What is guttate psoriasis? How does it differ from other forms of psoriasis? What are the risk factors and causes of this condition? Discover the answers to these questions and more in this comprehensive guide.

Understanding the Pathophysiology of Guttate Psoriasis

Guttate psoriasis is a distinct variant of the chronic inflammatory disorder, psoriasis. The condition is characterized by the development of several small, drop-like lesions, in contrast to the well-defined, scaly, erythematous plaques typically associated with plaque psoriasis. The pathogenesis of guttate psoriasis is complex, involving an interplay between genetic and environmental factors.

The primary driver of the condition is the dysregulation of the immune system, specifically the overactivation of T cells, both CD4+ and CD8+ cells, in the skin. This leads to the upregulation of various pro-inflammatory cytokines, such as interferon-gamma (IFN-γ), interleukin-2 (IL-2), IL-6, and tumor necrosis factor-alpha (TNF-α), while anti-inflammatory cytokines like IL-10 are downregulated.

The IL-23/Th17 axis plays a crucial role in the development of psoriatic lesions. Dendritic cells release IL-23, which stimulates the differentiation of Th17 cells, leading to the production of IL-17 and IL-22. These cytokines, in turn, drive the proliferation of keratinocytes and the inflammatory response in the skin.

Genetic factors also contribute significantly to the pathogenesis of guttate psoriasis. The PSORS1 gene, located on chromosome 6p, is the most important gene implicated in the development of the condition. The HLA-Cw6 allele within this gene is strongly associated with both early-onset plaque psoriasis and guttate psoriasis. Other HLA alleles, such as HLA-B13 and HLA-B17, have also been linked to guttate and erythrodermic forms of psoriasis.

Epidemiology and Risk Factors of Guttate Psoriasis

Guttate psoriasis accounts for less than 30% of all cases of psoriasis. It occurs equally in both genders and is more common in children and adolescents than in adults over the age of 30. The prevalence of psoriasis, in general, is estimated to be around 2% globally, with higher rates of up to 4% in the United States and Canada.

The primary risk factor for the development of guttate psoriasis is a recent streptococcal infection, either in the oropharynx or perianal region. These infections typically occur 1 to 3 weeks before the onset of the characteristic guttate lesions. Additionally, the use of TNF-alpha inhibitor therapy has been associated with the development of guttate psoriasis in some cases.

Clinical Presentation of Guttate Psoriasis

Guttate psoriasis is characterized by the sudden onset of numerous, small, drop-like (Latin “guttate” meaning “drop-like”) lesions on the skin. These lesions are typically erythematous (reddish) and scaly, and they can appear on various parts of the body, including the trunk, limbs, and scalp.

The lesions of guttate psoriasis are generally smaller and more numerous than the plaques seen in plaque psoriasis. They often have a distinct distribution, with the lesions being more widespread across the body, rather than being concentrated in specific areas.

Guttate psoriasis can be distinguished from plaque psoriasis by its acute onset, the smaller size of the lesions, and the characteristic “drop-like” appearance. Patients may also report a preceding streptococcal infection, which is a key diagnostic feature of guttate psoriasis.

Histopathological Features of Guttate Psoriasis

The histopathological features of guttate psoriasis are similar to those observed in other forms of psoriasis. The characteristic findings include:

• Epidermal hyperplasia with elongation of the rete ridges
• Dilated superficial blood vessels in the dermis
• Hypergranulosis (increased granular layer in the epidermis)
• Parakeratosis (retention of nuclei in the stratum corneum)
• Remnants of neutrophils in the stratum corneum, known as microabscesses of Munro
• Discrete collections of neutrophils in the upper stratum spinosum, called spongiform pustules of Kogoj

These histological features are indicative of the characteristic psoriasiform reaction pattern seen in various forms of psoriasis.

Diagnosing Guttate Psoriasis

The diagnosis of guttate psoriasis is primarily based on the clinical presentation and a thorough patient history. Eliciting a history of a recent streptococcal infection, typically pharyngitis or perianal streptococcus, can be a valuable clue in the diagnosis.

