicylic acid (12 weeks) and pimecrolimus (4 weeks), respectively. Finally, 66.7% of patients achieved Physician's Global Assessment success with 8 weeks of tacrolimus. There were no serious adverse events for the noncorticosteroid topicals. Conclusion: Noncorticosteroid topicals are suitable options for patients with plaque psoriasis who would like to avoid topical corticosteroids or have experienced adverse effects from chronic corticosteroid use. Due to treatment duration differences and varied outcome measures, it is unclear which noncorticosteroid topical is most efficacious; however, calcineurin inhibitors appear to exhibit the greatest efficacy. Each topical was efficacious in treating plaque psoriasis and had an adequate safety profile. Despite several treatment options for plaque psoriasis, medication adherence is a limiting factor.
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Affiliation(s)
- Rithi J. Chandy
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Diem-Phuong D. Dao
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cristian C. Rivis
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Divya M. Shan
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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4
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Ramic L, Sator P. Topical treatment of psoriasis vulgaris. J Dtsch Dermatol Ges 2023. [PMID: 37235479 DOI: 10.1111/ddg.15042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/05/2023] [Indexed: 05/28/2023]
Abstract
Topical therapy plays an important role in the treatment of psoriasis. It is the gold standard in mild psoriasis cases and is also recommended in addition to UV and systemic therapy in cases of moderate to severe psoriasis. In this overview article we summarize the current therapeutic options, taking into account special localizations (scalp, facial, intertriginous/genital, or palmoplantar lesions) and situations (hyperkeratotic or inflammatory forms), as well as the therapy options during pregnancy and breastfeeding. In the initial phase, the combination of topical corticosteroids and vitamin D analogues has proven to be the therapy of choice, as well as monotherapy in each case. In maintenance therapy, fixed combination therapy is recommended once or twice a week. In addition to the right choice of active substances, the choice of the right formulation also plays an important role. To increase adherence, it is very important to consider the personal preferences and experiences of the patient. If topical therapy does not lead to a satisfactory result, additional UV therapy or systemic therapy should be considered.
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Affiliation(s)
- Lejla Ramic
- Department of Dermatology, Hietzing Hospital, Vienna, Austria
| | - Paul Sator
- Department of Dermatology, Hietzing Hospital, Vienna, Austria
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Parab S, Doshi G. An update on emerging immunological targets and their inhibitors in the treatment of psoriasis. Int Immunopharmacol 2022; 113:109341. [DOI: 10.1016/j.intimp.2022.109341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
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Draelos ZD. The Efficacy and Tolerability of Turmeric and Salicylic Acid in Psoriasis Treatment. Psoriasis (Auckl) 2022; 12:63-71. [PMID: 35516971 PMCID: PMC9064175 DOI: 10.2147/ptt.s360448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients and Methods Results Conclusion
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Affiliation(s)
- Zoe Diana Draelos
- Dermatology Consulting Services, PLLC, High Point, NC, USA
- Correspondence: Zoe Diana Draelos, Dermatology Consulting Services, PLLC, 2444 North Main Street, High Point, NC, 27262, USA, Tel +1-336-841-2040, Fax +1 336-841-2044, Email
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Parveen S, Ahmed M, Baboota S, Ali J. An Innovative Approach In Nanotechnology-Based Delivery System For The Effective Management Of Psoriasis. Curr Pharm Des 2022; 28:1082-1102. [PMID: 35105284 DOI: 10.2174/1381612828666220201141915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Psoriasis is an ineradicable, non-contagious inflammatory autoimmune skin disorder exhibiting abnormal redness of the skin and flaky patches which affect the exposed body surface. It is caused by negative signals produced by the immune system, leading to excessive growth and differentiation of keratinocytes and other inflammatory reactions on the skin. The topical route is primarily preferred in treating skin disorders due to the smaller size of the drug molecule, which allows them to cross the outer layer of the skin, i.e., stratum corneum, and permeate into the deep layer, unlike transdermal and other routes. The conventional topical treatments used in the past, such as coal tar, and dithranol leads to meager patient compliance due to decreased potency, and imperfect aesthetic. In contrast, systemic therapy such as methotrexate, cyclosporine, and acitretin produce related side effects. At present, various novel carriers like liposomes, ethosomes, niosomes, nanostructured lipid carriers, etc., have shown promising results to treat psoriasis. Therefore, this review primarily concentrates on the current advancements in novel carriers for various drugs to treat psoriasis topically. Area covered: The objective of this review describes the detailed study such as pathophysiology, epidemiology, types, causes, diagnosis, and topical treatment options for psoriasis, as well as the role of the nanotechnology-based delivery system to manage psoriasis.
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Affiliation(s)
- Shaheen Parveen
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Musheer Ahmed
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Sanjula Baboota
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
| | - Javed Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062, India
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Ali F, Neha K, Sharma K, Khasimbi S, Chauhan G. Nanotechnology-based medicinal products and patents: a promising way to treat psoriasis. Curr Drug Deliv 2022; 19:587-599. [PMID: 35081890 DOI: 10.2174/1567201819666220126163943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
Psoriasis is an autoimmune skin disorder that is characterised by chronic inflammation and erythematous scaly patches. It has a significant impact on the patient's quality of life and can cause psychological stress. There are several aspects which cause psoriasis for instance, environmental issues, immune disorders, bacterial infections, and genetic issues. Plentiful therapeutic means or treatments are accessible, but not any of them can completely and effectively cure psoriasis without hindering patient compliance. Hence, it becomes challenging to discover a new drug moiety or any drug delivery method to cure psoriasis. Conventional treatment of psoriasis involves anti-inflammatory agents, immune suppressants, phototherapy, and biologic treatment, those were given in different forms such as topical, oral, or systemic formulations, but these all were unsuccessful to accomplish complete reduction of psoriasis as well as causing adverse side effects. In terms of dose frequency, doses, efficacy, and side effects, nanotechnology-based new formulations are the most promising prospects for addressing the challenges and limits associated with present psoriasis formulations. Hence, our major goal of this review is to present various advanced nanotechnological approaches for effective topical treatment of psoriasis. In short, nano-formulations continue to be formed as very promising modality in the treatment of psoriasis as they suggest improved penetration, targeted delivery, increased safety, and efficacy.
