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Ana Maria Alexandra, S. Metformin for Psoriasis Treatment. Encyclopedia. Available online: https://encyclopedia.pub/entry/8529 (accessed on 06 December 2025).
Ana Maria Alexandra S. Metformin for Psoriasis Treatment. Encyclopedia. Available at: https://encyclopedia.pub/entry/8529. Accessed December 06, 2025.
Ana Maria Alexandra, Stanescu. "Metformin for Psoriasis Treatment" Encyclopedia, https://encyclopedia.pub/entry/8529 (accessed December 06, 2025).
Ana Maria Alexandra, S. (2021, April 08). Metformin for Psoriasis Treatment. In Encyclopedia. https://encyclopedia.pub/entry/8529
Ana Maria Alexandra, Stanescu. "Metformin for Psoriasis Treatment." Encyclopedia. Web. 08 April, 2021.
Metformin for Psoriasis Treatment
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This entry is adapted from the peer-reviewed paper 10.3390/jpm11040251

Psoriasis is a chronic inflammatory condition with genetic, immunological, and metabolic etiology. The link between psoriasis and diabetes mellitus has been shown in genetic predisposition, environmental influences, inflammatory pathways, and insulin resistance, resulting in end-organ damage in both conditions. Because comorbidities often accompany psoriasis, the therapeutic management of the disease must also take into consideration the comorbidities.

psoriasis metformin metabolic syndrome

1. Introduction

Diabetes mellitus is a chronic disease affecting over 22 million people worldwide and has metabolic, inflammatory, and pathological genetic mechanisms [1][2]. A first-line treatment in type 2 diabetes, 1,1-dimethyl biguanide hydrochloride (metformin), is a biguanide that reduces hyperglycemia, prevents inflammation, normalizes lipid and carbohydrate metabolism, and reduces adipose tissue [3][4].

The good results obtained with metformin as the first-line treatment of type 2 diabetes have led to its successful use in many other conditions, such as cancer (breast, endometrial, colorectal, prostate, various other tumors), nonalcoholic fatty liver disease, chronic kidney disease, metabolic syndrome, obesity, coronary artery disease, polycystic ovary syndrome, and acne. It also has anti-aging effects and improves the efficiency of in vitro fertilization; some studies have demonstrated the benefits of metformin in patients with psoriasis [5][6][7][8][9][10][11][12][13][14][15]. Psoriasis is a chronic inflammatory condition with genetic, immunological, and metabolic etiology that affects over 8 million people in the US [16][17]. It is considered a severe, non-communicable disease [18]. Psoriasis is a systemic disease with numerous multiorgan complications because of chronic inflammation; due to the dominant TNF-α-IL-23-Th17 axis, chronic inflammation leads to dysfunctional differentiation, uncontrolled keratinocyte proliferation, and neovascularization [19]. Psoriasis and diabetes mellitus are linked by genetic predisposition, environmental influences, inflammatory pathways, and insulin resistance, which result in end-organ damage in both conditions [20]. By reducing hyperglycemia and metabolic syndrome, suppressing endogenous glucose production, metformin may play an important role in psoriasis [21]. There are currently several therapeutic options for psoriasis. These may vary by country, by associated comorbidities, and by severity of disease.

Topical treatment is used as first-line therapy or as a combination therapy depending on the severity of psoriasis. Among topical therapies used are corticosteroids, tar derivatives, calcineurin inhibitors, and vitamin D analogues [22][23]. Another therapeutic option is phototherapy with PUVA (psoralen and ultraviolet A) or UVB on its own or in combination with other therapies. Classical systemic therapy includes methotrexate, acitretin, and cyclosporine, but also other systemic therapies represented by biological agents. Even with these wide therapeutic options, psoriasis cannot always be controlled [22][24][25].

Because psoriasis treatment can be a challenge in the medical practice, there is an openness to new therapeutic approaches that have not been considered so far, such as oral administration of vitamin D or metformin [26]. Given that metformin’s therapeutic role in psoriasis is not yet fully elucidated, we raised the question of whether metformin could be a viable alternative for the treatment of psoriasis. We conducted a scoping review about the utility of metformin in patients with psoriasis. We searched to identify the current evidence and determine the gaps that will lead to new research.

