Introduction
In the therapy of psoriasis there are three main goals to be achieved: In addition to local (local, e.g. ointments) and systemic (introduced into the organism, e.g. tablets) treatment, UVA radiation is also used to alleviate the symptoms.
- Reducing the rate of migration of skin cells
- Inflammation inhibition
- Elimination of triggering factors
The local therapy is explained in more detail below:First, the dandruff is removed with the help of urea ointments and baths.
The classical therapy consists of dithranol (in the form of ointments). Dithranol normalizes the excessive proliferation of epidermal cells. However, it causes severe skin irritation and stains strongly.
Because of the strong skin irritation, it should only be applied to the foci and not to the surrounding healthy skin. The concentration of the active ingredient is determined individually for each patient. As a rule, the ointment must be washed off after a certain period of exposure.
Calcitriol, i.e. vitamin D3 preparations, also belong to the local therapy. They inhibit cell proliferation and are usually combined with UVA-UVB irradiation. Not only the increased cell proliferation is inhibited, but also the maturation of normal skin cells is stimulated.
The efficacy is about the same as with cortisone preparations (cortisone), but unlike these, they can be used well for long-term therapy. Retinoids (vitamin A preparations) are also used, but must not be used on the face and genitals. Pregnancy or breast-feeding (see Breastfeeding) also prevents the administration.
Besides inhibiting cell division, retinoids also have an anti-inflammatory effect. They represent an alternative to cortisone therapy. Glucocorticoids (cortisone) are also used locally, including in the face and genital area.
They have a strong anti-inflammatory effect and are the most frequently administered worldwide for the treatment of psoriasis. In addition, they suppress the immune response and have an inhibitory effect on increased cell division. Undesirable side effects of the locally applied glucocorticoids include thinning and increased vulnerability of the skin.
So-called steroid acne can also occur. The systemic therapy is used in case of failure of the local therapy. The systemic therapy takes the form of tablets.
The administered drugs include Methotrexate inhibits the inflammatory processes in the skin and is used for psoriasis with and without joint problems. It also reduces activated T-cells. Since methotrexate damages the liver, this drug may only be used in liver healthy individuals.
The patient treated with methotrexate should not consume alcohol if possible. Not only the liver is damaged, but also male germ cells and the embryo in the womb. Therefore, good contraception should be used for up to three months after the end of therapy.
The effect of fumarates is based on the inhibition of inflammatory cells and the inhibition of the release of cell messenger substances (cytokines). The therapeutic effect, however, only occurs after about 3-5 weeks. Diarrhea and nausea are among the undesirable effects.
Ciclosporin is prescribed exclusively for severe and therapy-resistant psoriasis. It inhibits the activity of the inflammatory cells and their substances. Because of the possible restriction of renal function, patients with damaged kidneys should not receive Ciclosporin for therapy.
Retinoids influence the growth and maturation of epidermal cells and the inflammatory activity in the psoriatic foci. Side effects include drying of the skin and mucous membranes. During pregnancy, malformations of the child are very likely to occur.
Therefore, such a therapy must not be used in this case. If possible, glucocorticoid cortisone should not be used for systemic therapy, as there are considerable side effects, especially in long-term treatment. Another possible active substance for treatment is the immunosuppressive agent Tacrolimus, Enbrel® or Adalimumab.
The effect of fumarates is based on the inhibition of inflammatory cells and the inhibition of the release of cell messengers (cytokines). The therapeutic effect, however, only occurs after about 3-5 weeks. Diarrhea and nausea are among the undesirable effects.Ciclosporin is prescribed exclusively for severe and therapy-resistant psoriasis.
It inhibits the activity of the inflammatory cells and their substances. Because of the possible restriction of kidney function, patients with damaged kidneys should not receive Ciclosporin for therapy. Retinoids influence the growth and maturation of epidermal cells and the inflammatory activity in the psoriatic foci.
Side effects include drying of the skin and mucous membranes. During pregnancy, malformations of the child are very likely to occur. Therefore, such a therapy must not be used in this case.
If possible, glucocorticoid cortisone should not be used for systemic therapy, as there are considerable side effects, especially in long-term treatment. Another possible active substance for treatment is the immunosuppressive agent Tacrolimus, Enbrel® or Adalimumab
- Fumarates
- Methotrexate
- Ciclosporin
- And also here retinoids
- And glucocorticoids.
The therapy of a patient suffering from psoriasis should always be carried out in defined stages. This means that before resorting to more aggressive treatment measures, one should first start to use the gentlest possible therapy methods.
Ointments and creams are particularly suitable for mild forms of psoriasis. Even the regular application of these local therapeutic measures often leads to satisfactory treatment results. In order to positively influence the treatment results, the affected patients should follow a few steps before applying the ointment.
