CN116265017A

CN116265017A - Pharmaceutical composition comprising benvimod and corticosteroid

Info

Publication number: CN116265017A
Application number: CN202211617317.0A
Authority: CN
Inventors: 马志龙; 陈明; 贾剑敏
Original assignee: Shanghai Zedeman Pharmaceutical Technology Co ltd
Current assignee: Shanghai Zedeman Pharmaceutical Technology Co ltd
Priority date: 2021-12-16
Filing date: 2022-12-15
Publication date: 2023-06-20
Also published as: WO2023109906A1

Abstract

The present disclosure provides a pharmaceutical composition for inflammatory skin diseases, wherein the active ingredients of the composition comprise present valmod or a pharmaceutically acceptable salt thereof and at least one corticosteroid. The pharmaceutical composition disclosed by the disclosure is used for treating immune, inflammatory and autoimmune diseases, overcomes the defects of single action, limited curative effect, common local side effect and poor patient compliance of the existing medicines, and has the remarkable advantages of convenience in use, high curative effect and low recurrence rate.

Description

Pharmaceutical composition comprising benvimod and corticosteroid

Technical Field

The present disclosure is in the field of medicinal chemistry, and relates to pharmaceutical compositions comprising present vermod and a corticosteroid, or their use in the treatment of immune, inflammatory and autoimmune diseases.

Background

Autoimmune diseases are a group of diseases characterized by a reduced tolerance of the immune system to the body's autoantigens, the production of large amounts of autoantibodies and immune complexes, and ultimately the impairment of the function of various tissues and organs (Guan SY et al, information, 2017,40 (1): 303-310). The world health organization has already listed autoimmune diseases as the third biggest killer against cardiovascular diseases, cancer and then against human health in 1999, and autoimmune diseases have also been listed as one of ten major diseases in the schema of long-term technological development in our country (Pan Haifeng et al, journal of Chinese disease control, 2018,22 (11): 1093-1095, 1105). The autoimmune diseases have wide spectrum distribution and different clinical manifestations, and mainly comprise more than 70 diseases, such as systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and the like (Fang Xinyu and the like, J.Zhonghua disease control, 2021,25 (8): 869-873).

Psoriasis is a common chronic, inflammatory, immune-mediated skin disorder characterized by rapid proliferation and renewal of epithelial cells, thickening of the epidermis, and the creation of inflamed and swollen skin lesions and ridges covered with silvery-white scales, which are prone to itching, scalding, stinging and bleeding. As one of the most serious non-infectious diseases, about 1.25 hundred million people worldwide have psoriasis, which greatly reduces the quality of life of the patient. Atopic dermatitis is a common chronic, recurrent, inflammatory skin disease, often characterized by overgrowth of staphylococcus aureus, followed by proteolytic destruction of the epidermal barrier and immune dysfunction. Although atopic dermatitis is not life threatening, it has profound effects on the quality of life of the patient and their relatives. The disease is reported to be the most non-fatal skin disease (the specialized committee on psoriasis, the department of dermatology of the China medical society, journal of the Chinese dermatology, 2019,52 (10), 667-710).

Although there are many treatment options for patients with immune, inflammatory and autoimmune diseases, such as chronic inflammatory skin diseases like psoriasis, atopic dermatitis, etc., conventional topical treatments are still the main clinical base treatments, with corticoids as first-line drugs, with higher side effects for long-term use, short periods of intermittent use remission, and susceptibility to recurrence. Non-hormonal topical medicaments such as vitamin D ₃ Derivatives, tretinoin, calcineurin inhibitors and the like have the defects of slow effect, limited curative effect, common local side effect, poor patient compliance and the like. The existing external preparation can only be temporarily relieved, is easy to relapse, has unsatisfactory curative effect, and still needs more effective therapeutic preparation for clinical use.

The vitamin mod emulsifiable paste is a national 1-type new medicine with complete independent intellectual property rights, is a major technological special result of 'major new medicine creation' in China, is marketed in batches in China in 5 months of 2019, and is used for the local treatment of light and moderate psoriasis vulgaris of adults.

The chemical structural formula of the vitamin mod is as follows:

this compound is also known as 5- [ (E) -2-styryl ] -2-isopropyl-1, 3-benzenediol. The great names include "Benzenmod", and the foreign names "Tapinarof", "GSK2894512", "WBI-1001", etc.

This valmod was originally disclosed by Paul et al as an antibiotic (Journal of Chemical Ecology,1981,7 (3): 589-597). WO1995003695A1 (Agro-Biotech Corporation) discloses the fungicidal activity of such compounds. The compounds are further described in WO2001042231A2 (webhem Biotech inc.) as being useful for the treatment of a variety of important skin disorders including psoriasis and inflammation. Example 3 of US patent 7868047B2 describes a cream formulation of an active ingredient prepared in a Galax matrix. WO2016185428A1 (GlaxoSmithKline inc.) provides a process for the preparation of topical pharmaceutical emulsion compositions involving the compound.

Immunosuppression by corticosteroids is known to be critical for inhibiting pro-inflammatory environments and T cell activation; the vitamin mod can inhibit potential inflammation and normalize skin homeostasis, regulate keratinocyte proliferation and differentiation and provide immune regulation, and can play an immune regulation role on Th2, th17 and T-reg cells. The pharmaceutical composition or the pharmaceutical composition provided by the disclosure has complementary effects on the potential pathophysiology of inflammatory diseases such as psoriasis, atopic dermatitis and the like, and can increase the curative effect of single active ingredient therapy.

Aiming at the problems of low curative effect, easy recurrence, low compliance and the like of the existing external preparation, the present disclosure provides a novel pharmaceutical composition which can be locally applied to treat immune, inflammatory and autoimmune diseases, effectively improve clinical curative effect, reduce disease recurrence rate and improve patient compliance.

Disclosure of Invention

In order to solve the problems of low curative effect, easy recurrence, low compliance and the like of external preparations in the prior art, the present disclosure provides a pharmaceutical composition comprising present valmod or pharmaceutically acceptable salts thereof and a corticosteroid; the pharmaceutical composition is a cream.