Additionally, the clinician should inquire about the patient’s recent use of TNF-alpha inhibitor therapy, as it has been associated with the development of guttate psoriasis in some cases.

In some instances, a skin biopsy may be performed to confirm the diagnosis and rule out other conditions that may present with a similar appearance, such as pityriasis rosea or secondary syphilis.

Treatment and Management of Guttate Psoriasis

The management of guttate psoriasis typically involves a combination of topical and phototherapeutic approaches. Topical treatments, such as corticosteroids, vitamin D analogues, and salicylic acid, are often the first-line therapy for mild to moderate cases.

For more extensive or treatment-resistant cases, phototherapy, such as narrow-band UVB or psoralen plus UVA (PUVA) therapy, can be an effective option. In some cases, systemic therapies, including oral retinoids, methotrexate, or biologic agents targeting the IL-23/Th17 axis, may be considered.

It is essential to address any underlying streptococcal infection, as appropriate antibiotic treatment can help resolve the acute flare of guttate psoriasis. Additionally, maintaining good skin care and avoiding triggers, such as stress and certain medications, can help manage the condition and prevent future flare-ups.

The Role of the Interprofessional Team

Effective management of guttate psoriasis requires an interprofessional approach, involving various healthcare professionals working collaboratively to provide comprehensive care. This team may include dermatologists, primary care physicians, pharmacists, and nurses, who can work together to:

• Accurately diagnose guttate psoriasis and rule out other conditions
• Develop a personalized treatment plan based on the patient’s specific needs
• Ensure appropriate medication management and monitor for side effects
• Provide patient education and support to improve adherence and self-care
• Coordinate care and communicate effectively to optimize patient outcomes

By adopting an interprofessional approach, the healthcare team can effectively manage guttate psoriasis and improve the overall quality of life for patients living with this condition.

Guttate Psoriasis – StatPearls – NCBI Bookshelf

Dahlia Saleh; Laura S. Tanner.

Author Information and Affiliations

Last Update: August 1, 2022.

Continuing Education Activity

Psoriasis is a chronic, inflammatory disorder that presents as well-defined, scaly, erythematous plaques, and occasionally, sterile pustules. Guttate psoriasis is a distinct variant of psoriasis that is classically triggered by streptococcal infection (pharyngitis or perianal) and is more common in children and adolescents than adults. Patients present with several, small drop-like lesions that respond well to topical and phototherapies. This activity describes the pathophysiology and presentation of guttate psoriasis and highlights the role of the interprofessional team in its management.

Objectives:

• Describe the pathophysiology of guttate psoriasis.

• Recall the presentation of guttate psoriasis.

• List the treatment and management options available for guttate psoriasis.

• Discuss interprofessional team strategies for improving care coordination and outcomes in patients with guttate psoriasis.

Access free multiple choice questions on this topic.

Introduction

Psoriasis is a chronic, inflammatory disorder that presents as well-defined, scaly, erythematous plaques, and occasionally, sterile pustules. Several clinical variants of psoriasis exist including plaque psoriasis, guttate psoriasis, and pustular variants. Psoriasis frequently involves the joints, leading to psoriatic arthritis. Nail involvement is found in 10-80% of patients with psoriasis. [1]Psoriasis displays a spectrum of clinical manifestations, and several variants may be present at one time in the same patient.

Guttate psoriasis is a distinct variant of psoriasis that is classically triggered by streptococcal infection (pharyngitis or perianal) and is more common in children and adolescents than adults. Patients present with several, small “drop-like” lesions that respond well to topical and phototherapies.  [2]

Etiology

Risk factors for developing guttate psoriasis include recent streptococcal infection (oropharynx or perianal) or upper respiratory infection. Infections typically occur 1 to 3 weeks before the onset of guttate lesions. Guttate psoriasis lesions have also been described following TNF-alpha therapy.[3]