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Affiliation(s)
- Faraat Ali
- Department of Inspection and Enforcement, Laboratory Services, Botswana Medicines Regulatory Authority, Plot 112, International Finance Park, Gaborone, Botswana
| | - Kumari Neha
- Department of Pharmaceutical Chemistry, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), DPSR University, New Delhi, India
| | - Kamna Sharma
- Department of Pharmaceutical Chemistry, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), DPSR University, New Delhi, India
| | - Shaik Khasimbi
- Department of Pharmaceutical Chemistry, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), DPSR University, New Delhi, India
| | - Garima Chauhan
- Department of Pharmaceutical Chemistry, Delhi Institute of Pharmaceutical Sciences and Research (DIPSAR), DPSR University, New Delhi, India
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Timis TL, Florian IA, Vesa SC, Mitrea DR, Orasan RI. An updated guide in the management of psoriasis for every practitioner. Int J Clin Pract 2021; 75:e14290. [PMID: 33928703 DOI: 10.1111/ijcp.14290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/23/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Psoriasis is one of the most common chronic cutaneous skin disorders, having genetic and immunological components. It is currently unknown what exactly triggers it, or how far reaching are the etiological factors, although great strides have been made in uncovering the pathophysiological cascade. Presently, there is a wide diversity of treatment methods for psoriasis, yet not all are applicable for each patient. Selection of both drug and dosage depends on both the knowledge and experience of the treating dermatologist and also on the specific characteristics of each patient. Therefore, the treating physicians should be made aware of the management possibilities, their advantages and their side effects. METHODS We have performed a non-systematic literature review on the current treatment methods for psoriasis. We have included the studies, articles, and prescription information that provided the most relevant information regarding each therapeutic agent. Afterward, we divided the treatment methods according to delivery and illustrated the management protocols for adult, paediatric, and pregnant patients. DISCUSSION AND CONCLUSIONS Current therapies are divided into topical drugs, phototherapy, systemic and biological agents. Topical therapies and phototherapy are generally the first and second line of management respectively, being typically effective in treating mild to moderate forms of psoriasis. On the other hand, the chronic moderate to severe forms usually benefit from systemic drugs, whereas biologic agents are reserved for severe or unremitting cases, especially those suffering from psoriatic arthritis. Also of importance is the understanding of the pathophysiological mechanisms in psoriasis and how the selected drugs interfere in the pathological cascade. Furthermore, physicians should be able to recommend the appropriate therapy not only for adults but also for paediatric and pregnant patients as well. In the following manuscript, we present an updated version of these management options, alongside their indications, posology and most common side effects, a guide that may be useful for every practitioner in this field.
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Affiliation(s)
- Teodora-Larisa Timis
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan-Alexandru Florian
- Department of Neurosciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stefan-Cristian Vesa
- Department of Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Rodica Mitrea
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Remus-Ioan Orasan
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Petit RG, Cano A, Ortiz A, Espina M, Prat J, Muñoz M, Severino P, Souto EB, García ML, Pujol M, Sánchez-López E. Psoriasis: From Pathogenesis to Pharmacological and Nano-Technological-Based Therapeutics. Int J Mol Sci 2021; 22:4983. [PMID: 34067151 PMCID: PMC8125586 DOI: 10.3390/ijms22094983] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Research in the pathogenesis of inflammatory skin diseases, such as skin dermatitis and psoriasis, has experienced some relevant breakthroughs in recent years. The understanding of age-related factors, gender, and genetic predisposition of these multifactorial diseases has been instrumental for the development of new pharmacological and technological treatment approaches. In this review, we discuss the molecular mechanisms behind the pathological features of psoriasis, also addressing the currently available treatments and novel therapies that are under clinical trials. Innovative therapies developed over the last 10 years have been researched. In this area, advantages of nanotechnological approaches to provide an effective drug concentration in the disease site are highlighted, together with microneedles as innovative candidates for drug delivery systems in psoriasis and other inflammatory chronic skin diseases.
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Affiliation(s)
- Robert Gironés Petit
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
| | - Amanda Cano
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
- Center for Biomedical Research in Neurodegenerative Diseases Network, Carlos III Health Institute, 28031 Madrid, Spain
| | - Alba Ortiz
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Marta Espina
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Josefina Prat
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Montserrat Muñoz
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Patrícia Severino
- University of Tiradentes (Unit) Av. Murilo Dantas, Aracaju 49010-390, Brazil;
- Institute of Technology and Research (ITP) Av. Murilo Dantas, Aracaju 49010-390, Brazil
| | - Eliana B. Souto
- CEB—Centre of Biological Engineering, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal
- Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Maria L. García
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
- Center for Biomedical Research in Neurodegenerative Diseases Network, Carlos III Health Institute, 28031 Madrid, Spain
| | - Montserrat Pujol
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - Elena Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, 08028 Barcelona, Spain; (R.G.P.); (A.C.); (A.O.); (M.E.); (J.P.); (M.M.); (M.L.G.)
- Institute of Nanoscience and Nanotechnology, Universitat de Barcelona, 08028 Barcelona, Spain
- Center for Biomedical Research in Neurodegenerative Diseases Network, Carlos III Health Institute, 28031 Madrid, Spain
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Abstract
Salicylates have a long history of use for pain relief. Salicylic acid and methyl salicylate are among the widely used topical salicylates namely for keratolytic and anti-inflammatory actions, respectively. The current review summarises both passive and active strategies, including emerging technologies employed to enhance skin permeation of these two salicylate compounds. The formulation design of topical salicylic acid targets the drug retention in and on the skin based on the different indications including keratolytic, antibacterial and photoprotective actions, while the investigations of topical delivery strategies for methyl salicylate are limited. The pharmacokinetics and metabolisms of both salicylate compounds are discussed. The current overview and future perspectives of the topical delivery strategies are also highlighted for translational considerations of formulation designs.
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12
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Xie J, Huang S, Huang H, Deng X, Yue P, Lin J, Yang M, Han L, Zhang DK. Advances in the Application of Natural Products and the Novel Drug Delivery Systems for Psoriasis. Front Pharmacol 2021; 12:644952. [PMID: 33967781 PMCID: PMC8097153 DOI: 10.3389/fphar.2021.644952] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
Psoriasis, an incurable autoimmune skin disease, is one of the most common immune-mediated disorders. Presently, numerous clinical research studies are underway, and treatment options are available. However, these treatments focus on improving symptoms of the disease and fail to achieve a radical cure; they also have certain toxic side effects. In recent years, natural products have increasingly gained attention because of their high efficiency and low toxicity. Despite their obvious therapeutic effects, natural products’ biological activity was limited by their instability, poor solubility, and low bioavailability. Novel drug delivery systems, including liposomes, lipospheres, nanostructured lipid carriers, niosomes, nanoemulsions, nanospheres, microneedles, ethosomes, nanocrystals, and foams could potentially overcome the limitations of poor water solubility and permeability in traditional drug delivery systems. Thus, to achieve a therapeutic effect, the drug can reach the epidermis and dermis in psoriatic lesions to interact with the immune cells and cytokines.
