Efficacy of the Apitherapy in the treatment of recalcitrant localized plaque psoriasis and evaluation of Tumor Necrosis Factor-Alpha (TNF-a) serum level: Double blind randomized clinical trial.

INTERVENTION: All patients will tested for existing immunity by intradermal injection of 0.05 ml of drug [Epivac 'Registered Trademark' Bee Venom (Apis mellifera)The Holding Company for Biological Products and Vaccines] into the skin of left forearm. the one who negative for anaphylactic reaction, will have a standard dose of 0. 05 mL/cm2 around psoriatic lesion were administered intradermaly. Injections were spaced 1 cm apart. An insulin syringe with a small‐bore needle (25 gauge) was used for accuracy of dose measurement and ease of administration. The session carried on once weekly for 3 months in small doses starting with 0.05‐0.1ml, and then increased gradually by 0.05 ml every other injection till reach a dose 1 ml every injection CONDITION: Localized psoriasis PRIMARY OUTCOME: To evaluate the therapeutic potential effect of Bee venom in recalcitrant localized Psoriasis at the end of 3 months of treatment. By assessing with physician global assessment (PGA). To evaluate the therapeutic potential effect of Bee venom in recalcitrant localized Psoriasis, by assessing Physician Global Assessment (PGA) before and after treatment SECONDARY OUTCOME: To detect the effect of Bee venom on the serum level of Tumor necrosis factor alpha (TNF‐a). INCLUSION CRITERIA: *Patients diagnosed as recalcitrant localized psoriasis. *Patients aged 18 ‐60 years. *Both genders. *Stopping any topical or systemic treatment for psoriasis during the last 2 months.