Psoriasis is characterized by hyperproliferation of cells with itchy and painful skin patches due to the failure of replacement of dead skin cells every three to four weeks that occur in a normal skin. Therapeutic strategies for psoriasis depend upon the severity and location of lesions. Conventional treatments include phototherapy, photochemotherapy and systemic therapy involving biologicals and immunomodulators. The synthetic drugs in use for treating psoriasis are associated with severe adverse effects. Patient affordability, intolerance, drug resistance, serious adverse events play a crucial role in the choice of systemic therapy. Eventhough biologicals might be life saving in cases of severe psoriasis, risks of infection in particular reactivation of latent tuberculosis and possibilities of cancer on prolonged treatment demands safe and efficient alternative treatments. Easy availability, better patient tolerance, affordability, multiple modes of biochemical action and acceptability strengthens the use of natural products for psoriasis. This comparative review documents the existing natural treasure with various plant extracts and secondary metabolites reported as antipsoriatic agents over conventional drugs and their associated adverse effects in the management of psoriasis.
Cite this article:
Sakthi Priyadarsini S, Vani PB, Kumar PR. A Comparative Review on Conventional and Traditional medicine in the Treatment of Psoriasis. Research J. Pharm. and Tech. 2020; 13(11):5642-5646. doi: 10.5958/0974-360X.2020.00983.X
Sakthi Priyadarsini S, Vani PB, Kumar PR. A Comparative Review on Conventional and Traditional medicine in the Treatment of Psoriasis. Research J. Pharm. and Tech. 2020; 13(11):5642-5646. doi: 10.5958/0974-360X.2020.00983.X Available on: https://rjptonline.org/AbstractView.aspx?PID=2020-13-11-98
1. Camp RDR. Psoriasis. In Champion RH, Burton JL, Burns DA. Textbook of Dermatology, Blackwell Science, London. 1998; 6th ed: pp. 1589–1590.
2. Gazi Shaikh, Sadath Ali, Talmale SY, Ulhas S Surwase, Kadam Bhalchandra, Shaikh Luqman. Alternative Medicine For Psoriasis - Natural Herbal Ayurvedic Treatment - A Review. International Journal of Herbal Medicine. 2012; 2(3): 455-463.
3. Eghlileb AM, Davies EG and Finlay AY. Psoriasis has a major secondary impact on the lives of family members and partners. British Journal of Dermatology. 2007; 156(6): 1245–1250.
4. Feldman SR, Fleischer AB Jr and Cooper JZ. New topical treatments change the pattern of treatment of psoriasis: dermatologists remain the primary providers of this care. International Journal of Dermatology. 2000; 39(1): 41-44.
5. Horn EJ, Fox KM, Patel V, Chiou CF, Dann F and Lebwohl M. Are patients with psoriasis undertreated? Results of National Psoriasis Foundation survey. Journal of the American Academy of Dermatology. 2007; 57(6): 957-962.
6. Langley RGB, Krueger GG and Griffiths CEM. Psoriasis: epidemiology, clinical features, and quality of life. Annals of the rheumatic diseases. 2005; 64(Suppl.2): ii18-ii23.
7. Rendon A and Schäkel K. Psoriasis Pathogenesis and Treatment. International Journal of Molecular Sciences. 2019; 20(6): 1475.
8. Ayala F. Clinical presentation of psoriasis. Reumatismo 2007; 59(Suppl.1): 40–45.
9. Singh RK, Lee KM, Ucmak D, Brodsky M, Atanelov Z, Farahnik B et al. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016; 6: 93–104.
10. Barr RJ and Young EM Jr. Psoriasiform and related papulosquamous disorders. Journal of Cutaneous Pathology. 1985; 12: 412-425.
11. De Rosa G and Mignogna C. The histopathology of psoriasis. Reumatismo 2007; 59(Suppl 1): 46-48.
12. Weedon D and Strutton J. The psoriasiform reaction pat-tern. In: David Weed on Skin Pathology. Churchill Livingstone, London.2002;12th ed: pp. 75-83.