The present disclosure provides a pharmaceutical composition characterized in that the pharmaceutical composition is a cream and comprises, in total weight percent of the pharmaceutical composition:

The amount of the present valmod or a pharmaceutically acceptable salt thereof is 0.5 to 1.5% by weight;

one or more corticosteroids in an amount of 0.01% to 1.5% by weight, respectively;

an oil phase matrix in an amount of 15% to 50% by weight; the oil phase matrix comprises vaseline and light liquid paraffin;

a surfactant in an amount of 0.1% to 8% by weight;

a solvent and/or a permeation enhancer in an amount of 5% to 20% by weight; and

the balance being aqueous phase.

In another aspect, the present disclosure provides a method of preparing a pharmaceutical composition comprising the steps of:

1) An oil phase: adding an oil phase matrix into a container with proper size, heating to 65-85 ℃ to dissolve uniformly, then optionally adding a preservative, stirring and dissolving to obtain a solution A, and preserving heat for later use; wherein the oil phase matrix comprises white vaseline and light liquid paraffin;

2) Aqueous phase: adding surfactant into purified water, heating to 65-85deg.C, dissolving to obtain solution B, and keeping the temperature for use;

3) Active ingredient solvents: adding the present vitamin mod and the corticosteroid into a solvent, heating to 65-85 ℃ to dissolve uniformly, and preserving the heat of the solution C for later use; wherein the solvent is preferably propylene glycol;

4) Mixing and emulsifying: adding the solution A into the solution C, mixing and stirring uniformly; then adding the solution B, stirring and homogenizing to form stable emulsion drops, and cooling to normal temperature to obtain the pharmaceutical composition.

In another aspect, the present disclosure also provides the use of a pharmaceutical composition of the present disclosure in the manufacture of a medicament for the treatment and/or prophylaxis of immune, inflammatory and autoimmune diseases, preferably for the treatment and/or prophylaxis of dermatological diseases or disorders selected from psoriasis, atopic dermatitis, acne and cutaneous pruritus.

The technical scheme of the present disclosure is detailed as follows:

the present disclosure relates to the present vitamin mod compound or the pharmaceutically acceptable salt thereof

The compound belongs to the prior art, and has the chemical name of 5- [ (E) -2-styryl ] -2-isopropyl-1, 3-benzenediol, and has the following structural formula:

the preparation method and chemical properties of the vitamin mod compound or the pharmaceutically acceptable salt thereof can be referred to as CN103467281B, CN104003848B, CN103992212B, WO2019063002A1, CN108066279A, CN112811985A, CN111148729A and CN113024357A.

The present disclosure relates to a pharmaceutical composition characterized in that the pharmaceutical composition is a cream and comprises, in total weight percent of the pharmaceutical composition:

a surfactant in an amount of 0.1% to 8% by weight;

a solvent and/or a permeation enhancer in an amount of 5% to 20% by weight; and

the balance being aqueous phase.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure comprises 0.5% to 1.25%, preferably 0.5% to 1.25%, more preferably 0.75% to 1.25%, most preferably 0.75% to 1% by weight of the present vitamin mod or pharmaceutically acceptable salt thereof, based on the total weight percent of the pharmaceutical composition; the content of the present valmod or pharmaceutically acceptable salt thereof may be 0.5%, 0.75%, 1% and 1.25%.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure comprises, based on the total weight percent of the pharmaceutical composition, from 0.01% to 1%, preferably from 0.01% to 0.75%, more preferably from 0.01% to 0.5%, even more preferably from 0.01% to 0.25%, even more preferably from 0.01% to 0.2%, most preferably from 0.01% to 0.1% by weight of the corticosteroid; in particular, the corticosteroid may be present in an amount of 0.01%, 0.05%, 0.075%, 0.1%, 0.125%, 0.15%, 0.175%, 0.2%, 0.25%, 0.3%, 0.5% and 1%.

In some embodiments of the present disclosure, the cream of the present disclosure, the corticosteroid is selected from one or more of beclomethasone or a derivative thereof, annonamide or a derivative thereof, betamethasone or a derivative thereof, clobetasol or a derivative thereof, clocortolone or a derivative thereof, budesonide or a derivative thereof, desoximetasone or a derivative thereof, diflorasone or a derivative thereof, fluocinolone or a derivative thereof, fluticasone or a derivative thereof, halcinonide or a derivative thereof, ubebetasol or a derivative thereof, hydrocortisone or a derivative thereof, mometasone or a derivative thereof, prednisone or a derivative thereof, triamcinolone or a derivative thereof, fludrocortisone or a derivative thereof, dexamethasone or a derivative thereof, and methylprednisolone or a derivative thereof;

preferably, the corticosteroid is selected from one or more of betamethasone or its derivatives, clocortolone or its derivatives, desoximetasone or its derivatives, fluocinolone or its derivatives, fluticasone or its derivatives, hydrocortisone or its derivatives, mometasone or its derivatives, prednisolide or its derivatives, triamcinolone acetonide or its derivatives, fludrolide or its derivatives;

More preferably, the corticosteroid is selected from one or more of betamethasone or its derivatives, clocortolone or its derivatives, triamcinolone or its derivatives, fluocinolone or its derivatives, fluticasone or its derivatives, hydrocortisone or its derivatives, mometasone or its derivatives, prednisolide or its derivatives, and triamcinolone acetonide or its derivatives;

further preferably, the corticosteroid is selected from one or more of betamethasone or derivatives thereof;

further preferably, the corticosteroid is selected from one or more of betamethasone propionate, betamethasone acetate, and betamethasone valerate;

further preferably, the corticosteroid is selected from betamethasone or a derivative thereof;

further preferably, the corticosteroid is selected from the group consisting of betamethasone, betamethasone propionate, betamethasone acetate, and betamethasone valerate;

most preferably, the corticosteroid is betamethasone or betamethasone propionate.

In some embodiments of the present disclosure, the total content of the oil phase matrix is 15% to 50%, preferably 15% to 40%, more preferably 15% to 30%, most preferably 15% to 25% by weight of the total weight of the pharmaceutical composition.

