From the Guidelines
Methylene blue is not currently recommended for treating psoriasis due to insufficient scientific evidence supporting its effectiveness for this specific skin condition. The most recent and highest quality study, published in 2022 by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), updated treatment recommendations for psoriatic arthritis and discussed the treatment of skin psoriasis 1. This study, along with others, emphasizes the use of topical agents, phototherapy, oral therapies (such as methotrexate, ciclosporin, PDE4 inhibitors, and JAK inhibitors), and biologic DMARDs (including TNF inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, and IL-23 inhibitors) for the treatment of psoriasis.
Key Points for Psoriasis Treatment:
- Topical corticosteroids (e.g., betamethasone or clobetasol) and vitamin D analogs (e.g., calcipotriene) are commonly used for mild to moderate psoriasis.
- Phototherapy is recommended for patients with more widespread psoriasis or those unresponsive to topical treatments.
- Systemic medications like methotrexate, cyclosporine, or biologics (such as adalimumab or secukinumab) are considered for more severe cases.
- The selection of a specific treatment should be based on the severity of psoriasis, the presence of comorbidities, and the results of head-to-head studies in psoriasis populations.
Considerations for Methylene Blue:
While methylene blue has antimicrobial and anti-inflammatory properties, it has not been proven effective specifically for psoriasis in clinical studies, as noted in the guidelines of care for the management of psoriasis with systemic nonbiologic therapies published in 2020 by the American Academy of Dermatology 1. The mechanism of psoriasis involves immune system dysfunction and accelerated skin cell growth, which methylene blue's properties do not adequately address.
Given the lack of evidence supporting the use of methylene blue for psoriasis, consulting with a dermatologist is recommended to determine the most appropriate, evidence-based treatment for an individual's specific type and severity of psoriasis. This approach ensures that the treatment plan is tailored to the patient's needs, maximizing the potential for effective management of the condition while minimizing risks.
From the Research
Efficacy of Methylene Blue for Psoriasis
- Methylene blue has been studied as a potential treatment for psoriasis, particularly for resistant plaque psoriasis 2.
- A study published in 2009 found that topical methylene blue hydrogel was effective in treating resistant plaque psoriasis, with 16 patients experiencing complete clearance of their treated lesions 2.
- The study also found that the treatment was safe and well-tolerated, with no significant side effects or complications 2.
- Another study published in 2023 compared the efficacy of intense pulsed light (IPL) versus photo-dynamic therapy (PDT) with methylene blue in the treatment of psoriatic nails, and found that both treatments were effective, but methylene blue mediated PDT was more effective in nail-bed lesions 3.
Comparison with Other Treatments
- Methylene blue has been compared to other treatments for psoriasis, including vitamin D analogues and systemic therapies 4, 5, 6.
- While these treatments have been shown to be effective, they may have limitations and side effects, and methylene blue may offer a safe and effective alternative for certain patients 2, 3.
- The use of methylene blue in combination with other treatments, such as vitamin D analogues or systemic therapies, may also be a promising approach, but further study is needed to determine its efficacy and safety 5, 6.