# Pathophysiologyiology and Treatment of Soriasis: From Clinical Practice to Basic Research
## 4 Diagnosis and Clinical Treatment of Psoriasis
### Clinical Treatment of Psoriasis
#### 4.2.1 Oral Medicines for Psoriasis  
Conventional oral treatments for psoriasis primarily include immunosuppression (such as methotrexate and cyclosporine), retinoids, and corticosteroids. Methotrexate is a folate reductase inhibitor that suppresses cell proliferation and reduces inflammation, making it suitable for patients with moderate to severe psoriasis. Several organ toxicities have been characterized during the clinical use of methotrexate, including hepatotoxicity, nephrotoxicity, pulmonary toxicity, and gastrointestinal toxicity. In the clinical setting, renal injury is the main dilemma limiting the utility of methotrexate [97]. Appemilast, a phosphodiesterase-4 inhibitor, regulates cyclic adenosine monophosphate (cAMP) levels, resulting in a broad suppression of proinflammatory mediators and a subsequent reduction in tumor necrosis factor-alpha (TNF-\(\alpha\)) activity. Phase III randomized controlled trials, including PALACE and ACTIVE, demonstrated the efficacy of appemilast in improving clinical and patient-reported outcomes in psoriatic arthritis (PsA) patients, regardless of prior disease-modifying anti-rheumatic agent (DMARD) experience [67]. Cyclosporine [98], another immunosuppressiveant, reduces skin inflammation by inhibiting T cell activation and is appropriate for severe cases of psoriasis. However, long-term use may lead to adverse effects such as liver and kidney dysfunction and bone marrow suppression. Retinoids, such as acitretin [99], regulate cell differentiation and proliferation, and are effective for plaque, pustular, and erythrodecrimic psoriasis. A double-blind study involving 38 patients  
Figure 2: Overview of the types, advantages, and disadvantages of medications for the clinical management of psoriasis. Created with BioRender.com. with stable, plaque-type psoriasis showed that the most frequent adverse effects of acitretin included cheilitis, peeling of the palms and soles, and alopecia, similar to those observed with etretinate therapy. Laboratory abnormalities primarily involved elevated serum triglycerides, with less frequent increases in serum cholesterol and liver transaminase levels [68]. Glucocorticosteroids [100], such as prednisone, offer potent anti-inflammatory and immunosuppressive effects. Due to potential side effects with long-term use (including osteoporosis, muscle atrophy, skin thinning, mood swings, immune suppression, glaucoma and cataracts, gastrointestinal issues, impaired growth, and increased bleeding risk), corticosteroids are typically recommended for short-term treatment. [PERSON] [69] et al. presented the case of a 43-year-old woman with multiple sclerosis who developed symptomatic bradycardia following three days of high-dose methylprednisolone treatment. Additionally, certain traditional Chinese medicine (TCM) formulations are used in psoriasis management, which refers to medicinal substances used for disease prevention and treatment based on TCM principles, including raw herbal materials, processed herbal pieces, and proprietary Chinese medicines. TCM differs from Western medicine in its theoretical foundation, treatment principles, sources of medication, and methods of application [101]. In TCM, psoriasis is often attributed to blood-related issues such as blood heat, blood dryness, and blood stasis and is associated with dysfunction in organs like the liver and kidneys. Formulations, such as Xiaoyin Jiedu Granules [102], and ingredients are as follows: 30 g of Shuiniujaao, 15 g of Shengdihuang, 15 g of Danpi, 15 g of Chishao, 15 g of Baihuasheshecao, 15 g of Quanshen, 20 g of Zicao, 10 g of Shenghuaihua, 15 g of Tufuling, 15 g of Daqingye, and 20 g of Rendongteng. These are thought to cool, detoxify, and nourish the blood and may be used, but treatment is usually tailored to individual conditions.