A detailed presentation on Herbals For Psoriasis including types, treatment methods, and recent advances. A case study is also included.

1. BY: Aswathi Thankam Peter
FY MPHARM QA
UNDER THE GUIDANCE OF: MR KEYUR SHASTRI
(ASSISTANT PROFESSOR)
Department of QUALITY ASSURANCE
VES COLLEGE OF PHARMACY,
CHEMBUR, MUMBAI
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2. Introdution
diagnosis
mechanism
Burden
Types
symptoms
prevalence
Causes and risk factors
Treatment
Alternative treatment methods
Herbals
Recent advances
Marketed preparations
Case study
conclusion
references
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3. INTRODUCTION:
Psoriasis is a chronic inflammatory disease of the skin
and joints.
Psoriasis is an immune-mediated disease that causes
raised, red, scaly patches to appear on the skin.
Affecting ∼0.2–2% of the world’s population .
Psoriasis typically affects the outside of the elbows,
knees or scalp, though it can appear on any location.
Psoriasis treatments include steroid creams, occlusion,
light therapy and oral medications, such as biologics.
Psoriasis isn’t contagious. You can’t pass the skin
condition from one person to another.
3

4. Psoriasis is a chronic skin condition caused by an overactive immune
system.
Psoriatic arthritis occurs when your body's immune system begins to attack healthy
cells and tissue
4

5. Psoriasis is diagnosed on the basis of clinical findings
(skin rash, changes to nails, joint involvement).
There are no special blood tests or tools to diagnose
psoriasis. A dermatologist (doctor who specializes in skin
diseases) or other health care provider usually examines
the affected skin and determines if it is psoriasis.
Your doctor may take a piece of the affected skin (a
biopsy) and examine it under the microscope. When
biopsied, psoriasis skin looks thicker and inflamed when
compared to skin with eczema.
Your doctor also will want to learn about your family
history
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6. Thought to be related to an immune system
problem with T cells and other white blood
cells, called neutrophils, in your body.
T cells normally travel to defend against foreign
substances, such as viruses or bacteria.
But if you have psoriasis, the T cells attack healthy skin cells
by mistake, as if to heal a wound or to fight an infection.
Overactive T cells also trigger increased production of healthy skin cells,
more T cells and other white blood cells, especially neutrophils. These
travel into the skin causing redness and sometimes pus in pustular
lesions.
The process becomes an ongoing cycle in which new skin cells move to the
outermost layer of skin too quickly — in days rather than weeks. Skin cells
build up in thick, scaly patches on the skin's surface, continuing until
treatment stops the cycle.
Mechanism
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7. 7

8. 8 Types of Psoriasis
1) Psoriasis Vulgaris
The most common form of
psoriasis. It’s characterized by
thick red patches of skin, often
with a silver or white scaly
layer.
2) Scalp psoriasis
For some people, it may cause
severe dandruff. For others, it can
be painful, itchy. Scalp psoriasis
can extend to the neck, face, and
ears in one large patch or many
smaller patches. 8

9. It appears in small red spots on the
skin. It’s the second most common
type, affecting 10 percent of
people with psoriasis. Most of the
time it starts during childhood or
young adulthood.
3) Guttate Psoriasis
4) Flexural or inverse
psoriasis
It often appears in skinfolds, such as
under the breasts or in the armpits or
groin area. This type of psoriasis is
red and often shiny and smooth. The
sweat and moisture causes this. 9