In some embodiments of the present disclosure, the oil phase base is selected from one or more of petrolatum (preferably white petrolatum), stearic acid, paraffin (preferably light liquid paraffin), isopropyl myristate, beeswax, medium chain triglycerides, higher alcohols and lanolin, preferably from one or more of white petrolatum, light liquid paraffin, stearic acid, isopropyl myristate, medium chain triglycerides, cetyl alcohol, stearyl alcohol and cetostearyl alcohol, more preferably from one or more of white petrolatum, light liquid paraffin, cetyl alcohol, stearyl alcohol and cetostearyl alcohol.

In some embodiments of the present disclosure, the oil phase matrix is selected from one or more of white petrolatum, light liquid paraffin, cetyl alcohol, stearyl alcohol and cetostearyl alcohol, and each oil phase matrix is present in an amount of 5% to 25%, preferably 5% to 20%, more preferably 5% to 15%, most preferably 5% to 10%.

In some embodiments of the present disclosure, the surfactant is selected from one or more of emulsifying wax, stearyl alcohol polyethers, polysorbates, glyceryl monostearate, cetomacrogol 1000, sorbitan fatty acid esters, and polyethylene glycol cetostearyl ether, preferably one of glyceryl monostearate, stearyl alcohol polyethers, polysorbates, cetomacrogol 1000, sorbitan fatty acid esters, and polyethylene glycol cetostearyl ether, more preferably glyceryl monostearate or glyceryl monostearate.

In some embodiments of the present disclosure, the surfactant is glyceryl monostearate or glyceryl monostearate in an amount of from 0.1% to 6%, preferably from 0.5% to 6%, most preferably from 0.75% to 6% by weight; in particular, the total content of the surfactant may be 0.1%, 0.25%, 0.5%, 0.75%, 1%, 1.5%, 2%, 3%, 4%, 5% and 6%.

In some embodiments of the present disclosure, the solvent and/or permeation enhancer is selected from one or more of propylene glycol, diethylene glycol monoethyl ether, glycerol, and PEG400, preferably one or more of propylene glycol, diethylene glycol monoethyl ether, and PEG400, more preferably propylene glycol and/or diethylene glycol monoethyl ether, and most preferably propylene glycol.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure comprises a total content of the solvent and/or permeation enhancer of 5% to 20%, preferably 10% to 20%, more preferably 10% to 15% by weight, based on the total weight percent of the pharmaceutical composition; specifically, the content of the surfactant may be 5%, 10%, 15% and 20%.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure, the solvent and/or permeation enhancer is propylene glycol in an amount of 5% to 20% by weight; preferably, the propylene glycol is present in an amount of 10% to 20%.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure further comprises a pH adjuster that is a buffer, preferably one or more selected from the group consisting of citrate/citric acid, acetate/acetic acid, phosphate/phosphoric acid, citrate/citric acid, propionate/propionic acid, lactate/lactic acid, and ammonium salt/ammonia, preferably citrate/citric acid.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure, the pH adjuster is present in an amount to adjust the pH of the pharmaceutical composition to 3-7; preferably, the pH of the pharmaceutical composition is 3-6; more preferably, the pharmaceutical composition has a pH of 4-6; most preferably, the pH of the pharmaceutical composition is between 4.5 and 5.5; in particular, the pH of the pharmaceutical composition may be 4, 4.5, 5, 5.5 and 6.

In some embodiments of the present disclosure, the pH adjuster is present in an amount of 0.01% to 5%, preferably 0.1% to 3%, more preferably 0.1% to 2%, even more preferably 0.1% to 1%, most preferably 0.1% to 0.5% by weight.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure, the pH adjuster is citrate/citric acid, in an amount of 0.01% to 5%; preferably, the pH regulator is citrate/citric acid, the content of which is 0.1% to 1%; most preferably, the pH adjuster is citrate/citric acid, at a level of 0.1% to 0.5%.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure further comprises a stabilizer in an amount of 0.005% to 2%, preferably 0.01% to 2%, more preferably 0.05% to 2%, even more preferably 0.075% to 1.5%, most preferably 0.1% to 1% by weight.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure, the stabilizer is selected from one or more of citric acid and salts thereof, glucuronic acid and salts thereof, sodium hexametaphosphate, zinc hexametaphosphate, ethylenediamine tetraacetic acid (EDTA) and salts thereof, and phosphonates; preferably, the stabilizer is ethylenediamine tetraacetic acid (EDTA) and salts thereof; more preferably, the stabilizer is EDTA-2Na.

In some embodiments of the present disclosure, the pharmaceutical composition described in the present disclosure, the stabilizer is ethylenediamine tetraacetic acid (EDTA) and salts thereof in an amount of 0.01% to 2% by weight; preferably, the stabilizer is ethylenediamine tetraacetic acid (EDTA) and salts thereof in an amount of 0.05% to 2% by weight; more preferably, the stabilizer is ethylenediamine tetraacetic acid (EDTA) and salts thereof in an amount of 0.1 to 1% by weight.

In some embodiments of the present disclosure, the pharmaceutical compositions described in the present disclosure further comprise a preservative.

As is known in the art, an effective amount of one or more of preservatives such as benzalkonium chloride, polyhexamethylene chloride (PHMB), sorbic acid, ethylparaben, methylparaben, propylparaben, methylsalicylate, benzyl alcohol, phenoxyethanol, and the like may be used.

In some embodiments of the present disclosure, the total preservative content of the cream is from 0.005% to 1%, preferably from 0.01% to 0.5%, more preferably from 0.01% to 0.25%, by total weight percent of the cream; specifically, the preservative may be present in an amount of 0.01%, 0.05%, 0.1%, 0.15%, 0.2% and 0.25%.

In some embodiments of the present disclosure, the pharmaceutical compositions described in the present disclosure further comprise an antioxidant.

As is known in the art, an effective amount of an antioxidant such as one or more of dibutyl hydroxy toluene (BHT), disodium edetate (EDTA-2 Na), butyl Hydroxy Anisole (BHA), vitamin E acetate, and vitamin E nicotinate, and the like, may be used.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure has a total antioxidant content of 0.001% to 1%, preferably 0.01% to 0.5%, more preferably 0.01% to 0.1%, by weight of the total weight of the pharmaceutical composition; specifically, the antioxidant may be present in an amount of 0.01%, 0.05%, 0.1%, 0.15, 0.2, 0.3%, 0.5% and 1%.

