Coal tar solution 12% / Salicylic acid 2% in Hydrocortisone 1% ointment

The dysregulated phosphatidylinositol-3-kinase (PI3K)-Akt-mammalian target of rapamycin (mTOR) signaling pathway has been implicated in various immune-mediated inflammatory and hyperproliferative dermatoses such as acne, atopic dermatitis, alopecia, psoriasis, wounds, and vitiligo, and is associated with poor treatment outcomes. Improved comprehension of the consequences of the dysregulated PI3K/Akt/mTOR pathway in patients with inflammatory dermatoses has resulted in the development of novel therapeutic approaches. Nonetheless, more studies are necessary to validate the regulatory role of this pathway and to create more effective preventive and treatment methods for a wide range of inflammatory skin diseases. Several studies have revealed that certain natural products and synthetic compounds can obstruct the expression/activity of PI3K/Akt/mTOR, underscoring their potential in managing common and persistent skin inflammatory disorders. This review summarizes recent advances in understanding the role of the activated PI3K/Akt/mTOR pathway and associated components in immune-mediated inflammatory dermatoses and discusses the potential of bioactive natural products, synthetic scaffolds, and biologic agents in their prevention and treatment. However, further research is necessary to validate the regulatory role of this pathway and develop more effective therapies for inflammatory skin disorders.

Abstract licence: CC BY

Psoriasis (PSO) is a chronic autoimmune skin condition characterized by the rapid and excessive growth of skin cells, which leads to the formation of thick, red, and scaly patches on the surface of the skin. These patches can be itchy and painful, and they may cause discomfort for patients affected by this condition. Therapies for psoriasis aim to alleviate symptoms, reduce inflammation, and slow down the excessive skin cell growth. Conventional topical treatment options are non-specific, have low efficacy and are associated with adverse effects, which is why researchers are investigating different delivery mechanisms. A novel approach to drug delivery using nanoparticles (NPs) shows promise in reducing toxicity and improving therapeutic efficacy. The unique properties of NPs, such as their small size and large surface area, make them attractive for targeted drug delivery, enhanced drug stability, and controlled release. In the context of PSO, NPs can be designed to deliver active ingredients with anti-inflammatory effect, immunosuppressants, or other therapeutic compounds directly to affected skin areas. These novel formulations offer improved access to the epidermis and facilitate better absorption, thus enhancing the therapeutic efficacy of conventional anti-psoriatic drugs. NPs increase the surface-to-volume ratio, resulting in enhanced penetration through the skin, including intracellular, intercellular, and trans-appendage routes. The present review aims to discuss the latest approaches for the topical therapy of PSO using NPs. It is intended to summarize the results of the in vitro and in vivo examinations carried out in the last few years regarding the effectiveness and safety of nanoparticles.

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The current state, tools, and applications of personalized medicine with special emphasis on inflammatory skin diseases like psoriasis and atopic dermatitis are discussed. Inflammatory pathways are outlined as well as potential targets for monoclonal antibodies and small-molecule inhibitors.

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Psoriasis is an immune-mediated inflammatory disease with a genetic predisposition. Although manifesting predominantly as a hyperproliferative skin disorder, psoriasis is a systemic disease associated with a range of comorbidities including arthritis, cardiovascular disease and depression. Educating the patient that psoriasis is chronic and that there are possible comorbidities is paramount. Patients with a limited number of plaques and no systemic symptoms may be managed with intermittent use of topical therapies. Those with more extensive or debilitating disease may require phototherapy or systemic medicines such as methotrexate or one of the newer targeted therapies. Newer systemic therapies, including oral medicines and injectable biologics, can only be used following unsuccessful treatment with traditional therapies such as methotrexate and phototherapy. Biologic therapies for psoriasis offer the possibility of near-complete symptom resolution in people with psoriatic disease.

Abstract licence: CC BY-NC-ND

Introduction Goeckerman therapy, which combines ultraviolet B (UVB) light with crude coal tar (CCT), remains highly effective for moderate-to-severe psoriasis. While it is rarely still used in the USA as effective biotherapeutics have become more readily available, it offers an alternative therapy in developing countries with limited access to newer medications. Moi Teaching & Referral Hospital (MTRH) in Eldoret, Kenya, in collaboration with UCSF, developed a modified Goeckerman regimen suitable for local healthcare needs, condensing the treatment into an intensive two-week program.Case report A 55-year-old female with erythrodermic psoriasis traveled 350 kilometers to MTRH. After the diagnosis was confirmed, she underwent a nine-day inpatient treatment with narrow-band UVB phototherapy and topical medications under occlusion as a modified Goeckerman regimen.Response to treatment Significant improvement was observed within three days, with full recovery in ten days. Follow-up one month later showed no active lesions, and her psoriasis remained controlled for four months with topical treatments.Conclusion The modified Goeckerman regimen at MTRH, in collaboration with UCSF, effectively treated severe psoriasis in a challenging healthcare context. This case highlights the potential for adapting established treatments to improve patient outcomes in developing countries with limited access to systemic therapies.

Abstract licence: CC BY-NC

BackgroundActivation of tumour necrosis factor receptor 1 (TNFR1) promotes inflammation in several autoimmune diseases.ObjectivesTo evaluate safety, tolerability and clinical efficacy of balinatunfib versus placebo in patients with mild-to-moderate psoriasis.MethodsPhase-1, 4-week, randomized, double-blind, placebo-controlled pilot study, including patients aged 18-65 years with chronic plaque-type psoriasis with mild-to-moderate severity as defined by Psoriasis Area Severity Index (PASI ≤16) and ≥2 lesions with a Target Lesion Severity Score (TLSS) ≥4 at both screening and baseline. The primary endpoint was safety and tolerability of balinatunfib as assessed by the incidence of adverse events (AEs), treatment-emergent AEs (TEAEs) and AEs of special interest. Secondary endpoints were the percent change in TLSS from baseline to Weeks 2 and 4. Serum biomarkers, interleukin-22 (IL-22), IL-17F and percent change in PASI from baseline to Weeks 2 and 4, were also evaluated.Results38 male patients (age [mean ± SD], 43 ± 10.6) were randomized to receive 200-mg balinatunfib (N = 26) or placebo (N = 12). No serious or severe TEAEs or adverse events of special interest were observed during the study. Dysgeusia (61.5% vs. 0%) and nausea (19.2% vs. 0%) were the most frequently reported TEAEs in the balinatunfib versus the placebo groups. Balinatunfib showed improvements from baseline in TLSS vs. placebo at Week 2 (17.06% vs. 6.29%, p = 0.032) and Week 4 (38.18% vs. 20.44%, p = 0.012). Exploratory analyses suggested an improvement in the total PASI scores at Week 2 (17.73% vs. 4.12%, nominal p = 0.005), Week 4 (35.09% vs. 15.71%, nominal p = 0.009) and decreased serum levels of IL-22 (nominal p = 0.0001) and IL-17F (nominal p = 0.0025) with balinatunfib treatment.ConclusionsPatients with mild-to-moderate psoriasis treated with balinatunfib reported no severe or serious TEAEs and showed promising clinical responses, suggesting that further evaluation of TNFR1 signal inhibition in inflammatory diseases is warranted.

Abstract licence: CC BY-NC