10. It is a severe form of psoriasis. It
develops fast in the form of many
white pustules surrounded by red
skin. These pustules can also join
together and form scaling
5) Pustular Psoriasis
6) Psoriatic arthritis (PsA)
It is a painful and physically limiting
condition that affects between 10 and 30
percent of people with psoriasis. There is
also no cure for this type of psoriasis. It
can trigger the body to attack the joints
and the skin. It can affect many joints and
often becomes quite severe in the hands.
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11. 7) Erythrodermic psoriasis
or exfoliative psoriasis
Rare psoriasis type that looks like
severe burns. The condition is serious,
and can be a medical emergency. You
may need hospitalization because your
body may not be able to control body
temperature.
8) Nail psoriasis
Although not an official type of psoriasis,
nail psoriasis is a manifestation of
psoriasis. The condition can often be
confused with fungal infections and other
infections of the nail.
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12. Symptoms
The most frequently reported symptoms connected
to psoriasis are:
I. scaling of the skin in 92%
II. itching in 72%
III. skin redness in 69%
IV. fatigue in 27%
V. swelling in 23%
VI. burning in 20%
VII. bleeding in 20%
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13. Most of the data on prevalence has been derived from hospital-based studies while there are
only few well-defined large population based studies done to find the exact prevalence.
On the basis of current evidence derived from hospital-based studies, mostly from North India,
the prevalence of psoriasis in adults varies from 0.44 to 2.8%, with a much lower prevalence in
children
The reported prevalence of psoriasis in countries ranges between 0.09% and 11.43%, making
psoriasis a serious global problem with at least 100 million individuals affected worldwide.
Psoriasis has an unpredictable course of symptoms, a number of external triggers and
significant comorbidities, including arthritis, cardiovascular diseases, metabolic syndrome,
inflammatory bowel disease and depression.
Prevalence:
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14. The drug ustekinumab (Stelara) has been used to treat
psoriasis since 2009. It blocks two proteins related to
inflammation.
interleukin-17 (IL-17) and interleukin-23 (IL-23).
But recent studies show that IL-12 may actually protect
skin cells from a different inflammatory protein.
Causes and Risk Factors
1) Protein Targets
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15. IL-17 Blockers
A new injectable drug that blocks the activity of IL-17 proteins
was approved in 2016.
Ixekizumab (Taltz) got treatment of moderate to severe psoriasis
after 80% of people in clinical trials improved when taking it.
Several pre-clinical data indicate that IL-17 inhibitors may be
effective in multiple muco-cutaneous disorders beyond psoriasis.
IL-23 Blockers
More traditional psoriasis treatments, like adalimumab
(Humira), block the inflammatory protein TNF-alpha.
IL-23 was responsible for the inflammation .
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16. Loss of morning sunlight
2)Vitamin D
deficiency
The link is complex: Pain and embarrassment
from the skin disease can lead to sadness and
isolation.
3)Depression
4)Sleep pain and itching keep you awake or if a
lack of shut-eye brings on skin problems
5) Bone Loss
People with psoriasis are more likely to
get osteoporosis
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17. Losing extra pounds can lower levels of
harmful inflammation throughout your body
7)Smoking
6)Weight
A recent study found that the gene GRHL3,
which helps grow skin before birth.
8)Healing Genes
Can cause lung damage and makes your
treatments less effective.
9) Heart Disease
The major blood vessel that runs through
the center of your body. Psoriasis and
internal inflammation are linked.
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18. Treatment for psoriasis
Treatments can be divided into three main types:
1) Topical treatments
2) Light therapy (phototherapy)
3) Systemic medications (Oral or injected medications)
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19. Topical corticosteroids.
These drugs are the most frequently prescribed
medications for treating mild to moderate psoriasis.
Vitamin D analogues- Calcipotriene
(Dovonex) is a prescription cream or
solution
Anthralin (Dritho-Scalp) -can also
remove scales and make skin smoother
Topical retinoids- These are vitamin
A derivatives that may decrease
inflammation.
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20. Calci neurin inhibitor are not recommended
for long-term or continuous use because of a
potential increased risk of skin cancer.
Salicylic acid- Available over-the-counter
(nonprescription) and by prescription,
salicylic acid promotes sloughing of dead
skin cells and reduces scaling.
Coal tar is available in over-the-
counter shampoos, creams and oils.
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21. Light therapy (phototherapy)
The simplest and easiest form of
phototherapy involves exposing your skin to
controlled amounts of natural sunlight.
UVB phototherapycan be used to treat
single patches, widespread psoriasis and
psoriasis that resists topical treatments
Narrow band UVB phototherapy. A newer
type of psoriasis treatment, narrow band UVB
phototherapy may be more effective than
broadband UVB treatment.
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22. Goeckerman therapy The two therapies together are
more effective than either alone because coal tar makes
skin more receptive to UVB light.
Psoralen plus ultraviolet A (PUVA). This form of
photochemotherapy involves taking a light-
sensitizing medication (psoralen) before exposure to
UVA light. UVA light penetrates deeper into the skin
than does UVB light.
Excimer laser therapy requires fewer
sessions than does traditional phototherapy
because more powerful UVB light is used.
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23. Oral or injected medications
Methotrexate. Taken orally, methotrexate (Rheumatrex)
helps psoriasis by decreasing the production of skin cells
and suppressing inflammation. Eg- FOLITRAX 10MG
Cyclosporine suppresses the immune system
and is similar to methotrexate in effectiveness,
but can only be taken short-term. Eg-PSORID
CAPSULES
Vitamin A, this group of drugs may help if
you have severe psoriasis that doesn't respond
to other therapies. Even taken as suppliment
If you have severe psoriasis to other types of treatment, your
doctor may prescribe
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25. . Curcuma Longa
Biological source: Rhizomes of curcuma longa, Zingiberaceae
Common names: Haridra in Sanskrit and haldi in hindi
Chemical Constituents: Curcumin
Mechanism of action: Curcumin can block the protein TNF-alpha,
which triggers psoriasis inflammation.
Curcumin appears to inhibit the production of substances known as
cytokines, that can lead to inflammation
Curcumin 25

