Worms : A remarkably reasonable treatment option for psoriasis

There is a need to expand safe and effective treatment options for patients with moderate to severe psoriasis. This article hypothesizes one promising novel treatment option: Trichuris Suis. Epidemiological, experimental, and clinical evidence suggest that Trichuris Suis therapy may be both applicable and advantageous in the treatment of psoriasis. Epidemiologically, the de-worming of developed nations has been correlated with the increased prevalence of immune-mediated disease such as psoriasis. Additionally, the mechanisms of helminth immune regulation should mitigate the underlying immunopathology in psoriasis. Finally, safety and efficacy of Trichuris Suis has been demonstrated in other immune-mediated diseases such as Crohn’s, ulcerative colitis, and multiple sclerosis with clinical responses in as many as 80% of patients. Evidently, there is ample evidence to warrant the investigation of Trichuris Suis therapy as a novel psoriasis treatment. Worms: A remarkably reasonable treatment option for psoriasis Tufts Medical Center, Boston, Massachusetts Corresponding author jacqueline Greb, B.a. 1 Nassau St., Apt. 2004 Boston, MA 02111 Email: [email protected] Phone: 781.248.6837 Disclosures The authors have no conflicts of interest to disclose. introduction Psoriasis is a chronic inflammatory immunemediated disease of the skin and nails. Psoriasis is considered the most common immune-mediated disease, with an estimated global prevalence of 2-3% and an annual expenditure of $3 billion in the United States alone.1 The disease may dramatically impact quality of life and is associated with major cardiovascular and metabolic co-morbidities. The development of new therapies with favorable safety and efficacy profiles remains a priority in order to decrease disease burden and improve patient quality of life. Helminths There is evidence that helminths, eukaryotic parasitic worms, have been infecting humans since ancient times.2,3 As a result of their subsequent co-evolution, few people infected by helminths exhibit any symptoms of infection due to the parasites’ ability to modulate the immune system of the human host. 4 In fact, helminth infection often provides advantage to the human host. According to the “hygiene hypothesis” and its newest iteration, the “old friends hypothesis,” modern sanitary advances with their concurrent de-worming of much of the developed world have been deemed responsible for the rise in immune dysfunction.5, 6