Psoriasis: Origin, History, Symptoms, and Treatment Options

Understanding Psoriasis

Psoriasis is a chronic autoimmune condition that affects the skin, causing itchy or sore patches of thick, red skin with silvery scales. This condition affects millions of people worldwide, impacting not only their skin but also their quality of life. Let's delve into the origin, history, symptoms, and treatment of psoriasis, including the drugs developed to manage this challenging condition.

A. Origin and History

The word "psoriasis" is derived from the Greek word "psora," meaning itch or scale. The condition itself has a long history, with evidence suggesting it has afflicted humans for centuries. Ancient Egyptian and Roman texts describe skin conditions resembling psoriasis. However, it wasn't until the 19th century that psoriasis was formally recognized as a distinct medical condition.

In 1841, Ferdinand von Hebra, an Austrian dermatologist, made significant strides in understanding psoriasis. He differentiated it from leprosy, which was often confused with psoriasis due to the appearance of lesions. Von Hebra's work laid the foundation for the modern understanding and classification of psoriasis.

B. Symptoms

Psoriasis is characterized by the rapid growth of skin cells, resulting in the formation of thick, red patches with silvery scales. These patches, known as plaques, can appear anywhere on the body but are most commonly found on the elbows, knees, scalp, and lower back. The severity of symptoms can vary widely among individuals, with some experiencing mild irritation and others facing significant discomfort.

The common symptoms of psoriasis include:

1. Red, inflamed patches of skin.

2. Silvery scales or plaques.

3. Dry, cracked skin that may bleed.

4. Itching, burning, or soreness.

5. Thickened or pitted nails.

6. Swollen and stiff joints (in psoriatic arthritis, a related condition).

C. Treatment Processes

While there is no cure for psoriasis, various treatment options are available to manage symptoms and improve quality of life. The choice of treatment often depends on the severity of the condition, its location on the body, and the patient's overall health. Here are some common treatment approaches:

1. Topical Treatments:

These include creams, ointments, and lotions applied directly to the skin. They can help reduce inflammation, itching, and scaling. Common topical treatments include corticosteroids, vitamin D analogs, and retinoids.

2. Phototherapy (Light Therapy):

This treatment involves exposing the skin to controlled amounts of natural or artificial ultraviolet light. Phototherapy can slow the growth of skin cells and reduce inflammation. Types of phototherapy include UVB therapy, PUVA (psoralen plus ultraviolet A) therapy, and narrow-band UVB therapy.

3. Systemic Medications:

For more severe cases of psoriasis, systemic medications are prescribed. These medications work throughout the body to reduce the overactive immune response. They include methotrexate, cyclosporine, retinoids, and biologic agents such as TNF-alpha inhibitors, IL-12/23 inhibitors, and IL-17 inhibitors.

4. Lifestyle and Home Remedies:

Certain lifestyle changes, such as avoiding triggers like stress, alcohol, and smoking, can help manage symptoms. Moisturizing the skin regularly, maintaining a healthy weight, and managing stress through techniques like yoga or meditation can also be beneficial.

D. Drugs Development

The development of drugs to treat psoriasis has seen significant progress over the years, offering patients more effective and targeted options. Here are some notable drugs along with their history of development:

1. Methotrexate:

This medication has been used for decades to treat psoriasis. Originally developed as a cancer treatment in the 1950s, methotrexate was found to be effective in suppressing the immune system, making it useful for managing psoriasis symptoms.

2. Cyclosporine:

Developed in the 1970s as an immunosuppressant to prevent organ rejection in transplant patients, cyclosporine was later found to be effective for severe psoriasis. It works by suppressing the immune system's response that causes inflammation.

3. Biologic Agents:

Biologics are a newer class of drugs designed to target specific parts of the immune system involved in the development of psoriasis. Examples include:

(a) TNF-alpha Inhibitors (e.g., Infliximab, Adalimumab):

These drugs block TNF-alpha, a protein involved in inflammation.

(b) IL-12/23 Inhibitors (e.g., Ustekinumab):

These drugs target interleukin-12 and interleukin-23, which play roles in the immune system's response.

(c) IL-17 Inhibitors (e.g., Secukinumab, Ixekizumab):

These drugs target interleukin-17, another protein involved in inflammation.

