Can topical urolithin A be used to treat psoriasis?

Topical Urolithin A for Psoriasis Treatment

Topical urolithin A is not recommended for the treatment of psoriasis, as there is no evidence supporting its efficacy, and it is not included in any established psoriasis treatment guidelines or approved therapies.

Evidence-Based Topical Treatments for Psoriasis

The established guidelines provide clear recommendations for topical psoriasis management, none of which include urolithin A:

First-Line Topical Therapies

Combination corticosteroid and vitamin D analog therapy represents the gold standard for mild-to-moderate psoriasis. 1 This combination provides superior efficacy compared to monotherapy with either agent alone 2, 3.

• Potent corticosteroids (Class 2-5) combined with calcipotriene (vitamin D analog) should be used for maximum 4 weeks, then transitioned to weekend-only corticosteroid application with weekday vitamin D analog use for maintenance 4, 5.

• Very potent corticosteroids or potent corticosteroids applied twice daily show no significant difference in achieving clear or nearly clear status compared to combined vitamin D analog and potent corticosteroid products 3.

• The combination of calcipotriene/betamethasone dipropionate is well-established as first-line treatment, offering clinical effectiveness, fast onset of action, and good tolerability 2, 6.

Alternative Topical Agents

Topical calcineurin inhibitors (tacrolimus 0.1% ointment, pimecrolimus 0.1% cream) are particularly useful for facial and intertriginous psoriasis 1, 4:

• 65% of patients treated with tacrolimus 0.1% ointment achieved clear or almost clear status after 8 weeks compared to 31% with placebo 1.
• 71% of patients treated with pimecrolimus 0.1% cream achieved clear or almost clear status after 8 weeks compared to 21% with placebo 1.
• These agents do not cause atrophy, making them ideal for sensitive areas 1.

Treatments with Limited or No Efficacy

Coal tar and retinoids show limited benefit and are no better than placebo in achieving clear or nearly clear status 3.

Why Urolithin A Is Not Recommended

The comprehensive guidelines from the American Academy of Dermatology 1, British Association of Dermatologists 1, and other authoritative sources 4, 5, 7 make no mention of urolithin A as a treatment option for psoriasis.

The absence of urolithin A from evidence-based guidelines indicates:

• No randomized controlled trials demonstrating efficacy in psoriasis
• No FDA or regulatory approval for psoriasis treatment
• No established safety profile for topical application in psoriatic skin
• No mechanism of action validated for psoriasis pathophysiology

Practical Treatment Algorithm

For patients seeking topical psoriasis treatment, the evidence-based approach is:

1. Mild psoriasis (<3% BSA): Start with combination calcipotriene/betamethasone dipropionate for up to 4 weeks 4, 5, 2.

2. Facial/intertriginous involvement: Use topical calcineurin inhibitors (tacrolimus or pimecrolimus) to avoid corticosteroid-induced atrophy 1, 4.

3. Scalp psoriasis: Use solution, foam, or gel formulations of corticosteroids or vitamin D analogs for better cosmetic acceptability 1.

4. Maintenance therapy: Transition to weekend-only corticosteroid with weekday vitamin D analog to minimize adverse effects 4, 5.

Critical Caveat

Approximately 80% of patients with psoriasis have mild-to-moderate disease that can be effectively managed with established topical agents 1. There is no clinical rationale to use unproven agents like urolithin A when highly effective, well-studied treatments are readily available 2, 8, 9, 3, 6.