Treatment of psoriasis

What treatment options are there?

The psoriasis (Psoriasis) is a complex skin disease that occurs in flares and can be very stressful for those affected.
There are various options available for treating psoriasis, which are individually tailored to the patient. A basic distinction is made between local and systemic therapy for psoriasis. In the following, the individual treatment options for local and systemic therapy for psoriasis are presented.

Read also on this topic Therapy of psoriasis

Local therapy for psoriasis

All patients struggling with psoriasis receive salicylic acid and urea for topical application as basic therapy. These active ingredients are used for Keratolysis, i.e. the detachment 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. Drugs used are glucocorticoids, such as Mometasone furoate, Vitamin D derivatives, such as Calcipotriol, synthetic tar derivatives (Dithranol), Tar preparations (Coal tar) and retinoids. If the psoriasis is severe, 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 downregulate the immune system.
UV-A therapy penetrates deeper layers of the skin and has an anti-inflammatory and growth-inhibiting effect in particular.

PUVA is a kind of intermediate between systemic and local therapy (Psoralen plus UV-A). In this therapy, the active ingredient Psoralen, which makes the skin more sensitive to UV radiation, either applied to the skin or taken as an active ingredient in tablet form. The skin is then irradiated with UV-A rays.

Read more on the topic: Light therapy for psoriasis

Systemic therapy for psoriasis

In the case of severe psoriasis, involvement of the joints or an inadequate response to local therapeutic measures, systemic treatment options are used.

One option is treatment with retinoids, such as IsotrentinoinThese inhibit the growth rate of the upper layers of the skin and can be easily combined with PUVA therapy.

Another active ingredient used is fumaric acid. This inhibits the inflammatory reaction in psoriasis.

In systemic therapy, so-called immunosuppressants, such as Methotrexate or ciclospoprin A, plays an important role. These drugs downregulate the immune system and are an important part of psoriasis treatment.

The so-called biologicals (Infliximab, Adalimumab) is used. These are antibodies that are used when other treatments don't work.

Read more on the topic: Psoriasis in Pregnancy

What drugs are there for psoriasis?

For the treatment of psoriasis there are various active ingredients that are either applied externally or in the form of tablets and injections for systemic therapy. Many drugs are now available that have different advantages and disadvantages.
For a simple overview, it is advisable to first differentiate between local therapeutics and systemic drugs.

• Local therapeutic agents: Corticoids (including mometasone furoate), tar derivatives (dithranol), tar preparations, retinoids and vitamin D analogs are used for local therapy.
• Systemic therapeutics: Retinoids (isotrentinoin), fumaric acid, methotrexate, ciclosporin A, infliximab and adalimumab are preferably used for systemic therapy of psoriasis.
• in rare cases, Enbrel® can also be used

Which drugs are ultimately best suited for the course of psoriasis must ultimately be decided on an individual basis.

MTX

Methotrexate is one of the oldest drugs used to treat psoriasis internally. It is an immunosuppressive agent that downregulates the activity of the immune system. The active ingredient is either injected into the vein or the skin or taken as a tablet once a week. The usual dose is between 15 and 25 mg. However, the exact dose is determined individually. The onset of action can be expected after about 2 to 4 weeks, although it does occur in around 60% of patients.

Methotrexate enables these patients to be as free of symptoms as possible. Methotrexate is a very effective drug, but unfortunately also has a lot of side effects. It must not be used for many pre-existing conditions as it can worsen these conditions. Methotrexate should not be taken in particular in patients with impaired liver function. Pronounced disorders of the kidney function, the blood-forming system and alcoholism can also be contraindications for therapy with methotrexate. Blood, liver and kidney values ​​must be checked regularly during therapy with methotrexate.

Read more about this under Side effects of methotrexate

Fumaderm

Fumaderm is a commonly used drug for psoriasis. These are tablets that contain various fumarates. The drug has an anti-inflammatory effect and is taken according to a fixed schedule over several weeks. The first treatment success can be expected after about 6 weeks. Therefore some patience is required with this therapy.