In some embodiments of the present disclosure, the pharmaceutical composition described in the present disclosure has a particle size of less than 10 μm, preferably 1-5 μm, more preferably 1-3 μm.

In some embodiments of the present disclosure, the pharmaceutical composition of the present disclosure comprises 0.5% to 1.25% of the present vitamin mod or pharmaceutically acceptable salt thereof, by weight percent of the total weight of the pharmaceutical composition; the corticosteroid (preferably betamethasone or a derivative thereof) is present in an amount of 0.01% to 1%; the oil phase matrix is selected from one or more of white vaseline, light liquid paraffin, cetyl alcohol, stearyl alcohol and cetostearyl alcohol, and the content of each oil phase matrix is 5-25%; the surfactant is glyceryl monostearate or glyceryl monostearate, and the amount of the surfactant is 0.1-6% by weight; the solvent and/or the penetration enhancer is propylene glycol, and the total amount of the solvent and/or the penetration enhancer is 5-20% by weight; the pH regulator is citrate/citric acid or citrate/citric acid, and the content of the pH regulator is 0.01-5%; the stabilizer is ethylenediamine tetraacetic acid (EDTA) and salts thereof, and the amount of the stabilizer is 0.01 to 2 percent by weight; the total content of the preservative (preferably methylparaben or ethylparaben) is 0.01% to 0.5%; and the total content of the antioxidant (preferably BHT) is 0.01% to 0.5%.

In some aspects of the disclosure, the pharmaceutical composition further comprises an emulsifier, an antimicrobial preservative, and a stabilizer.

In some aspects of the present disclosure, the mass of the present vitamin mod or pharmaceutically acceptable salt thereof of the pharmaceutical composition is 50mg to 200mg, preferably 100mg to 200mg, more preferably 150mg to 200mg. The mass of the corticosteroid of the pharmaceutical composition is 0.01 mg-10 mg. Preferably 1mg to 50mg, more preferably 5mg to 20mg, and most preferably 15mg to 20mg.

In some embodiments of the present disclosure, the amount of the present vitamin mod or pharmaceutically acceptable salt thereof of the pharmaceutical composition is selected from 0.1 to 10% wt, preferably 0.1 to 5%, more preferably 0.5 to 2%, most preferably 0.5 to 1%, and the amount of corticosteroid is selected from 0.005 to 5% wt, preferably 0.01 to 1%, most preferably 0.05 to 0.5%.

In some aspects of the disclosure, the emulsifier is selected from the group consisting of glyceryl monostearate, glyceryl distearate, polysorbate 80, cetostearyl ether-20, polysorbate 80, cetyl alcohol.

In some aspects of the disclosure, the antimicrobial preservative is selected from sorbic acid, ethyl hydroxy benzoate, or mixtures thereof.

In some embodiments of the present disclosure, the stabilizer is selected from polyethylene glycol monostearate, sorbitol solution, or mixtures thereof.

In some aspects of the disclosure, the pH of the pharmaceutical composition is selected from 5 to 8, preferably 5 to 6.

In some aspects of the present disclosure, the emulsifier, antimicrobial preservative, humectant, and stabilizer may also be mixed each independently in portions or added at once. When auxiliary materials such as an emulsifier, an antibacterial preservative, a humectant and a stabilizer are added in portions, the proportion of the addition in portions can be determined as required by those skilled in the art.

The pharmaceutical composition obtained by the preparation method disclosed by the invention can have excellent uniformity and stability.

In some aspects of the present disclosure, the pharmaceutical composition active ingredients of the present disclosure include:

a) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

0.5-2.0% wt of a present vitamin mod compound or a pharmaceutically acceptable salt thereof;

0.01 to 2.5% by weight of a corticosteroid or a pharmaceutically acceptable salt thereof;

b) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

0.8% wt of the present vitamin mod compound or a pharmaceutically acceptable salt thereof;

0.025% by weight of a triamcinolone acetonide compound or a pharmaceutically acceptable salt thereof;

c) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

1.0% wt of the present vitamin mod compound or a pharmaceutically acceptable salt thereof;

0.1% wt triamcinolone acetonide compound or a pharmaceutically acceptable salt thereof;

D) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

1.2% wt of the present vitamin mod compound or a pharmaceutically acceptable salt thereof;

0.1% wt of a betamethasone compound or a pharmaceutically acceptable salt thereof;

e) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

1.5% wt of the present vitamin mod compound or a pharmaceutically acceptable salt thereof;

0.1% wt of a chlorocortolone compound or a pharmaceutically acceptable salt thereof;

f) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

2.0% wt of the present vitamin mod compound or a pharmaceutically acceptable salt thereof;

0.1% wt of a mometasone compound or a pharmaceutically acceptable salt thereof;

g) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

0.05% by weight of a deoxomipsone compound or a pharmaceutically acceptable salt thereof;

h) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

0.05% wt of a fluticasone compound or a pharmaceutically acceptable salt thereof;

i) In some embodiments, the pharmaceutical composition comprises, as active ingredients:

0.05% by weight of a fludropindolol compound or a pharmaceutically acceptable salt thereof.

In some embodiments of the present disclosure, the pharmaceutical composition is in a single dose of 50mg to 200mg, preferably from 100mg, 110mg, 120mg, 130mg, 140mg, 150mg, 160mg, 170mg, 180mg, 190mg, 200mg.

The present disclosure further relates to the use of a pharmaceutical composition as described above for the manufacture of a medicament for the treatment and/or prophylaxis of immune, inflammatory and autoimmune diseases, preferably for the treatment and/or prophylaxis of dermatological diseases or disorders; wherein the skin disease or disorder is selected from psoriasis, atopic dermatitis, acne and skin itch; preferably, the skin disease or disorder is psoriasis.

The present disclosure further relates to the use of a pharmaceutical composition as described above for the preparation of a medicament for the treatment and/or prevention of psoriasis.

The present disclosure also relates to a method of treating and/or preventing immune, inflammatory and autoimmune diseases comprising administering to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition as described above.

The present disclosure also relates to a method of treating and/or preventing a skin disorder selected from psoriasis, atopic dermatitis, acne and itch of skin comprising administering to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition as described above.