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Affiliation(s)
- Jin Xie
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shengjie Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haozhou Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xuan Deng
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Pengfei Yue
- State Key Laboratory of Innovation Medicine and High Efficiency and Energy Saving Pharmaceutical Equipment, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Junzhi Lin
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ming Yang
- State Key Laboratory of Innovation Medicine and High Efficiency and Energy Saving Pharmaceutical Equipment, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Li Han
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ding-Kun Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,State Key Laboratory of Innovation Medicine and High Efficiency and Energy Saving Pharmaceutical Equipment, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Dey P, Puppala ER, Naidu VGM, Das G, Ramesh A. Multifunctional Synthetic Amphiphile for Niche Therapeutic Applications: Mitigation of MRSA Biofilms and Potential in Wound Healing. ACS APPLIED BIO MATERIALS 2020; 3:8830-8840. [PMID: 35019558 DOI: 10.1021/acsabm.0c01164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The relentless menace of implant- and skin wound-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA) biofilms demands the design of therapeutics that have an edge over conventional antibiotics. The present study reports the potential of pluri-active amphiphiles having a 12-carbon alkyl chain and a salicaldehyde head group (C1) or a napthaldehyde head group (C2) in mitigating wound site- and implant-associated MRSA biofilms and as a topical wound healing agent. The amphiphiles impeded S. aureus MRSA 100 biofilm formation on collagen both on extraneous addition and on impregnation into collagen and inflicted damage to MRSA cells embedded in collagen matrix infused with simulated wound fluid, with C1 being more potent than C2. Adhesion of the MRSA biofilm was hampered on C1-coated orthopedic stainless-steel wire, while eluates from C1-coated wires were non-toxic to HEK 293 cells, highlighting the prospect of C1 as an implant-associated antibacterial coating. Upon treatment with C1, expression of the adhesin fnbA gene was low in the MRSA biofilm and downregulated in non-adherent MRSA cells, while δ-toxin (hld) gene expression in the MRSA biofilm increased, implying that C1 hindered cell-cell adhesion and planktonic-biofilm transition and also reduced biofilm adhesion. Oral administration of C1 (300 and 1000 mg/kg) was non-toxic to BALB/c mice as evidenced in stable hematological parameters and normal histopathological features of vital organs. Topical application of C1 (50 and 100 mg/kg) on a skin excision wound in female BALB/c mice resulted in effective wound closure, fibrous tissue proliferation, and tissue reorganization. Confocal microscopy revealed that topical application of C1 in an ex vivo murine skin explant could alleviate invasion of skin by MRSA, while solution-based studies indicated subdued MRSA adhesion onto the skin explants. The pluri-active synthetic amphiphile C1 provides a framework for developing antibacterials that hold translational potential as a therapeutic for implant- and skin wound-associated MRSA infections.
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Affiliation(s)
- Poulomi Dey
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Eswara Rao Puppala
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati 781125, India
| | - Vegi Ganga Modi Naidu
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research Guwahati, Guwahati 781125, India
| | - Gopal Das
- Department of Chemistry, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Aiyagari Ramesh
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
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14
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Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2020; 84:432-470. [PMID: 32738429 DOI: 10.1016/j.jaad.2020.07.087] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/23/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
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Affiliation(s)
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- The National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana
| | | | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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15
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Otarola JJ, Cobo Solís AK, Mariano Correa N, Molina PG. Piroxicam‐Loaded Nanostructured Lipid Nanocarriers Modified with Salicylic Acid: The Effect on Drug Release. ChemistrySelect 2020. [DOI: 10.1002/slct.201904227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica J. Otarola
- Instituto para el Desarrollo Agroindustrial y de la Salud (IDAS). UNRC-CONICET. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
- Departamento de Química. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Físico-Químicas y Naturales. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
| | - Airam K. Cobo Solís
- Instituto para el Desarrollo Agroindustrial y de la Salud (IDAS). UNRC-CONICET. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
- Departamento de Química. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Físico-Químicas y Naturales. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
| | - N. Mariano Correa
- Instituto para el Desarrollo Agroindustrial y de la Salud (IDAS). UNRC-CONICET. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
- Departamento de Química. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Físico-Químicas y Naturales. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
| | - Patricia G. Molina
- Instituto para el Desarrollo Agroindustrial y de la Salud (IDAS). UNRC-CONICET. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
- Departamento de Química. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Físico-Químicas y Naturales. Agencia Postal # 3. C.P. X5804BYA Río Cuarto. Argentina
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Cortés H, Del Prado-Audelo ML, Urbán-Morlán Z, Alcalá-Alcalá S, González-Torres M, Reyes-Hernández OD, González-Del Carmen M, Leyva-Gómez G. Pharmacological treatments for cutaneous manifestations of inherited ichthyoses. Arch Dermatol Res 2019; 312:237-248. [DOI: 10.1007/s00403-019-01994-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/26/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022]
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17
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Vall M, Ferraz N, Cheung O, Strømme M, Zardán Gómez de la Torre T. Exploring the Use of Amine Modified Mesoporous Magnesium Carbonate for the Delivery of Salicylic Acid in Topical Formulations: In Vitro Cytotoxicity and Drug Release Studies. Molecules 2019; 24:molecules24091820. [PMID: 31083517 PMCID: PMC6539276 DOI: 10.3390/molecules24091820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 01/09/2023] Open
Abstract
Salicylic acid (SA) has for a long time been used to treat various skin disorders due to its anti-inflammatory, bacteriostatic, and antifungal properties. In the present work, mesoporous magnesium carbonate (MMC), a promising drug carrier, was modified with 3-aminopropyl-triethoxysilane to enable loading of SA. The amine modified MMC (aMMC) was successfully loaded with 8 wt.% of SA via a solvent evaporation method. SA was later completely released from the carrier in less than 15 min. Furthermore, the cytotoxicity of the functionalized material was evaluated. aMMC was found to be non-toxic for human dermal fibroblast cells with particle concentration of up to 1000 µg/mL when exposed for 48 h. The presented results form the basis of future development of aMMC as a potential carrier for SA in dermatological applications.
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Affiliation(s)
- Maria Vall
- Division for Nanotechnology and Functional Materials, Department of Engineering Sciences, SE-751 21 Uppsala, Sweden.
| | - Natalia Ferraz
- Division for Nanotechnology and Functional Materials, Department of Engineering Sciences, SE-751 21 Uppsala, Sweden.
| | - Ocean Cheung
- Division for Nanotechnology and Functional Materials, Department of Engineering Sciences, SE-751 21 Uppsala, Sweden.
| | - Maria Strømme
- Division for Nanotechnology and Functional Materials, Department of Engineering Sciences, SE-751 21 Uppsala, Sweden.
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18
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Effect of Achillea millefolium Mouthwash on Oral Mucositis Induced by Chemotherapy in AML Patients. Jundishapur J Nat Pharm Prod 2019. [DOI: 10.5812/jjnpp.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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19
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Martínez-Ortega L, Mira A, Fernandez-Carvajal A, Mateo CR, Mallavia R, Falco A. Development of A New Delivery System Based on Drug-Loadable Electrospun Nanofibers for Psoriasis Treatment. Pharmaceutics 2019; 11:E14. [PMID: 30621136 PMCID: PMC6359116 DOI: 10.3390/pharmaceutics11010014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/19/2018] [Accepted: 12/23/2018] [Indexed: 02/06/2023] Open
Abstract
Psoriasis is a chronic autoimmune systemic disease with an approximate incidence of 2% worldwide; it is commonly characterized by squamous lesions on the skin that present the typical pain, stinging, and bleeding associated with an inflammatory response. In this work, poly(methyl vinyl ether-alt-maleic ethyl monoester) (PMVEMA-ES) nanofibers have been designed as a delivery vehicle for three therapeutic agents with palliative properties for the symptoms of this disease (salicylic acid, methyl salicylate, and capsaicin). For such a task, the production of these nanofibers by means of the electrospinning technique has been optimized. Their morphology and size have been characterized by optical microscopy and scanning electron microscopy (SEM). By selecting the optimal conditions to achieve the smallest and most uniform nanofibers, approximate diameters of up to 800⁻900 nm were obtained. It was also determined that the therapeutic agents that were used were encapsulated with high efficiency. The analysis of their stability over time by GC-MS showed no significant losses of the encapsulated compounds 15 days after their preparation, except in the case of methyl salicylate. Likewise, it was demonstrated that the therapeutic compounds that were encapsulated conserved, and even improved, their capacity to activate the transient receptor potential cation channel 1 (TRPV1) channel, which has been associated with the formation of psoriatic lesions.