13. Hani AA, Muhammad S, Abdullah A, AlSayed K, Ahmad S and Issam B. Genetic Background of Psoriasis. International Journal of Health Sciences. 2010; 4(1): 23-29.
14. Nair RP, Henseler T, Jenisch S, Stuart P, Bichakjian CK, Lenk W, et al. Evidence for two psoriasis susceptibility loci (HLA and 17q) and two novel candidate regions (16q and 20p) by genome-wide scan. Human Molecular Genetics. 1997; 6(8): 1349–1356.
15. Trembath RC, Clough RL, Rosbotham JL, Jones AB, Camp RD, Frodsham A, et al. Identification of a major susceptibility locus on chromosome 6p and evidence for further disease loci revealed by a two stage genome-wide search in psoriasis. Human Molecular Genetics. 1997; 6(5): 813–820.
16. Gudjonsson JE, Karason A, Runarsdottir EH, Antonsdottir AA, Hauksson VB, Jónsson HH, et al. Distinct clinical differences between HLA-Cw*0602 positive and negative psoriasis patients - An analysis of 1019 HLA-C- and HLA-B-typed patients. Journal of Investigative Dermatology. 2006; 126(4): 740–745.
17. Nair RP, Stuart PE, Nistor I, Hiremagalore R, Chia NVC, Jenisch S, et al. Sequence and Haplotype Analysis Supports HLA-C as the Psoriasis Susceptibility 1 Gene. American Journal of Human Genetics. 2006; 78(5): 827–851.
18. Fry L, Baker BS. Triggering psoriasis: the role of infections and medications. Clinical Dermatology. 2007; 25(6): 606-615.
19. Naldi L, Chatenoud L, Linder D, Fortina AB, Peserico A, Virgili AR, et al. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: Results from an Italian case-control study. Journal of Investigative Dermatology. 2005; 125(1): 61–67.
20. Verhoeven EW, Kraaimaat FW, De Jong EM, Schalkwijk J, Van de Kerkhof PC and Evers AW. Individual differences in the effect of daily stressors on psoriasis: a prospective study. British Journal of Dermatology. 2009; 161(2): 295–299.
21. Verhoeven EWM, Kraaimaat FW, De Jong EMGJ, Schalkwijk J, Van de Kerkhof PCM, Evers AWM. Effect of Daily Stressors on Psoriasis: A Prospective Study. Journal of Investigative Dermatology. 2009; 129(8): 2075–2077.
22. Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis. International Journal of Dermatology. 2010; 49(12): 1351–1361.
23. O'Brien M, Koo J. The mechanism of lithium and beta-blocking agents in inducing and exacerbating psoriasis. Journal of Drugs in Dermatology. 2006; 5(5): 426–432.
24. Ashcroft DM, Po AL, Williams HC, Griffiths CE. Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis. British Medical Journal. 2000; 320(7240): 963–967.
25. Kragballe K, Gjertsen BT, De Hoop D, Van de Kerkhof PCM, Karlsmark T, Larko O, et al. Double-blind, right/left comparison of calcipotriol and betamethasone valerate in treatment of psoriasis vulgaris. Lancet. 1991; 337(8735): 193–196.
26. Mason AR, Mason J, Cork M, Dooley G and Edwards G. Topical treatments for chronic plaque psoriasis. Cochrane Database of Systematic Reviews. 2009; 2: Art. No.:CD005028.
27. Morison WL, Marwaha S and Beck L. PUVA-induced phototoxicity : Incidence and causes. Journal of the American Academy of Dermatology. 1997; 36(2 Pt 1): 183-185.
