Potential Treatment of Psoriasis with Oral Spironolactone as TNF-Alpha Inhibitor – A Future Prospective Review

Psoriasis is a chronic dermatological condition that cause scaly red patches on the different parts of body. It always tends in cycles of months wherein winter aggravation is most common then it subsides for a while then again relapse or remission. The exact identity of the factors causing psoriasis is not established but the fact that T cell activates the release of proinflammatory cytokines such as TNF-α, interferon-γ and IL-2 has been identified. Cytokine, TNF- α plays a key role in keratinocyte proliferation and other vascular changes in psoriasis. TNF-α protein levels has been found on higher side in psoriasis lesions, intraepidermal Langerhans cells and dermal dendrocytes. The available treatment options for suppressing TNF-α are given only by IV/SC route like adalimumab, infliximab and etanercept also costlier and give only symptomatic relief for a shorter period of time. Hence, we need a pharmacologically active, therapeutically safe and cost-effective agent for long term use. Against all the available data, Spironolactone an aldosterone antagonist has been found to fulfill all the necessary conditions to be used as TNF- α antagonist, a noticeable suppressive effect on TNF- α receptor along with several pro-inflammatory cytokines. Such findings encouraged beginning of clinical studies of spironolactone as TNF- 𝛼 antagonist in patients with psoriasis.