Epidemiology

Approximately 2% of the world population is afflicted with psoriasis; in the United States and Canada, the prevalence is as high as 4%. In general, psoriasis has a bimodal peak of onset. Onset can peak at 20 to 30 years of age and 50 to 60 years of age. Guttate psoriasis accounts for less than 30% of all total cases of psoriasis. It occurs equally in both genders and is more common in children and adolescents than adults over the age of 30. [1]

Pathophysiology

The interplay between genetic and environmental factors are implicated in the pathogenesis of psoriasis. Psoriasis is primarily a disorder of T cells, namely CD*+ T cells in the epidermis and a mixture of CD4+ and CD8+ cells in the dermis. ;[4]Th2 cytokines (interferon-gamma [IFN-] and interleukin [IL-]2), IL-1, I-6, and tumor necrosis factor-alpha (TNF-alpha) are upregulated, and Th3 cytokines (IL-10) are downregulated. Much of the success of biologic therapy is owed to the role of IL-23 in the pathogenesis of psoriasis. Dendritic cells release IL-23, which promotes Th27 stimulation, causing IL-17 and IL-22 release leading to dermal inflammation and keratinocyte replication. An understanding of this complex interplay between interleukins has allowed targeted biologic therapy for psoriasis.

The most important gene implicated in the pathogenesis of psoriasis is the PSORS1 gene on chromosome 6p, containing the HLA-Cw6 allele.  The HLA-Cw6 allele is strongly linked to both early onset plaque psoriasis and guttate psoriasis. HLA B-13 and HLA B-17 are also strongly associated with guttate psoriasis (and erythrodermic) psoriasis.

Histopathology

Psoriasis is the model of the psoriasiform reaction pattern, defined as epidermal hyperplasia with elongation of the rete ridges. In addition to hyperplasia of the epidermis, there is an elongation of the dermal papillae, dilated superficial blood vessels, hypergranulosis, and parakeratosis.

Remnants of neutrophils in the stratum corneum are referred to as microabscesses of Munro. A discrete collection of neutrophils  (spongiform pustule of Kogoj) can also be found in the upper stratum spinosum.

History and Physical

Eliciting a thorough history can be valuable in the diagnosis of guttate psoriasis. Assessing the presence of risk factors can aid in diagnosing guttate psoriasis. Guttate psoriasis classically follows a preceding streptococcal infection, typically pharyngitis or perianal streptococcus.  The patient should be questioned regarding recent use of TNF- alpha inhibitors, as they have been implicated in guttate psoriasis.

On physical exam, guttate psoriasis manifests as numerous, small scattered papules and plaques. These are often referred to as “drop-like” and typically manifest as 2 to 6 mm papules. These lesions exhibit an isomorphic response or the Koebner phenomenon. The Koebner phenomenon refers to the appearance of lesions in areas of trauma (e.g., excoriations, sunburn, lesions of other eruptions such as Varicella or pityrosporum folliculitis), as wound healing triggers hyperproliferative changes in the skin. Although psoriasis is the prototype of koebnerization, this response can also be seen in pityriasis rubra pilaris, lichen planus, verruca plana (flat warts), lichen nitidus, vitiligo, lichen sclerosus, elastosis perforans serpiginosa, systemic lupus erythematosus, and other dermatological conditions.

In addition to Koebner phenomenon, all variants of psoriasis share certain characteristics that are reflected on histology, for example, erythema (elongated and dilated capillaries on histology), thickness (acanthosis with cellular infiltrates on histology), and silver scale (reflects abnormal keratinization). All lesions of psoriasis exhibit Auspitz sign, or pinpoint bleeding when the surface of a psoriatic lesion is removed. This reflects elongated vessels in the dermal papillae, together with thinning of the epidermis.

Evaluation

A diagnosis of guttate psoriasis can usually be made on history and clinical grounds alone. Skin biopsy is typically not necessary; however, lesions should demonstrate the histopathological findings discussed above. An elevated antistreptolysin O, anti-DNase B or streptozyme titer can indicate a recent streptococcal infection, further guiding the diagnosis towards guttate psoriasis.