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Affiliation(s)
- Leticia Martínez-Ortega
- Institute of Research, Development and Innovation in Biotechnology of Elche (IDiBE) and Molecular and Cellular Biology Institute (IBMC), Miguel Hernández University (UMH), 03202 Elche, Spain.
| | - Amalia Mira
- Institute of Research, Development and Innovation in Biotechnology of Elche (IDiBE) and Molecular and Cellular Biology Institute (IBMC), Miguel Hernández University (UMH), 03202 Elche, Spain.
| | - Asia Fernandez-Carvajal
- Institute of Research, Development and Innovation in Biotechnology of Elche (IDiBE) and Molecular and Cellular Biology Institute (IBMC), Miguel Hernández University (UMH), 03202 Elche, Spain.
| | - C Reyes Mateo
- Institute of Research, Development and Innovation in Biotechnology of Elche (IDiBE) and Molecular and Cellular Biology Institute (IBMC), Miguel Hernández University (UMH), 03202 Elche, Spain.
| | - Ricardo Mallavia
- Institute of Research, Development and Innovation in Biotechnology of Elche (IDiBE) and Molecular and Cellular Biology Institute (IBMC), Miguel Hernández University (UMH), 03202 Elche, Spain.
| | - Alberto Falco
- Institute of Research, Development and Innovation in Biotechnology of Elche (IDiBE) and Molecular and Cellular Biology Institute (IBMC), Miguel Hernández University (UMH), 03202 Elche, Spain.
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20
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Kivelevitch D, Frieder J, Watson I, Paek SY, Menter MA. Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas. Expert Opin Pharmacother 2018; 19:561-575. [PMID: 29565192 DOI: 10.1080/14656566.2018.1448788] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite great therapeutic advancements in psoriasis, four notable difficult-to-treat areas including the scalp, nails, intertriginous (including genitals), and palmoplantar regions, pose a challenge to both physicians and patients. Localized disease of these specific body regions inflicts a significant burden on patients' quality of life and requires an adequate selection of treatments. AREAS COVERED This manuscript discusses appropriate therapies and important treatment considerations for these difficult-to-treat areas based on the available clinical data from the literature. EXPERT OPINION Clinical trials assessing therapies for the difficult-to-treat areas have been inadequate. With the first biological clinical trial for genital psoriasis pending publication, it is with hope that other biological agents will be evaluated for region-specific psoriasis. A greater understanding of the genetic and immunologic aspects of regional psoriasis, as well as identification of unique biomarkers, will further guide management decisions. For example, the recent discovery of the IL-36 receptor gene for generalized pustular psoriasis may prove valuable for other forms of psoriasis. Ultimately, identification of the most beneficial treatments for each psoriasis subtype and difficult-to-treat area will provide patients with maximal quality of life.
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Affiliation(s)
- Dario Kivelevitch
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Jillian Frieder
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
| | - Ian Watson
- b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - So Yeon Paek
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA.,b Texas A&M Health Sciences Center College of Medicine , Bryan , TX , USA
| | - M Alan Menter
- a Division of Dermatology , Baylor Scott and White , Dallas , TX , USA
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21
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Hengge UR, Röschmann K, Candler H. Single-center, noninterventional clinical trial to assess the safety, efficacy, and tolerability of a dimeticone-based medical device in facilitating the removal of scales after topical application in patients with psoriasis corporis or psoriasis capitis. PSORIASIS-TARGETS AND THERAPY 2018; 7:41-49. [PMID: 29387607 PMCID: PMC5774606 DOI: 10.2147/ptt.s130295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Psoriasis is a frequent inflammatory skin disease affecting ~2%-3% of the population in western countries. Scaling of the psoriatic lesions is the most impairing symptom in patients with psoriasis. In contrast to conventional keratolytic treatment concepts containing salicylic acid or urea, a dimeticone-based medical device (Loyon®) removes scales in a physical way without any pharmacological effect. Objective To assess the efficacy and tolerability of a dimeticone-based medical device in removal of scales in patients with psoriasis corporis/capitis under real-life conditions. Methods Forty patients with psoriasis capitis or corporis were included and received once-daily treatments for 7 days. Clinical assessment of the psoriasis area severity index score (psoriasis corporis) and the psoriasis scalp severity index score (psoriasis capitis) was performed and evaluated at baseline, after 3 and 7 days of treatment. Baseline scaling scores and redness scores were calculated for two target lesions of the scalp or the body on a 5-point scale each. Results For the primary efficacy variable scaling score, a statistically significant decrease was observed after treatment, with a relative reduction in scaling of 36.8% after 7 days of treatment within patients affected by psoriasis capitis. Treatment success was achieved in 76.8% of patients with psoriasis capitis, and time to treatment success was evaluated to be 4.14 days for these patients and 4.33 days for patients suffering from psoriasis corporis. Conclusion In conclusion, this trial demonstrated that the dimeticone-based medical device is a safe, well-tolerated, practicable, and efficient keratolytic compound, which can be well implemented in and recommended for standard therapy of psoriasis.
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Affiliation(s)
| | | | - Henning Candler
- Department of Medical Affairs, G. Pohl-Boskamp GmbH & Co. KG, Hohenlockstedt, Germany
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22
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Abstract
Topical therapy as monotherapy is useful in psoriasis patients with mild disease. Topical agents are also used as adjuvant for moderate-to-severe disease who are being concurrently treated with either ultraviolet light or systemic medications. Emollients are useful adjuncts to the treatment of psoriasis. Use of older topical agents such as anthralin and coal tar has declined over the years. However, they are cheaper and can still be used for the treatment of difficult psoriasis refractory to conventional treatment. Salicylic acid can be used in combination with other topical therapies such as topical corticosteroids (TCS) and calcineurin inhibitors for the treatment of thick limited plaques to increase the absorption of the latter into the psoriatic plaques. Low- to mid-potent TCS are used in facial/flexural psoriasis and high potent over palmoplantar/thick psoriasis lesions. The addition of noncorticosteroid treatment can also facilitate the avoidance of long-term daily TCS. Tacrolimus and pimecrolimus can be used for the treatment of facial and intertriginous psoriasis. Tazarotene is indicated for stable plaque psoriasis usually in combination with other therapies such as TCS. Vitamin D analogs alone in combination with TCS are useful in stable plaques over limbs and palmoplantar psoriasis. Topical therapies for scalp psoriasis include TCS, Vitamin D analogs, salicylic acid, coal tar, and anthralin in various formulations such as solutions, foams, and shampoos. TCS, vitamin D analogs, and tazarotene can be used in the treatment of nail psoriasis.
