الفهرس 
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Abstract
Psoriasis is a common chronic inflammatory disease with unpredictable prognosis. A strong association between “psoriasis” and “atherosclerosis” had emerged. Psoriasis patients have an increased prevalence of atherosclerotic disease including coronary artery, cerebrovascular, and peripheral vascular diseases. One CAD risk factor in psoriasis patients that can easily be managed is “hyperlipidemia.” In addition to their lipid lowering properties, Statins have been suggested as a potential treatment for psoriasis because of their anti-inflammatory immunomodulator properties. Another therapy that may have a promising role in psoriasis is the thiazolidinedione derivative, pioglitazone. Mechanism of action of pioglitazone involves activation of peroxisome proliferator-activated receptors (PPARs), which belong to the superfamily of steroid⁄thyroid ligand-activated nuclear receptors.
OBJECTIVE: The present study was conducted to determine whether the addition of each of orally administered atorvastatin and pioglitazone, separately, to the topical betamethasone valerate, a standard antipsoriatic treatment, can produce a more powerful therapeutic response against psoriasis or not.
METHODS: In a double-blind study, 30 patients with plaque type psoriasis were randomly divided into three equal treatment groups. Group I received oral atorvastatin (40 mg/d) plus topical steroid (50% betamethasone valerate) for 12 weeks, group II received oral pioglitazone (30 mg/d) plus the same topical steroid for the same time period and group III received oral placebo plus the same topical steroid for the same time period. Psoriasis Area and Severity Index (PASI) score was checked before and at the end of the treatment period.
RESULTS: PASI score decreased significantly in all groups, but the decline of PASI score was more significant in patients who received atovastatin (P-value < 0.001) compared to patients who received oral pioglitazone (P-value =0.003) and oral placebo (P-value =0.003). No side effect or any laboratory abnormality was detected in patients.
CONCLUSION: Our work, which is the first double-blind, randomized, placebo-controlled study study comparing the efficacy of each of atorvastatin and pioglitazone in the same study, shows that both oral atorvastatin and pioglitazone enhance the therapeutic effect of topical steroids against psoriasis. The increased risk of cardiovascular accidents in psoriatic patients and the protective effect of statins and thiazolidinediones against cardiovascular disease further encourages their use in the treatment of this clinical conundrum.
Keywords: psoriasis, statins, thiazolidinediones.