Treatment / Management

For mild psoriasis, topical corticosteroids are first-line treatment. [5] Topical steroids are available in several forms including ointments, creams, lotions, gels, foams, sprays, and shampoos. Ointment formulations are the most efficacious mainly secondary to their lipophilic properties. Corticosteroids are contraindicated in cases of bacterial, viral, and mycotic infections, atrophy of the skin, pregnancy, and lactation. Second-line therapy for mild psoriasis is anthralin (dithranol) as monotherapy or in combination with topical corticosteroids. Other topical steroids include vitamin D analogs (calcipotriene), topical retinoids (tazarotene), topical calcineurin inhibitors, and salicylic acid.[5]

For moderate to severe psoriasis, phototherapy is first-line treatment as monotherapy or in combination. This includes phototherapy with broadband or narrowband ultraviolet B (UVB) and photochemotherapy with ultraviolet A (UVA) following psoralen ingestion or application (PUVA). Broadband UVB is the best phototherapy option for guttate psoriasis, in contrast to plaque psoriasis, which is better treated by narrowband UVB. Excimer laser (308 nm) can be used for localized psoriatic plaques.

Currently, there are several biologic treatment options indicated for plaque psoriasis. However, they have not been well-studied for guttate psoriasis. At this time, targeted biologic therapy is best reserved for the 40% of guttate lesions that progress to plaque type.

Differential Diagnosis

The differential diagnoses of guttate psoriasis include tinea corporis, secondary syphilis, nummular eczema, and pityriasis rosea. Guttate psoriasis can be distinguished from these entities by history and physical exam, although further studies such as potassium hydroxide (KOH) scrapings and serologies may be helpful in ruling out the other disorders in the differential diagnoses.

Prognosis

Forty percent of patients with guttate psoriasis convert to plaque psoriasis.

Enhancing Healthcare Team Outcomes

Psoriasis is a chronic inflammatory disorder that is challenging to evaluate and treat. It is more common in children and adolescents than adults. An interprofessional team of clinicians, nurses, and pharmacists managing patients with this disease will lead to the best outcomes. [Level 5]

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• Comment on this article.

Figure

Guttate Psoriasis. Contributed by DermNetNZ

References

1.

Chimenti MS, Caso F, Alivernini S, De Martino E, Costa L, Tolusso B, Triggianese P, Conigliaro P, Gremese E, Scarpa R, Perricone R. Amplifying the concept of psoriatic arthritis: The role of autoimmunity in systemic psoriatic disease. Autoimmun Rev. 2019 Jun;18(6):565-575. [PubMed: 30959209]

2.

Dupire G, Droitcourt C, Hughes C, Le Cleach L. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2019 Mar 05;3(3):CD011571. [PMC free article: PMC6400423] [PubMed: 30835819]

3.

Brandon A, Mufti A, Gary Sibbald R. Diagnosis and Management of Cutaneous Psoriasis: A Review. Adv Skin Wound Care. 2019 Feb;32(2):58-69. [PubMed: 30653184]

4.

Gürel G, Sabah-Özcan S. Evaluation of Toll-like receptor expression profile in patients with psoriasis vulgaris. Gene. 2019 Jun 20;702:166-170. [PubMed: 30935923]

5.

Sarzi-Puttini P, Ceribelli A, Marotto D, Batticciotto A, Atzeni F. Systemic rheumatic diseases: From biological agents to small molecules. Autoimmun Rev. 2019 Jun;18(6):583-592. [PubMed: 30959214]

Disclosure: Dahlia Saleh declares no relevant financial relationships with ineligible companies.

Disclosure: Laura Tanner declares no relevant financial relationships with ineligible companies.

