Objective: Methotrexate (MTX) is a commonly prescribed drug for patients with psoriasis. Nigella sativa (NS) has been shown beneficial in vitiligo and in eczema. Recently, NS has shown activity in modifying psoriatic lesions. The aim of this study was to evaluate the effect of the combination (NS+MTX) on psoriasis and to compare that with NS or MTX monotherapy.
Methods: Sixty patients with moderate to severe plaque, palmoplantar and guttate psoriasis were enrolled for 12 weeks study. The patients were divided into 3 groups; 20 patients in each. Group 1 was treated with NS ointment (20% w/w) 2 times daily + 500 mg NS capsule 3 times daily. Group 2 received MTX tablets 15 mg weekly and group 3 received MTX + NS (topical + oral).
Results: Marked response was achieved in 60%, 80%, and 90% of patients on NS, MTX, and (NS + MTX) respectively. The respective relapse rate was 33.3%, 56.3%, and 27.8%. Serum malondialdehyde (sMDA), a parameter of oxidative stress was decreased from 4.39 ± 0.81 to 2.31 ± 0.72 µmol/L with NS treatment while a small increase in sMDA was observed with MTX. NS + MTX treatment reduced sMDA from 4.39 ± 0.67 to 3.49 ± 0.65 µmol/L after 12 weeks treatment. All treatments did not change liver enzymes or complete blood count. NS was well tolerated and showed ability in ameliorating gastric upset of MTX.
Conclusion: NS augments antipsoriatic effect of MTX. Topical and oral use of NS is effective and safe in moderate to severe psoriasis.