Psoriasis

Even if no absolute cure for psoriasis is possible, the skin symptoms can be significantly improved and often also made to disappear for longer periods of time. Basically, there are three forms of therapy for this:

• External treatment e.g. with ointments, creams, emulsions and solutions
• Radiation with UV light, also in combination with various bathing applications
• Internal treatment e.g. with tablets or injections

Bathing and climatic therapies and psycho-social therapies are also used as accompanying measures. The care of the skin with so-called 'basic therapies' is also of great importance.

For the majority of those affected, treatment successes can be achieved with an external and/or with a combined UV light therapy. Internal forms of therapy are only used in severe cases.

Types of treatment

1. Scaling

So that the actual drugs against psoriasis can be used to full effect, the scaly skin first needs to be removed as it prevents the active ingredients from penetrating into the skin. Salicylic acid, a substance that was originally produced from willow bark, is most often used for this. Lactic acid and urea in a very high concentration also offer good alternatives.

2. Drugs against the functional disorders of the skin

• Vitamin D₃ derivatives
  The active ingredients that are derived from vitamin D are now standard in therapy. These prescription preparations normalise the formation of new cells and cell development. Some examples of vitamin D₃ derivatives are Tacalcitol, Calcipotriol und Calcitriol. They are usually very well tolerated and easy to use externally.
• Dithranol
  is another very effective and safe substance. It has been used to treat psoriasis since as early as the beginning of the last century. However, its disadvantages are irritation and discoloration of the skin and clothing that can occur when it is used. Since the middle of the 1990s, the so-called minute therapy has been used, during which the dithranol preparation only remains on the skin for a short time and is then washed off again. This form of treatment is particularly well tolerated.
• Cortisone preparations
  are an important component of psoriasis treatment. They work quickly and in a targeted manner against increased cell formation and the inflammation events. When used properly and checked by the dermatologist, they can bring treatment success very quickly. Cortisone preparations are normally also only available on prescription.
• Tar preparations
  were part of the standard treatment for psoriasis in the past. A few years ago, they were criticised because evidence of carcinogenic properties was discovered (coal tar). Today, tar preparations are manufactured from other sources and cleaned (e.g. shale oil) but these preparations are hardly used any more.

3. Supporting external treatment (basic therapy)

Some types of treatment, e.g. the application of Dithranol or UV light can dry the skin out considerably. Additional skin oil therefore needs to be applied. In the symptom-free period, it is also generally expedient to supply the skin with oils and moisture using special skin care products. It is then less susceptible to stimuli and feels softer and smoother. Unfortunately, care products and other basic therapies are no longer paid by health insurance companies in all cases but can be bought in the pharmacy over the counter (Balneum Hermal^® F Oilbath, Basodexan^®, Optiderm^®, aqeo skin care series.

4. UV light treatment (phototherapy)

It has been known for centuries that sunlight has many positive effects on the skin and on skin diseases. Diseases such as acne, eczema and psoriasis are therefore often less frequent or less pronounced in the summer than in the winter months. Dermatologists can also use the different spectrum of rays from the sun in the treatment prescribed. Frequently, a combination of applications of bathing and radiation therapy are used during stays at a health resort (e.g. at the Dead Sea).

The dermatologist has a selection of special radiation lamps that can be used for light therapy. Light therapy is also often used in combination with other treatment procedures to enhance the effect. The energy-rich UV-B radiation is frequently combined with other drugs (cortisone, vitamin D₃ preparations).

The lower energy UV-A radiation is used in the treatment of psoriasis primarily in combination with active ingredients that make the skin more light-sensitive (Psoralen-UVA = PUVA therapy), or with salt baths that have a similar effect. The PUVA bathing therapy has been used with success for some years.

As the radiation can also represent a burden in the long term (e.g. the risk of skin cancer is increased in some cases), phototherapy is only recommended for medium and severe psoriasis.

5. Internal treatment

The dermatologist will prescribe an internal treatment in severe cases. All drugs that can be currently used are highly effective but also have a range of unwanted effects. The doctor's experience and the patient's compliance with the dosages are the basic requirements for their safe application.

The following are prescribed:

• Vitamin A derivatives (e.g. Acitretin)
• Cytostatics (e.g. Methotrexate)
• Substances that influence the immune system (e.g. Cyclosporine)
• Derivatives of fumaric acid (e.g. fumaric acid esters)
• So-called "biologics" (biotechnologically produced proteins)