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Current Treatment of Psoriasis

Abstract

This study observes there is a range of definite treatments and the concrete identification of the symptoms and their effects on the patients. The drawbacks of non-invasive delivery of lipophilic and hydrophilic drugs into skin is been addressed. CBD which accumulates in bio membranes, is a promising antioxidant defensive compound. MHRA and FHA have authorised the Cannabis-based products for medicinal use in humans that are listed in Schedule 2 to the MDR 2001. The study of drug loading vs. drug crystallisation in pressure sensitive adhesives to design transdermal patches are achieved. For many diseases like pancreatic disorder or Psoriasis, the severe seen condition of the patient with excessive pain, this CBD treatment immediately progresses the patient condition and this helps the patient for faster recovery from the previous condition. As a result, the aim of this research is to include a concise statement about the incorporation of CBD with microneedles and the treatment of psoriasis, and clinical challenges.

Advanced drug delivery system for the treatment of psoriasis

Advanced drug delivery system for the treatment of psoriasis

Psoriasis

Psoriasis is an autoimmune disorder characterized by general, chronic, inflammation and proliferation of the skin. Treatment for psoriasis has advanced over the years, based on continued research on how psoriasis attacks the body and the role of the body’s immune system in fighting it. Biologic therapy to target specific cells of the body involved in immune mediation, has been very efficient in the current treatment of psoriasis. Non biological therapy has also been effective.


Recent advanced drug delivery systems

Biological treatment targets the immune system cells that cause the clinical symptoms seen in psoriatic patients. These agents are specifically made to interfere with activation of T cells and effector functions. (Okubo et al., 2021)

There are a number of strategies applied in the blockage of T cells activation. One is reduction of the number of T cells that are pathogenic, and alefacept uses this strategy. This is a fusion protein that is composed of leukocyte function associated antigen. The mechanism of action involves binding of the drug to CD2 cells on T cells to prevent binding of CD2 to leukocyte function associated antigen. It also causes apoptosis of activated memory T cells. It is approved by the FDA to treat moderate to severe psoriasis. For patients showing great initial response, there are long remission periods. However, this drug has a side effect of reducing CD4 count, which could predispose the patient to infections. CD4 count has to be monitored weekly and if it is too low, treatment has to be stopped and alternative treatment sought.

Another strategy applied is blocking of T cell migration. Efalizumab falls under this class of drugs. Mechanism of action involves binding to the CD11 portion of leukocyte function associated antigen. It prevents adhesion of leukocyte function associated antigen to intercellular adhesion molecule. It is approved by FDA for treating moderate to severe psoriasis. Side effects include fever, chills, nausea, vomiting and headaches.

A different strategy involves the shifting from T cell production of Th1 to Th2 cell type cytokines. This decreases the symptoms of psoriasis. Some cytokine antagonists may also prevent the differentiation of T cells towards the Th1 cell types. An example of a drug with this mechanism of action is CNTO-1275. This involves the inhibition of IL-12, which is normally involved in the differentiation of Th1 cells. (Agozzino, Noal, Lacarrubba & Ardigò, 2017)

The last strategy is that of inactivation of already secreted cytokines. Infliximab is an anti-TNF given intravenously. It is used to treat moderate and severe psoriasis. Commonest side effects are reactions at infusion site and headaches. A major side effect is increased risk to development of tuberculosis. Etanercept works by the same mode of action, and is the only therapy approved for the treatment of cutaneous psoriasis.

