Therapeutic moisturizers as adjuvant therapy for psoriasis patients

Flavonoid compounds and their synergistic effects: Promising approaches for the prevention and treatment of psoriasis with emphasis on keratinocytes - A systematic and mechanistic review

Psoriasis, a chronic autoimmune skin disorder, causes rapid and excessive skin cell growth due to immune system dysfunction. Numerous studies have shown that flavonoids have anti-psoriatic effects by modulating various molecular mechanisms involved in inflammation, cytokine production, keratinocyte proliferation, and more. This study reviewed experimental data reported in scientific literature and used network analysis to identify the potential biological roles of flavonoids' targets in treating psoriasis. 947 records from Web of Sciences, ScienceDirect database, Scopus, PubMed, and Cochrane library were reviewed without limitations until June 26, 2023. 66 articles were included in the systematic review. The ten genes with the highest scores, including interleukin (IL)-10, IL-12A, IL-1β, IL-6, Tumor necrosis factor-α (TNF-α), Janus kinase 2 (JAK 2), Jun N-terminal kinase (JUN), Proto-oncogene tyrosine-protein kinase Src (SRC), Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), and Signal transducer and activator of transcription 3 (STAT3), were identified as the hub genes. KEGG pathway analysis identified connections related to inflammation and autoimmune responses, which are key characteristics of psoriasis. IL-6, STAT3, and JUN's presence in both hub and enrichment genes suggests their important role in flavonoid's effect on psoriasis. This comprehensive study highlights how flavonoids can target biological processes in psoriasis, especially when combined for enhanced effectiveness.

Types of Psoriasis and Their Effects on the Immune System

Psoriasis is a chronic inflammatory skin disease which is identified by the appearance of erythematous that is clearly demarcated, scaly plaques. It is a skin disease seen regularly around the elbow, scalp, trunk, and also on the knees. Psoriasis is a commonly occurring chronic disease with no cure. In psoriasis, which is thought to be an immune system-related problem, the cells of the skin grow quicker than normal cells. The rapid turnover of cells is responsible for the dry scaly patches seen clinically, also called plaque type of psoriasis. The etiopathogenesis of psoriasis is not yet fully understood. It is considered an outcome of some alteration of the cells in the immune system, which fights infections, but here, it attacks healthy cells, which is the problem. Researchers believe both environmental and genetic factors play a role. It is commonly known that psoriasis is not contagious as it does not spread by air or water. There is a chance of increasing the risk of acquiring psoriasis, also worsening the disease severity by smoking and tobacco consumption. Anyone irrespective of age or gender can develop psoriasis. Psoriasis is divided into various kinds: plaque, nail type, guttate, or inverse, also pustular. The most commonly occurring type of psoriasis is plaque psoriasis, seen with itchy, dry, scales covering patches of skin that are raised.

Treatment Strategies Against Psoriasis: Principle, Perspectives and Practices

BACKGROUND

Psoriasis is a genetically predisposed autoimmune disease mediated by cytokines released by the activated immune cells. It manifests inflammatory, scaly red or white silvery flaky skin which may be a fluid-filled lesion with soreness and itchiness. The prevalence rate of psoriasis is increasing day by day. Despite having such a high prevalence rate, the treatment of psoriasis is still limited. Hence, there is a need to rethink the various treatment strategies available in the allopathic as well as in the alternative systems of medicine.

METHODS

Various bibliographic databases of previously published peer-reviewed research papers were explored and systematic data culminated in terms of various treatment strategies used for the management of psoriasis. The prime focus is given towards modern as well as alternative systems of medicine such as phototherapy, a combination of phototherapy with pharmacotherapy such as Ayurveda, Yoga and naturopathy, Unani, Siddha, and Homeopathy to treat psoriasis.

RESULTS

A comprehensive review of 161 papers, including both research and review articles, was carried out to make the article readily understandable. The pathogenesis including inflammatory mediators and type of psoriasis is discussed before the treatment strategies to understand the pathophysiology of the disease. The uniqueness, procedure, advantages, and limitations of conventional, advanced, and traditional systems of medicine to treat psoriasis are discussed in detail. Emphasis has also been given towards marine sources such as fish oil, marine sponges, and algae.

CONCLUSION

Although there are many modern and alternative treatment strategies available to treat psoriasis, none of them have been proven to provide complete relief to patients. Moreover, they are associated with certain side effects. In order to overcome them, novel drug delivery systems have been utilized and found effective; however, their stability and safety become the major impediments towards their successful positioning. Traditional and alternative treatment strategies have found to be safe and effective but their use is localized to certain areas. In a nutshell, to achieve successful treatment of psoriasis, there is a need to focus on the development of stable and non-toxic novel drug delivery systems or the promotion of traditional systems to treat psoriasis.

Treatment Modalities of Psoriasis: A Focus on Requisite for Topical Nanocarrier

BACKGROUND AND OBJECTIVE

Psoriasis is an autoimmune skin disease involving cascading release of cytokines activated by the innate and acquired immune system. The increasing prevalence rate of psoriasis demands for more appropriate therapy. The existing chemical moiety is promising for better therapeutic outcome, but the selection of a proper channel for administration has to be reviewed. Hence there is a need to select the most appropriate dosage form and route of administration for improving the curative rate of psoriasis.

