Challenges and Roadmap for Treatment of Psoriasis

Abstract: Psoriasis is a chronic skin disease characterized by the provocation of immune-mediated inflammatory mediators, affecting 2 to 5% of the population worldwide regardless of age. Conventional treatment with systemic and topical drug regimens for 12 to 16 weeks can lead to side effects, safety concerns, cost issues, and the possibility of noncompliance, which may result in treatment failure. There is potential for combining phytoactives with these treatments to explore synergistic effects. A literature search on PubMed, ScienceDirect, Connected Papers, and Google Scholar was conducted, focusing on recent articles based on keywords related to “psoriasis, psoriasis pathogenesis, IL-23/IL-17, biosimilars, stem cells, herbals, phytoactives, nanoformulation, quality of life, and patient compliance.” The present study aimed to understand different psoriasis lesions and correlate the pathogenic involvement of inflammatory mediators. It also sought to explain available conventional therapies, including small molecules and phototherapy, and discuss the paradigm shift toward the development of biosimilars and stem cell therapy. Considering the chronic nature of psoriasis, reported adverse effects, and its impact on cost-effectiveness and patient quality of life, systemic and topical applications of natural products may be a better option. Natural products are well studied at the preclinical and clinical levels, targeting the cytokine IL-17/IL-23 pathways. Nanoformulation can overcome solubility and bioavailability issues and has proven effective in clinical trials. This review further elaborates on psoriasis management to address side effects, cost-effectiveness, patient compliance, and overall quality of life. Psoriasis significantly affects quality of life across demographics. Standard guidelines outline treatment protocols with appropriate follow-up and checklists for secondary infections and comorbidities. There is a need for rigorous clinical trials to establish the efficacy and safety profiles of specific phytoactives that can act as immunostimulants when combined with available treatments. Additionally, synergistic effects can be achieved, as phytoactives are known for their antioxidant and anti-inflammatory activities, which may help refine and optimize treatment protocols.