Vol 11, Issue 12, 2018 Online - 2455-3891 Print - 0974-2441 EXISTING AND NOVEL THERAPIES FOR PSORIASIS CH. NAGA NAVYA 1 , GAURAV K JAIN 2 , VIKAS JAIN 1 * 1 Department of Pharmaceutics, J.S.S College of Pharmacy, Mysore, Karnataka, India. 2 Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi India. *Email: vikasjain@jssuni.edu.in Received: 10 July 2018, Revised and Accepted: 05 September 2018 ABSTRACT Psoriasis is adjudged as prototypic papulosquamous skin condition attributed by the erythematous papules (or) plaques. It occurs at any age but commonly seen in age groups of 20–30 and 50–60 years. Psoriasis affects around 2% of the world population. Psoriasis has a broad spectrum of skin indications occurring in different forms with common characteristics. It is clinically classified as non-pustular and pustular psoriasis. Existing therapies include topical therapy, systematic therapy, and phototherapy. Biological drugs and novel immunological factors have been identified as alternative therapy to conventional therapies. These biological drugs show more efficacies with fewer side effects in long-term application. Keywords: Psoriasis, Biological therapy, Anticytokine therapy, Phototherapy. INTRODUCTION Psoriasis is characterized by papulosquamous skin condition with erythematous papules (or) plaques. Dysregulation of the immune system leads to red, scaly, flaky, chronic inflammatory, and itchy patches with increased keratinocytes proliferation [1]. Sometimes, the body’s immune system cannot differentiate between the foreign particle and its own. During the process of defending itself against infection, it may lead to excessive skin cell proliferation. Psoriatic arthritis refers to psoriasis that affects the joints. The severity of psoriasis varies among individuals of different age groups. Psoriasis impacts patient’s psychological stress due to its appearance. This stress may trigger psoriasis even more which might worsen the condition at times. Psoriasis is prevalent in 2% population around the world, mainly seen in the age groups of 20–30 and 50–60 years. Plaque psoriasis is prevalent among 80% of individuals, of which around 33% suffers from mild diseases and remaining from moderate-to-severe conditions [1,2] TYPES OF PSORIASIS Psoriasis is classified into a broad spectrum of skin indications. It is generally divided into pustular and non-pustular forms. A person can represent different forms of psoriasis at the same time. It can affect any part of the body. However, all forms show common characteristics like erythema with thickened scales, and the size of lesions varies from a pinhead to 20-cm diameter. These lesions may appear oval, polycyclic, or round in shape [Table 1] [3,4]. Psoriasis vulgaris About 90% of cases are noticed as psoriasis vulgaris in clinical form. It appears as erythematous plaques which are covered by silver scales. Lesions distribute symmetrically and frequently occur on the knees, scalps, sacral region, and elbow. If psoriatic plaques surface is scraped with a blunt scalpel, flakes fall off as layers and it exhibits a phenomenon called as “wax spot phenomenon.” Further scrapping discloses a wet layer attached to the lesion, and this is the last layer of dermal papillae which is referred as “last membrane phenomenon.” If it is scraped further, an erythematous background and bleeding foci which look like red pinpoints referred as “Woronoff ring” are observed. There is no clarified pathogenesis for this ring. However, it may be due to a reduced level of prostaglandins in healing lesions [5-8]. Guttate psoriasis It is mostly seen in children and young adults. The lesions structurally look like small droplets and rarely convert into squamous psoriatic papules. It usually manifests after a streptococcal infection. It is generally linked with HLA-Cw6 gene. These types of psoriasis occur on the trunk, proximal part of extremities, scalp, and face. They usually revert within 3–4 months, but in rare cases, it develops into plaques [9]. Erythrodermic psoriasis Nearly 80% of the lesions that affect body surface are categorized as a generalized form of psoriasis, plaques, and papules which lose their attributes. Desquamation is not so definite, but it causes protein loss as well as some systematic problem such as edema of lower extremities, and cardiac, hepatic, and renal failure. Damage of skin barrier results in systematic reactions, which in turn leads to the development of psoriasis vulgaris or erythrodermic psoriasis [10]. Palmoplantar psoriasis In general, palmoplantar psoriasis occurs on palms, hands, and soles of the feet. It affects more on thenar regions than the hypothenar region. Usually, erythema does not appear, but incase if it exists, then it appears as pinkish yellow lesions. Scales are the main lesions, and thick flakes may provide an appearance of keratoderma [11]. Inverse psoriasis Inverse psoriasis or flexural psoriasis is localized in skin folds. Scaly lesions do not form because of friction and moisture produced between the skin folds. This form of psoriasis is diagnosed with fissured plaques. It is commonly observed in obese individuals with a tendency to develop a seborrheic lesion. This type of psoriasis refuses to accept classical therapy [10]. Generalized pustular psoriasis It is the rare form of psoriasis with pustules, usually observed in young individuals. It either develops independently or seen as a complication of psoriasis vulgaris. In this form, leukocytosis, lymphopenia, and nitrogen balance will be increased. Within few days, pustules get dried, and new pustules arise within no time. Peripustular erythema has behavior to spread which leads to erythrodermia. The disseminated region should be promptly treated;otherwise, acute phase may cause to the fatal course [10-12]. © 2018 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2018.v11i12.27383 Review Article