Botulinum Toxin Use for Modulating Neuroimmune Cutaneous Activity in Psoriasis

Abstract

Psoriasis is a complex immune-mediated inflammatory disorder that generates enormous interest within the scientific communities worldwide, with new therapeutic targets being constantly identified and tested. Despite the numerous topical and systemic medications available for the treatment of psoriasis, alternative therapies are still needed for the optimal management of some patients who present with localized, resistant lesions. Novel insights into the contribution of cutaneous neurogenic inflammation in the pathogenesis of psoriasis have yielded exciting new potential roles of nerve-targeting treatments, namely botulinum toxin type A (BoNT-A), for the management of this disease. This paper aims to review the existing literature on knowledge regarding the potential role of BoNT-A in psoriasis treatment, with a focus on its ability to interfere with the immunopathogenetic aspects of psoriatic disease. Furthermore, in our paper, we are also including the first report of psoriatic lesions remission following local BoNT-A injections that were administered for treating upper limb spasticity, in a patient that concomitantly suffered from psoriasis and post-stroke spasticity.

Keywords: botulinum toxin; neurogenic inflammation; neuroimmune system; neuropeptides; psoriasis.

Figure 1

Psoriasis plaques on the extensor surfaces of the elbow and forearm before (A) and 1 month after (B) a single injection session with 1000 U of abobotulinumtoxinA for treating upper-limb spasticity.