A review of advancements in the management and treatment of Psoriasis

Abstract

Psoriasis is a hereditary, autoimmune, chronic illness that influences the immune system and can have both cutaneous and systemic symptoms. It can seriously impair a patient’s quality of life. Psoriasis affects 2.3 percent of people globally and has a significant financial cost for those who suffer from it. Genes and environmental factors are the primary etiological factors. Dendritic cells, T cells, human neutrophilic peptides, lipoprotein-2, galactosin-3, fractalkine, vaspin, and familial predispositions, among other factors, are characteristics of the pathophysiology of psoriasis. Conventional psoriasis treatments for patients include corticosteroids, biological agents, vitamin D3 analogs, acitretin, calcineurin inhibitors, cyclosporine, methotrexate, and phototherapy. Growing in popularity as a multidisciplinary field of study, nano dermatology is being used to treat psoriasis. Over the years, major advancements have been made in understanding its complex pathogenesis and developing more effective, targeted treatments. Medication delivery methods utilizing nanocarriers demonstrate promise in treating psoriasis because they improve medication penetration, reduce side effects, and provide targeted action at the afflicted areas. Because of their biological compatibility, adaptability, and capacity for carrying a variety of therapeutic substances, lipid-based and polymer-based nanocarriers have demonstrated exceptional promise among them. This article summarizes the pathogenesis, epidemiology, clinical diagnosis, and conventional psoriasis treatments. Furthermore, the review includes an overview of various nanotechnology-based psoriasis treatments.

Introduction

Psoriasis is regarded as a common inflammatory disease impacting the relationship within two and three percent of the global population [1]. Within India, the frequency of adult psoriasis spans between 0.44 percent to 2.8 percent. Males are twice as inclined to have it compared with females, and the majority are approaching their third or subsequent generation when they first appear [2]. Psoriasis sufferers experience a broad spectrum of emotional as well as mental impacts in addition to this disease’s physical symptoms, necessitating adequate therapy [3]. It gets challenging because of the additional complications of recurrent episodes, lack of response to conventional treatment, and engagement from problematic areas such as nails, palms, and feet [4]. There is a paradox of plenty because a greater variety of therapeutic alternatives is available [5]. Initial treatments frequently employed involve topical medicines like Analogs of vitamin D, corticosteroids, and phototherapy. The lack of sustained effectiveness and safety evidence imposes restrictions on this therapy. Considering other forms of therapy, especially phototherapy, additional compliance may be a problem (approximately 11% of patients stick to the proposed regimen consisting of three weekly treatments [6]. The financial challenges and time restrictions associated with travel make phototherapy a major barrier to access in India.

Presently, a variety of conventional regional therapy strategies, like acitretin, cyclosporine, corticosteroids, methotrexate, and phototherapy, have been utilized for managing the disease for some time or longer. However, it has not been documented that these therapies lead to overall psoriasis healing. As a result, scientists from all over the world are primarily investigating and utilizing multiple nanotechnology remedies to entirely remove this disease [7]. Novel drug delivery vehicles, especially nanocarriers, have an opportunity to alleviate a few limitations linked with conventional therapy approaches, like a lowering in dosage, management frequency, and dosage-dependent adverse reactions [8]. Although psoriasis is an autoimmune condition for which no specific immunogen has been identified, its main pathophysiology appears to be excessive stimulation of particular adaptive immune system components [9] particularly, it is the joint function of numerous cellular kinds like dendritic and T cells and keratinocytes which generate cytokines and lead cells to remain in a chronic inflammatory state [10, 11]. Psoriasis may also arise due to genetic abnormalities and inheritance, environmental variables, infections, anxiety, and skin lesions [12].

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Table 1 List of nanocarriers based on lipids and polymers for psoriasis therapy

