Table 1.

List of current treatments available for psoriasis and its respective mechanisms.

		Anti-Psoriatic Drug/Material	Trade Name	Application	Mechanism	Reference
Conventional	Topical	Betamethasone/calcipotriol	Dovobet® gel	Gel	These drugs inhibit cell proliferation and initiate cell differentiation on the affected skin. They also serve as immunomarkers.	[48,49,50]
		Betamethasone/calcipotriol	Xamiol®	Gel
		Calcipotriol	Calcipotriol® ointment	Ointment
		Calcipotriol	Dovonex® ointment	Ointment		[51]
		Coal tar	Capasal®	Shampoo	These drugs inhibit cell proliferation and initiate cell differentiation on the affected skin. They also serve as immunomarkers.	[52,53]
		Coal tar, coconut oil, salicylic acid, sulfur	Cocois®	Ointment		[52]
		Coal tar	Carbo-Dome®	Cream		[54]
		Coal tar	Exorex®	Lotion		[55]
		Coal tar	Polytar® plus liquid	Solution		[56]
		Coal tar	Psoriderm® cream	Cream		[57]
		Coal tar, coconut oil, salicylic acid, sulfur	Sebco®	Ointment		[58]
		Concentrate cetrimide, phenylethyl alcohol, undecenoic acid (antifungal and antibacterial)	Ceanel®	Shampoo	This drug demonstrates antibacterial activity. As the drug is hydrated, small inactive anions and complex cations are dissociated, activating its bactericidal properties.	[59,60]
		Tacalcitol	Curatoderm®	Ointment	These drugs regulate cell apoptosis, differentiation, proliferation, and immunomodulation.	[59,61]
		Tacalcitol	Curatoderm® lotion	Lotion		[62]
		Benzalkonium chloride	Dermax® therapeutic shampoo	Shampoo	This drug exhibits antifungal and antibacterial activity.	[63,64]
		Dithranol	Dithrocream®	Cream	These drugs inhibit hyperproliferation of keratinocyte and granulocyte function. They may also help to suppress the immunoresponse triggered by psoriasis.	[63]
		2% Dithranol	Dithrocream®	Cream		[63]
		Dithranol	Micanol®	Cream		[65,66]
	Systemic	Methotrexate	Otrexup™, Rasuvo®, Rheumatrex®, and Trexall™	Subcutaneous injection or oral	This drug inhibits dihydrofolate reductase production, which offsets purine synthesis. This may also lead to lymphocyte apoptosis.	[66]
		Cyclosporine	Neoral, Sandimmune, and Gengraf	Oral	This drug inhibits production of calcineurin, leading to a reduction in IL-2 levels.	[67]
		Acitretin	Soriatane and Neotigason	Oral	This drug helps normalize the proliferation of keratinocyte and differentiation by binding to the retinoid receptor.	[68]
		Fumarate	Tecfidera	Oral	This drug regulates intracellular glutathione, Nrf2, HIF-1α, and NF-κB, and by doing so creates a shift from pro-inflammatory Th1/Th17 response to an anti-inflammatory/regulatory Th2 response.	[69]
		Apremilast	Otezla, Aplex	Oral	This drug inhibits PDE4, thereby increasing the level of intracellular cAMP in immune and non-immune cells, reducing the inflammation.	[70]
		Etanercept	Enbrel	Subcutaneous injection	This drug is a dimeric human fusion protein that is a TNF-α antagonist. TNF-α is the pro-inflammatory cytokine in pathogenesis.	[71]
		Infliximab	Remicade	Intravenous	This drug is a chimeric IgG1κ monoclonal antibody that binds to soluble and transmembrane forms of TNF-α, another TNF-α antagonist.	[72]
		Adalimumab	Humira, Mabura, Exemptia	Subcutaneous injection	This drug is a human monoclonal antibody that is yet another TNF-α antagonist.	[73]
		Certolizumab	Cimzia	Subcutaneous injection	This drug is a humanized antigen-binding fragment (Fab) of monoclonal antibody TNF-α conjugated to polyethylene glycol.	[74]
		Ustekinumab	Stelara	Subcutaneous injection	The drug is a human IgG1k monoclonal antibody that specifically binds to p40 protein subunit that is required for IL-12 and IL-23 cytokines IL-12/IL-23 p40 functionality.	[75]
		Tildrakizumab	Ilumya, Ilumetri	Subcutaneous injection	The drug is a humanized IgG1κ, which inhibits IL-23 selectively by binding to its p19 subunit.	[76]
		Guselkumab	Tremfya	Subcutaneous injection	The drug is a human immunoglobulin G1 lambda (IgG1λ) monoclonal antibody, inhibiting IL-23 selectively by binding to its p19 subunit.	[77]
		Risankizumab	Skyrizi	Subcutaneous injection	The drug is a humanized IgG1 monoclonal antibody that inhibits IL-23 by binding to its p19 subunit.	[78]
		Secukinumab	Cosentyx	Subcutaneous injection	This drug is a human IgG1κ monoclonal antibody that is a IL-17A antagonist.	[79]
		Ixekizumab	Taltz	Subcutaneous injection	This drug is a humanized, immunoglobulin G4κ monoclonal antibody that binds selectively to IL-17A and thereby neutralizes it functionality.	[80]
		Brodalumab	Siliq, Kyntheum	Subcutaneous injection	This drug is a human monoclonal IgG2 antibody that acts against IL-17RA.	[81]
Natural		Bee venom	-	Venom acupuncture	The venom has an analgesic and anti-inflammatory effect.	[82]
		Aloe vera (aloesin)	-	Gel	Aloesin initiates the upregulation of cytokines and growth factor (IL-1β, IL-6, TGF-β1, and TNF-α) release from macrophages. This enhances the angiogenesis in endothelial cells. It also accelerates wound healing in mice model by activating MAPK and Smad signalling proteins.	[83]
		Turmeric (curcumin)	-	Powder	Curcumin inhibits the proliferation of IMQ-induced differentiated HaCaT cells (psoriatic-like cells) by downregulation of pro-inflammatory cytokines, IL-17, TNF-α, IFN-γ, and IL-6.	[84]
		Oregon grape (berberine)	-	Ointment/cream	Berberine inhibits 5-lipoxygenase and lipid peroxidation in liposomes, as well as immune markers ICAM-1, CD-3, and HLA-DR, and keratins 6 and 16, resulting in an antiproliferative effect on human keratinocytes.	[85]
		Propolis	-	Ethanolic extract	Propolis prevents the release of prostaglandins and leukotrienes, and it decreases neutrophil infiltration into the skin.	[86]
		Neem (azadirachtin)	-	Soap	Azadirachtin modulates the activity of transcription factors NF-κB and cell apoptosis.	[87]