26. Mahonia aquifolium
Biological source: flowering plant of
Berberidaceae
Common names: Oregon grape
Chemical Constituents: Berberine
Mechanism of action: a multi drug resistance
pump inhibitor, which works to decrease
bacterial resistance to berberine.
Berberine
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27. Psoralea corylifolia
Biological source: plant of Fabaceae
family, Leguminosae
Common names: Babchi
Chemical Constituents: Psoralen
Mechanism of action:
intercalates into the DNA double helix
positioned to form adduct with adjacent
pyrimidine bases upon excitation by an
ultraviolet photon.
Psoralen
It is widely used in PUVA (psoralen + UVA)
treatment for psoriasis
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28. Aloe
Biological source: Aloe barbadensis ,Liliaceae
Common names: Musabar , Aloevera
Chemical Constituents: Anthraquinones
Mechanism of action:
An induction of glutathione S-transferase
an inhibition of the tumor-promoting effects
Aloes act as analgesics, antibacterials and antivirals, actions
may be due to indirect or direct effects. Indirect effect is due to
stimulation of the immune system and direct effect is due to
anthraquinones.
Anthraquinones 28

29. Tea tree oil
Biological source: leavess of Melaleuca alternifolia
Common names: ti tree,
Chemical Constituents: Terpinen-4-ol
Mechanism of action: It exhibits broad‐spectrum
antimicrobial activity,
Release of Ca2+ and Mg2+increase cell membrane
permeability release of lactate dehydrogenase
cell wall was destroyed
Terpinen-4-ol
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30. Indigo naturalis (Qing Dai)
Indigo naturalis can be distilled into an
oil extract.
This extract can treat nail psoriasis
Indigo naturalis is a plant used in
traditional Chinese medicine
1) Sheng Di Huang 2)Qian Cao Gin 3)Bai Hua She She Cao
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31. YOGA
APPLE CIDAR VINEGAR
FISHOIL CAPSULES
MASSAGE
SUPPLIMENTS
PROPER DIET
COUNSELLING
CHINESSE TREATMENT
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32. Foods to avoid if you have psoriasis
Red meat and dairy. Both red meat and dairy,
especially eggs, contain a polyunsaturated fatty
acid called arachidonic acid. ...
Gluten. Celiac disease is a health condition
characterized by an autoimmune response to the
protein gluten. ...
Processed foods. ...
Nightshades. ...
Alcohol.
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33. 33
Niosomal formulations are already proven its potential in treating various
diseases.
The two plants Wrightia tinctoria and Aloe barbadensis having potent anti-
psoriatic activity.
Niosomes are non-ionic surfactant vesicles, in which it is formed by the self-
assembly of non-ionic surfactants in aqueous medium resulting in a closed
bilayer structures
In-vitro antioxidant activity
Hydrogen peroxide assay
the percentage inhibition was calculated using the following formula:
% Scavenged (H2O2) = (A0−A1)/A0× 100,
Where, A0 - Absorbance of the standard (ascorbic acid), A1- Absorbance of
samples.
Herbal niosomal gel for psoriasis

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In-vivo study
PPD-induced psoriatic rat model
CONCLUSION:
Novel drug delivery system such as niosomes can be used to achieve
localized drug action.
 The herbal niosomal gel was an excellent method to improve the drug
delivery in the case of psoriasis.
 The drug loaded niosomes were stable in carbopol gel and the optimum
HLB value of the surfactant span 60 made this formulation stable