RESULTS

A total of 108 systematic reviews of research and review articles were conducted to make the manuscript comprehensible. The role of inflammatory mediators in the pathogenesis of the disease is discussed for a better understanding of the selection of pharmacotherapy. The older and newer therapeutic moiety with its mode of administration for psoriasis treatment has been discussed. With a comparative review on topical and oral administration of first-line drugs such as methotrexate (MTX), cyclosporine (CsA), and betamethasone, its benefits-liabilities in the selected routes were accounted for. Emphasis has also been paid on advanced nanocarriers for dermatologic applications.

CONCLUSION

For a better therapeutic outcome, proper selection of drug moiety with its appropriate administration is the major requisite. With the advent of nanotechnology, the development of nanocarrier for dermatologic application has been successfully demonstrated in positioning the systemically administrated drug into topical targeted delivery. In a nutshell, to achieve successful treatment strategies towards psoriasis, there is a need to focus on the development of stable, non-toxic nanocarrier for topical delivery. Inclusion of the existing orally administered drug moiety into nanocarriers for topical delivery is proposed in order to enhance therapeutics payload with reduced side effects which serves as a better treatment approach for relief of the psoriasis condition.

Dermatology Life Quality Index and disease coping strategies in psoriasis patients

Introduction

Psoriasis is a chronic, psycho-dermatological condition. Psychological factors can trigger and/or exacerbate skin lesion. Relapse of disease can be a source of stress and can worsen the patient's Quality of Life. Coping with psoriasis can create stress. This can become a vicious cycle.

Aim

To illustrate the connection between quality of life and coping strategies in a psoriasis patient group and to describe a methodology for identifying the risk group of patients who need immediate attention in terms of developing better coping strategies.

Material and methods

Fifty patients with psoriasis were enrolled in the study. The severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI), the Dermatology Life Quality Index (DLQI) was used for quality of life assessment, and the COPE questionnaire was used for determination of coping strategies used by psoriasis patients.

Results

The results of the study indicate the relationship between quality of life and coping strategies. In patients with coping < 140 and at least elementary education, psoriasis disease is most likely to have an extremely large effect on quality of life as measured by the DLQI score being above 21.

Conclusions

Psoriasis is a distressing disorder that significantly impairs quality of life. There is a close link between quality of life and coping strategies. This study illustrates a methodology for identification of a risk group of patients with a highly decreased quality of life indicator and underdeveloped coping strategies. Future management of psoriasis may require involvement of multidisciplinary teams that help patients to manage the physical and psychological aspects of psoriasis.

Self-care for older people with psoriasis

Psoriasis affects 1.5% of the UK population and due to the ageing population it is more common in older people. The incidence of type II psoriasis peaks in patients between 57 and 62 years of age, and has different genetic markers. Chronic plaque psoriasis can be challenging for older people as the majority are treated in primary care and expected to self-manage. Community nurses can support older people with psoriasis and their families in understanding current evidence based psoriasis management, and finding solutions to these challenges.

Topical Therapies in Psoriasis

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.

The science of dermocosmetics and its role in dermatology

Our increased knowledge of normal skin physiology has ushered in a subtle revolution in cosmetic science. Originally designed as preparations to enhance personal appearance by direct application on to the skin, cosmetics have now taken on a new role in dermatology, through the support of the management of many skin disorders. This evolving role of cosmetics in skin care is primarily due to scientific and technological advancements that have changed our understanding of normal skin physiology and how cosmetics modify its appearance both physically and biologically. The vast array of techniques currently available to investigate skin responsivity to multiple stimuli has brought about a new era in cosmetic and dermocosmetic development based on a robust understanding of skin physiology and its varied responses to commonly encountered environmental insults. Most cosmetic research is undertaken on reconstructed skin models crucial in dermatological research, given the strict ban imposed by the European Union on animal testing. In addition, the design and conduct of trials evaluating cosmetics now follow rules comparable to those used in the development and evaluation of pharmaceutical products. Cosmetic research should now aim to ensure all trials adhere to strictly reproducible and scientifically sound methodologies. The objective of this review is to provide an overview of the multidisciplinary scientific approach used in formulating dermocosmetics, and to examine the major advances in dermocosmetic development and assessment, the safety and regulatory guidelines governing their production and the exciting future outlook for these dermocosmetic processes following good practice rules.

An overview of psoriasis and the role of emollient therapy

Psoriasis is a common skin condition affecting 1.5% of the UK population. Patients with psoriasis have to manage and cope with their psoriasis on a day to day basis; which includes understanding how to self manage and use topical therapy. General skin care, including the importance of emollients is often an overlooked therapy area in psoriasis. This article gives an overview of psoriasis and current recommended topical treatments by the new NICE Assessment and Management of psoriasis Guidelines (2012). A recent survey looking at emollients and psoriasis are discussed. The best emollient for the patients is the one with the formulation that individually suits them and they want to use as part of a daily skin care routine.

Diagnosis and treatment of pediatric psoriasis: current and future

Psoriasis is a common yet complex inflammatory dermatosis that may be seen in infants, children, and adolescents. The clinical presentation and course may be quite variable, and while patients with mild disease are often easily managed, those with recalcitrant or more severe disease often present a therapeutic dilemma given the number of therapies available and the relative lack of data on the efficacy and safety of use of these therapies in children. This review presents the reader with an overview of the current understanding of the pathophysiology, diagnosis, and treatment of pediatric psoriasis, with an emphasis on the available data in the literature that pertains to the use in children of currently available topical and systemic therapies, including topical corticosteroids, vitamin D analogs, phototherapy, systemic immunosuppressive medications, and biologic agents.