Before the psoriasis ointment is applied to the affected areas of skin, the surface of the skin must be carefully freed of skin scales. Creams or ointments containing urea or salicylic acid are suitable for this purpose. In this context, however, it must be noted that an ointment containing salicylic acid must never be applied to large areas of skin.
Ideally, the ointment should first be applied to a small area of the body. If no skin reactions occur even after an application time of about ten minutes, the actual treatment can begin. Patients who are allergic to the application of the usual ointments and creams can alternatively use oil baths to descale the skin surface.
In less severe cases, special shampoos can be sufficient to achieve a successful psoriasis therapy. After the skin surface of the affected patient has been descaled and prepared for the application of further substances, the actual psoriasis therapy can be started by applying an ointment. Especially by regular use of an ointment containing coal tar, satisfactory treatment results could be achieved so far.
The active ingredients contained in the ointment inhibit the excessive cell division typical of psoriasis, curb inflammatory reactions and prevent keratinization of the uppermost skin layer. In addition, creams and ointments containing the active ingredient “dithranol”, a synthetic tar preparation, have proven successful in the treatment of psoriasis. With regular local application of this ointment, the typical inflammatory processes as well as excessive horn production should be demonstrably reduced.
However, the therapy of psoriasis with the help of a dithranol ointment should be viewed critically. Parts of the body where the ointment is applied excessively tend to develop a brownish discoloration. For this reason, the therapy of psoriasis with an ointment containing dithranol should be carried out very carefully and sparingly.
In case of any abnormality after application (redness, burning, itching) a dermatologist must be consulted immediately. Moderately severe and severe forms of the disease usually hardly respond to ointments containing tar. For this reason, the patients affected usually have to resort to a cortisone ointment.
This ingredient is a hormone that is also produced in the adrenal cortex. In psoriasis therapy with an ointment containing cortisone, however, care must be taken to cover the skin surface very sparingly. Furthermore, this ointment must never be used on children, on the face, neck or genital area.
The reason for this is the fact that the active ingredient cortisone thins the skin surface and the skin areas just mentioned are already quite thin anyway. The most important side effects of cortisone ointment include redness, burning and itching.If such a side effect occurs, the therapy must be interrupted and a specialist must be consulted. In everyday clinical practice, ointments with vitamin D derivatives have proven to be particularly suitable for the treatment of psoriasis.
When applied regularly, vitamin D3 in particular ensures that the growth and maturation of the cells of the epidermis is positively influenced and the dandruff formation typical of psoriasis is inhibited. According to extensive studies, the effectiveness of the ointment containing vitamin D is equivalent to that of a medium-strength cortisone ointment. Regarding possible side effects Vitamin D descendants show up however as substantially more careful and better compatible.
To the most well-known ointments on Vitamin D basis belong: Curatoderm® (Tacalcitol), Silkis® (Calcitriol), Daivonex® (Calcipotriol). The classic ointments with vitamin A derivatives are particularly suitable for the treatment of mild to moderate forms of psoriasis. On average, it can be assumed that about 70-80 percent of the foci heal after regular application of a vitamin A ointment.
In severe forms of the disease, an ointment containing vitamin A can be combined with an ordinary cortisone cream. The therapy of psoriasis can be problematic during pregnancy. This is particularly the case if an expectant mother suffers from a particularly severe form of psoriasis.
The reason for this is the fact that the local application of ointments and creams alone is usually not sufficient to effectively relieve the symptoms. However, since most of the drugs suitable for systemic therapy of psoriasis must not be administered during pregnancy, treatment must often be paused. This is particularly problematic because the classic symptoms of psoriasis become worse for many women during pregnancy anyway.
Women who suffer from psoriasis and are planning a pregnancy should therefore inform their dermatologist early on. Only then can an early decision be made as to whether the respective therapy can be continued during pregnancy or whether the patient may need to switch to another medication. Nevertheless, it must be noted that there are not many drugs for the treatment of psoriasis that are approved during pregnancy.
For most of the active ingredients it is assumed that damage to the fetus cannot be completely ruled out. The use of systemic medication can lead to serious malformations, especially during the first third of the pregnancy. For this reason, all oral medications used to treat psoriasis should be discontinued during pregnancy.
This is especially true for drugs that contain the active ingredients “Acitretin” (or other vitamin A derivatives) or “Methotrexate”. Both active ingredients can lead to severe malformations and miscarriages during pregnancy. For women who take one of these preparations, it is important to ensure effective contraception during the entire therapy.
In addition, affected women should not become pregnant after the actual intake (two years in the case of acitretin; four months in the case of methotrexate). In general, local medications to treat psoriasis can also be used during pregnancy. Creams and ointments containing vitamin A are an exception. These must not be applied during pregnancy.
