الفهرس 
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Abstract
Psoriasis is a chronically recurring inflammatory disease that affects skin, scalp and joints. Skinlesions in the form of plaques covered by silvery white scales. T-cell and cytokines play an important role in the pathogenesis of psoriasis.
The goal of psoriasis treatment are to gain initial and rapid control of the disease process, decrease the percentage of the body surface area involved, achieve and maintain long-term remission, minimize adverse events and improve patients quality of life. Therapy for psoriasis varies depending on the disease severity. Topical immunological treatment for mild psoriasis includes topical corticosteroids, calcipitriol, tazarotene, anthralin and keratolytics. Systemic therapies include methotrexate, acetritine, cyclosporine and biologic agents. Treatment could be improved using combination, rotational, or sequential regimens.
Bee venom is composed of a mixture of enzymes and peptides that possess several pharmacological activities. The main enzymes are hyaluranidase, Phospholipase A2and acid phosphatase. Peptides include mellitin, apamine and peptide401.
The aim of this work was to evaluate the effect of bee venom in treatment of localized plaque psoriasis,and to investigate its possible influence on serum level of tumor necrosis factor alpha (TNF- α).
The present study was carried on 50 patients with localized psoriasis 17 females and 8 males in each group, selected from the out patient clinic of department of dermatology ,Suez Canal University Hospital. Their ages ranges from 18to 60yearswith the duration of the disease ranged from 0.5 to 25years. They were divided into 2groups :the 1st group received intradermaly injection of bee venom and the 2nd group received intradermaly injection of saline
In this study 23 patients showed complete clinical improvement and 2 patients showed no clinical evidence of improvement in bee venom group while all patients in placebo group did not show any clinical evidence of improvement.
For all patients. Clinical assessment and laboratory TNF-α was done before and after treatment. In bee venom group PASI score with a mean 3.63±0.81 showed statistically significant reduction after treatment to 0.16± 0.06 (p<0.001) while in placebo group did not show reduction in PASI score after treatment.
In addition the level of TNF-α in bee venom group reduced from 55.56±17.56 to become 48.46±6.71 this reduction was statistically significant p<0.05* while in placebo group the mean of TNF-α was 53±8.32 and did not reduced after treatment.
No side effects occurred in anypatientexceptpain, erythema and swelling (non-allergicreaction) occurred at the site of bee venom injection. Also we found no recurrenceof the disease during the follow-up observationperiod (3 months).
The mechanism of action of bee venom in psoriasis might be due to the blocking effect of bee venom on tumor necrosis factor-α, interleukin-1β, interleukin-6 and induction of interleukin-10 and interleukin- 4 in the present study TNF-α was reduced with the use of bee venom, so it could be used as an indicator for psoriasis response and treatment of the bee venom.