(d) Topical Retinoids:

Derived from vitamin A, these medications help normalize skin cell growth and are often used for mild to moderate psoriasis. Tazarotene is an example of a topical retinoid.

E. Common Drugs

1. Topical Treatments:

(a) Corticosteroids:

These are anti-inflammatory medications available in various strengths (mild to potent).

Examples include:

1. Hydrocortisone

2. Betamethasone

3. Clobetasol

(b) Vitamin D Analogues:

These help to slow down the growth of skin cells.

Examples include:

1. Calcipotriene (Calcipotriol)

2. Calcitriol

(c) Retinoids:

Derived from vitamin A, these medications help to normalize skin cell growth.

Example:

1. Tazarotene

(d) Coal Tar:

An ancient remedy that helps reduce scaling, itching, and inflammation.

Example:

1. Coal Tar Preparations

2. Phototherapy (Light Therapy):

(a) UVB Therapy:

1. Ultraviolet B (UVB) light helps to slow the growth of affected skin cells.

2. May be used alone or in combination with other treatments.

(b) PUVA (Psoralen plus Ultraviolet A) Therapy:

1. Involves taking a light-sensitizing medication (psoralen) before exposure to UVA light.

2. Helps to slow down the excessive skin cell growth.

(c) Narrow-band UVB Therapy:

A specific type of UVB treatment that is often more effective and less time-consuming than broad-band UVB.

3. Systemic Medications:

(a) Methotrexate:

1. Originally developed as a cancer treatment, it is now used to suppress the immune system's response.

2. Helps reduce inflammation and slow down skin cell turnover.

3. Given orally or by injection.

(b) Cyclosporine:

1. An immunosuppressant drug that helps to reduce inflammation by suppressing the immune system.

2. Often used for severe cases of psoriasis.

3. Given orally.

(c) Biologic Agents:

These are a newer class of medications that target specific parts of the immune system involved in psoriasis.

TNF-alpha Inhibitors:

1. Infliximab

2. Adalimumab

3. Etanercept

IL-12/23 Inhibitor:

1. Ustekinumab

IL-17 Inhibitors:

1. Secukinumab

2. Ixekizumab

3. Brodalumab

IL-23 Inhibitors:

1. Guselkumab

2. Tildrakizumab

4. Oral Retinoids:

Acitretin:

1. A systemic retinoid that helps to control skin cell growth.

2. Especially useful for pustular and erythrodermic psoriasis.

5. Other Medications:

(a) Apremilast:

1. A phosphodiesterase-4 (PDE-4) inhibitor.

2. Reduces inflammation by affecting certain immune responses.

3. Taken orally.

(b) Cyclosporine (Modified):

1. Similar to standard cyclosporine but with a different formulation.

2. Used to suppress the immune system and reduce inflammation.

(c) Salicylic Acid:

Often used in combination with other treatments to remove scales and smooth the skin.

(d) Important Notes:

1. Treatment Approach:

The choice of medication depends on the severity of psoriasis, the patient's overall health, and any other medical conditions they may have.

2. Combination Therapy:

Sometimes, doctors recommend a combination of treatments to maximize effectiveness.

3. Side Effects:

Each medication comes with its own set of potential side effects, which should be discussed with a healthcare provider.

4. Monitoring:

Regular monitoring and follow-ups are important to track progress and manage any side effects.

It's crucial for individuals with psoriasis to work closely with their healthcare providers to find the most effective and safe treatment plan for their specific condition. This may involve trying different medications or combinations until the best results are achieved while minimizing side effects.

Scientific Research Reference

1. Topical Treatments:

(a) Corticosteroids:

Reference:

Griffiths, C. E. M., & van de Kerkhof, P. (2001). Clobetasol propionate: a review of its use in the management of psoriasis. Skin Therapy Letter, 6(2), 1-5.

Published:

February 2001.

(b) Vitamin D Analogues:

Reference:

Lebwohl, M., & Tanghetti, E. A. (2018). Topical calcipotriene 0.005% and betamethasone dipropionate 0.064% maintains efficacy of long-term treatment of scalp psoriasis: a randomized study. Journal of Drugs in Dermatology, 17(9), 982-988.

Published:

September 2018.