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Affiliation(s)
- R. Torsekar
- Department of Dermatology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India
| | - Manjyot M. Gautam
- Dr. D.Y. Patil Medical College and Research Center, Navi Mumbai, Maharashtra, India
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23
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Sharma M, Levenson C, Clements I, Castella P, Gebauer K, Cox ME. East Indian Sandalwood Oil (EISO) Alleviates Inflammatory and Proliferative Pathologies of Psoriasis. Front Pharmacol 2017; 8:125. [PMID: 28360856 PMCID: PMC5352686 DOI: 10.3389/fphar.2017.00125] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/28/2017] [Indexed: 12/21/2022] Open
Abstract
Psoriasis, a chronic inflammatory skin disease marked by hyper proliferation and aberrant differentiation of keratinocytes, affects 2–3% of the world’s population. Research into the pathogenesis of psoriasis has been hampered by the lack of models that accurately reflect the biology of the psoriatic phenotype. We have previously reported that East Indian Sandalwood oil (EISO) has significant anti-inflammatory properties in skin models and hypothesized that EISO might provide therapeutic benefit to psoriasis patients due to its anti-inflammatory and anti-proliferative properties. Here we present interim results from an on-going proof-of-concept Phase 2 clinical trial in which topically applied EISO is demonstrating to be well tolerated and helpful in alleviating mild to moderate psoriasis symptoms. This led us to evaluate the ability of EISO to affect the psoriatic phenotype using MatTek Corporation reconstituted organotypic psoriatic and normal human skin models. EISO had no impact on the phenotype of the normal skin tissue model, however, EISO treatment of the psoriasis tissue model reverted psoriatic pathology as demonstrated by histologic characterization and expression of keratinocyte proliferation markers, Ki67 and psoriasin. These phenotypic affects correlated with suppressed production of ENA-78, IL-6, IL-8, MCP-1, GM-CSF, and IL-1β. Demonstration of the ability of EISO to abrogate these psoriasis symptoms in well-characterized in vitro psoriatic tissue models, supports the hypothesis that the clinically observed symptom alleviation is due to suppression of intrinsic tissue inflammation reactions in afflicted lesions. This study presents a systematic approach to further study the underlying mechanisms that cause psoriasis, and presents data supporting the potential of EISO as a new ethnobotanical therapeutic concept to help direct and accelerate the development of more effective therapies.
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Affiliation(s)
- Manju Sharma
- The Vancouver Prostate Centre, Vancouver BC, Canada
| | | | - Ian Clements
- Santalis Pharmaceuticals, Inc., San Antonio TX, USA
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Langasco R, Spada G, Tanriverdi ST, Rassu G, Giunchedi P, Özer Ö, Gavini E. Bio-based topical system for enhanced salicylic acid delivery: preparation and performance of gels. J Pharm Pharmacol 2016; 68:999-1009. [DOI: 10.1111/jphp.12582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/14/2016] [Indexed: 12/14/2022]
Abstract
Abstract
Objectives
New salicylic acid (SA)-loaded gels were developed using excipients made from renewable materials, and our goal was to improve drug permeation in the topical treatment of acne vulgaris.
Methods
We studied the preparation parameters to obtain suitable gel formulations. Only naturally occurring polymers were used as gelling agents. Two hydrogels and three lipogels were selected and characterized in terms of drug loading, pH, viability cells, rheology, mechanical properties and in vitro permeation; these hydrogels and lipogels were compared with the traditional ointment. We also evaluated skin parameters before and after gel application.
Key findings
The formulations that we studied are non-Newtonian fluids; they have high drug loading and suitable mechanical properties. Lipogels exhibit a slower and more linear in vitro permeation profile compared with hydrogels. The different vehicles that we used affected drug permeation and improve patient compliance. Cytotoxicity studies suggest that all of the formulations are non-toxic.
Conclusions
Lipogels demonstrate appropriate technological features and improved performance compared with the traditional ointment with regard to their composition. Lipogels may represent a new bio-based topical system for SA delivery. The use of ‘green’ excipients leads to ‘skin-friendly’ formulations that are able to satisfy environmental safety.
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Affiliation(s)
- Rita Langasco
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | | | | | - Giovanna Rassu
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | - Paolo Giunchedi
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | - Özgen Özer
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Ege University, Izmir, Turkey
| | - Elisabetta Gavini
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
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25
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Thaçi D, Augustin M, Krutmann J, Luger T. Importance of basic therapy in psoriasis. J Dtsch Dermatol Ges 2016; 13:415-8. [PMID: 25918082 DOI: 10.1111/ddg.12615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Basic therapy plays an important role in the management of psoriasis, regardless of disease severity or the therapeutic concept used. It helps reduce symptoms such as pruritus and scaling, decreases exacerbations, and may therefore prolong the remission period after successful antipsoriatic treatment. Accordingly, adequate basic therapy can also have a positive effect on patients' severely impaired quality of life. Unfortunately, the importance of basic therapy in psoriasis is still underestimated. Based on clinical trial data, the present review highlights the efficacy and potential of basic therapy, and focuses on new data and developments in this field.
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Affiliation(s)
- Diamant Thaçi
- Comprehensive Center Inflammation Medicine, University zu Lübeck University Hospital Schleswig- Holstein, Campus Lübeck
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26
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Gholam P, Fink C, Bosselmann I, Enk A. Retrospective analysis evaluating the effect of a keratolytic and physical pretreatment with salicylic acid, urea and curettage on the efficacy and safety of photodynamic therapy of actinic keratoses with methylaminolaevulinate. J Eur Acad Dermatol Venereol 2015; 30:619-23. [DOI: 10.1111/jdv.13449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. Gholam
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - C. Fink
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - I. Bosselmann
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
| | - A.H. Enk
- Department of Dermatology; University of Heidelberg; Heidelberg Germany
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Thomas J, Narkowicz CK, Jacobson GA, Peterson GM. Safety and efficacy of kunzea oil-containing formulations for the management of psoriasis: a randomized, controlled trial. J Clin Pharm Ther 2015; 40:566-572. [PMID: 30156327 DOI: 10.1111/jcpt.12311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 06/28/2015] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Anecdotally, topical kunzea oil has been used to treat various skin conditions, including psoriasis and eczema, with good results. This study compared the clinical efficacy of kunzea oil (20%)-containing formulations in mild to moderate psoriasis. METHODS A randomized, comparative, double-blind, 8-week study was undertaken. Thirty patients (age range: 25-74 years and mean ± SD: 52·8 ± 13·6 years) with mild to moderate psoriasis (affecting at least 10% of one or more body regions: arms, head, legs and trunk) randomly received ointment and/or scalp lotion containing 20% kunzea oil (test group) or control medications not containing kunzea oil (control group). Formulations in both treatment arms also contained 5% liquor carbonis detergens (LCD) and 3% salicylic acid. The clinical responses to the test and control formulations were evaluated using the Psoriasis Area and Severity Index (PASI). RESULTS AND DISCUSSION After 8 weeks of treatment, both test and control groups demonstrated a significant (P < 0·05) improvement in PASI scores. Subjects in the test group had a decrease in mean±SD PASI score from 12·7 ± 7·9 to 6·7 ± 7·2, whereas the control group showed a decrease in PASI score from 8·1 ± 4·6 to 3·5 ± 4·7. Comparative efficacy analysis between the test and control groups did not reveal any significant difference (P > 0·05). WHAT IS NEW AND CONCLUSIONS The inclusion of kunzea oil made no difference to the efficacy of topical formulations containing LCD and salicylic acid for the treatment of psoriasis.