35. A gel known as AST-005 proved safe for people with psoriasis in
a small, phase I clinical trial. It uses microscopic spheres of genetic
material to stop your body from making TNF-alpha. Larger and
longer studies are needed, but experts say this could be a first step
toward new treatment options
Research on new treatments focuses on options which can be
applicable globally, on a large scale. New treatments need to be
affordable, effective and safe in the long term, stable in hot and
humid climates and require minimal monitoring.
Prospective, controlled studies are needed to further clarify the
association between psoriasis and cardiovascular disorders on a
pathogenic level and to substantiate the beneficial effect of
treatment for skin/joints and associated disorders.
RECENT ADVANCES
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36. In clinical research, there is a need for comparative effectiveness
research in order to identify the benefits and efficiency of
treatments.
For research outcomes that are more reliable, the currently used
clinical outcome parameters, including PASI and patient-reported
outcomes such as DLQI, need to be improved.
Health services research needs to be better used in identifying
specific needs of health care, unmet patient needs and barriers of
guideline-compliant treatment. Health services research should
monitor and provide feedback on the actions taken to improve
quality of care and investigate efficiency of care.
. Researchers are investigating the etiology of psoriasis and
therapies to prevent as well as to manage the symptoms of the
disease. It is vital to create low-cost effective treatment options
that can be made widely available.
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37. Ayurved is aboon for psoriasis patients
Jiva Ayurvedic Pharmacy Ltd – Jiva neem soap
Khadi Naturals - Khadi Naturals Ayurvedic Aloevera
Gel
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38. Dr.Stanley's - Psorease Oil
Organic India - Turmeric Formula
Capsule
Shrey Nutraceuticals & Herbals Pvt Ltd-
Shrey's Psorcare Capsule
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39. Aim and Objective -To evaluate the role of Ayurveda in
management of Psoriasis.
Place of study -The present case study was done in the Deptt. of
Kayachikitsa, Gangasheel Ayurvedic medical college, Bisalpur road,
Bareilly (Uttar Pradesh).
CASE REPORT
Basic information of the patient Age -19 yrs, Socioeconomic status-
Middle class. He is a farmer and has mixed diet pattern. Patient has
habit of chewing Gutkha (1 packet in 2-3 Days).
The PASI is a measure of the average redness, thickness and scaling
of the lesions (each graded on a 0-4 scale), weighted by the area of
involvement.
CASE STUDY
39

40. .
Steps in generating PASI score
1. Divide body into four areas: head, arms, chest and legs.
2. Generate a percentage for skin covered with psoriatic plaques
for each area and convert that
3. Generate an average score for the redness, thickness and
scale for each of the areas.
4. Sum the score of redness, thickness and scale for each of the
areas.
5. Multiply item (3) and (4) for each area and multiply that by
0.1, 0.2, 0.3 and 0.4 for head, arms, chest and legs
respectively.
6. Add these scores to get the PASI score.
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41. CONCLUSION
This case report showed that combined Ayurvedic regimen
is potent and effective in treatment of Psoriasis. No adverse
effect and aggravation of the symptoms was found in the patient
during and after the treatment.
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42. CONCLUSION
•Psoriasis is a multisystem inflammatory disease that is
under diagnosed as well as under treated despite its
prevalence and considerable effect on quality of life.
• Psoriasis require timely therapy to improve long-term
outcomes.
•Researchers are still working on the development of drug
therapy.
• Patients with psoriasis for whom topical therapy fails
should surely look through other evaluation.
•Psoriasis belongs to the class of complex autoimmune
genetic diseases that include diabetes, rheumatoid arthritis,
multiple sclerosis and Crohn's disease. The proportion of
genetic as opposed to environmental contributions in these
diseases is not clear.
42

43.  Jayant Bhalerao, Anne M. Bowcock, The Genetics of Psoriasis: A Complex
Disorder of the Skin and Immune System, Human Molecular Genetics, Volume
7, Issue 10, September 1998, Pages 1537–1545
 Smith, C. and Barker, J. (2006). Psoriasis and its management. BMJ,
333(7564), pp.380-384.
 Tampa, M., Sarbu, M., Mitran, M., Mitran, C., Matei, C. and Georgescu, S.
(2018). The Pathophysiological Mechanisms and the Quest for Biomarkers in
Psoriasis, a Stress-Related Skin Disease. Disease Markers, 2018, pp.1-14.
 Nickoloff, B. and Nestle, F. (2004). Recent insights into the
immunopathogenesis of psoriasis provide new therapeutic
opportunities. Journal of Clinical Investigation, 113(12), pp.1664-1675.
REFERENCE
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 Clinicaltrials.gov. (2019). Mechanism of Action Study for Psoriasis - Full
Text View - ClinicalTrials.gov.
 Whan B. Kim, J. (2019). Diagnosis and management of psoriasis. [online]
PubMed Central (PMC).
 Shijila P.* and Gowtham M, Formulation and evaluation of herbal
niosomal gel for psoriasis like effect, World Journal of Pharmacy and
Pharmaceutical Sciences, Vol 8, Issue 4, 2019,pg1-28
 Kumar Sahoo, *Sushanta, Singh, A., & Kumari, N. (2017). AYURVEDIC
MANAGEMENT OF PSORIASIS: A CASE STUDY. International
Journal of Ayurveda and Pharma Research, 5(10).

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