Rash, Causes, Stages, Symptoms, Treatment

Written by WebMD Editorial Contributors

• What Is Guttate Psoriasis?
• Symptoms of Guttate Psoriasis
• Stages of Guttate Psoriasis
• Causes and Triggers of Guttate Psoriasis
• Diagnosis of Guttate Psoriasis
• Treatment for Guttate Psoriasis
• More

Guttate psoriasis is a type of psoriasis that shows up on your skin as red, scaly, small, teardrop-shaped spots. It doesn’t normally leave a scar. You usually get it as a child or young adult. Less than a third of people with psoriasis have this type. It’s not as common as plaque psoriasis.

It’s an autoimmune disease, meaning your body treats your own cells like invaders and attacks them. You might get it only once, or you could have several flare-ups. In some cases, this type of psoriasis doesn’t go away. With the help of your doctor, you can find a treatment to keep your symptoms under control.

The spots you get from guttate psoriasis aren’t as thick as the ones from plaque psoriasis. You can sometimes have both kinds of psoriasis at once. You probably would get them on your arms, legs, and upper body.

It can sometimes spread from there to your face, ears, and scalp. But it doesn’t show up on your palms, the soles of your feet, or nails like other forms of psoriasis can. You’re more likely to have a flare-up during the winter, when the air is dry. Your symptoms may clear up more quickly in summer.

There are three:

• Mild. Only a few spots cover about 3% of your skin.
• Moderate. Lesions cover about 3%-10% of your skin.
• Severe. Lesions cover 10% or more of your body and could cover your entire body.

The stage can also be based on how much they interfere with your daily life and activities. For example, psoriasis on your face or scalp can affect only 2%-3% of your total body surface area, but it could be classified as severe because it affects your appearance and livelihood. Psoriasis on your hands might only cover 2% total body surface area, but could affect your livelihood if you work with your hands. In that case it would be classified as moderate to severe.

An outbreak is usually triggered by a bacterial infection — typically streptococcus (strep throat). It sets off an immune system reaction that causes the spots on your skin.

In some cases, guttate psoriasis is genetic. If someone in your family has it, your chances of getting it go up.

Other triggers include:

• Upper respiratory infections
• Sinus infections
• Flu
• Tonsillitis
• Stress
• Cuts, burns, or bites on your skin
• Some drugs you take (antimalarials and beta-blockers)

Your doctor will want to know your medical history, especially what kinds of medications you may be taking. They’ll look at your skin. Usually, a physical exam gives your doctor enough information to diagnose or rule out guttate psoriasis.

If they need more information, your doctor may take a blood sample or a throat culture to check for strep. It’s also common for doctors to perform a skin biopsy when they want to know for sure what you have.

In most cases, an outbreak of guttate psoriasis lasts 2 to 3 weeks. But your doctor may want to treat your symptoms and help prevent other infections in your body.

• Medications. There are several over-the-counter or prescription options for the itchy, flaky skin, as well as the dryness and swelling. They include:
  • Cortisone cream for itching and swelling
  • Dandruff shampoo for your scalp
  • Lotions with coal tar to soothe your skin
  • Moisturizers
  • Prescription medicines with vitamin A
  • If your case is more serious, your doctor may give you a prescription to take by mouth. These include:
    • Corticosteroids
    • Biologics (guselkumab, ixekizumab)
    • Apremilast (Otezla)
    • Deucravacitib (Sotyktu)
    • Methotrexate
• Phototherapy. Also known as light therapy, this is another option. Your doctor will shine ultraviolet light onto your skin during this treatment. They may also give you medication to make your skin react more quickly to light. Sometimes, just going out into the sunshine can help.

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symptoms, diagnosis and treatments

Contents

• Signs of disease
• Why does disease occur?
• Manifestations of psoriasis in children
• How does guttate psoriasis develop?

Hello everyone! Today I will tell you about how guttate psoriasis looks and is treated. The disease is chronic, and only you can, thanks to the right treatment, keep it in remission. And here’s how to do it, read from our article.

Signs of illness

Most often, the first symptoms occur in adolescents, and this happens unexpectedly. Small plaques from 3 to 10 mm appear on the body, similar to droplets, which increase in size over time and also spread throughout the body.