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Affiliation(s)
- J Thomas
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - C K Narkowicz
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - G A Jacobson
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - G M Peterson
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Thaçi D, Augustin M, Krutmann J, Luger T. Stellenwert der Basistherapie bei Psoriasis. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12615_suppl] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Diamant Thaçi
- Exzellenzzentrum Entzündungsmedizin der Universität zu Lübeck; Universitätsklinikum Schleswig-Holstein Campus Lübeck
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen; Universitätsklinikum Hamburg-Eppendorf
| | - Jean Krutmann
- IUF-Leibniz, Institut für Umweltmedizinische Forschung; Heinrich-Heine-Universität; Düsseldorf
| | - Thomas Luger
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie; Universitätsklinikum Münster
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Jacobi A, Mayer A, Augustin M. Keratolytics and emollients and their role in the therapy of psoriasis: a systematic review. Dermatol Ther (Heidelb) 2015; 5:1-18. [PMID: 25604924 PMCID: PMC4374065 DOI: 10.1007/s13555-015-0068-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Psoriasis is a common chronic disease with significant impairment in quality of life. As there is no cure, it often requires lifelong disease control to minimize the development of skin lesions and to relieve symptoms. The aim of this publication is to systematically review the role of currently used emollients and keratolytics in the treatment of psoriasis. METHODS A systematic literature search was conducted in Medline via PubMed regarding reviews, meta-analyses, and trials published from January 1983 to December 2013 dealing with topical administration of emollients and keratolytics in patients with psoriasis. A subsequent search in EMBASE regarding clinical trials published from 1983 to 2013 was performed to complement the findings. RESULTS A total of 60 publications met the inclusion criteria for full-text evaluation. While current reviews, meta-analyses, and guidelines state that adjuvant therapy with emollients and keratolytics should be an obligatory part in the therapy of psoriasis to facilitate descaling and/or penetration enhancement, comprehensive trials on these agents are missing, with the exception of combination products containing salicylic acid and corticosteroids. In the mentioned trials, addition of salicylic acid was beneficial in inducing a more rapid onset of action as well as a reduction of severity parameters and the area affected. However, its use has substantial limitations in young children, in patients with renal/hepatic impairment, with widespread psoriasis, those undergoing phototherapy, or those concomitantly treated with calcipotriene/systemic salicylates. CONCLUSION In view of these shortcomings, there is a need for well-designed studies on suitable keratolytic alternatives to salicylic acid offering an indisputable positive benefit-risk ratio.
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Affiliation(s)
- Arnd Jacobi
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Dermatological Research (CeDeF), University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
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Khandpur S, Sahni K. An open label prospective randomized trial to compare the efficacy of coal tar-salicylic Acid ointment versus calcipotriol/betamethasone dipropionate ointment in the treatment of limited chronic plaque psoriasis. Indian J Dermatol 2014; 59:579-83. [PMID: 25484388 PMCID: PMC4248495 DOI: 10.4103/0019-5154.143523] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Chronic plaque psoriasis is a common papulosquamous skin disorder, for which a number of topical agents are being used including coal tar, topical steroids and more recently topical calcipotriol/betamethasone dipropionate. There is no study comparing purified coal tar preparation with calcipotriol/betamethasone dipropionate ointment in limited chronic plaque psoriasis. Aims and Objectives: A prospective randomized open label controlled trial to compare the efficacy and safety of topical application of coal tar-salicylic acid ointment with calcipotriol/betamethasone dipropionate ointment applied once at night for 12 weeks for the treatment of limited chronic plaque psoriasis. Materials and Methods: A total of 62 patients of limited chronic plaque psoriasis (body surface area <10%) were randomized into two treatment groups: Group A received topical application of 6% coal tar with 3% salicylic acid ointment and Group B received calcipotriol/betamethasone dipropionate, once at night for 12 weeks. Results were assessed based on psoriasis area severity index (PASI) scores and patient global assessment (PGA) at each visit. Results: Mean PASI was significantly lower at week 2 (P = 0.01) and week 4 follow-up (P = 0.05) and the mean reduction in PASI was significantly higher at week 2 (P = 0.02) with calcipotriol/betamethasone than coal tar-salicylic acid, but this difference was not sustained at subsequent follow-up visits. Similarly, PGA scores at weeks 2 and 4 were significantly lower with calcipotriol/betamethasone dipropionate ointment (P = 0.003 and P = 0.007 respectively). There was no significant difference in any parameter during subsequent follow-up visits or at the end of the treatment phase (12 weeks). Conclusion: Topical nightly application of calcipotriol/betamethasone dipropionate ointment leads to an initial, more rapid reduction in disease severity, but the overall outcome parameters are comparable in the two treatment groups.
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Affiliation(s)
- Sujay Khandpur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Sahni
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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31
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Chiricozzi A, Chimenti S. Effective topical agents and emerging perspectives in the treatment of psoriasis. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.12.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Chiricozzi A, Pitocco R, Saraceno R, Nistico SP, Giunta A, Chimenti S. New topical treatments for psoriasis. Expert Opin Pharmacother 2014; 15:461-70. [DOI: 10.1517/14656566.2014.875159] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Manczinger M, Kemény L. Novel factors in the pathogenesis of psoriasis and potential drug candidates are found with systems biology approach. PLoS One 2013; 8:e80751. [PMID: 24303025 PMCID: PMC3841158 DOI: 10.1371/journal.pone.0080751] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/15/2013] [Indexed: 01/12/2023] Open
Abstract
Psoriasis is a multifactorial inflammatory skin disease characterized by increased proliferation of keratinocytes, activation of immune cells and susceptibility to metabolic syndrome. Systems biology approach makes it possible to reveal novel important factors in the pathogenesis of the disease. Protein-protein, protein-DNA, merged (containing both protein-protein and protein-DNA interactions) and chemical-protein interaction networks were constructed consisting of differentially expressed genes (DEG) between lesional and non-lesional skin samples of psoriatic patients and/or the encoded proteins. DEGs were determined by microarray meta-analysis using MetaOMICS package. We used STRING for protein-protein, CisRED for protein-DNA and STITCH for chemical-protein interaction network construction. General network-, cluster- and motif-analysis were carried out in each network. Many DEG-coded proteins (CCNA2, FYN, PIK3R1, CTGF, F3) and transcription factors (AR, TFDP1, MEF2A, MECOM) were identified as central nodes, suggesting their potential role in psoriasis pathogenesis. CCNA2, TFDP1 and MECOM might play role in the hyperproliferation of keratinocytes, whereas FYN may be involved in the disturbed immunity in psoriasis. AR can be an important link between inflammation and insulin resistance, while MEF2A has role in insulin signaling. A controller sub-network was constructed from interlinked positive feedback loops that with the capability to maintain psoriatic lesional phenotype. Analysis of chemical-protein interaction networks detected 34 drugs with previously confirmed disease-modifying effects, 23 drugs with some experimental evidences, and 21 drugs with case reports suggesting their positive or negative effects. In addition, 99 unpublished drug candidates were also found, that might serve future treatments for psoriasis.