Fumarates are used for internal therapy when local measures are insufficient or severe psoriasis is present. In about 50 to 70% of patients, fumarates lead to the greatest possible freedom from symptoms. The drug can cause gastrointestinal and kidney problems. During therapy with Fumaderm, blood, liver and kidney values ​​must therefore be checked regularly. Diseases of the gastrointestinal tract and kidneys can be an exclusion criterion for treatment with Fumaderm.

Creams to treat psoriasis

Treatment for psoriasis involves the use of various skin creams. Every patient with psoriasis should receive basic care with creams that contain salicylic acid and urea. These creams help loosen the flakes of skin. To do this, dry skin should be cared for with moisturizing creams. Examples of such moisturizing creams are Dermalex or Physioderm®. In addition, various creams and ointments with various local active ingredients can be prescribed by the dermatologist. Such creams contain the usual topical therapeutic agents.

Cortisone

Cortisone-like drugs, so-called Corticoids, are used in the local therapy of psoriasis.Not only is the anti-inflammatory effect of these drugs used, but also the inhibiting effect on the growth of the upper layers of the skin.
As a cream, for example, the active ingredients Mometasone furoate and Betamethasone benzoate applied locally to the affected skin areas. As a rule, the active ingredients are applied up to 3 times a day. The first therapeutic success can already be seen after 1 to 2 weeks. A satisfactory result is achieved in up to 50% of patients. However, the therapy should be limited to a few weeks, otherwise skin changes such as a atrophy skin (thinning). Cortisone-like drugs are usually used in combination with other active ingredients.

Vitamin D

So-called vitamin D analogs are an important component of the local therapy for psoriasis. The active ingredients Calcipotriol and Tacalcitol are derived from vitamin D and are applied to psoriasis in the form of ointments, creams and emulsions. The preparations are applied 1 to 2 times a day. A healing success can be expected after 2 to 3 weeks at the earliest. Unlike cortisone-like active ingredients, the very well-tolerated drugs are also suitable for long-term therapy over 12 to 18 months. They can be used well in combination with corticoids or UV therapy. When used over a large area, they can affect the calcium balance, especially in children. Therefore, they should not be used over a large area.

Vitamin B12

Some time ago, vitamin B12 ointments and creams came on the market that were recommended by the respective manufacturers for the treatment of psoriasis. However, from the conventional medical point of view, these preparations cannot be recommended. The effectiveness is strongly questioned. Theoretically, vitamin B-12 ointments should "intercept" inflammatory processes in the skin and thus alleviate the inflammatory reaction. However, there is no reliable evidence of this effectiveness, so that the use of vitamin B-12 ointments is not recommended in the current guideline for the treatment of psoriasis.

light therapy

Light therapy is a common and very effective treatment option for psoriasis. In this form of therapy, two main effects of UV light are used. On the one hand, the cell growth of the upper skin layers is inhibited and, on the other hand, the immune system is downregulated. This can improve the symptoms of psoriasis.

Common light therapy uses UV-B light with a wavelength of 311 nanometers. Radiation is carried out approximately 3 to 5 times a week. The first successes of the treatment can be seen after about 2 to 3 weeks. After about six weeks of therapy, the irradiation leads to freedom from symptoms in 75% of patients.

The therapy causes side effects such as reddening of the skin, itching and irritation in some patients, but these are temporary in nature. Additional sunlight should be avoided during therapy.

PUVA is a modification of light therapy. This therapy involves irradiating the skin with UV-A light and using the active ingredient psoralen as an additional treatment. This is either applied to the skin or taken as a tablet and increases the skin's sensitivity to UV light. Here even 90% of the patients are free of symptoms.

Laser treatment

For the treatment of psoriasis, there are now various laser therapies available that allow precise irradiation of the affected areas of the skin. Special UV-B lasers are used, which, similar to conventional light therapy, inhibit the growth of the upper layers of the skin and regulate the immune system. The laser can be aimed specifically at the plaques, thus protecting healthy skin. Furthermore, fewer treatments are necessary than with conventional light therapy. The treatment is suitable for patients with localized psoriasis foci, it is not suitable for large-area application.