The color of the rash varies from light pink to purple. Most often, the disease affects the trunk, limbs, less often the head, ears, but the feet, palms, nails usually remain clean. In this case, the person begins to itch, because the plaques itch a lot.

Many immediately start to shy away from the patient, thinking that he is contagious. However, I want to tell you that psoriasis is not transmitted to other people in any way, so you don’t need to worry about the health of those around you.

Look at the photo: this is what guttate psoriasis looks like:

Why does the disease occur?

I want to tell you that doctors still cannot find the true cause of this disease. The only thing that is known for sure is that the disease can be inherited, or it can manifest itself and progress with exacerbated bacterial / viral infections.

This was identified as a result of multiple cultures of swabs taken from patients with guttate psoriasis. The result always showed that there was also an infection in the body.

But there are several reasons that can cause illness:

• When a person’s metabolism is disturbed;
• There are neurological disorders;
• Genetics;
• Frequent hormonal disruptions, transition period in adolescents;
• Presence of viral antigens;
• Problems in the functioning of the immune system;
• Diseases of an infectious nature.

Manifestations of psoriasis in children

Babies are also susceptible to this disease. Usually there are small foci under the diaper. Parents often confuse the first symptoms with diaper dermatitis, as a result of which they are treated independently and incorrectly. You need to urgently show the child to the doctor in order to accurately diagnose.

Read about the causes of psoriasis in children and preventive measures in this article.

How guttate psoriasis develops

The disease begins a couple of weeks after an infectious disease. If a person gets sick often, the disease will become chronic and will constantly recur.

The disease has three stages of development :

1. Mild – when about 3% of the entire epidermis is affected. Usually these are only single rashes.
2. Moderate/moderate when the papules begin to coalesce. In this case, about 10% of the entire body is already affected.
3. Severe form, when more than 10% of the body surface has undergone rashes. Small plaques merge into one large one, and the disease itself can even lead to complications. It is the most difficult to treat, which is selected only on an individual basis.

If you injure a plaque, it can develop into an ulcer or erosion, and this, in turn, is fraught with bacterial infections. Moreover, plaques leave ugly scars on the body that can remain for life.

If you scrape off the plaque, this is what happens:

• The stearin stain phenomenon is the formation of a whitish scale.
• Terminal pellicle phenomenon – a moist, shiny area of ​​skin is exposed.
• Blood dew phenomenon – with further erasing, droplets of blood appear.

The disease may worsen during the period of infectious diseases such as otitis media, tonsillitis, pharyngitis and others.

Disease diagnosis

To make an accurate diagnosis, the dermatologist will ask you to take a skin biopsy, which will show that the skin cells are immature during the thickening of their layer, and will also find T-lymphocytes among them.

You will also need a bacteriological analysis, namely a throat swab and a blood test that determines the presence of an inflammatory process.

Treatment of the disease

If you notice rashes of this nature in yourself, then you need to urgently go for an examination to the doctor, who, after making a diagnosis, will prescribe you treatment measures.

An integrated approach is needed here, which consists in:

1. The use of external preparations.
2. Diet.
3. Plasmapheresis.
4. Phototherapy.
5. The use of immunomodulators.

The diet involves the complete exclusion from the diet of fatty, spicy, sweet, salty foods. It is necessary to give preference to vegetables, fruits, low-fat meats, fish, sour milk. You also need to completely abandon bad habits (drinking alcohol, smoking).

If you have been diagnosed with such an ailment for the first time and it will be associated with a staphylococcal infection, then you will definitely be prescribed a staphylococcal vaccine, as well as vitamins of groups A, B, E, D, C, P.

Corticosteroid preparations are prescribed externally, such as:

• Diprosalic;
• Advantan;
• Triderm;
• Elokom.

Drugs to suppress proliferation (growth) of skin cells with calcitriol can also be prescribed – Daivonex, Psorkutan, and drugs rich in vitamin D3 derivatives.

Read about what non-hormonal ointments are used to treat psoriasis in this article.