28. Wolff K. Side-effects of psoralen photochemotherapy (PUVA). British Journal of Dermatology. 2006; 122(s36): 117–125.
29. Cox AJ. Epidermal Dystrophy. Archives of Dermatology. 2011; 115(5): 567.
30. Pearce DJ, Higgins KB, Stealey KH, Balkrishnan R, Crane MM, Camacho F, et al. Adverse events from systemic therapies for psoriasis are common in clinical practice. Journal of Dermatological Treatment. 2006; 17(5): 288–293.
31. Katz HI, Waalen J and Leach EE. Acitretin in psoriasis: An overview of adverse effects. Journal of the American Academy of Dermatology. 1999; 41(Suppl 3): 7–12.
32. Sarkar R, Chugh S and Garg V. Acitretin in dermatology. Indian Journal of Dermatology Venereol Leprol. 2013; 79(6): 759-771.
33. Colombo MD, Cassano N, Bellia G and Vena GA. Cyclosporine Regimens in Plaque Psoriasis: An Overview with Special Emphasis on Dose, Duration, and Old and New Treatment Approaches. Scientific World Journal. 2013; 2013: 805705.
34. Grossman RM, Chevret S, Abi-Rached J, Blanchet F and Dubertret L. Long-term Safety of Cyclosporine in the Treatment of Psoriasis. Archives of Dermatology. 1996; 132(6): 623-629.
35. Kim BR, Yang S, Doh EJ, Choi CW and Youn SW. Risk factors affecting adverse effects of cyclosporine a in a real-world psoriasis treatment. Annals of Dermatology. 2018; 30(2): 143–149.
36. Markham T, Watson A and Rogers S. Adverse effects with long-term cyclosporin for severe psoriasis. Clinical and Experimental Dermatology. 2002; 27(2): 111–114.
37. West J, Ogston S and Foerster J. Safety and efficacy of methotrexate in psoriasis: A meta-analysis of published trials. PLoS One. 2016; 11(5): 1–14.
38. Masuria B L, Mittal A, Gupta L K, Sharma M, Bansal N. Methotrexate: Side effects and the role of folic acid supplementation in psoriasis – A study. Indian Journal of Dermatology Venereol Leprol. 1997; 63: 219-222.
39. Balighi K, Zahra G, Azadeh G, Pardis H, Ehsan S, Arghavan A. Assessment of the therapeutic aspect of systemic non-biologic anti-psoriatic treatment modalities used in combination with methotrexate. Indian Journal of Dermatology. 2016; 61(1): 118.
40. Langley A, Beecker J. Management of common side effects of apremilast. Journal of Cutaneous Medicine and Surgery. 2018; 22(4): 415–421.
41. Papp KA. The safety of etanercept for the treatment of plaque psoriasis. Therapeutics and Clinical Risk Management. 2007; 3(2): 245–258.
42. Scheinfeld N. The medical uses and side effects of etanercept with a focus on cutaneous disease. Journal of Drugs in Dermatology. 2004; 3(6): 653-659.
43. Fleischmann R and Iqbal I. Risk: Benefit profile of etanercept in elderly patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis. Drugs and Aging 2007; 24(3): 239–254.
44. Leman JA and Burden AD. Treatment of severe psoriasis with infliximab. Therapeutics and Clinical Risk Management. 2008; 4(6): 1165–1175.
45. Antonio JR, Sanmiguel J, Cagnon GV, Augusto MSF, de Godoy MF and Pozetti EMO. Infliximab in patients with psoriasis and other inflammatory diseases: Evaluation of adverse events in the treatment of 168 patients. Anais brasileiros de dermatologia. 2016; 91(3): 306–310.
46. Schmitt J and Wozel G. Targeted treatment of psoriasis with adalimumab: A critical appraisal based on a systematic review of the literature. Biologics: Targets and Therapy. 2009; 3: 303–318.
47. Alwawi EA, Mehlis SL and Gordon KB. Treating psoriasis with adalimumab. Therapeutics and Clinical Risk Management. 2008; 4(2): 345–351.