The present disclosure also relates to a method of treating and/or preventing psoriasis comprising administering to a patient in need thereof a therapeutically effective amount of a pharmaceutical composition as described above.

The present disclosure also relates to a pharmaceutical composition as described above for use as a medicament.

The present disclosure also relates to a pharmaceutical composition as described above for use as a medicament for the treatment and/or prevention of immune, inflammatory and autoimmune diseases.

The present disclosure also relates to a pharmaceutical composition as described above for use as a medicament for the treatment and/or prevention of a skin disease or disorder selected from psoriasis, atopic dermatitis, acne and skin itch.

The present disclosure also relates to a pharmaceutical composition as described above for use as a medicament for the treatment and/or prevention of psoriasis.

Preferably, the skin disease or disorder described in the present disclosure is psoriasis.

Pharmaceutical combination

The present disclosure provides a pharmaceutical combination comprising present valmod or a pharmaceutically acceptable salt thereof and a corticosteroid or a pharmaceutically acceptable salt or ester thereof.

In some aspects of the disclosure, the corticosteroid is selected from one or more of an alclomethasone or derivative thereof, an ambetanide or derivative thereof, betamethasone or derivative thereof, clobetasol or derivative thereof, a clocortolone or derivative thereof, a budesonide or derivative thereof, a deoxomethasone or derivative thereof, a diflorasone or derivative thereof, fluocinolone or derivative thereof, fluticasone or derivative thereof, halcinonide or derivative thereof, a ubebetasol or derivative thereof, hydrocortisone or derivative thereof, mometasone or derivative thereof, a prednisolide or derivative thereof, triamcinolone acetonide or derivative thereof, fludrocortisone or derivative thereof, dexamethasone or derivative thereof, methylprednisolone or derivative thereof; preferably one or more of betamethasone or a derivative thereof, clocortolone or a derivative thereof, deoxomethasone or a derivative thereof, fluocinolone or a derivative thereof, fluticasone or a derivative thereof, hydrocortisone or a derivative thereof, mometasone or a derivative thereof, prednisolide or a derivative thereof, triamcinolone acetonide or a derivative thereof, fludrolide or a derivative thereof; more preferably one or more of betamethasone or a derivative thereof, clocortolone or a derivative thereof, desoximetasone or a derivative thereof, fluocinolone or a derivative thereof, fluticasone or a derivative thereof, hydrocortisone or a derivative thereof, mometasone or a derivative thereof, prednisolide or a derivative thereof, and triamcinolone acetonide or a derivative thereof; most preferably triamcinolone acetonide or a derivative thereof.

Triamcinolone acetonide, which is known in the art under the chemical name 9-fluoro-11 b, 21-dihydroxy-16 a,17- [ (1-methylethylene) bis (oxy) ] -pregna-1, 4-diene-3, 20-dione, has the following formula:

the preparation method and chemical properties of triamcinolone acetonide or its pharmaceutically acceptable salts can be found in CN107573398B, CN103421075B, CN101618019B, CN104971039B and CN109206471a.

The components of the pharmaceutical combinations of the present disclosure may each be administered independently, or some or all of them together, in a suitable variety of ways, including, but not limited to, orally or parenterally (via intravenous, intramuscular, topical, or subcutaneous routes). In some embodiments, the components of the pharmaceutical combinations of the present disclosure may each independently, or some or all of them may be co-administered topically or by injection, such as dermal or intravenous injection or glass balloon injection.

The components of the pharmaceutical combinations of the present disclosure may each independently, or some or all of them together be the same dosage form, including, but not limited to, dosage forms of creams, ointments, gels, sprays, emulsions, creams, foams, solutions, dispersions, injections, and sustained release formulations for either oral or non-oral administration.

In some aspects of the disclosure, the pharmaceutical combination is for treating immune, inflammatory and autoimmune diseases in a patient. In some aspects of the disclosure, the pharmaceutical combination is used simultaneously, separately or sequentially for treating immune, inflammatory and autoimmune diseases in a patient. In some aspects of the disclosure, one treatment cycle of the pharmaceutical combination is 2-8 weeks. In some aspects of the disclosure, the pharmaceutical combination may be administered for 1, 2, 3, 4, or more treatment cycles.

The components of the pharmaceutical combinations of the present disclosure may each independently, or some or all of them together contain a pharmaceutically acceptable carrier and/or excipient.

The present valmod or pharmaceutically acceptable salt thereof or corticosteroid may be the same or different in terms of dosing regimen, dosage, mode of administration, etc.

In some aspects of the disclosure, the dosing regimen of the present vitamin mod or pharmaceutically acceptable salt thereof in the pharmaceutical combination can be daily, e.g., 1, 2, 3, or more times daily; 1 administration every two, three, four or five days; administration 1 time per week, two weeks, three weeks or four weeks; administered 1 time every 1 month, 2 months or more.

In some aspects of the disclosure, the regimen of administration of the corticosteroid in the pharmaceutical combination is 1 time per day to 3 times per day, 1 time every two, three, four, or five days; administration 1 time per week, two weeks, three weeks or four weeks; each month, two months or more, 1 administration was performed.

In some aspects of the present disclosure, the pharmaceutical combination comprises the weight ratio of the present vitamin mod or pharmaceutically acceptable salt thereof to the corticosteroid or pharmaceutically acceptable salt or ester thereof within a single treatment cycle of (0.1-100): 1, preferably (1-80): 1, more preferably (1-20): 1, still more preferably (5-20): 1; most preferably (5-10): 1.

In some aspects of the present disclosure, the combination of the present vitamin mod or a pharmaceutically acceptable salt thereof and the corticosteroid are each in the form of or present in the same pharmaceutical composition.

In some aspects of the disclosure, the pharmaceutical combination, the present vitamin mod or pharmaceutically acceptable salt thereof and the corticosteroid are each in the form of a pharmaceutical composition that can be administered simultaneously, sequentially or at intervals.

In some aspects of the disclosure, the present vitamin mod or pharmaceutically acceptable salt thereof and the corticosteroid are present in the same pharmaceutical composition, which may be administered simultaneously.