Lipidic carrier & Polymeric carrier	Drug	Composition	Method of preparation	Remarks	Reference
Liposome	Metformin	Ginger	Thin layer hydration	Drug-loaded liposomes have showed potential in distributing drug at the skin’s surface, possibly via improving the psoriatic skin barrier.	[85]
Ethosome	Curcumin	Tween 20, Diethyl pyrocarbonate, propylene glycol, hydrogenated soybean phospholipids cholesterol	Simple modified Injection	Drug was delivered and resulted in less drug leakage, a slower release of the loaded drug, and increased stability.	[86]
Ethosomal gel	Methotrexate and salicylic acid	Carbopol 934, salicylic acid, soyalecithin, and triehanolamine	Cold method	Decrease in hyperkeratosis and parakeratosis observed which is an indication of healing.	[87]
Nanoemulsion	8- Methoxypsoralen	Poloxamer 407, clove oil, Anhydrous monosodium phosphate and monohydrated sodium phosphate dibasic	High-energy method	Enhanced retention in viable skin.	[88]
Nanoemulsion	Methotrexate	Chaulmoogra oil, tween 80	Emulsification technique	Skin permeation is improved, with good skin retention and less systemic toxicity.	[89]
Liposome	Capsaicin	Capsaicin, Carbopol 934, Soya, phosphatidylcholine, Span 80	Thin-film hydration Method	The drug accumulation was dramatically enhanced in both laboratory and animal studies when an emulgel formulation was used.	[90]
Liposome	Tretinoin	Vitamin E, propylene glycol, propyl paraben, methyl paraben, soy phosphatidylcholine, and HEPES (4-(2-Hydroxyethyl) 1-piperazine ethanesulfonic acid)	Fusion method	Skin permeation was improved.	[91]
NLC	Dithranol	Glyceryl monostearate, Precirol, Tween 80, Tween 20, and stearyl alcohol, Formaldehyde, paraffin wax, Butylated and Pluronic F68	Solvent evaporation method	The NLCs gel demonstrates a slower drug release rate and deeper penetration.	[92]
NLC	Cyclosporine	Tween80, Span 20, Stearic acid, Span 40, Ethyl acetate, and glyceryl monosteartae	Hot homogenization –ultrasonication	Cell line in vitro studies showed enhanced absorption and effectiveness with decreased cell survival.	[93]
NLC	Clobetasol propionate	Chitosan, oleic acid, sodium taurodeoxycholate, propylene glycol, and stearic acid	Microemulsion method	The amount of medication in the epidermis was 80 times higher than with a commercial product.	[94]
SLN	Apremilast	Glyceyl monostearate, oleic acid, stearic acid, carbopol 974, Compritol 888 ATO and Precirol ATO 5	Hot emulsification	The formulation exhibited improved penetration, skin accumulation, and prolonged release when compared to standard preparations.	[95]
Niosomal gel	Cyclosporine	Cholesterol, Span 60	Film hydration method	For successful treatment of psoriasis, Niosomes demonstrated substantial potential for enhancing medication delivery and tissue accumulation.	[66]
Niosome	Acitretin	Cholesterol, span 60 and Hydroxypropylmethyl cellulose	Thin film hydration	Enhanced penetration, decreased systemic absorption, and drug deposition in deeper dermal layers.	[96]
SLN	Apremilast	Acetonitrile, Stearic acid, Glyceryl monostearate, and Oleic acid	Hot emulsification	SLN formulation outperformed standard preparation in terms of penetration, skin deposition, and duration of release.	[97]
Nanoemulgel	Clobetasol propionate	Squalene, Acetonitrile	Homogenisation	Improving the drug’s efficacy by boosting skin retention, improving penetration	[98]
Poly lactic-co-glycolic acid (PLGA) NPs	Coal tar (CT)	PLGA	Nanoprecipitation	The findings reveal a potential drug nanoformulation that can combat its drawbacks for the psoriasis treatment, such as toxicity.	[99]
NPs	Methotrexate	Eudragit E100, polyvinyl alcohol, monobasic potassium phosphate, chitosan and potassium dihydrogen phosphate, dimethyl sulfoxide, triethanolamine, phosphate, glutaraldehyde	Solvent evaporation	Mild hyperkeratosis and parakeratosis were barely noticeable in the developed drug loaded NPs.	[100]
Dendrimer	Dithranol	Polyvinyl alcohol, Dichloromethane, Ethyl cellulose, Sodium metabisulphate	Emulsion solvent diffusion	Enhanced skin permeability and drug release for a longer time.	[101]
Polymeric micelles	Resveratrol	Poloxamer F127, and poloxamer P123, Triethanolamine, glycerol, ascorbic acid, ethyl oleate, vitamin E, tweens 20, 80, 163 PEG 400, and carbomer (Carbopol 974P NF).	Film hydration	This study found strong proof for using polymeric micelles of drug as alternate therapy in plaque psoriasis management with improved dermatological results.	[102]
PLGA NPs	Curcumin	Polyvinylpyrrolidone, Carbopol 974 and PLGA	Antisolvent and flash precipitation	Stratum corneum accumulation and regulated release.	[103]
PLGA NPs	Apremilast	PLGA lactide: polyvinyl alcohol	Emulsion and evaporation method	Reduced dosing frequency, greater bioavailability, and improved patient compliance	[104]
Chitosan NPs	Tacrolimus	Chitosan, ethylene glycol, Propylene glycol and PEG 400	Solvent free ionic gelation method	Hydrophobic medicines can be incorporated into chitosan NPs, Chitosan NPs of drug in the management of plaque psoriasis outperform ointment.	[105]
Polymeric nanosphere	Vitamin D3	Tween80, Dimethylformamide, Polyethylene glycol and suberic acid		With continuous drug release enhanced binding and loading of drug was achieved. Hydrolysis and photodegradation of drug were actively prevented, resulting in a considerable increase in drug stability in topical formulations.	[106]
Nanocapsule	Dithranol	Ascorbicacid, ethylene diamine tetraacetic acid, Span 60, Tween 80, and a combination of caprylic and capric triglycerides	Prefabricated polymer interfacial deposition	In comparison to the drug free solution, it decreases the skin irritation and improve photostability.	[107]
Niosomal hydrogel	8-Methoxy psoralen	Span 60, span 40, carboxymethyl cellulose	Thin film hydration method	Improved skin permeation and drug deposition provide by nanosized niosomes.	[108]
Polymeric hydrogel	Methoxsalen and curcumin	Carbopol–940	Emulsification solvent evaporation	There is hope for the treatment of psoriasis with the newly created polymeric hydrogel, which has synergistic therapeutic effects.	[109]

Excipiens mentioned in the study nect to others: Carbopol 934, chitosan, squalene

Wilson K, Dora CP, Chopra H, Gupta S. A review of advancements in the management and treatment of psoriasis. Biomed Eng Commun. 2026;5(2):10. doi: 10.53388/BMEC2026010.