2. Develpment

The biguanide metformin is more than an antidiabetic drug; it has a direct anti-inflammatory effect. The anti-inflammatory mechanism of action of metformin is based on AMPK activation and inhibition of mTOR pathways. Metformin acts on mitochondrial function and cellular homeostasis processes; dysregulation of autophagy or mitochondrial function in immune cells raises the susceptibility to develop autoimmune and inflammatory diseases [27].

Chronic inflammation is essential in the pathophysiology of psoriasis, being a predisposing factor for the development of other diseases, such as diabetes. Patients with psoriasis have a higher risk of developing abdominal obesity, insulin resistance, and dyslipidemia, leading to the development of metabolic syndrome [28]. Due to predisposition to obesity of patients with psoriasis and systemic inflammation, both may contribute to the development of insulin resistance and type 2 diabetes in these patients [29].

Osteopontin participates in inflammation, being secreted by T-lymphocytes and activated by macrophages; low levels of osteopontin or lack of expression reduce inflammation [30]. In psoriasis, osteopontin acts by promoting vessel formation, subsequently supporting the influx of inflammatory cells through a mechanism mediated by IL-1 and matrix metalloproteinase-9 [31].

It is considered that osteopontin is involved in the development of insulin resistance, obesity, and type 2 diabetes [32]. Metformin attenuates the upregulation of osteopontin and monocyte chemoattractant protein 1 induced by oxalate in vitro. Metformin may simultaneously regulate these two molecular targets during the formation of stones [33].

Other mechanisms may influence the positive response to metformin therapy in patients with psoriasis associated with diabetes or metabolic syndrome, especially given the common role of inflammation.

Summarizing the evidence on metformin treatment in psoriasis, we can conclude that:

  • Metformin plays an important role in the treatment of autoimmune diseases.

  • Better results are achieved with metformin and methotrexate combined, compared with methotrexate therapy alone.

  • Good results have also resulted from topical therapy combined with metformin.

  • Metformin decreases the risk of developing psoriasis in diabetic patients.

  • Good results have been achieved with metformin treatment in patients with psoriasis and metabolic syndrome, for both psoriasis and metabolic syndrome.

  • Metformin is generally safe for administration in patients with psoriasis.

3. Conclusions

We demonstrated that metformin is safe to use in patients with psoriasis associated with diabetes, metabolic syndrome, and obesity. Antidiabetic agents may be useful for the treatment of psoriasis, especially with co-existing diabetes or when immunosuppression is contraindicated. Moreover, in psoriasis accompanied by metabolic syndrome with an inadequate response to biological therapies, metformin could be an alternative treatment and an important add-on in the management of this chronic autoimmune disease. Because comorbidities often accompany psoriasis, the therapeutic management of the disease must also take into consideration the comorbidities. There is a need to further evaluate metformin in larger clinical trials, as a therapy in psoriasis.

