Psoriasis is a chronic inflammatory disease, affecting about 3% of the worldwide population. Although there are many therapeutic options available today for psoriasis, none of them can be considered as the gold standard treatment for maintaining a sustained period of remission. The aim of this study was to investigate whether a maintenance dosage of Michaels® Soratinex® product family is effective in maintaining a symptom-free state for patients in remission. Fifty patients (23 male, 27 female), aged 18-58-years-old (mean age: 38.3), affected by mild to severe plaque psoriasis (mean duration: 29.5), were included in this retrospective study. All of them had completed previous treatment and achieved remission. Twenty-eight had been previously treated with an Australian series of herbal skin-care products (Dr. Michaels® Soratinex® skincare products for psoriasis) and 22 treated with biologics. We evaluated the clinical condition of the member of each group every 4 weeks, for 16 times following remission. Maintenance group continued treatment with Dr Michaels® (Soratinex®). Non-Maintenance group discontinued both forms of treatment. The evaluation was based on the PASI score, assuming that at baseline it was zero. Out of 34 patients who continued treatment with Dr Michaels® (Soratinex®) product family in the Maintenance group (22 previously treated with Dr Michaels and 12 previously treated with Biologic), 26 remained symptom free with baseline PASI of zero. Six patients had a mild flare with a PASI increase of 0-25%. Two patients were in the moderate group with a PASI increase of 26-50% and were initially treated with biologic. Out of 6 patients in Dr Michaels non-maintenance group, 3 patients remained symptom free, 1 had a rebound starting on week 36 and 2 rebounded at week 44. Out of 10 patients who were in the non-maintenance from the biologic group, 6 rebounded at week 12, 2 rebounded at week 16, 1 rebounded at week 24 and 1 rebounded at week 32. In the maintenance group no side effects were described, except for a mild form of folliculitis in 3 patients. Treatment did not have to be discontinued and all 3 patients cleared. Based on the results of this study, Dr. Michaels® (Soratinex®) product family can be safely and successfully applied to maintain a symptom-free state, after patients go into remission following treatment with Dr. Michaels® (Soratinex®) product family or biologics in mild to very severe psoriasis, when considering the exclusion criteria.

2nd Medical Faculty Charles University Bulovka Hospital Institute of Clinical and Experimental Medicine Prague Czech Republic

Centro Studi per la Ricerca Multidisciplinare e Rigenerativa Università Degli Studi G Marconi Rome Italyi

Chair of Dermatology University of Rome G Marconi Rome Italy

Department Medicinal Information and Non interventional studies Bulgarian Drug Agency Sofia Bulgaria

Department of Dermatology and Allergology Academic Teaching Hospital Dresden Friedrichstadt Dresden Germany

Department of Dermatology and Cutaneous Surgery Department of Psychiatry and Behavioral Sciences Institute for Bioethics and Health Policy University of Miami Miller School of Medicine Miami FL USA

Department of Dermatology and Venereology Medical University of Plovdiv Medical faculty Plovdiv Bulgaria

Department of Nuclear Physics Sub nuclear and Radiation G Marconi University Rome Italy

Dermatological Department University of Pisa Pisa Italy

Medical Institute of Ministry of Interior Department of Dermatology Venereology and Dermatologic Surgery Sofia Bulgaria

Onkoderma Policlinic for dermatology and dermatologic surgery Sofia Bulgaria

PRO SANUM Ltd Sanatorium of Prof Novotný Štěpánská Prague 1 Czech Republic

Psoriasis and Skin Clinic Melbourne Australia

University B 1 S Group of Institutions Punjab Technical University Punjab India