48. Patel T and Gordon KB. Adalimumab: Efficacy and safety in psoriasis and rheumatoid arthritis. Dermatologic Therapy. 2004; 17(5): 427–431.
49. Morais MR, Meneghello LP, De Oliveira CF and Carvalho AVE. Late reaction to ustekinumab infusion. Dermatology Reports 2013; 5(1): 3–4.
50. Chu CH, Davis C. Urticarial reaction to ustekinumab during the treatment of plaque psoriasis in a hepatitis C-positive patient. Drug Safety - Case Reports. 2017; 4(1): 1–3.
51. Masood E. Medicinal plants threatened by over-use. Nature. 1997; 385(6617): 570.
52. Müller K. Antipsoriatic anthrones: Aspects of oxygen radical formation, challenges and prospects. General Pharmacology. 1996; 27(8): 1325–1335.
53. Saelee C, Thongrakard V and Tencomnao T. Effects of Thai medicinal herb extracts with anti-psoriatic activity on the expression on NF-κb signaling biomarkers in Hacat keratinocytes. Molecules. 2011; 16(5): 3908–3932.
54. Ronpirin C, Charueksereesakul T, Thongrakard V and Tencomnao T. Effects of ethanolic extract of Annona squamosa L. leaves on the expression of EGFR. Journal of Chemical and Pharmcaeutical Research. 2014; 6(4): 791–797.
55. Kawjit N, Charueksereesakul T, Thongrakard V, Sangsuthum S and Tencomnao T. Suppressive effect of ethanolic extract of Annona squamosa L. leaves on the expression of Id1 biomarker: Phytochemical investigation and antioxidant activity study. Journal of Chemical and Pharmaceutical Research. 2014; 6(1): 499–506.
56. Azadeh Izadyari Aghmiuni and Azim Akbarzadeh Khiavi. Medicinal Plants To Calm And Treat Psoriasis Disease. Aromatic and Medicinal Plants – Back to Nature. 2017; Chapter1,1-28.
57. Safayhi H, Sabieraj J, Sailer ER and Ammon HP. Chamazulene: an antioxidant-type inhibitor of leukotriene B4 formation. Planta Medica. 1994; 60(5): 410-413.
58. Alalaiwe A, Hung C, Leu Y, Tahara K, Chen H, Hu K, et al. The active compounds derived from Psoralea corylifolia for photochemotherapy against psoriasis-like lesions: The relationship between structure and percutaneous absorption. European Journal of Pharmaceutical Sciences. Available from: https://doi.org/10.1016/j.ejps.2018.08.031
59. Bader A, Martini F, Schinella GR, Rios JL and Prieto JM. Modulation of Cox-1, 5-, 12- and 15-Lox by popular herbal remedies used in Southern Italy against psoriasis and other skin diseases. Phytotherapy Research. 2015; 29(1): 108–113.
60. Palaniswamy D, Nithyanantham M, Raghu P and Dwarampudi L. Antipsoriatic activity and cytotoxicity of ethanolic extract of Nigella sativa seeds. Pharmacognosy Magazine. 2012; 8(32): 268.
61. Okasha EF, Bayomy NA, Abdelaziz EZ. Effect of topical application of black seed oil on imiquimod-induced psoriasis-like lesions in the thin skin of adult male albino rats. The Anatomical Record. 2018; 301(1): 166–174.
62. Vijayalakshmi A, Ravichandiran V, Velraj M, Nirmala S and Jayakumari S. Screening of flavonoid “quercetin” from the rhizome of Smilax china Linn. for anti-psoriatic activity. Asian Pacific Journal of Tropical Biomedicine. 2012; 2(4): 269–275.
63. Vijayalakshmi A, Geetha M. Anti-psoriatic activity of flavonoids from Cassia tora leaves using the rat ultraviolet B ray photodermatitis model.
Revista Brasileira de Farmacognosia., June 2014, vol.24, no.3, p.322-329.