Embodiments of pharmaceutical combinations/compositions

In some embodiments of the present disclosure, the individual to whom the pharmaceutical composition/composition is administered is a psoriasis vulgaris patient.

In some embodiments of the present disclosure, the individual to whom the pharmaceutical composition is administered receives a course of topical administration of the pharmaceutical composition or composition and receives an assessment and detection of the effect of the drug-related therapy.

Psoriasis, atopic dermatitis

Psoriasis, atopic dermatitis, pathogenesis is closely related to individual dendritic cytokine release, activation of adaptive immune response, th17 cytokine release, keratinocyte activation, pro-inflammatory mediator release, treg cell modulation, etc.; in addition, th1 cytokine release in psoriatic individuals, and Th2 cytokine release in atopic dermatitis individuals are also important factors for the pathogenesis.

Immunosuppression by corticosteroids is critical for inhibiting the pro-inflammatory milieu and T cell activation; the vitamin mod can inhibit potential inflammation and normalize skin homeostasis, regulate keratinocyte proliferation and differentiation and provide immune regulation, and can play an immune regulation role on Th2, th17 and T-reg cells. The pharmaceutical composition or the pharmaceutical composition provided by the disclosure has complementary effects on the potential pathophysiology of inflammatory diseases such as psoriasis, atopic dermatitis and the like, and can increase the curative effect of single active ingredient therapy.

Advantageous effects

The pharmaceutical composition or the pharmaceutical composition provided by the application has a synergistic effect on the curative effect of the diseases in the process of being applied to individuals with psoriasis, atopic dermatitis or other immune, inflammatory and autoimmune diseases, is higher than the curative effect of each single-active-ingredient drug, is beneficial to alleviating the side effect of corticosteroid and improving the use compliance of individuals. The method comprises the following steps:

1. synergistic therapeutic effect

Immune dysfunction of the organism is the pathogenesis basis of inflammatory diseases such as psoriasis, atopic dermatitis and the like, and bacterial colonization, especially staphylococcus aureus, is one of the important reasons for inducing or aggravating immune dysfunction. Corticosteroids have immunosuppressive effects, can suppress the pro-inflammatory milieu, are critical for T cell activation, and produce strong anti-inflammatory effects. The present valmod has high antibacterial activity against staphylococcus aureus highly involved in inflammatory reaction of atopic dermatitis. While Th17/Treg imbalance plays an important role in psoriasis, the present vitamin mod induces an immunomodulatory Th17/T-reg cellular response, which is inhibited by corticosteroids, and the pharmaceutical combination/composition therapy produces a gentle induction of this immunomodulatory process.

The aromatic hydrocarbon receptor AHR has been shown to be closely related to immune and inflammatory diseases of the body. The vitamin mod can regulate and treat focus by specifically binding and activating AHR, inhibiting pro-inflammatory factors, promoting normal differentiation of skin cells, proliferation and differentiation of keratinocytes.

In addition, pro-inflammatory cytokines that initiate the pro-inflammatory feedback loop promote the development of the disease inflammatory response. The combination of the present vitamin mod with corticosteroids enhances the inhibition of pro-inflammatory cytokines such as IL-6, IL-8, IL-17C, IL-20, IFN-c and AMPs.

In conclusion, the pharmaceutical composition/composition plays a synergistic treatment role in pathogenesis of inflammatory diseases such as psoriasis, atopic dermatitis and the like, and the pharmaceutical composition/composition increases the curative effect of single active ingredient therapy.

2. Safety of

Corticosteroid treatment may result in reduced skin thickness, increased transdermal moisture loss, loss of skin barrier function and skin atrophy. It causes atrophy of the dermis often at the site of administration, mainly due to reduced collagen synthesis after binding to specific receptors. For skin atrophy, no better treatment mode exists except for the minimally invasive surgery to inject related skin tissues. The vitamin mod has local effect, can induce the expression of skin barrier protein genes, activate Nrf2 to inhibit oxidative stress, promote the recovery and the integrity of skin barrier functions, and prevent the loss of water through epidermis. The pharmaceutical composition/composition minimizes skin atrophy and reduces the risks associated with corticosteroid treatment. The pharmaceutical composition/composition reduces side effects associated with monotherapy and provides better safety.

The clinical medicine concentration selected by each single party in the medicine combination/composition is not higher than the common clinical concentration, and the expected clinical exposure dose does not exceed the clinical dosage of each single party.

In addition, in pharmacodynamics, pharmacological action mechanisms of the two drugs are different, action targets are different, the vitamin is locally effective, the concentration of the vitamin entering the internal circulatory system is extremely low, the drug does not interact with corticosteroid in the links of absorption, distribution, metabolism and excretion of the drug, the toxicity or adverse reaction of the same or similar target organs does not exist, and the drug combination/composition does not cause toxicity superposition to cause obvious toxicological worry.

3. Compliance with

The quick response of corticosteroid in the pharmaceutical composition to the focus and the long remission period of the vitamin is used, so that the acceptance of the patient to the treatment is greatly improved. And the treatment of the pharmaceutical composition may provide good convenience to the patient and help promote patient compliance with the treatment of the pharmaceutical composition during long term management, improving the quality of life and treatment confidence of the patient, and thus improving patient treatment compliance. The pharmaceutical composition promotes rapid response of diseases, realizes good long-term control, and improves use compliance of patients.

Definition and description

The following terms used in this application have the following meanings, unless otherwise indicated. A particular term, unless otherwise defined, shall not be construed as being ambiguous or otherwise unclear, but shall be construed in accordance with the ordinary meaning in the art.

As used herein, the present vitamin mod compounds and corticosteroids include non-salt forms thereof (e.g., free acid or free base) and also pharmaceutically acceptable salts thereof, which are included within the scope of the present application.

The term "administering" or "using" or "administering" means physically introducing a composition comprising a therapeutic agent into a subject using any of a variety of methods and delivery systems known to those of skill in the art.

The term "treatment" generally refers to obtaining a desired pharmacological and/or physiological effect. The effect may be therapeutic in terms of partial or complete stabilization or cure of the disease and/or side effects due to the disease. As used herein, "treatment" encompasses any treatment of a disease in a patient, including: (a) inhibiting the symptoms of the disease, i.e., arresting its development; or (b) alleviating a symptom of the disease, i.e., causing regression of the disease or symptom.

