## 5 Antioxidants from Natural Products as Alternative Treatment
### Other Antioxidants  
Beyond the well-known antioxidant compounds, recent research has identified several other natural compounds that could play a significant role in managing psoriasis by targeting oxidative stress and mtROS. These emerging antioxidants offer new avenues for therapeutic intervention, expanding the potential treatment options for this chronic inflammatory skin condition. For instance, epigallocatechin-3-gallate (EGCG), the flavonoid compound from green tea, has also demonstrated the ability to suppress mtROS production and enhance mitochondrial function by upregulating antioxidant defenses and reducing pro-oxidant enzyme activity [95]. These compounds collectively target oxidative stress and mtROS, offering promising avenues for improving psoriatic outcomes through natural antioxidant therapy. EGCG exhibited its antioxidant properties in psoriasis by reducingMDA concentrations, which serve as an indicator of oxidative stress, and enhancing the effectiveness of antioxidant enzymes such as SOD and CAT [96]. This study also discovered that applying EGCG topically improved skin structure, decreased T-cell infiltration, and reduced pro-inflammatory cytokines such as IL-17 and IL-23, thereby alleviating psoriasis-like symptoms in imiquimod-induced mice [96]. Other than that, a study also shows that EGCG effectively decreases MDA levels in HaCaT cells that are subjected to UV light. The optimized formulation of EGCG with hyaluronic acid exhibited the most significant decrease in MDA levels, suggesting a more potent inhibition of UV-induced oxidative damage in comparison to plain EGCG and EGCG-transfersomes [97]. The results emphasize the prospective of EGCG as a potent natural antioxidant in controlling oxidative stress and inflammation in psoriasis. In addition, rutin is a hydrophobic polyphenic constituent of the flavonoid family found in several foods, including citrus, apples, buckwheat, black tea, and green tea [98]. Numerous studies demonstrate that the inherent antioxidant characteristics of rutin may contribute to the mitigation of oxidative stress and inflammation, pivotal elements in the pathogenesis and advancement of psoriasis. A study provides evidence that rutin effectively mitigates psoriasis-like symptoms in a mouse model generated by imiquimod by decreasing inflammation, severity of skin lesions, and oxidative stress. The utilization of a melatonin and rutin ointment topically successfully reduced the concentrations of inflammatory markers such as TNF-\(\alpha\) and IL-17A and decreased MDA, suggesting its potential as a therapeutic intervention for psoriasis [99]. The results were similar to those of lobetasol, a conventional therapy, indicating that rutin shows promise as a natural alternative for the management of psoriasis. A study also demonstrates that rutin efficiently safeguards keratinocytes against oxidative stress by decreasing the concentrations of ROS, nitric oxide (NO), and MDA while simultaneously increasing the activity of SOD and GSH-Px [100]. Furthermore, rutin reduced the synthesis of inflammatory cytokines (IL-6, IL-18, IL-23A) and stimulated the Nrf2 pathway, therefore enhancing the expression of antioxidant enzymes NQO1 and HO-1 [100]. Additionally, a study demonstrates that the combination of ascorbic acid and rutin provides enhanced antioxidant protection against UV-induced skin damage in keratinocytes and fibroblasts. The combined treatment significantly increased the activity of antioxidant enzymes, including CAT and SOD [101]. The concurrent therapy successfully decreased the production of ROS, reduced the oxidation of lipids and proteins, and targeted pro-inflammatory and pro-apoptotic pathways, including NF\(\kappa\)B and caspases [101]. These findings indicate that the combination of ascorbic acid and rutin has strong cytoprotective, anti-inflammatory, and anti-apoptotic properties, making them a promising method for to minimize oxidative stress in psoriasis.