What are the treatment options?
Psoriasis is a complex skin disease that occurs in relapses and can be very stressful for those affected. There are various options available for the treatment of psoriasis, which are individually adapted to the patient. A basic distinction is made between local and systemic therapy of psoriasis.
In the following, the individual treatment options of local and systemic therapy of psoriasis will be presented. All patients suffering from psoriasis receive salicylic acid and urea as basic therapy for local application. These active ingredients serve the purpose of keratolysis, i.e. the removal of the excess cornea.
Apart from this basic therapy, there are other locally effective drugs. They either have an anti-inflammatory or growth-inhibiting effect on the skin cells. The drugs used are glucocorticoids like mometasone furoate, vitamin D derivatives like calcipotriol, synthetic tar derivatives (dithranol), tar preparations (coal tar) and retinoids.
In severe cases of psoriasis, these local agents are combined with systemic therapeutic approaches or phototherapy. UV-B therapy is one of the possible phototherapies for psoriasis. The skin is irradiated with the short-wave portion of UV light.
This therapy is said to have a growth-inhibiting effect on the skin cells of the upper skin layer and to downregulate the immune system. UV-A therapy penetrates into deeper skin layers and has a particularly anti-inflammatory and growth-inhibiting effect. PUVA (psoralen plus UV-A) is a kind of intermediate between systemic and local therapy.
In this therapy, the active ingredient psoralen, which makes the skin more sensitive to UV radiation, is either applied to the skin or taken as an active ingredient in tablet form. The skin is then irradiated with UV-A rays. In cases of severe psoriasis, an infestation of the joints or an insufficient response to local therapy measures, systemic therapy options are used.
One possibility is the treatment with retinoids such as isotrentinoin. These inhibit the growth rate of the upper skin layers and can be combined well with PUVA therapy. Another active agent used is fumaric acid.
This inhibits the inflammatory reaction in psoriasis. In systemic therapy, so-called immunosuppressive agents such as methotrexate or ciclospoprine A also play an important role. These drugs regulate the immune system and are an important component of psoriasis treatment. The so-called biologicals (Infliximab, Adalimumab) are used as relatively new drugs. These are antibodies that are used when other treatments do not work.
What medications are available for psoriasis?
For the treatment of psoriasis, there are various active ingredients that are either applied externally or used in the form of tablets and injections for systemic therapy. In the meantime, many drugs are available, which have different advantages and disadvantages. For a simple overview, it is advisable to first distinguish between local therapeutic agents and systemic drugs.
Which medication is ultimately best suited for the course of psoriasis must ultimately be decided individually. – Local therapeutics: For local therapy corticoids (including mometasone furoate), tar derivatives (dithranol), tar preparations, retinoids and vitamin D analogues are used. – Systemic therapeutics: For the systemic therapy of psoriasis, retinoids (isotrentinoin), fumaric acid, methotrexate, ciclosporin A, infliximab and adalimumab are preferably used.
- In rare cases Enbrel® can also be used
Methotrexate is one of the oldest drugs used for internal treatment of psoriasis. It is an immunosuppressive agent that downregulates the activity of the immune system. The active ingredient is injected once a week either into the vein or skin or taken as a tablet.
The usual dose is between 15 and 25 mg. However, the exact dose is determined individually. After about 2 to 4 weeks, the effect can be expected to start to take effect, but it does occur in about 60% of patients.
Methotrexate can be used to achieve the greatest possible freedom from symptoms in these patients. Methotrexate is a very effective drug, but unfortunately also a drug with many side effects. It must not be used for many pre-existing conditions, as it can lead to a worsening of these conditions.
In particular, patients with liver dysfunction must not take Methotrexate. Pronounced disorders of kidney function, the haematopoietic system and alcoholism can also be contraindications for therapy with Methotrexate. During therapy with methotrexate, regular checks of the blood, liver and kidney values must be carried out.
Fumaderm is a frequently used drug in psoriasis. These are tablets containing various fumarates. The drug has an anti-inflammatory effect and is taken according to a fixed schedule over several weeks.
A first treatment success can be expected after about 6 weeks. Therefore, some patience is required for this therapy. Fumarates are used for internal therapy when local measures are not sufficient or when severe psoriasis is present.
In about 50 to 70% of the patients, fumarates lead to the greatest possible freedom from symptoms. The drug can cause complaints of the gastrointestinal tract and the kidney. During therapy with Fumaderm, blood, liver and kidney values must therefore be checked regularly. Diseases of the gastrointestinal tract and the kidney can be a criterion for exclusion from treatment with Fumaderm.
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