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Affiliation(s)
- Máté Manczinger
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
- * E-mail:
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
- Dermatological Research Group of the Hungarian Academy of Sciences, Szeged, Hungary
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Salicylates and the Microbiota: A New Mechanistic Understanding of an Ancient Drug's Role in Dermatological and Gastrointestinal Disease. Drug Dev Res 2013. [DOI: 10.1002/ddr.21086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Lau WM, Heard CM, White AW. Design, synthesis and in vitro degradation of a novel co-drug for the treatment of psoriasis. Pharmaceutics 2013; 5:232-45. [PMID: 24300448 PMCID: PMC3834954 DOI: 10.3390/pharmaceutics5020232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/01/2013] [Accepted: 04/10/2013] [Indexed: 12/20/2022] Open
Abstract
Psoriasis is a common, chronic and relapsing inflammatory skin disease. It affects approximately 2% of the western population and has no cure. Combination therapy for psoriasis often proves more efficacious and better tolerated than monotherapy with a single drug. Combination therapy could be administered in the form of a co-drug, where two or more therapeutic compounds active against the same condition are linked by a cleavable covalent bond. Similar to the pro-drug approach, the liberation of parent moieties post-administration, by enzymatic and/or chemical mechanisms, is a pre-requisite for effective treatment. In this study, a series of co-drugs incorporating dithranol in combination with one of several non-steroidal anti-inflammatory drugs, both useful for the treatment of psoriasis, were designed, synthesized and evaluated. An ester co-drug comprising dithranol and naproxen in a 1:1 stoichiometric ratio was determined to possess the optimal physicochemical properties for topical delivery. The co-drug was fully hydrolyzed in vitro by porcine liver esterase within four hours. When incubated with homogenized porcine skin, 9.5% of the parent compounds were liberated after 24 h, suggesting in situ esterase-mediated cleavage of the co-drug would occur within the skin. The kinetics of the reaction revealed first order kinetics, Vmax = 10.3 μM·min-1 and Km = 65.1 μM. The co-drug contains a modified dithranol chromophore that was just 37% of the absorbance of dithranol at 375 nm and suggests reduced skin/clothes staining. Overall, these findings suggest that the dithranol-naproxen co-drug offers an attractive, novel approach for the treatment of psoriasis.
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Affiliation(s)
- Wing Man Lau
- School of Pharmacy, University of Reading, Whiteknights, P.O. Box 226, Reading, RG6 6AP, UK
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, CF10 3NB, UK; E-Mails: (C.M.H.); (A.W.W.)
| | - Charles M. Heard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, CF10 3NB, UK; E-Mails: (C.M.H.); (A.W.W.)
| | - Alex W. White
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, CF10 3NB, UK; E-Mails: (C.M.H.); (A.W.W.)
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Ardigò M, Agozzino M, Longo C, Conti A, Di Lernia V, Berardesca E, Pellacani G. Psoriasis plaque test with confocal microscopy: evaluation of different microscopic response pathways in NSAID and steroid treated lesions. Skin Res Technol 2013; 19:417-23. [PMID: 23521429 DOI: 10.1111/srt.12062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pathophysiology of psoriasis is complex and characterized by microscopic, specific changes. In vivo reflectance confocal microscopy (RCM) provides tissue and cell morphology information in non-invasive way, generating quasi-histologic resolution. Concerning plaque psoriasis, confocal criteria have been described disclosing high agreement between RCM and conventional histology. OBJECTIVE We sought to evaluate the in vivo microscopic changes in plaque psoriasis occurring during treatment with two distinct actives (aceclofenac and betamethason). METHODS A total of 32 patients with psoriasis were recruited. Two lesions from the same body area or symmetrical were evaluated at baseline and after 3-6 weeks by RCM. RESULTS Aceclofenac induced clinical improvement in 32% of patients after 3 weeks and in 76% after 6 weeks. With betamethason, at the end of the 3rd week, the 45% of patients showed improvement that increased to 81% at the end of the study. Single confocal criteria was evaluated and results underwent to statistical analysis considering the modification of the microscopical changes during the two treatments. CONCLUSION RCM followed the microscopic changes during treatment and enabled to differentiate effects of different actives. Although data are preliminary and based on a limited sample, aceclofenac seems to be effective in the treatment for psoriasis.
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Affiliation(s)
- Marco Ardigò
- San Gallicano Dermatological Institute, Rome, Italy
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Rubio L, Alonso C, Rodríguez G, Cócera M, López-Iglesias C, Coderch L, De la Maza A, Parra J, López O. Bicellar systems as new delivery strategy for topical application of flufenamic acid. Int J Pharm 2013; 444:60-9. [DOI: 10.1016/j.ijpharm.2013.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/14/2013] [Accepted: 01/17/2013] [Indexed: 11/25/2022]
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Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Sammain A, Schlaeger M, Sebastian M, Sterry W, Streit V, Augustin M, Erdmann R, Klaus J, Koza J, Muller S, Orzechowski HD, Rosumeck S, Schmid-Ott G, Weberschock T, Rzany B. S3 - Guidelines on the treatment of psoriasis vulgaris (English version). Update. J Dtsch Dermatol Ges 2012; 10 Suppl 2:S1-95. [PMID: 22386073 DOI: 10.1111/j.1610-0387.2012.07919.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5% to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, surveys have shown that patients still do not received optimal treatments. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologi sche Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. They were first published in 2006 and updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate and severe plaque-type psoriasis in adults including systemic therapy, UV therapy and topical therapies. The therapeutic recommendations were developed based on the results of a systematic literature search and were finalized during a consensus meeting using structured consensus methods (nominal group process).
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Affiliation(s)
- Alexander Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité- Universitätsmedizin Berlin, Germany
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Abstract
PURPOSE Sodium salicylate has shown potential as a component of contact lens care solutions designed to reduce Acanthamoebal attachment to contact lenses. This study determined the minimum effective concentration required to significantly reduce amoebal attachment. METHODS Different concentrations of sodium salicylate (10, 15, and 20 mM) were applied during exposure of unworn or bacterial biofilm-coated hydrogel contact lenses to Acanthamoeba castellanii trophozoites. Salicylate was applied at stage 1 intervention during biofilm formation on lenses, at stage 2 intervention during amoebal exposure, or at both stages. RESULTS A significant reduction in amoebal attachment was achieved when 10 mM salicylate was included during stage 1 alone; however, 15 mM was required for stage 2 intervention to significantly reduce attachment to clean or biofilm-coated lenses. For stages 1 and 2 combined intervention, 10 mM sodium salicylate produced a significant reduction in amoebal attachment. CONCLUSIONS In situ, within a contact lens case, biofilm formation and amoebal attachment would occur concurrently; therefore, stages 1 and 2 intervention would be closest to the real-life situation, thus indicating that 10 mM of salicylate would be an effective minimum concentration for reducing amoebal attachment to hydrogel contact lenses. Inclusion of components in contact lens care solution, such as sodium salicylate, which reduce Acanthamoebal attachment, has the potential to enhance effectiveness, particularly where amoebicidal efficacy may be limited, thus reducing the risk of contact lens-associated Acanthamoebal infection.