References

  1. Lin, X.; Xu, Y.; Pan, X.; Xu, J.; Ding, Y.; Sun, X.; Song, X.; Ren, Y.; Shan, P.-F. Global, regional, and national burden and trend of diabetes in 195 countries and territories: An analysis from 1990 to2025. Sci. Rep. 2020, 10, 1–11.
  2. Schwartz, S.S.; Epstein, S.; Corkey, B.E.; Grant, S.F.; Iii, J.R.G.; Aguilar, R.B.; Herman, M.E. A Unified Pathophysiological Construct of Diabetes and its Complications. Trends Endocrinol. Metab. 2017, 28, 645–655.
  3. Madsen, K.S.; Chi, Y.; Metzendorf, M.-I.; Richter, B.; Hemmingsen, B. Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst. Rev. 2019, 2019, CD008558.
  4. Shpakov, A.O. Improvement Effect of Metformin on Female and Male Reproduction in Endocrine Pathologies and Its Mechanisms. Pharmaceuticals 2021, 14, 42.
  5. Meyerhardt, A.J.; Irwin, M.L.; Jones, L.W.; Zhang, S.; Campbell, N.; Brown, J.C.; Pollak, M.; Sorrentino, A.; Cartmel, B.; Harrigan, M.; et al. Randomized Phase II Trial of Exercise, Metformin, or Both on Metabolic Biomarkers in Colorectal and Breast Cancer Survivors. JNCI Cancer Spectr. 2020, 4, 96.
  6. Mu, N.; Xu, T.; Gao, M.; Dong, M.; Tang, Q.; Hao, L.; Wang, G.; Li, Z.; Wang, W.; Yang, Y.; et al. Therapeutic effect of metformin in the treatment of endometrial cancer (Review). Oncol. Lett. 2020, 20, 1.
  7. Zhang, Z.-J.; Zheng, Z.-J.; Kan, H.; Song, Y.; Cui, W.; Zhao, G.; Kip, K.E. Reduced Risk of Colorectal Cancer with Metformin Therapy in Patients with Type 2 Diabetes: A Meta-Analysis. Diabetes Care 2011, 34, 2323–2328.
  8. Pircher, A.; Zieher, M.; Eigentler, A.; Pichler, R.; Schäfer, G.; Fritz, J.; Puhr, M.; Steiner, E.; Horninger, W.; Klocker, H.; et al. Antidiabetic drugs influence molecular mechanisms in prostate cancer. Cancer Biol. Ther. 2018, 19, 1153–1161.
  9. Podhorecka, M.; Ibanez, B.; Dmoszyńska, A. Metformin—Its potential anti-cancer and anti-aging effects. Postępy Higieny i Medycyny Doświadczalnej 2017, 71, 170–175.
  10. LaVine, J.E. Effect of Vitamin E or Metformin for Treatment of Nonalcoholic Fatty Liver Disease in Children and Adolescents. JAMA 2011, 305, 1659–1668.
  11. Bell, S.; Farran, B.; McGurnaghan, S.; McCrimmon, R.J.; Leese, G.P.; Petrie, J.R.; McKeigue, P.M.; Sattar, N.; Wild, S.; McKnight, J.; et al. Risk of acute kidney injury and survival in patients treated with Metformin: An observational cohort study. BMC Nephrol. 2017, 18, 163.
  12. Dziubak, A.; Wójcicka, G.; Wojtak, A.; Bełtowski, J. Metabolic Effects of Metformin in the Failing Heart. Int. J. Mol. Sci. 2018, 19, 2869.
  13. Mohan, M.; Al-Talabany, S.; McKinnie, A.; Mordi, I.R.; Singh, J.S.S.; Gandy, S.J.; Baig, F.; Hussain, M.S.; Bhalraam, U.; Khan, F.; et al. A randomized controlled trial of metformin on left ventricular hypertrophy in patients with coronary artery disease without diabetes: The MET-REMODEL trial. Eur. Heart J. 2019, 40, 3409–3417.
  14. Sharma, S.; Mathur, D.K.; Paliwal, V.; Bhargava, P. Efficacy of Metformin in the Treatment of Acne in Women with Polycystic Ovarian Syndrome: A Newer Approach to Acne Therapy. J. Clin. Aesthet. Derm. 2019, 12, 34–38.
  15. Sharpe, A.; Morley, L.C.; Tang, T.; Norman, R.J.; Balen, A.H. Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome. Cochrane Database Syst. Rev. 2019, 2019, CD013505.
  16. Vashist, S.; Mahajan, V.K.; Mehta, K.S.; Chauhan, P.S.; Yadav, R.S.; Sharma, S.B.; Sharma, V.; Sharma, A.; Chowdhary, B.; Kumar, P. Association of Psoriasis with Autoimmune Disorders: Results of a Pilot Study. Indian Dermatol. Online J. 2020, 11, 753–759.
  17. National Psoriasis Foundation. Statistics. Available online: (accessed on 20 April 2020).
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  20. Abramczyk, R.; Queller, J.N.; Rachfal, A.W.; Schwartz, S.S. Diabetes and Psoriasis: Different Sides of the Same Prism. Diabetes Metab. Syndr. Obesity Targets Ther. 2020, 13, 3571–3577.
  21. Glossmann, H.; Reider, N. A marriage of two “Methusalem” drugs for the treatment of psoriasis? Derm. Endocrinol. 2013, 5, 252–263.
  22. Arnone, M.; Takahashi, M.D.F.; De Carvalho, A.V.E.; Bernardo, W.M.; Bressan, A.L.; Ramos, A.M.C.; Terena, A.C.; Souza, C.D.S.; Nunes, D.H.; Bortoletto, M.C.D.C.; et al. Diagnostic and therapeutic guidelines for plaque psoriasis—Brazilian Society of Dermatology. An. Bras. Dermatol. 2019, 94, 76–107.
  23. Dattola, A.; Silvestri, M.; Bennardo, L.; Passante, M.; Rizzuto, F.; Dastoli, S.; Patruno, C.; Bianchi, L.; Nisticò, S.P. A novel vehicle for the treatment of psoriasis. Dermatol. Ther. 2020, 33, e13185.
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