What Is the Main Idea?

Psoriasis is an inflammatory skin problem from which more than 125 million people worldwide suffer. Over the past 20 years, researchers have tested different medicines for the treatment of psoriasis. However, there has not yet been an overall examination combining all the test results. The authors of the research article “Effect of Different Types of Hypoglycemic Medications on Psoriasis: An Analysis of Current Evidence”, published in the journal Dermatology, aimed to find out whether a specific type of medicine can help psoriasis by carrying out an overall review of past research.

What Else Can You Learn?

Psoriasis and its treatment are connected to the symptoms and treatment of diabetes mellitus and cardiovascular conditions.

What Is Psoriasis?

Psoriasis is a problem with the skin, caused by over-production of the skin cells that sit on the very outside of the skin (keratinocytes). The skin becomes thick and scaly (known as plaque), silvery-red in color, and can have pinpoint bleeding (known as Auspitz’s sign). It most often affects the elbow, but can happen in any part of the skin, including the nails, palms and soles, and genitalia. Known fully as psoriasis vulgaris, it is a chronic, recurring, multisystem, inflammatory disease. This means that it lasts longer than a few weeks, can come and go in severity, and affects many parts of the body due to an underlying inflammation problem (in the case of psoriasis this inflammation leads to the skin cell over-production).

What Are Hypoglycemic Medications?

In people with psoriasis these medications help improve the body’s metabolism, which is how it processes glucose and lipid (sugar and fat). If the body’s metabolism doesn’t work properly, the body can become hypoglycemic (known as hypoglycemia) and, amongst other things, inflammation and immunity processes are affected.

What Is Diabetes Mellitus and How Is It Connected to Psoriasis?

Hypoglycemia is also a symptom of diabetes. Psoriasis is connected with diabetes because diabetes is more common in people with psoriasis. Known fully as diabetes mellitus (DM), it is a metabolic disease that can damage the blood vessels, nerves, eyes, and kidneys, leading to serious complications and possible death. Most people with diabetes have type 2 (T2DM), which must be treated with changes to diet and exercise and also, like psoriasis, medicines that help hypoglycemia.

Unfortunately, for people with psoriasis, the risk of T2DM and also cardiovascular problems increases as the disease worsens. Therefore, psoriasis researchers are focusing on treatments that help the body’s metabolism, reduce inflammation, and improve immunity.

How Is Psoriasis Treated?

Both external medicines (such as creams and oils) and medicines taken by mouth have been used to treat psoriasis. However, they have not been very helpful. In the past 20 years, there have been many tests using hypoglycemic medicines. The authors reviewed all the tests using these medicines, to see how effective they can be. This has never been done before.

How Do Researchers Compare so Many Different Tests?

The authors carried out a systematic review and meta-analysis. They searched research databases for all research on hypoglycemic medicines and psoriasis. There are international guidelines for how to do this in the best way: such as using key search words to find suitable papers and using logical processes to categorize the different types of research.

The authors selected only the best and most relevant research, using the international guidelines and statistical methods to compare the research. This resulted in information on 223 patients within 14 studies, described in 18 papers.

How Did They Measure the Treatment Efficacy?

The authors identified different ways to measure whether a hypoglycemic medicine helped psoriasis. The first was that some studies used specialist scoring systems for skin symptoms. These were the psoriasis area and severity index (PASI) score, and dermatology life quality index (DLQI) score. The authors could then take these scores and use formulas to work out whether a treatment helped or not.

The next two methods the authors used were chosen in order to account for the interaction between psoriasis, diabetes and cardiovascular problems (inflammation, immunity and metabolism problems). They looked for scores that represented metabolic health and cardiovascular health. These included information on waist circumference, body mass index (BMI), levels of cholesterol and blood pressure. As for the skin symptom scores, by using these measurements and applying statistical methods the authors could then determine how effective a treatment was.

What Did the Authors Find?

The authors found that all the hypoglycemic medications studied could reduce psoriasis to varying degrees. They also found that the hypoglycemic medications could reduce some of the signs of poor metabolic and cardiovascular health (e.g., waist circumference, cholesterol, and blood pressure).

It is worth noting that none of the included studies involved patients taking a different type of medicine often used to treatment psoriasis, known as biologics. The authors mention that further studies could explore taking a combination of medicines.

Take-Home Message

The authors were excited to see that the use of hypoglycemic medicines may help the treatment of psoriasis alongside symptoms of diabetes or cardiovascular diseases. However, they reported that it is very important that people with psoriasis do not rely just on medicines, but instead also change their diet and exercise.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.

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