If the disease progresses, then be ready for plasmapheresis – a blood purification procedure. Also, an effective method of dealing with guttate psoriasis is physiotherapy, when the plaques are irradiated with ultraviolet long rays. In order for the patient to improve the photosensitivity of the epidermis, PUVA therapy is prescribed.

Remember! If the rash has disappeared, this does not mean that psoriasis is gone forever! He can come back again. Often this happens due to a decrease in immunity, as well as in the off-season – in autumn / spring.

Traditional methods of treatment

I do not recommend using folk remedies without consulting a doctor, as the course of the disease can turn in an unexpected direction. All of the methods listed below are auxiliary treatment, but by no means the main one.

Kalanchoe and honey ointment

You will need 10 grams of each component, 30 ml of eucalyptus oil. Mix all this and apply on rashes.

Remember! Honey is the strongest allergen, so you can only make yourself worse!

Rubbing with celandine juice

Take 300 grams of a fresh plant, squeeze the juice (this should be done with gloves), mix with red wine (2 large spoons). Then moisten a cotton pad in the solution and treat problem areas.

After 20 minutes, the body must be treated again, but with just wine. The procedure ends with a warm shower.

Watch a video about the treatment of psoriasis with celandine juice:

Ointment based on string

Take 0. 5 kg of chopped grass and the same amount of alcohol. Insist for 3 days in a dark, cool place. After that, filter, add a jar of lanolin there, as well as a tube of petroleum jelly, mix thoroughly and apply twice a day. Store the composition in the refrigerator on the door.

To relieve the condition, you can take baths, adding decoctions of herbs of lavender, chamomile, string, with sea salt.

Herbal drinks with soothing herbs (melissa, chamomile flowers, linden) will also be useful.

What is the prognosis of the disease?

According to patients and doctors, guttate psoriasis does not disappear completely. It often manifests itself again with a decrease in immunity, as well as against the background of viral and infectious diseases.

Some say that their disease has progressed to chronic plaque psoriasis and only a small part of those who have been ill claim that the skin has completely cleared up after the disease.

But it is not known exactly when their psoriasis will reappear. Alas, so far no one has been able to completely defeat him. It is in your power to keep the disease in remission for as long as possible. Good luck to you!

Injections, ointments for psoriasis – effective remedies

Date of publication: 01.10.2022

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS REQUIRED. Ointment Psoriasis

Author of the article

Zotina Natalya Igorevna,

Diploma of pharmaceutical education: 105924 1197876, reg. number 30353

All authors

Article content

• Non-hormonal
• Head psoriasis remedy
• Ask an expert on the subject of article

Do you know what disease was called the “devil’s rose” in the Middle Ages? This is psoriasis. The disease is also called “imperial disease”. Because many great people suffered from it: Joseph Stalin, Winston Churchill, John Rockefeller and Henry Ford.

Psoriasis is a chronic inflammatory skin disease of a non-infectious nature. The causes of the disease have not yet been elucidated. It is believed that the basis of psoriasis is a failure of the immune system, provoking factors and genetic predisposition. Stress, infection, hormonal failure, trauma, burns, medication can give impetus to the development of the disease.

The main symptom of the disease is the appearance of red scaly papules (plaques). Epidermal cells in psoriasis multiply many times faster than normal. They do not have time to “grow old” and accumulate on the surface of the skin in the form of psoriatic plaques. Most often they appear on the skin of the hands, legs, feet and scalp. Cause inflammation, severe itching and peeling.

Pharmacist Natalya Zotina talks about which ointments are used to treat psoriasis, which ones do not contain hormones and what helps with scalp psoriasis.

Non-hormonal

To date, no drugs have been invented that completely cure psoriasis. The action of drugs is aimed at reducing clinical manifestations, alleviating symptoms, lengthening the period of remission and improving the quality of life. For this, experts prescribe funds for external and systemic use.

External preparations are divided into containing hormones and non-hormonal. The first are effective and quickly relieve inflammation. But they shorten the remission period and give severe side effects. Such drugs cannot be used without a doctor’s prescription.

