Psoriasis is a chronic autoimmune skin disorder

 Psoriasis is a chronic autoimmune skin disorder characterized by the rapid overproduction of skin cells, leading to the formation of thick, red, scaly patches on the skin. These patches, or plaques, commonly appear on the elbows, knees, scalp, and lower back, but can develop anywhere on the body. Psoriasis is caused by an overactive immune system, where T-cells mistakenly attack healthy skin cells, triggering inflammation and rapid skin cell turnover. The exact cause is unknown, but genetic and environmental factors (like stress, infections, or injury to the skin) play a role.

Psoriasis is categorized into different types, including plaque psoriasis (the most common form), guttate psoriasis, pustular psoriasis, inverse psoriasis, and erythrodermic psoriasis. It can also be associated with psoriatic arthritis, which causes joint inflammation and pain.

Medicines Used in the Treatment of Psoriasis (India)

Treatment options for psoriasis focus on managing symptoms, reducing inflammation, and slowing the overproduction of skin cells. Medications can be topical, oral, or injectable, depending on the severity of the condition. Below is a list of common treatments for psoriasis, their mechanisms of action, and brand names available in India.

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1. Topical Corticosteroids

• Mechanism of Action: Topical corticosteroids reduce inflammation and suppress the immune response in the affected skin areas, slowing skin cell turnover and relieving itching and inflammation.
• Common Drugs:
  • Hydrocortisone
  • Betamethasone
  • Clobetasol
• Brand Names in India:
  • Hydrocortisone:
    • Soframycin-HC, Cortaid
  • Betamethasone:
    • Betnovate, Beta-Cort
  • Clobetasol:
    • Tenovate, Topclob

2. Vitamin D Analogues

• Mechanism of Action: These topical medications slow down skin cell growth and have an anti-inflammatory effect by modulating calcium metabolism in the skin cells. They are commonly used in combination with corticosteroids.
• Common Drugs:
  • Calcipotriol (also called Calcipotriene)
• Brand Names in India:
  • Calpsor, Daivonex

3. Topical Retinoids

• Mechanism of Action: Retinoids, which are derived from vitamin A, help normalize the growth of skin cells and reduce the inflammation associated with psoriasis.
• Common Drugs:
  • Tazarotene
• Brand Names in India:
  • Tazret, Tazarot

4. Coal Tar

• Mechanism of Action: Coal tar reduces scaling, itching, and inflammation by slowing down the growth of skin cells and decreasing the formation of psoriatic plaques.
• Common Forms: Topical ointments, shampoos (for scalp psoriasis)
• Brand Names in India:
  • Protar, Carboderm

5. Salicylic Acid (Topical Keratolytic)

• Mechanism of Action: Salicylic acid helps remove the dead skin cells (scales) by softening and sloughing off the outer layer of the skin, which allows other topical medications to penetrate more effectively.
• Brand Names in India:
  • Scalpe Plus, Keralyt

6. Phototherapy (Light Therapy)

• Mechanism of Action: Ultraviolet B (UVB) and PUVA (a combination of psoralen and UVA light) therapies help slow down the rapid skin cell growth in psoriasis. UV light reduces inflammation and slows down cell turnover.
• Treatment Method: UVB therapy is often done in specialized clinics or with home units under medical supervision. PUVA involves taking psoralen (a light-sensitizing drug) before UVA exposure.

7. Systemic Treatments (Oral or Injectable)

a) Methotrexate

• Mechanism of Action: Methotrexate is an immunosuppressant that slows down the rapid division of skin cells and modulates the immune response by inhibiting dihydrofolate reductase (an enzyme involved in DNA synthesis).
• Brand Names in India:
  • Trexate, Folitrax

b) Cyclosporine

• Mechanism of Action: Cyclosporine is an immunosuppressive agent that inhibits T-cell activation, thus reducing the immune response and inflammation in psoriasis.
• Brand Names in India:
  • Cymevene, Panimun Bioral

c) Acitretin (Oral Retinoid)

• Mechanism of Action: Acitretin, a retinoid, normalizes skin cell growth by reducing the hyperproliferation of skin cells and promoting differentiation.
• Brand Names in India:
  • Acitron, Soriatane

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8. Biologic Therapies

Biologics are advanced therapies targeting specific components of the immune system involved in psoriasis. These drugs are typically used for moderate to severe cases of psoriasis that do not respond to conventional treatments.

a) TNF-α Inhibitors (Tumor Necrosis Factor-Alpha Inhibitors)

• Mechanism of Action: TNF-α inhibitors block tumor necrosis factor-alpha, a pro-inflammatory cytokine involved in the immune response and inflammation in psoriasis.
• Common Drugs:
  • Etanercept
  • Infliximab
  • Adalimumab
• Brand Names in India:
  • Etanercept:
    • Enbrel, Etacept
  • Infliximab:
    • Remicade, Infimab
  • Adalimumab:
    • Humira, Exemptia

b) IL-17 Inhibitors (Interleukin-17 Inhibitors)

• Mechanism of Action: IL-17 inhibitors block the action of interleukin-17, a cytokine that plays a key role in inflammation and psoriasis development.
• Common Drugs:
  • Secukinumab
  • Ixekizumab
• Brand Names in India:
  • Secukinumab:
    • Cosentyx
  • Ixekizumab:
    • Taltz

c) IL-23 Inhibitors (Interleukin-23 Inhibitors)

• Mechanism of Action: IL-23 inhibitors block the action of interleukin-23, a cytokine that promotes the development and maintenance of inflammation in psoriasis.
• Common Drugs:
  • Guselkumab
• Brand Names in India:
  • Tremfya

d) IL-12/IL-23 Inhibitors

• Mechanism of Action: These biologics target both IL-12 and IL-23, which are involved in immune system signaling that leads to psoriasis.
• Common Drugs:
  • Ustekinumab
• Brand Names in India:
  • Stelara

9. Phosphodiesterase-4 (PDE-4) Inhibitors

• Mechanism of Action: PDE-4 inhibitors work by blocking the enzyme phosphodiesterase-4, which results in lower levels of inflammation by reducing the production of pro-inflammatory cytokines.
• Common Drugs:
  • Apremilast
• Brand Names in India:
  • Otezla, Apremy

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Lifestyle and Supportive Treatments

• Moisturizers: Regular use of emollients and moisturizers helps reduce dryness, scaling, and itching. Moisturizing the skin also improves the efficacy of topical treatments.
• Stress Management: Stress is a common trigger for psoriasis flare-ups. Stress reduction techniques like yoga, meditation, or therapy can help manage symptoms.

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Conclusion

Psoriasis is a chronic autoimmune skin condition that requires long-term management with a variety of treatment options. These include topical treatments (corticosteroids, vitamin D analogues), systemic treatments (methotrexate, biologics), and phototherapy, depending on the severity of the disease. In India, these medications are available under various brand names, and treatment plans are customized based on the individual’s response to therapy and the extent of skin involvement.