Epidural lidocaine injections show promise for treating psoriasis

Psoriasis is a chronic inflammatory, debilitating skin condition. While there is no cure for psoriasis, several treatment options can inhibit inflammation and relieve signs and symptoms of this disease. In this new study in the Journal of Investigative Dermatologypublished by Elsevier, researchers report surprising results for the treatment of psoriasis with epidural lidocaine injections.

Case studies have shown that psoriasis patients have experienced significant symptom relief after epidural anesthesia during surgery, indicating a critical role of the nervous system in the pathogenesis of psoriasis. In addition, there is mounting evidence linking the neuroimmune connection to psoriasis and other skin diseases. These factors inspired us to explore the possibility of targeting the nervous system directly for the treatment of psoriasis and the detailed mechanism of neuroimmune crosstalk in psoriasis.”

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Honglin Wang, PhD, Principal Investigator, Shanghai Institute of Immunology, Precision Research Center for Refractory Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Researchers conducted a proof-of-concept study using an epidural injection of lidocaine to treat four patients with psoriasis. An epidural catheter was inserted between T12 (ie the 12th thoracic vertebra) and L1 (ie the first lumbar vertebra) of the spinal cord. Lidocaine solution was injected through the catheter. Each patient received a total of three or four treatments. Two patients had psoriatic lesions throughout the body; two patients had psoriatic lesions, mainly spread over the legs.

By the end of the study period, all patients achieved remarkable improvements in nearly all lesions, with a 35%-70% reduction in Psoriasis Area and Severity Index (PASI) scores. In addition, skin improvements persisted for at least 24 weeks after discontinuation of lidocaine treatment. No adverse effects occurred. This study provides the first clinical evidence that sensory nerves are potential targets for the treatment of psoriasis.

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To evaluate neuroimmune communication signaling in psoriasis and the mechanism for lidocaine therapy, researchers also conducted a number of experiments on rats in which a psoriasis-like skin inflammation was induced. They found that lidocaine acts on sensory neurons by downregulating the disordered growth of neurites and pro-inflammatory CGRP (calcium gene-related peptide) release. Concurrently limited CGRP+ nerve density leads to decreased production of IL-23 by dendritic cells, which overexpress CGRP receptors.

In summary, this proof-of-concept pilot study highlights the potential for epidural lidocaine injection as an effective and safe therapeutic strategy for the treatment of psoriasis and increases the understanding of the role of the peripheral nervous system in psoriasis and potentially other skin diseases. Manipulating the neuroimmune interplay inhibits neurogenic inflammation and the downstream major inflammatory cytokine production, offering therapeutic prospects for sensory neuron-orchestrated inflammatory skin diseases.

“Epidural lidocaine therapy provides a new choice for patients who respond poorly to current treatment modalities for psoriasis,” added lead author Qianqian Yin, PhD, Shanghai Institute of Immunology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

“While these findings are promising, this was a small pilot study without a placebo-controlled arm and controls to avoid interference from environmental changes. Next, we need to conduct large-scale clinical trials,” said co-investigator Libo Sun, PhD, Shanghai Institute of Immunology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

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Psoriasis affects more than 3% of the US adult population. It is a chronic immune-mediated skin disease in which the peripheral sensory nervous system plays an active role in its pathogenesis. The most common form of psoriasis is plaque psoriasis. Symptoms include patches of skin that are dry, red, and covered with silvery scales that usually appear on the elbows, knees, lower back, and scalp. There is no cure for psoriasis, but a range of systemic and topical treatments can relieve symptoms and signs and improve the appearance of skin blemishes.


Reference magazine:

Yin, Q., et al. (2022) Lidocaine improves psoriasis by interfering with pathogenic CGRP signaling-mediated sensory neuron-dendritic cell communication. Journal of Research Dermatology.

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