Epidural Nerve Blocking With Lidocaine Shows Promise in Treatment of Psoriatic Skin Lesions

Treating psoriasis using epidural lidocaine injections has shown promise for lesions, according to the results of a study published in the Journal of Investigative Dermatology.

“Case studies have shown that [individuals with] psoriasis have experienced significant symptom relief after receiving epidural anesthesia during surgery, suggesting a pivotal role of the nervous system in psoriasis pathogenesis,” Honglin Wang, PhD from the Shanghai Institute of Immunology, said in a statement.

“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,” Wang said.

Investigators used an epidural injection of lidocaine to treat 4 individuals with psoriasis. The epidural catheter was inserted between the 12th thoracic vertebra and the 1st lumbar vertebra of the spinal cord. The solution was injected through the catheter.

Each individual received 3 to 4 treatments, and 2 had lesions all over their bodies, while the other 2 had them mainly on their legs.

At the end of the study period, all individuals achieved improvement in almost all lesions, with a 35% to 70% reduction in Psoriasis Area and Severity Index (PASI) scores. The improvements were also maintained for at least 24 weeks after discontinuation of the lidocaine treatment.

Additionally, there were no adverse events in the study.

These results provide the first clinical evidence that sensory nerves are potential targets for psoriasis treatment, investigators said.

“Epidural lidocaine therapy provides a novel choice for patients who respond poorly to the current treatment modalities for psoriasis,” Qianqian Yin, PhD of the Shanghai Institute of Immunology, said in the statement.

Furthermore, the investigators conducted a number of experiments on rates who had induced psoriasis-like skin inflammation. They wanted to evaluate the neuroimmune communication signaling in psoriasis and the mechanism for the lidocaine therapy.

They found that the lidocaine responds to sensory neurons by downregulating disordered neurite growth and proinflammatory calcium gene-related peptide (CGRP) release. The restricted CGRP+ nerve density leads to reduced interleukin-23 production from the dendritic cells expressed in excessive CGRP receptors.

“Although these findings are promising, this was a small pilot study that lacks a placebo-controlled arm and controls to prevent interference by environmental changes. We next need to conduct large-scale clinical studies,” Libo Sun, PhD of the Shanghai Institute of Immunology, said.

The proof-of-concept study highlights the potential for epidural lidocaine injection as an effective and safe therapeutic strategy for psoriasis treatment and calls for further investigation on the subject.

It also expands the understanding of the peripheral nerve system in psoriasis as well as other skin conditions.

Psoriasis symptoms include patches of skin that are covered in scabs, dry, and red that usually appear on the elbows, knees, lower back, and scalp. There is no cure, but there are a variety of systemic and topical treatments for the appearance and symptoms of skin lesions.

Reference

Epidural nerve block with lidocaine leads to clearance of psoriatic skin lesions. News release. EurekAlert. August 10, 2022. Accessed November 4, 2022. https://www.eurekalert.org/news-releases/961468