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Corticosteroids have also been approved by the FDA for use in the treatment of mild to moderate form of the disease. These are administered topically. Hydrocortisone, a mild ointment, is given for sensitive body parts such as the face, and for treatment of widespread body patches. Stronger creams or ointments like triamcinolone are given for less sensitive or harder to treat areas. Side effects may include thinning of the skin on long term use. Systemic side effects like diabetes and hypertension may also be of major concern. (Šimonienė, Auglytė & Liolytė, 2019)

Vitamin D analogues fall under the category of new drug therapy. Synthetic vitamin D forms slow down the growth of skin cells and examples include calcipotriene and calcitriol. These may be used as single therapy or concomitantly with corticosteroids. Calcitriol is more preferred because it may cause less irritation in more sensitive areas. This class of drugs is however more expensive than corticosteroids. (Burch & Fernandez-Peñas, 2017)

Anthralin is also used as a cream, and it slows down the growth of skin cells. It is very useful in removal of scales and in making the skin smoother. A common side effect is irritation of the skin. It is only applied for a short time, and it must be washed off after. It is used as an additive for combined topical therapy. It is mainly used in the scalp for fast recovery.

Cyclosporine is used for management of severe psoriasis. (Korman, Zhao, Roberts, Pike & Sullivan, 2016)Administration is oral, and the mode of action involves suppression of the immune system. It is very effective, but is not recommended for use for more than a year continuously. A common side effect is the likelihood to develop other infections because of the diminished function of the immune system. Frequent monitoring of blood pressure and kidney function is very necessary in patients receiving this treatment.

Give no one the power to bring you down, not a person, not a disorder, not a sickness.

Make yourself happy by taking charge of your life.

— Yashaswi Mohan

Research findings

  1. As Psoriasis is a multisystem inflammatory disorder, nearly 80% of almost clear patients in clinical practice meet DLQI(Dermatology life quality index) criteria for treatment change.
  2. While local therapy is a mainstay treatment, therapies with lesser side effects are forced to have demand.
  3. According to my survey, many people found great help through physiotherapists, yoga, essential nutritional food habits and stress-free life.
  4. The medicine that works for one person does not work for other.
  5. Incorporating smallest molecules are the advanced method to treat psoriasis.
  6. Cannabidiol is proving to be effective in case of different phenotypes of psoriasis.
  7. Psoriasis treatment using CBD should become intense research and clinical trails to understand the extent of its benefits, as comparatively short range of research is available due to the resulting stigma with it.
  8. A range of different unexplored traditional medications are quite popular due to their effectiveness and popularity, extensive research should be conducted to develop compounds that eliminate the possibilities of having side effects.

References

  1. Agozzino, M., Noal, C., Lacarrubba, F., & Ardigò, M. (2017). Monitoring treatment response in psoriasis: current perspectives on the clinical utility of reflectance confocal microscopy. Psoriasis: Targets And Therapy, Volume 7, 27-34. doi: 10.2147/ptt.s107514
  2. Agozzino, M., Noal, C., Lacarrubba, F., & Ardigò, M. (2017). Monitoring treatment response in psoriasis: current perspectives on the clinical utility of reflectance confocal microscopy. Psoriasis: Targets And Therapy, Volume 7, 27-34. doi: 10.2147/ptt.s107514
  3. Burch, J., & Fernandez-Peñas, P. (2017). In people with chronic plaque psoriasis, how do vitamin D analogues, corticosteroids and dithranol compare?. Cochrane Clinical Answers. doi: 10.1002/cca.492
  4. Korman, N., Zhao, Y., Roberts, J., Pike, J., & Sullivan, E. (2016). Physician Satisfaction with Current Psoriasis Treatment: A Real-World Study in the USA. Journal Of Psoriasis And Psoriatic Arthritis, 1(2), 86-89. doi: 10.1177/247553031600100207
  5. Okubo, Y., Torisu-Itakura, H., Hanada, T., Aranishi, T., Inoue, S., & Ohtsuki, M. (2021). Evaluation of treatment satisfaction misalignment between Japanese psoriasis patients and their physicians – Japanese psoriasis patients and their physicians do not share the same treatment satisfaction levels. Current Medical Research And Opinion, 37(7), 1103-1109. doi: 10.1080/03007995.2021.1920898
  6. Šimonienė, D., Auglytė, I., & Liolytė, S. (2019). Side effects of topical corticosteroids in the treatment of psoriasis: a case report. Endocrine Abstracts. doi: 10.1530/endoabs.63.ep49

© 2022 Yashaswi Mohan

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