Psoriasis: Drug Therapy

Therapy goals

  • Improvement of symptomatology. Low disease activity status.
  • Ideally, remission (temporary or permanent abatement of disease symptoms) should be achieved.

Therapy recommendations

The therapeutic approach to psoriasis is classic dermatological: it consists of basic therapy, topical (local) therapy and systemic treatment:

  • All severities of psoriasis receive basic therapy:
    • Topical therapy:
      • Oil or salt water baths, initially 2 times, then 1 time daily (15-20 min each), depending on age.
      • Active substance-free ointment bases as well as topical urea preparations (5-10%) and salicylic acid preparations (for circumscribed plaques in the head area (from 6 years of age; 1%; in children < 8 years total treatment area max. palm size) (= keratolysis (“desquamation”)).
      • Creams, emulsions or pastes with a low fat content are preferred.
  • Mild forms (less than ten percent of the body surface affected, PASI (Psoriasis Area and Severity Index), 10 points out of 72 at worst) receive local therapy:
    • Initial therapy

      Evaluation after 2-8 weeks: Therapy success no: modify therapy; Therapy success: yes → maintenance therapy.

    • Maintenance therapy
      • Therapy of 1st choice: (Cal + Bet) 1-2 x weekly.
      • Therapy of the 2nd choice: TCI or vitamin D3 analogues 1-2 x weekly.
  • Moderate and severe forms of psoriasis receive systemic therapy, phototherapy:
  • Special therapy situations
    • Severe inflammatory psoriasis: class III-IV corticosteroid for 1-3 weeks, then as initial therapy.
    • Hyperkeratotic infestation: salicylic acid 5-10% for 3 to 5 days, other keratolytics if necessary, then as initial therapy.
    • Intertriginous affection / face: class II-III corticosteroid for 1-4 weeks, then as initial therapy.
    • Scalp, hand and foot infestation: Class III-IV corticosteroid (occlusive if necessary), then as initial therapy.
  • See also under “Further therapy”.

Further notes

Phytotherapeutics

A systematic review is available on this topic. The following phytotherapeutics are supported with studies for adjuvant therapy of psoriasis:

  • Cayenne pepper (Capsicum frutescens): capsaicin; note: do not use on the face! Contraindication: injured skin
  • Chrysarobin (component of the bark of the araroba or goa tree (Andira araroba)): Cignolin (anthralin, dithranol); Effects: Inhibition of the release of proinflammatory cytokines and the growth of keratinocytes.
  • Cartilage carrot (Ammi majus): from it psoralens; effects: Inhibition of keratinocyte proliferation; in combination with UV-A irradiation (PUVA) also anti-inflammatory effect.
  • Mahonia (Mahonia aquifolium): 10% mahonia cream.
  • Niembaums (Azadirachta indica): nimbidin
  • Silver willow (Salix alba; salicylic acid from silver willow bark); Effects: Keratolysis

Supplements (dietary supplements; vital substances)

Other complementary and alternative medicine (CAM) therapies with evident effects:

  • Indigo naturalis (derived from plants such as Baphicacanthus cusia); effect: the active ingredient indirubin is thought to reduce skin hyperproliferation (by influencing the cell cycle and epidermal growth factor receptor (EGFR)).
  • Curcumin (from turmeric); effect: anti-inflammatory (anti-inflammatory); improvement of psoriasis plaques.
  • Omega-3 fatty acids (in most RCT (randomized placebo-controlled trial) no significant improvement in skin lesions, while in uncontrolled studies showed benefit).
  • Hypocaloric diet (low-energy diet), with the goal of achieving normal weight; participation in a weight-loss program, if necessary.

Suitable dietary supplements should contain the following vital substances: