Plaque Psoriasis (Localized)
Investigational use for localized stable plaque psoriasis; small case series suggest plaque thinning. Not a primary treatment.
Краткая информация для пациента
- Есть ли FDA-допуск для этого показания?
- Not FDA-cleared for plaque psoriasis. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, 2004). Use for plaque psoriasis is investigational.
- Какие доказательства существуют?
- Tier C (investigational). Small case reports describe plaque thinning at sites of leech application. There are no randomized controlled trials. Psoriasis has many highly effective evidence-based treatments — topical corticosteroids, vitamin D analogues, phototherapy (UVB, PUVA), and biologics (IL-17, IL-23, TNF inhibitors) — supported by extensive RCT data and guidelines.
- Основные риски
- Bleeding from bite sites for 6 to 24 hours after detachment
- Bruising and tenderness around plaques for 5 to 10 days
- Itching and irritation at bite sites for days to weeks
- Local skin infection or, rarely, Aeromonas infection (heightened with psoriatic skin barrier disruption)
- Koebner phenomenon — new psoriatic plaques forming at bite sites in some patients
- Allergic reaction to leech saliva (uncommon)
- Small permanent scars at bite sites
- Кому не следует это рассматривать
- Patients on blood thinners (warfarin INR >2.0, DOACs, heparin)
- Patients with hemophilia or other bleeding disorders
- Patients with severe anemia (Hb <10 g/dL)
- Patients on systemic immunosuppressants or biologics (higher infection risk)
- Patients with active erythrodermic, pustular, or unstable psoriasis
- Patients with active skin infection
- Patients with extensive disease where topical/systemic treatments are clearly indicated
- О чём спросить врача
- Have I been evaluated by a dermatologist?
- Have I had adequate trials of topical corticosteroids, vitamin D analogues, phototherapy, or biologics?
- What evidence supports leech therapy for plaque psoriasis specifically?
- What is the risk of Koebner phenomenon (new plaques at bite sites)?
- What is the realistic chance of benefit, and for how long?
- What is the practitioner's experience and Aeromonas-prevention plan?
- What is the cost?
- Когда срочно обратиться за медицинской помощью
- Rapid widespread reddening of skin (possible erythroderma — emergency)
- Spreading pus, redness, warmth, or red streaks (cellulitis, especially with biologic users)
- Bleeding from a bite site lasting more than 24 to 48 hours
- Fever above 38.0 C / 100.4 F or chills
- Hives, throat tightness, or breathing difficulty
Что это НЕ означает
- This is not FDA-cleared for plaque psoriasis.
- Case reports do NOT establish efficacy versus evidence-based topical, phototherapy, or biologic therapies.
- Mechanism rationale does NOT establish clinical efficacy.
- Leech bites may trigger the Koebner phenomenon — new psoriasis plaques at bite sites.
- Leech therapy is not a substitute for dermatology evaluation and standard psoriasis care.
Перекрёстные ссылки безопасности
Clinical Profile
- Category
- dermatological
- ICD-10
- L40.0, L40.4, L40.8
- Safety tier
- medium
Evidence Summary
No controlled clinical trial or credible case series of leech therapy for plaque psoriasis has been published; there is no reliable evidence that it reduces PASI scores or thins plaques. Any proposed local immunomodulatory mechanism is speculative and unproven. Generalized psoriasis is not appropriate for leech therapy, and standard care (topical corticosteroids, vitamin D analogues such as calcipotriol, phototherapy, and systemic or biologic agents including methotrexate for moderate-to-severe disease) remains the standard. The Koebner phenomenon (new lesions provoked at sites of skin trauma) is a genuine theoretical concern with any skin-breaking procedure. ASH position: any use of leech therapy for psoriasis is investigational and mechanistic only.
Treatment specifics
How many leeches, where they are placed, how long a session lasts, and whether to repeat are clinical decisions made by a qualified provider under institutional protocol — not something to self-administer. Discuss the specifics with a clinician experienced in medicinal leech therapy. (Clinicians: switch the audience selector in the top bar to “Clinician” to view protocol detail.)
Key Trials
- Ashraf S et al. (2014), n=15
Contraindications
- Active anticoagulant therapy (warfarin INR >2.0, DOACs, heparin)
- Hemophilia or other bleeding disorder
- Severe anemia (Hb <10 g/dL)
- Active bacteremia or sepsis
- Known hypersensitivity to leech salivary proteins
- Pregnancy (relative — first/third trimester)
- Immunocompromised state with severe neutropenia
- Erythrodermic or generalized pustular psoriasis
- Active concomitant biologic therapy
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