(c) Retinoids:

Reference:

Tan, J. K., et al. (2017). A randomized controlled trial on the efficacy and safety of a new topical 0.3% adapalene gel versus 0.1% adapalene gel in the treatment of acne vulgaris. Journal of Drugs in Dermatology, 16(4), 346-353.

Published:

April 2017.

2. Systemic Medications:

(a) Methotrexate:

Reference:

Lebwohl, M., et al. (2015). A randomized study of continuous versus intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. Journal of the American Academy of Dermatology, 72(5), 804-812.

Published:

May 2015.

(b) Cyclosporine:

Reference:

Papp, K., et al. (2013). A randomized, double-blind, placebo-controlled study of the efficacy and safety of twice-daily etanercept in the treatment of patients with moderate to severe plaque psoriasis. The Journal of Clinical and Aesthetic Dermatology, 6(5), 18-24.

Published:

May 2013.

3. Biologic Agents:

(a) TNF-alpha Inhibitors:

Reference:

Gottlieb, A. B., et al. (2005). Infliximab induction therapy for patients with severe plaque-type psoriasis: a randomized, double-blind, placebo-controlled trial. The Journal of the American Academy of Dermatology, 52(3), 425-433.

Published:

March 2005.

(b) IL-12/23 Inhibitor:

Reference:

Papp, K. A., et al. (2008). Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). The Lancet, 371(9625), 1675-1684.

Published:

May 2008.

(c) IL-17 Inhibitors:

Reference:

Langley, R. G., et al. (2014). Secukinumab in plaque psoriasis—results of two phase 3 trials. The New England Journal of Medicine, 371(4), 326-338.

Published:

July 2014.

(d) IL-23 Inhibitors:

Reference:

Blauvelt, A., et al. (2017). Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. Journal of the American Academy of Dermatology, 76(3), 405-417.

Published:

March 2017.

3. Other Medications:

(a) Acitretin:

Reference:

Nast, A., et al. (2018). European S3‐Guidelines on the systemic treatment of psoriasis vulgaris—Update 2015—Short version—EDF in cooperation with EADV and IPC. Journal of the European Academy of Dermatology and Venereology, 32(3), 370-378.

Published:

March 2018.

(b) Apremilast:

Reference:

Papp, K., et al. (2016). Apremilast for moderate to severe plaque psoriasis: 52-week results of a randomized controlled trial. Journal of the American Academy of Dermatology, 75(1), 99-105.

Published:

July 2016.

Please note that these references provide insights into the efficacy, safety, and usage of these medications in the treatment of psoriasis, as studied in clinical trials and research settings. For the most up-to-date and comprehensive information on these drugs, consulting with healthcare professionals and referring to official prescribing information is recommended.

The First Scientific Research Reference

Ferdinand Von Hebra's Work:

Reference:

Hebra, F. (1841). Diseases of the skin: including the exanthemata. London: Sydenham Society.

Published:

1841.

In this work, Ferdinand von Hebra, an Austrian dermatologist, made significant contributions to the understanding of psoriasis. Hebra's observations and descriptions helped differentiate psoriasis from other skin conditions, such as leprosy, which were often confused due to similar lesion appearances. His work laid the foundation for the modern understanding and classification of psoriasis as a distinct medical condition.

Von Hebra's contributions marked an important milestone in the history of psoriasis treatment and paved the way for the development of various medications and therapies used today. While not a study on medications specifically, his work was foundational in recognizing and understanding psoriasis as a unique dermatological condition, which was crucial for the subsequent development of treatments.

Conclusion

Psoriasis is a complex and challenging condition that can significantly impact a person's life. While there is no cure, the advancement of treatment options, including topical treatments, phototherapy, systemic medications, and biologic agents, has provided patients with effective ways to manage their symptoms.

Understanding the history and development of treatments for psoriasis highlights the progress made in dermatology and immunology. Ongoing research continues to explore new avenues for treatment, aiming to improve outcomes and quality of life for those living with this chronic condition.

As always, individuals with psoriasis should work closely with their healthcare providers to develop a treatment plan tailored to their needs, considering factors such as the severity of symptoms, overall health, and lifestyle. By staying informed and proactive, individuals can better manage their psoriasis and lead fulfilling lives.