A novel combination anti-psoriasis therapy has potential for superior and longer-lasting therapeutic effects than current topical treatments by targeting genetic abnormalities in deeper layers of the skin. This research is being presented at the 2013 American Association of Pharmaceutical Scientists (AAPS) Annual Meeting and Exposition, the world’s largest pharmaceutical sciences meeting, in San Antonio, Nov. 10-14.
Psoriasis is a chronic autoimmune skin disorder that significantly impacts a patient’s quality of life. The overactive immune system triggers skin cells to grow rapidly and then form psoriatic plaques. Approximately 7.5 million people have psoriasis in the United States, according to the American Academy of Dermatology.
Mandip Sachdeva, Ph.D., and Srujan Marepally, Ph.D., along with their colleagues from Florida Agricultural and Mechanical University, developed a topical formulation of a gene-regulating nanoparticle (Dual-F-NALP) carrying two nucleic acids, which controls the skin cells from developing psoriatic plaques and suppresses inflammation.
To test the effectiveness of their formulation they used the Psoriasis Area and Severity Index (PASI), a clinical scoring system from 0, with four being the most severe. Before treatment, the psoriatic plaque-like mouse model had a score of four, with increased inflammation and skin thickening, which confirmed their impaired natural healing. Their PASI score decreased to zero after five days of Dual-F-NALP treatment.
“Our goal was to reconstitute the balance between skin and immune system in psoriatic plaques,” said Sachdeva. “Since this therapy targets the vicious cycle within skin over activation and immune hypersensitivity in the deeper dermal layers, the chance for relapse of the disease is less. We anticipate a once-a-day application with the therapeutic effects lasting longer than current topical treatment, which need to be applied multiple times a day. It is possible that this increased effectiveness will translate to early recovery from psoriatic lesions, and that is an area we will be examining in our future work.”
Sachdeva compared their formulation with Tacrolimus, an existing topical ointment used to treat psoriasis. Since Tacrolimus is an immunosuppressant, a main side effect is redness and itchiness around the application area and long-term use is avoided because it has been linked to skin cancer and lymphoma.
The next stage of Sachdeva’s research is to test in humanized mouse models with psoriasis plaque and conduct toxicology tests.
Topical Treatments for Psoriasis
For most people with mild psoriasis, therapy begins with topical treatments. These are medications in creams, solutions, lotions, foams, sprays, or ointments that are applied to the skin and scalp. There are a number of different approaches possible. It may take some time to find the one that works best for you.
Here are some of the most common topical treatments.
Corticosteroids, or steroids, are the most commonly prescribed drug for psoriasis. They are often used to treat mild to moderate cases. They work by reducing inflammation and slowing the growth and build-up of skin cells.
Topical corticosteroids come in different strengths designed for use on different parts of the body. Stronger potency steroids might be necessary for tough to treat areas of psoriasis on the elbows or knees. Weaker formulas are good for more sensitive skin on the face or groin. Directions for use vary depending on the particular medication. You will probably have to apply it once or twice a day. Your doctor may recommend that you try occlusion, which means applying the steroid cream and then wrapping the area with tape or plastic to increase the effect.
Steroids can cause side effects, such as thinning of the skin, changes in the skin color, bruising, and dilated blood vessels. Occlusion may increase these side effects. If steroids are used on too much of the body, it’s possible to develop more serious health problems.
Although steroids may work very well at first, your psoriasis may become resistant to them over time. Topical corticosteroids are now often used in combination with topical vitamin D analogs such as calcipotriene (Dovonex) or topical retinoids such as tazarotene (Tazorac). In some cases, steroids may be injected instead of applied to the surface of the skin.
Vitamin D analogues. Dovonex (calcipotriene) is a form of vitamin D that is sold as a cream, ointment, or solution. It treats psoriasis by slowing down the growth of your skin cells, and it’s safer than steroids for long-term use. Because Dovonex can irritate the skin, it should only be used in small amounts. Be careful not to get it on the healthy skin surrounding the psoriatic plaques. Your doctor will probably tell you to apply it twice a day. Dovonex is toxic if ingested, so keep it away from pets and children. You may use Dovonex together with a corticosteroid. Be careful with any medications that you use along with Dovonex. Some topical medicines, like salicylic acid, can stop it from working.
Another new vitamin D analogue has been introduced and contains both a topical steroid and calcipotriene (Taclonex).
Tazorac (tazarotene) and other retinoids are gels or creams derived from vitamin A. Retinoids come in different strengths to treat different types of psoriasis in different locations, including the scalp and nails. Usually, you would apply a small dab to each lesion once a day, before bed. Tazorac is often combined with steroid treatment. Women who are pregnant or who might become pregnant should probably not use topical retinoids.
This work was supported by NIMHD P20 grant, 1P20MD006738-0.
The 2013 AAPS Annual Meeting and Exposition aims to improve global health through advances in pharmaceutical sciences, and there will be 480 exhibits and an estimated 7,500 attendees. The meeting features nearly 105 programming sessions, including more than 50 symposia and roundtables and more than 2,200 posters. Download the AAPS smartphone application for additional information.
What are the aims of this leaflet?
Patients with psoriasis are usually treated with preparations that are applied to the skin. This leaflet has been written to help you understand more about these treatments. It tells you what they are, how they are used, and where you can find out more about them.
What are topical treatments?
Treatments that are applied directly to the skin are known as topical treatments. They are the main type of treatment prescribed for most patients with psoriasis. More severe psoriasis may need a variety of other treatments including ultraviolet light or special tablets. Details of these further treatments are given in a separate Patient Information Leaflet: “Treatments for moderate or severe psoriasis”. However, most patients on these further (second line) treatments will still need to continue to use topical treatments.
What is psoriasis?
Psoriasis is a common skin disorder affecting about 1-3% of the UK population. It occurs equally in men and women, may occur at any age, and tends to come and go unpredictably. It is not contagious from one person to another and does not form scars on the skin. Patches of psoriasis are red and covered by silvery white scale. These patches (also called plaques) usually occur on the knees, elbows, trunk or scalp, but may occur on any area of the skin.
The patches of psoriasis are the result of a process occurring in the skin that leads to thickened, inflamed scaly skin. The cause of psoriasis is not known. It sometimes occurs in family members or family members from a previous generation (genetic cause). Sometimes psoriasis is triggered by an outside event such as a sore throat, stress or an injury to the skin.
Can psoriasis be cured?
Unfortunately there is no cure for psoriasis. However, treatments for psoriasis are usually effective. Psoriasis may clear after a course of treatment, but it may return (relapse). Relapse may not occur for years, but it can occur within a few weeks. There is no evidence that any treatments alter the future of psoriasis (prognosis). Delaying treatment or using treatment early does not affect the future outcome of psoriasis.
The American Association of Pharmaceutical Scientists is a professional, scientific association of approximately 11,000 members employed in academia, industry, government and other research institutes worldwide. Founded in 1986, AAPS provides a dynamic international forum for the exchange of knowledge among scientists to serve the public and enhance their contributions to health. AAPS offers timely scientific programs, on-going education, information resources, opportunities for networking, and professional development.
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