Biologicals

The treatment of psoriasis also includes the use of so-called biologicals. This relatively new class of substances consists of antibodies that are used in therapy refractivity. This means that biologicals are used when other drugs are not working and the treatment is not successful. Specifically, these are the active ingredients infliximab and adalimumab. These drugs belong to the TNF-alpha inhibitors and have an anti-inflammatory and regulating effect on the immune system. These are powerful drugs that are used to treat various chronic inflammatory diseases and, unfortunately, can also have many side effects. Their use must therefore be carefully considered.

Further information can be found here: Infliximab

What can I achieve through diet?

Opinions on diet for psoriasis vary widely. There are many nutrition tips, diet plans and recommendations for those affected, but their usefulness can be questioned. People with psoriasis have a certain genetic predisposition to the disease. Different triggering factors lead to a disease outbreak and disease phases. From the medical point of view, nutrition plays a rather subordinate role, so that patients with psoriasis should not set up a special nutrition plan.

Ultimately, those affected should take care to reduce excess weight and avoid alcohol. Both can put stress on the liver and make the disease worse. Alcohol, in particular, like many psoriasis medications, puts additional strain on the liver and should therefore ideally not be consumed at all. Obesity and a very fatty diet promote inflammatory processes in the body and can therefore also lead to a deterioration in the complexion of the skin. However, this does not mean that radical zero diets make sense. Rather, you should pay attention to a balanced and healthy diet, fresh vegetables and fruits. Unfortunately, drug therapy cannot be avoided even with a healthy diet.

Read more about this under

• Wholesome nutrition
• Cortisone and alcohol - are they compatible?

Home remedies for psoriasis

There are many different home remedies available for the supportive treatment of psoriasis. Whether a home remedy is effective varies greatly from person to person. Usually the simple principle applies: trying is better than studying. What works well for one does not help the other at all. Here are some home remedies that you can use to treat psoriasis:

• 1. Compresses with black tea: For these simple compresses only a little black tea has to be boiled. As soon as the tea has cooled down to a comfortable temperature, a clean cotton cloth can be soaked with it. The cloth is now well wrung out and placed on the affected area .;
• 2. Quark wrap: some quark is placed on a clean cotton cloth. Now the cloth is folded up and pressed onto the affected skin area. The cooling compress provides quick relief from the symptoms .;
• 3. Salt bath: A salt bath can help to soften the flaky skin and make subsequent care easier. To do this, add 2 to 3 handfuls of sea salt to a bath and bathe in the water for about 10 to 15 minutes. Then the skin is cared for as usual.

honey

Recommendations from various non-scientific sources for the use of manuka honey for psoriasis are increasingly circulating. However, an effect cannot be scientifically proven. In fact, Manuka honey can actually make psoriasis more painful and shouldn't be applied to psoriasis. The increased sensation of pain is based on the active ingredient in honey, methyl glyoxal.

No recommendation can be made for normal honey either. The symptoms of psoriasis can neither be improved by eating the honey nor by applying it to the skin.

Tea tree oil

Tea tree oil is mentioned in some forums as a home remedy for psoriasis. In most cases, an external application in bath water or directly on the affected skin areas is recommended. Although some people believe that tea tree oil relieves their discomfort, the oil should be consumed with caution. It can lead to contact allergies and eczema. We therefore advise against using it at this point.

Read more about this on our main page Tea tree oil

Homeopathy for psoriasis

Psoriasis sufferers often have a high level of suffering and often change medication in the course of their lives. This is common for chronic diseases. Therefore, many patients turn to homeopathic active ingredients in the course of their illness. Above all, many of those affected hope to be able to get by with less conventional medicine. The use of homeopathic remedies often does not improve the complexion of the skin, but it does improve the psychological constitution of the patient and their attitude towards the disease. Frequently used homeopathic remedies are Natrum muriaticum, Sulfur, Sepia Suuccus, Lycopodium, Phosphorus Silicea Terra, Pulsatilla Pratensis and Calcium carbonicum.