Neuromodulatory treatment of recalcitrant plaque psoriasis with onabotulinumtoxinA

To the Editor: The role of neurocutaneous pathways in the pathogenesis of psoriasis has been suggested in cases of dermatomal improvement in psoriatic plaques following central or peripheral nerve damage1-3; however, few studies have assessed the effect of nerve-targeting treatments,4,5 especially in plaque psoriasis. This study investigated the effect of onabotulinumtoxinA injections on psoriasis severity, epidermal nerve fiber (ENF) density, and expression of the neuropeptides substance P (SP) and calcitonin gene–related peptide (CGRP).

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