The term "individual" may be a mammal. In some embodiments, the subject is a mouse, rat, rabbit. In some embodiments, the subject is a human.

The term "pharmaceutical combination" refers to the simultaneous, concurrent or sequential use of two or more active ingredients in combination.

The term "pharmaceutical composition" refers to a mixture of one or more compounds of the present application or a pharmaceutical combination or salt thereof and pharmaceutically acceptable excipients. The purpose of the pharmaceutical composition is to facilitate administration of a compound of the present application or a pharmaceutical combination thereof to a subject.

The term "pharmaceutically acceptable excipients" refers to those excipients which do not significantly stimulate the organism and which do not impair the biological activity and properties of the active compound. Suitable excipients are well known to the person skilled in the art, such as carbohydrates, waxes, water soluble and/or water swellable polymers, hydrophilic or hydrophobic materials, gelatin, oils, solvents, water and the like.

The pharmaceutical compositions of the present application may be prepared by combining the compounds of the present application with suitable pharmaceutically acceptable excipients, for example, may be formulated as semi-solid formulations, such as creams, ointments, gels, and the like.

The semi-solid composition may be prepared by conventional mixing, stirring, emulsifying, etc. For example, it can be obtained by the following method: the active compound is dissolved in a solvent and mixed with other suitable excipients, and the mixture is then processed to a semi-solid. Suitable excipients include, but are not limited to: emulsifying agents, antibacterial preservatives, stabilizers, viscosity modifiers, humectants, and the like.

The term "pharmaceutically acceptable" is intended to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.

The term "pharmaceutically acceptable salt" or "pharmaceutically acceptable salt or ester" or "pharmaceutically acceptable salt or ester" refers to salts or esters of the compounds of the present application that are within the definition of "pharmaceutically acceptable".

Unless specifically stated otherwise, singular terms encompass a plurality of terms and plural terms encompass singular terms. The terms "a" or "an" mean "at least one" or "at least one" unless specifically indicated otherwise. The use of "or" means "and/or" unless stated otherwise.

In this document, the terms "comprises, comprising, and/or equivalents are used in an open-ended fashion, meaning that additional elements, components, and steps are not recited in addition to the recited elements, components, and steps.

All patents, patent applications, and other identified publications are expressly incorporated herein by reference for the purpose of description and disclosure. These publications are provided solely for their disclosure prior to the filing date of the present application. All statements as to the date or representation as to the contents of these documents are based on the information available to the applicant and do not constitute any admission as to the correctness of the dates or contents of these documents. Moreover, any reference to such publications in this document does not constitute an admission that the publications are part of the common general knowledge in the art, in any country.

Drawings

FIG. 1 shows a temporal analysis of PASI75 response (%) of patients using a pharmaceutical composition;

FIG. 2 shows PASI score changes for patients using pharmaceutical compositions;

FIG. 3 shows the PGA score change for a patient using a pharmaceutical composition;

Figure 4 shows the erythema score profile for patients using the pharmaceutical composition.

Detailed Description

For clarity, the present application is further illustrated with examples, but the examples do not limit the scope of the present application. All reagents used in this application are commercially available and can be used without further purification.

Example 1

The combination of the vitamin mod emulsifiable paste and the triamcinolone acetonide acetate emulsifiable paste is obtained by locally applying the vitamin mod emulsifiable paste (1%), the triamcinolone acetonide acetate emulsifiable paste (0.1%) is sequentially and locally applied to the skin lesion tissue, and the effect of the medicine combination on the disease part is observed 2 times a day.

Example 2

The present vitamin Morde triamcinolone acetonide emulsifiable paste

Composition of the composition	Proportion (%) (w/w)
		Local vitamin mod	0.8％
Triamcinolone acetonide	0.05％
		Cetostearyl alcohol
	20％
		White vaseline	25％
Light liquid paraffin	12％
		Propylene glycol
	20％
		Glyceryl monostearate	0.2％
Sorbic acid	0.05％
		Purified water	To 100%

Preparation method

Adding light liquid paraffin, white vaseline and cetostearyl alcohol into the propylene glycol-dissolved benamode and triamcinolone acetonide, stirring uniformly, adding glyceryl monostearate, heating and melting, adding purified water, stirring and homogenizing to obtain stable emulsion drops, cooling to normal temperature, and subsequently adding sorbic acid.

Example 3

Mometasone furoate cream

Composition of the composition	Proportion (%) (w/w)
		Local vitamin mod	1.5％
Mometasone furoate	0.5％
		Glyceryl monostearate	2.5％
White vaseline	10％
		Light liquid paraffin	10％
Propylene glycol
		30％
Polysorbate
	80	5.0％
Cetyl alcohol			25％
	Hydroxy-phenyl ethyl ester	0.02％
Purified water			To 100%

Preparation method

The preparation method comprises the steps of dissolving the vitamin mod and the mometasone furoate in propylene glycol, adding white vaseline, light liquid paraffin and hexadecanol, stirring uniformly, adding glyceryl monostearate, heating and melting, adding purified water, stirring and homogenizing to form stable emulsion drops, cooling, and then adding ethylparaben, and cooling to room temperature.

Example 4

Preparation of the present vitamin Mortiered betamethasone cream

The method for preparing the raw and auxiliary materials into the cream comprises the following steps:

step 1, oil phase preparation: weighing cetostearyl alcohol, white vaseline, light liquid paraffin and glyceryl monostearate according to a prescription, heating to 75-85 ℃, dissolving and mixing uniformly; adding ethylparaben, stirring for dissolving, and maintaining at 80deg.C.

Step 2, preparing an aqueous phase: weighing purified water and polysorbate 80 according to the prescription, heating to 75-85deg.C, stirring, and maintaining at 80deg.C.

Step 3, preparing a raw material medicine solution: adding the present vitamin mod and betamethasone into propylene glycol, stirring at 75-85 ℃ to dissolve the raw materials, and preserving heat at 80 ℃ for later use.

Step 4, mixing and emulsifying:

a, adding the raw material medicine solution into an oil phase, mixing and uniformly stirring;

b adding water phase, homogenizing at 75-85deg.C at 1800rpm for 10min;

c, stirring and cooling to below 45 ℃ to form paste.