Hormone therapy is contraindicated in patients with reduced liver and kidney function and hypertension. If more than 20% of the skin is affected, doctors also do not recommend treatment with hormonal ointments.

Consider non-hormonal ointments. They are used to treat mild forms of psoriasis when hormones are not needed or possible. They are less effective than hormonal ones. But they have their own advantages:

• safety
• non-habituation
• application duration
• hormonal maintenance
• low cost

Non-hormonal drugs are divided into groups according to the composition of active substances:

• Daivonex, Deyvoderm. They contain calcipotriol, which inhibits the reproduction of epidermal cells (keratinocytes), accelerates their maturation and stabilizes immune processes in the skin.
• Keratolytics: creams and ointments with 2-5% salicylic acid, 5% lactic acid, urea. They soften plaques and accelerate the exfoliation of horny scales, which accumulate and do not have time to be rejected.
• Preparations based on wood tar, naftalan, grease, ichthyol: Birch tar, Akrustal, Kartalin, Losterin, Naftaderm, Ichthyol ointment. They have anti-inflammatory, disinfectant, exfoliating, antipruritic, softening effect. Such ointments are not effective in the progressive stage of psoriasis and in large lesions. Ichthyol ointment is used in remission and at the stage when plaque growth stops.
• Zinc preparations: Zinocap, Skincap. Psoril. They inhibit the accelerated growth of keratinocytes, reduce peeling and relieve inflammation.
• Homeopathic and herbal preparations: Psoriaten with Holly Magonia extract has an anti-inflammatory and antiproliferative effect. Softens the skin and accelerates the disappearance of the remnants of the rash.

Efficacy in psoriasis of Daivonex, Daivobet, Skincap, Cinocap is confirmed by clinical studies.

In severe forms, doctors prescribe systemic psoriasis drugs (by mouth and injections). Their action is aimed at suppressing the immune system:

• Methotrexate – cytostatic
• Sandimmun Neoral, Cyclosporine – immunosuppressants
• Stelara, Remicade – Monoclonal Antibody

Psoriasis Scalp

Scalp psoriasis is characterized by a “psoriasis corona” where psoriasis plaques bulge from the scalp to the forehead, behind the ear, or neck. For treatment, ointments, pastes, lotions and shampoos are used.

Products with tar, zinc, salicylic acid and glucocorticosteroids have proven themselves:

• Belosalik and Diprosalik in the form of ointment and lotion. The composition includes betamethasone and salicylic acid. Relieve inflammation, itching, exfoliate scales. The combination of two active substances increases the effectiveness of drugs. Salicylic acid improves the penetration of the hormone and enhances its action. Belosalik lotion is produced with a convenient spray nozzle.
• Xamiol gel, Daivobet ointment. Contains calcipotriol and betamethasone. The drugs inhibit excessive cell division of the epidermis, have anti-inflammatory, antipruritic and immunosuppressive effects.
• Skin cap and Zinocap (aerosol, cream). Contains zinc pyrithione. Apply if there is no pronounced inflammation, with redness, peeling and itching.

Proper care of the scalp reduces the period of exacerbation and prolongs the period of remission of the disease. To wash the hair, patients with psoriasis are recommended shampoos with tar Friderm-tar and zinc Friderm-Zinc, Cynovit, Belosalik, Skin-cap. They are used 2-3 times a week. Shampoos inhibit excessive growth of epidermal cells, have anti-inflammatory, astringent and antifungal effects.

So, psoriasis is a chronic inflammatory disease with periods of exacerbation and remission. The exact reasons for its occurrence have not been clarified. Psoriasis cannot be completely cured. Complex therapy, diet, healthy lifestyle facilitate the course of the disease, reduce the number of exacerbations and improve the quality of life of patients.

For mild forms of psoriasis, non-hormonal agents are prescribed. In severe cases, doctors use glucocorticoid hormones and drugs that suppress the immune system.

Ointments, lotions, aerosols and shampoos with betamethasone, calcipotriol, zinc and salicylic acid help with scalp psoriasis.

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