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Although psoriasis has been a well-recognized skin condition for many years, there has been significant progress over the last decade on effective therapeutic models and treatment modalities for this autoimmune condition. But what exactly is this condition that affects nearly 125 million people across the globe and more than 8 million Americans?
As explained by the Centres for Disease Control and Prevention (CDC), psoriasis “is a chronic autoimmune skin disease that speeds up the growth cycle of skin cells.” This often emanates as “patches of thick red skin and silvery scales…” which “…are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places (fingernails, toenails, and mouth).”
The condition may present as a wide spectrum of severity and skin symptoms. Furthermore, psoriasis is often linked to more severe and chronic medical conditions, such as psoriatic arthritis, diabetes, and cardiac issues, to name a few. Psoriatic arthritis is especially common in those that have psoriasis, resulting in inflammation, joint pain, and stiffness that may inevitably lead to severe mobility issues.
Given the seriousness of this condition as well as its widespread prevalence, significant research and efforts have gone into finding sustainable treatments. There are entire labs, fellowships, clinical platforms, and organizations dedicated to helping individuals with psoriasis. Notably, the past decade has seen significant improvements in various treatment modalities, ranging from topical treatments, to injections and oral medications. There are many different mechanisms of action and physiological targets for psoriasis treatments; a few examples include reducing inflammation, slowing skin growth, or altering the immune system.
Phototherapy has received a lot of attention and research in the past few years. Per The National Psoriasis Foundation, the basic premise of phototherapy “involves exposing the skin to wavelengths of ultraviolet A light (UVA) or ultraviolet B light (UVB) under the supervision of a health care provider to treat psoriasis.” The idea behind this treatment is that “UV light penetrates the top layers of skin and stops the skin cells from growing too quickly, leading to improvement in psoriasis symptoms.”
Using phototherapy to help with psoriasis symptoms. Getty
More recent developments are also gaining traction. Late last week (July 16th), The New England Journal of Medicine (NEJM) published an article titled “Trial of Roflumilast Cream for Chronic Plaque Psoriasis.” The article discusses a clinical trial in which researchers tested the use of Roflumilast cream, which contains phosphodiesterase type 4 (PDE-4) inhibitor, as a potentially viable and sustainable topical treatment modality for plaque psoriasis. The study describes that 331 patients were randomized: “109 were assigned to roflumilast 0.3% cream, 113 to roflumilast 0.15% cream, and 109 to vehicle [placebo] cream.” The results indicated that “Roflumilast cream administered once daily to affected areas of psoriasis was superior to vehicle cream in leading to a state of clear or almost clear at 6 weeks.” However, the authors explicitly conclude that “Longer and larger trials are needed to determine the durability and safety of roflumilast in psoriasis.” This is often the case with new and cutting-edge therapies—larger and well-repeated, evidence-backed trials are required in order to truly understand a treatment’s efficacy and safety.
Another fascinating research trial by Harvard University’s Wyss Institute for Biologically Inspired Engineering and John A. Paulson School of Engineering and Applied Sciences (SEAS) was published yesterday, describing the use of small interfering RNA (siRNA) to help control psoriasis-related activity at the genetic level. The article explains that using siRNA based therapies on the skin has traditionally been challenging, given the compound’s instability and the skin’s barrier function. However, in this study, the authors claim that they found a way to effectively deliver the treatment molecule into the skin, resulting “in down-regulation of psoriasis-related signals.” Though more testing will be required to fully determine the safety and efficacy of this treatment model, this new development may potentially open the doors to a new way of delivering topical medications.
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