Example 5

Preparation of the present vitamin Monod hydrocortisone cream

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Step 3, preparing a raw material medicine solution: adding the present vitamin mod and hydrocortisone into propylene glycol, stirring at 75-85deg.C to dissolve the raw materials, and keeping the temperature at 80deg.C.

Step 4, mixing and emulsifying:

b adding water phase, homogenizing at 75-85deg.C at 1800rpm for 10min;

c, stirring and cooling to below 45 ℃ to form paste.

Example 6

Preparation of mometasone furoate cream

Step 3, preparing a raw material medicine solution: adding the present vitamin mod and mometasone furoate into propylene glycol, stirring at 75-85 ℃ to dissolve the raw materials, and preserving heat at 80 ℃ for later use.

Step 4, mixing and emulsifying:

b adding water phase, homogenizing at 75-85deg.C at 1800rpm for 10min;

c, stirring and cooling to below 45 ℃ to form paste.

Example 7

Preparation of the present vitamin Mortiered betamethasone cream

Step 4, mixing and emulsifying:

b adding water phase, homogenizing at 75-85deg.C at 1800rpm for 10min;

c, stirring and cooling to below 45 ℃ to form paste.

Example 8

Drug effect study of psoriasis patients carrying out the pharmaceutical composition of the application:

example 4 pharmaceutical composition: the vitamin Monod cream and betamethasone cream

The specific steps of the medicine are as follows: the medicine is applied to the patients with light and moderate psoriasis, and the compound emulsifiable paste of the benvimod and the betamethasone is smeared on the disease parts of the patients, namely the composition consisting of the two medicines is used. The patient's disease improvement was observed periodically, once a day, in the morning and evening. The implementation results are as follows:

1. temporal analysis of PASI75 response (%) in patients with pharmaceutical compositions

To determine the clinical practical efficacy of the pharmaceutical composition, a study of the efficacy of the pharmaceutical combination was administered to psoriatic patients and the results are shown in figure 1, with which the patient's PASI75 response rate is significantly higher from week 6 than for each active ingredient alone.

2. PASI score change in patients using the pharmaceutical composition

The results before and after administration of the pharmaceutical composition show that the PASI score of the patient with the pharmaceutical composition changes most from the baseline and the PASI score of the patient with the pharmaceutical composition is obviously different from that of each single drug and the control group from week 6, which shows that the psoriasis area and the severity of the patient with the pharmaceutical composition can be improved more effectively than those of the patient with the single drug, and proves that the patient has better clinical prospect in using the pharmaceutical composition.

3. PGA score change in patients using the pharmaceutical composition

The overall injury of patients with psoriasis before and after administration of the pharmaceutical composition was scored (PGA), the results of which are shown in fig. 3, were shown to be the greatest in the change of PGA score from baseline for patients with psoriasis after 8 weeks of treatment, and were significantly different from each individual and the control group from week 4, indicating that the overall injury of patients with psoriasis using the pharmaceutical composition was more effectively improved than that of individual, and the PGA score was reduced by nearly 80% for patients with psoriasis after 8 weeks of treatment, demonstrating the good effect of the pharmaceutical composition on the overall injury of patients who were in session.

4. Erythema scoring of patients using the pharmaceutical composition

The results of exploring the erythema situation of the disease parts before and after the psoriasis patient uses the pharmaceutical composition are shown in figure 4, the erythema symptom is improved faster and more obviously compared with the single drug, and the treatment effect is better than that of each single drug treatment from the 2 nd week to the 8 th week, thus proving the treatment effect and benefit of the pharmaceutical composition on erythema improvement.

Claims

1. A pharmaceutical composition, characterized in that the pharmaceutical composition is a cream and comprises, in total weight percent of the pharmaceutical composition:

a surfactant in an amount of 0.1% to 8% by weight;

a solvent and/or a permeation enhancer in an amount of 5% to 20% by weight; and

the balance being aqueous phase.

2. Pharmaceutical composition according to claim 1, characterized in that the content of the present retinmod or a pharmaceutically acceptable salt thereof is 0.5% to 1.25%, preferably 0.75% to 1% by weight.

3. The pharmaceutical composition according to any one of claims 1 or 2, wherein the corticosteroid is present in an amount of 0.01% to 1% by weight.

4. A pharmaceutical composition according to any one of claims 1 to 3, wherein the corticosteroid is betamethasone or a derivative thereof; preferably, the corticosteroid is betamethasone or betamethasone propionate.

5. The pharmaceutical composition according to any one of claims 1 to 4, wherein the surfactant is selected from one or more of emulsifying waxes, stearyl alcohol polyethers, polysorbates, glyceryl monostearate, cetomacrogol 1000, sorbitan fatty acid esters and polyethylene glycol cetostearyl ether, preferably one of glyceryl monostearate, stearyl alcohol polyethers, polysorbates, cetomacrogol 1000, sorbitan fatty acid esters and polyethylene glycol cetostearyl ether.

6. The pharmaceutical composition according to claim 5, wherein the surfactant is glyceryl monostearate or glyceryl monostearate in an amount of 0.1% to 6% by weight.

7. The pharmaceutical composition according to any one of claims 1 to 6, wherein the solvent and/or permeation enhancer is selected from one or more of propylene glycol, diethylene glycol monoethyl ether, glycerol and PEG400, preferably propylene glycol and/or diethylene glycol monoethyl ether, more preferably propylene glycol.

8. The pharmaceutical composition according to any one of claims 1 to 7, further comprising a preservative in an amount of 0.05% to 10% by weight; and/or

An antioxidant in an amount of 0.05 to 10% by weight.

9. A method of preparing a pharmaceutical composition according to any one of claims 1 to 8, comprising the steps of:

10. Use of a pharmaceutical composition according to any one of claims 1 to 8 in the manufacture of a medicament for the treatment and/or prophylaxis of immune, inflammatory and autoimmune diseases, preferably in the manufacture of a medicament for the treatment and/or prophylaxis of dermatological diseases or disorders; wherein the skin disease or disorder is selected from psoriasis, atopic dermatitis, acne and skin itch; preferably, the skin disease or disorder is psoriasis.