Intralesional Mode of Drug Administration in Psoriasis

February 2022 | Volume 21 | Issue 2 | Original Article | 186 | Copyright © February 2022


Published online January 26, 2022

Suja Sathyan MD,a Komal Agarwal MD,b Indrashis Podder MD,c Anant Patil MD,d Leon H. Kircik MD,e Jeffrey M. Weinberg MD,f Paul S. Yamauchi MD,g Stephan Grabbe MD,h Mohamad Goldust MDi

aSparsh Skin Clinic, Kerala, India
bDepartment of Dermatology, CNMC, Kolkata, India
cDepartment of Dermatology, Venereology and Leprosy, College of Medicine and Sagore Dutta Hospital, Kolkata, India
dDepartment of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
eIcahn School of Medicine at Mount Sinai, New York, NY; Indiana University Medical Center, Indianapolis, IN; Physicians Skin Care, PLLC Louisville, KY; DermResearch, PLLC Louisville, KY; Skin Sciences, PLLC Louisville, KY
fIcahn School of Medicine at Mount Sinai, New York, NY
gDermatology Institute and Skin Care Center, Santa Monica, CA; Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, CA
hDepartment of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
iDepartment of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

Abstract
The use of various conventional systemic and topical therapies in psoriasis has resulted in various major and minor side effects. Hence, we need to switch to intralesional administration of antipsoriatic drugs, to achieve better safety and efficacy profile. Intralesional drug therapy is most suitable for scalp, nail, and localized and recalcitrant plaque psoriasis. However, there are specific drugs, which can be used for this purpose, under strict monitoring. We have attempted to review all the possible drugs and indications where intralesional administration is feasible, along with their efficacy, adverse effects, dosage, and recommended duration of treatment.

J Drugs Dermatol. 2022;21(2):186-190. doi:10.36849/JDD.6196

INTRODUCTION

Therapeutic use of various systemic and topical modalities for psoriasis have been well studied and practiced by dermatologists worldwide.1 However, there is always a need for newer effective and convenient modes of therapies as the disease is relapsing and remitting, often recalcitrant to topical treatment and adversely affects the patient’s quality of life. Moreover, with increasing reports suggesting association of psoriasis with multiple co-morbidities, newer intralesional mode of drug administration is gaining popularity. We need a detailed discussion on these intralesional drugs with respect to their regimens and specific indications to ensure a patientcentric approach with minimum systemic adverse effects. In this article we review the various intralesional (IL) drugs which have been tried in psoriasis or are in the pipeline, along with their mechanism of action, dose and possible adverse effects.

MATERIALS AND METHODS

We undertook a comprehensive English literature search across multiple databases such as PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane using keywords (alone and in combination) and MeSH items such as “psoriasis” AND “intralesional” OR “treatment” OR “drugs” OR “administration” OR “therapy” to obtain several relevant articles, priority being given to prospective randomized controlled trials. We scanned all the relevant articles in English literature and summarized them to obtain the latest information about this molecule to prepare the current review article. The references of selected articles were scanned for more relevant articles. Articles in other languages were excluded from our search (Table 1).

Corticosteroids
Corticosteroids are potent anti-inflammatory agents used in topical or systemic form in various inflammatory disorders. The general rebound or flare up of the psoriatic lesions post systemic corticosteroids limits its usage in psoriasis. Topical corticosteroids have poor percutaneous absorption especially in the thick scaly plaques of scalp psoriasis and palmoplantar areas, they are therefore often used with keratolytic agents and occlusive dressings.2,4 Due to these drawbacks of systemic and topical corticosteroid therapy, intralesional therapy offers a new avenue of hope.