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Uva L, Miguel D, Pinheiro C, Antunes J, Cruz D, Ferreira J, Filipe P. Mechanisms of action of topical corticosteroids in psoriasis. Int J Endocrinol 2012; 2012:561018. [PMID: 23213332 PMCID: PMC3508578 DOI: 10.1155/2012/561018] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 10/14/2012] [Accepted: 10/20/2012] [Indexed: 11/17/2022] Open
Abstract
Psoriasis is a lifelong, chronic, and immune-mediated systemic disease, which affects approximately 1-3% of the Caucasian population. The different presentations of psoriasis require different approaches to treatment and appropriate prescriptions according to disease severity. The use of topical therapy remains a key component of the management of almost all psoriasis patients, and while mild disease is commonly treated only with topical agents, the use of topical therapy as adjuvant therapy in moderate-to-severe disease may also be helpful. This paper focuses on the cutaneous mechanisms of action of corticosteroids and on the currently available topical treatments, taking into account adverse effects, bioavailability, new combination treatments, and strategies to improve the safety of corticosteroids. It is established that the treatment choice should be tailored to match the individual patient's needs and his/her expectations, prescribing to each patient the most suitable vehicle.
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Affiliation(s)
- Luís Uva
- Clínica Universitária de Dermatologia, Faculdade de Medicina de Lisboa, Av. Professor Egas Moniz, 1649-035 Lisbon, Portugal
- *Luís Uva:
| | - Diana Miguel
- Clínica Universitária de Dermatologia, Faculdade de Medicina de Lisboa, Av. Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Catarina Pinheiro
- Clínica Universitária de Dermatologia, Faculdade de Medicina de Lisboa, Av. Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Joana Antunes
- Clínica Universitária de Dermatologia, Faculdade de Medicina de Lisboa, Av. Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Diogo Cruz
- Clínica Universitária de Dermatologia, Faculdade de Medicina de Lisboa, Av. Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - João Ferreira
- Clínica Universitária de Dermatologia, Faculdade de Medicina de Lisboa, Av. Professor Egas Moniz, 1649-035 Lisbon, Portugal
| | - Paulo Filipe
- Clínica Universitária de Dermatologia, Faculdade de Medicina de Lisboa, Av. Professor Egas Moniz, 1649-035 Lisbon, Portugal
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van de Kerkhof P, Kragballe K, Segaert S, Lebwohl M. Factors impacting the combination of topical corticosteroid therapies for psoriasis: perspectives from the international psoriasis council. J Eur Acad Dermatol Venereol 2011; 25:1130-9. [DOI: 10.1111/j.1468-3083.2011.04113.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zulfakar MH, Alex A, Povazay B, Drexler W, Thomas CP, Porter RM, Heard CM. In vivo response of GsdmA3Dfl/+ mice to topically applied anti-psoriatic agents: effects on epidermal thickness, as determined by optical coherence tomography and H&E staining. Exp Dermatol 2011; 20:269-72. [DOI: 10.1111/j.1600-0625.2010.01233.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Znamenskaya LF, Yakovleva SV, Volnukhin VA, Pirogova EV. Modern treatment methods for patients with psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2011. [DOI: 10.25208/vdv917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Modern approaches to treatment of patients with psoriasis depending on the type and stage of the disease, its localization and the severity degree of skin pathology are given. Data regarding external and systemic therapeutic agents as well as phototherapeutic methods of treatment currently used at inpatient & outpatient medical facilities are represented.
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Abstract
IMPORTANCE OF THE FIELD The majority of patients with psoriasis can be safely and effectively treated with topical therapy alone, either under the supervision of a family physician or dermatologist. For those requiring systemic agents, topical therapies can provide additional benefit. Optimal use of topical therapy requires an awareness of the range and efficacy of all products. AREAS COVERED IN THIS REVIEW The review covers the efficacy and role of topical therapies including emollients, corticosteroids, vitamin D analogs, calcineurin inhibitors, dithranol, coal tar, retinoids, keratolyics and combination therapy. The report was prepared following a PubMed and Embase literature search up to April 2010. WHAT THE READER WILL GAIN The paper provides a broad review of the relevant topical therapeutic options available in routine clinical practice for the management of psoriasis and a recommendation for selection of treatment. TAKE HOME MESSAGE Topical therapies used appropriately provide a safe and effective option for the management of psoriasis. An awareness of the available products and their efficacy is key to treatment selection and patient satisfaction.
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Affiliation(s)
- Philip M Laws
- The University of Manchester, Salford Royal Hospital (Hope), Manchester Academic Health Sciences Centre, Department of Dermatology, Salford, Manchester M6 8HD, UK
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Javadzadeh Y, Hamishehkar H. Enhancing percutaneous delivery of methotrexate using different types of surfactants. Colloids Surf B Biointerfaces 2010; 82:422-6. [PMID: 20951009 DOI: 10.1016/j.colsurfb.2010.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 08/01/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
Abstract
Regarding the potential severe toxicity associated with systemic administration of methotrexate (MTX), a topical formulation might be of greater utility for the treatment of psoriasis and other hyperproliferative skin disorders. One of the presumed reasons for the lack of clinical activity of topical methotrexate in psoriasis is insufficient percutaneous penetration necessary to inhibit epidermal DNA synthesis. The present study was undertaken to prepare a formulation to enhance skin penetration of MTX. For this mean, topical gel formulations were prepared and evaluated for MTX percutaneous absorption using rat skin and standard Franz diffusion cells. For enhancing percutaneous absorption, three surfactants (anionic, cationic and nonionic) were incorporated into formulations with different concentrations. Finally salicylic acid as a keratolytic material was added for more enhancement effect. The results showed that SLS (sodium lauryl sulphate) and alkyl benzyl dimethyl chloride did not show significant enhancement effect on the penetration of MTX. Transcutol was able to enhance transdermal absorption of MTX and the higher enhancement ratio was obtained with 2% (w/w) concentration of transcutol. Addition of salicylic acid increased this ratio. Prepared formulation containing transcutol 2% (w/w) and salicylic acid 6% (w/w) showed higher enhancement property and could be used clinically for local treatment of psoriasis.
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Affiliation(s)
- Yousef Javadzadeh
- Biotechnology Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, Iran.
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Enhanced topical delivery and ex vivo anti-inflammatory activity from a betamethasone dipropionate formulation containing fish oil. Inflamm Res 2009; 59:23-30. [DOI: 10.1007/s00011-009-0065-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 06/25/2009] [Accepted: 06/29/2009] [Indexed: 11/25/2022] Open
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2009; 60:643-59. [DOI: 10.1016/j.jaad.2008.12.032] [Citation(s) in RCA: 327] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 12/16/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
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Tiong W, Kelly E. Salicylic acid burn induced by wart remover: A report of two cases. Burns 2009; 35:139-40. [DOI: 10.1016/j.burns.2007.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
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50
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Carrascosa J, Vanacloch F, Borrego L, Fernández-López E, Fuertes A, Rodríguez-Fernández-Freire L, Zulaica A, Tuneu A, Caballé G, Colomé E, Bordas X, Hernanz J, Brufau C, Herrera E. Update of the Topical Treatment of Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70044-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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