A proof-of-concept study in four patients has shown that an epidural nerve block using lidocaine can lead to clearance of psoriatic skin lesions. The report was published in the Journal of Investigative Dermatology.
“Case studies have shown that psoriasis patients have experienced significant symptom relief after receiving epidural anesthesia during surgery, suggesting a pivotal role of the nervous system in psoriasis pathogenesis,” lead investigator Honglin Wang, PhD, of the Shanghai Jiao Tong University School of Medicine in Shanghai, China said in a news release.
“Additionally, there is increasing evidence linking the neuroimmune connection to psoriasis and other skin diseases. These factors inspired us to explore the possibility of directly targeting the nervous system for psoriasis treatment and the detailed mechanism of neuroimmune crosstalk in psoriasis.”
All four patients in this study were diagnosed with moderate-to-severe psoriasis with body surface area ≥10% and PASI ≥12. They ranged in age from 18 to 65 years, were randomly recruited, and underwent a three-month washout period.
The researchers noted that patients 1 and 2 had psoriatic lesions on their entire body, while patients 3 and 4 had psoriatic lesions mainly distributed in the legs. Patient 1 received treatment on days 1, 27, and 75; patient 2 received treatment on days 1, 56, and 114; patient 3 received treatment on days 1, 48, 94, and 165; and patient 4 received treatment on days 1 and 64.
An epidural catheter was inserted between the 12th thoracic vertebra and the first lumbar vertebra of the spinal cord. Lidocaine solution 1% was injected through the catheter based on 4 mg/kg body weight, with each patient receiving three or four treatments. Patients were photographed and scored on each treatment day.
The authors report that patients achieved improvements in all assessments with a 35 to 70% reduction in their PASI scores. The improvements were maintained for at least 24 weeks after the last lidocaine treatment.
No adverse effects were observed in the patients throughout the treatment.