64. Vijayalakshmi A, Geetha M. Anti-psoriatic activity of Givotia rottleriformis in rats. Indian Journal of Pharmacology. 2014;46(4):386–390.
65. Lebwohl M and Ali. S. Treatment of psoriasis. Part 2. Systemic therapies, Journal of the American Academy of Dermatology. 2001; 45(5): 649-661.
66. Fortune DG, Richards HL and Griffiths CE. Psychologic factors in psoriasis: consequences, mechanisms, and interventions. Dermatologic Clinics. 2005; 23(4): 681-694.
67. Raychaudhuri SP, Nguyen CT, Raychaudhuri SK and Gershwin ME. Incidence and nature of infectious disease in patients treated with anti-TNF agents. Autoimmunity Reviews. 2009; 9(2): 67-81.
68. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD et al. Tuberculosis associated with Infliximab, a tumor necrosis factor alpha-neutralizing agent. The New England Journal of Medicine. 2001; 345(15): 1098-1104.
69. Lancet R. Adverse reactions to TNF-alpha inhibitors in Rheumatoid arthritis. 2002; 359(9306): 540-541.
70. Fuchs E and Raghavan S. Getting under the skin of epidermal morphogenesis. Nature Reviews Genetics. 2002; 3(3): 199-209.
71. Zhou Q, Mrowietz U and Rostami-Yazdi M. Oxidative stress in the pathogenesis of psoriasis. Free Radical Biology and Medicine. 2009; 47(1): 891-905.
72. Bertrand Rihn, Claude Saliou, Marie Claire Bottin, Gerard Keith and Lester Packer. From ancient remedies to modern therapeutics: pine bark uses in skin disorders revisited. Phytotherapy research. 2001; 15(1): 76-78.
73. Chung-yu Liang, Tung-Yi Lin, and Yin –Ku Lin. Successful treatment of pediatric nail psoriasis with periodic pustular eruption using topical Indigo naturalis oil extract. Pediatric Dermatology. 2013; 30(1): 117-119.
74. Lin YK, Wong WR, Chang YC, Chang CJ, Tsay PK, Chang SC et al. The efficacy and safety of topically applied Indigo naturalis ointment in patients with plaque-type psoriasis. Dermatology. 2007; 214(2): 155-161.
75. Lin YK, Chen HW, Leu YL, Yang YL, Fang Y, Su Pang JH and Hwang TL. Indigo naturalis upregulates claudin-1 expression in human keratinocytes and psoriatic lesions. Journal of Ethnopharmacology. 2013; 145: 614-620.
76. Lin YK, Leu YL, Huang TH, Wu YH, Chung PJ, Su Pang JH and Hwang TL. Anti-inflammatory effects of the extract of Indigo naturalis in human neutrophils. Journal of Ethnopharmacology. 2009; 121(1): 51-58.
77. Wu Y, Chen X, Ge X, Xia H, Wang Y, Su S et al. Isoliquiritigenin prevents the progression of psoriasis-like symptoms by inhibiting NF-κB and proinflammatory cytokines. Journal of Molecular Medicine. 2016; 94(2): 195-206.
78. Grossman RM, Krueger J, Yourish D, Granelli-Piperno A, Murphy DP, May LT et al., Interleukin 6 is expressed in high levels in psoriatic skin and stimulates proliferation of cultured human keratinocytes. Proceedings of the National Academy of Sciences of the United States of America. 1989; 86(16): 6367-6371.
79. Maggiolini M, Statti G, Vivacqua A, Gabriele S, Rago V, Loizzo M et al. Estrogenic and antiproliferative activities of isoliquiritigenin in MCF7 breast cancer cells. Journal of Steroid Biochemistry and Molecular Biology. 2002; 82(4-5): 315-322.
80. Li HJ, Wu NL, Lee GA and Hung CF. The Therapeutic Potential and Molecular Mechanism of Isoflavone Extract against Psoriasis. Scientific Reports. 2017; 8: 6335.