The Efficacy of Low-Dose Enoxaparin in Psoriasis

Psoriasis is a frequently encountered inflammatory skin disease with unclear etiology and no curative therapy. Enoxaparin is a low-molecular weight heparin analogue. Heparin and its analogues in low doses have antiproliferative and immunomodulatory effects. Low-dose enoxaparin has inhibitory effects on T cell-mediated immune reactions. T lymphocytes play a key role in the immunpathogenesis of psoriasis. The aim of this study was to evaluate the efficacy of low-dose enoxaparin in the treatment of psoriasis. Twenty-three patients with chronic plaque and guttate psoriasis were enrolled in an open study. Patients were given subcutaneous injections of 5 mg enoxaparin once weekly for a total of 6 weeks. There was a statistically significant difference between the PASI (Psoriasis Area and Severity Index) scores at the beginning and at the 6th week follow up (p=0.008). Four out of 23 patients (17%) showed marked improvement (≥50% reduction in the PASI score), eight patients (35%) showed moderate improvement (25-49% reduction), five (22%) were unchanged (<25% reduction). Six patients (26%) experienced worsening with a corresponding increase in the PASI scores. According to these findings, 52% of patients were considered to get benefit from enoxaparin treatment. No systemic side-effects due to enoxaparin were observed. The only local side-effect recorded in seven patients (30%) was ecchymosis at the injection site. Low-dose enoxaparin, which appears to be safe, is a candidate to become a future alternative in the treatment of psoriasis. Further studies assessing the optimum dose and duration of treatment, as well as patient subgroups that will benefit most from enoxaparin treatment are required. In addition, efficacy of enoxaparin in psoriasis should be compared to those of standard therapeutic modalities.