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Pictures, Symptoms, Causes, Diagnosis, Treatment

Written by WebMD Editorial Contributors

Medically Reviewed by Poonam Sachdev on April 25, 2023

• What Is Psoriasis?
• Is Psoriasis a Chronic Disease?
• Psoriasis Symptoms
• Psoriasis Types
• What Causes Psoriasis?
• Psoriasis Diagnosis
• Psoriasis Treatment
• Psoriasis Risk Factors
• Psoriasis Triggers
• Is There a Cure for Psoriasis?
• Psoriasis Statistics
• More

Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales. On darker skin, the patches can be purplish, violet, or brown with gray scales. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. Psoriasis can’t be passed from person to person. It does sometimes happen in members of the same family.

Yes. Psoriasis usually appears in early adulthood. For most people, it affects just a few areas. In severe cases, psoriasis can cover large parts of the body. The patches can heal and then come back throughout a person’s life.

Psoriasis is a lifelong condition that can go through periods of remission and flare-ups, but there is currently no known cure.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis (which is the most common variety of the condition) include:

• Plaques of red skin, often covered with silver-colored scales. In darker skin tones, plaques may be brown or purplish with gray scales. These plaques may be itchy and painful, and they sometimes crack and bleed. In severe cases, the plaques will grow and merge, covering large areas.
• Disorders of the fingernails and toenails, including discoloration and pitting of the nails. The nails may also crumble or detach from the nail bed.
• Plaques of scales or crust on the scalp.

People with psoriasis can also get a type of arthritis called psoriatic arthritis. It causes pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other types of psoriasis include:

• Pustular psoriasis, which causes discolored, scaly skin with tiny pustules on the palms of the hands and soles of the feet.
• Guttate psoriasis, which often starts in childhood or young adulthood, causes small spots that are pink, red, brown, or purple in color, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and taking antimalarial and beta-blocker medications.
• Inverse psoriasis, which causes discolored, shiny lesions that appear in skin folds, such as the armpits, groin, and under the breasts. On light skin, the lesions will be bright red. On darker skin, they’ll be darker than the surrounding skin and can be purplish or brown in color. 
• Erythrodermic psoriasis, which causes intense discoloration of the skin and shedding of scales in sheets. It’s triggered by severe sunburn, infections, certain medications, and stopping some kinds of psoriasis treatment. It needs to be treated immediately because it can lead to severe illness.

No one knows the exact cause of psoriasis, but experts believe that it’s a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10-30 days. With psoriasis, new cells grow every 3-4 days. The buildup of old cells being replaced by new ones creates the scales. The exact cause of psoriasis is still a mystery; however, researchers think it is caused when something sets off your immune system. But it’s probably a combination of risk factors and triggers.

Psoriasis tends to run in families, but it may skip generations. For instance, a grandfather and their grandson may be affected, but not the child’s mother.

Things that can trigger an outbreak of psoriasis include:

• Cuts, scrapes, or surgery
• Emotional stress
• Strep infections
• Medications, including blood pressure medications, anti-malarial drugs, lithium and other mood stabilizers, antibiotics, and NSAIDs

Physical exam. It’s usually easy for your doctor to diagnose psoriasis, especially if you have plaques on areas such as your:

• Scalp
• Ears
• Elbows
• Knees
• Belly button
• Nails

Your doctor will give you a full physical exam and ask if people in your family have psoriasis.

Lab tests. The doctor might do a biopsy — remove a small piece of skin and test it to make sure you don’t have a skin infection. There’s no other test to confirm or rule out psoriasis.

Luckily, there are many treatments. Some slow the growth of new skin cells, and others relieve itching and dry skin. Your doctor will select a treatment plan that is right for you based on the size and location of your rash, your age, your overall health, and other things. Common treatments include:

• Steroid creams
• Moisturizers for dry skin
• Coal tar (a common treatment for scalp psoriasis available in lotions, creams, foams, shampoos, and bath solutions)
• Vitamin D-based cream or ointment (a strong kind ordered by your doctor — vitamin D in foods and pills has no effect)
• Retinoid creams
• Calcineurin inhibitors
• Anthralin

Treatments for moderate to severe psoriasis include:

• Light therapy. A doctor shines ultraviolet light on your skin to slow the growth of skin cells. Psoralen plus ultraviolet-A radiation (PUVA) is a treatment that combines a medicine called psoralen with a special form of ultraviolet light.
• Methotrexate. This drug can cause bone marrow and liver disease as well as lung problems, so it’s only for serious cases, and doctors closely watch patients who take this drug. You will have to get lab tests, perhaps a chest X-ray, and possibly a liver biopsy.
• Retinoids. These pills, creams, foams, lotions, and gels are a class of drugs related to vitamin A. Retinoids can cause serious side effects, including birth defects, so they’re not recommended for women who are pregnant or planning to have children.
• Cyclosporine. This drug, made to suppress the immune system, may be taken for serious cases that do not respond to other treatments. It can damage the kidneys and raise blood pressure, so your doctor will closely watch your health while you take it.
• Biologic treatments. These work by blocking the part of the body’s immune system that is overactive in psoriasis. Biologic medications include adalimumab (Humira), brodalumab (Siliq), certolizumab pegol (Cimzia) etanercept (Enbrel), guselkumab (Tremfya), infliximab (Remicade), ixekizumab (Taltz), risankizumab-rzaa (SKYRIZI), secukinumab (Cosentyx), tildrakizumab (Ilumya), and ustekinumab (Stelara).
• Enzyme inhibitors. The medications, apremilast (Otezla) or deucravacitinib (Sotyktu), are new kinds of drug for long-term inflammatory diseases, such as psoriasis and psoriatic arthritis. They are pills that block a specific enzyme, which helps slow other reactions that lead to inflammation.
• An aryl hydrocarbon receptor (AHR) agonist. Tapinarof (Vtama) is a steroid-free, once-a-day topical cream, which can be used on all body areas, including most sensitive locations except the eyes and inside the vagina.

Genes: Little bits of your DNA, called genes, carry instructions for your cells. They control your eye and hair color, your ability to taste certain things, and the other ways your body works. Some genes are active only at certain times.

When you have psoriasis, the genes that control your immune system’s signals get mixed up. Instead of protecting your body from invaders, as it’s meant to do, it promotes inflammation and turns skin cells on overdrive.

Scientists have found more than 80 genes that are different in people with psoriasis. They think it takes more than one gene to cause the disease, and they’re looking for the main ones.

About 10 in every 100 people have genes that make them more likely to get psoriasis, but only two or three of them actually do.

Alcohol: Heavy drinkers are at a higher risk, especially younger men. Moreover, alcohol can make treatments less effective.

Smoking: Lighting up can double your risk of getting psoriasis. If you also have relatives with the condition, you’re nine times more likely to get it. And smoking makes it harder to get rid of symptoms. It’s closely linked to a hard-to-treat type called pustular psoriasis, which affects the palms of your hands and the soles of your feet.

Hormone changes: The condition often shows up or flares during puberty. Menopause can also trigger it. During pregnancy, your symptoms may get better or even go away. But after the baby’s born, you might have a flare.

Stress: Scientists think your immune system may respond to emotional and mental pressures the same way it does to physical problems, such as injuries and infections.

Medications: Some treatments can make psoriasis worse. These include:

• Lithium, which treats bipolar disorder and other mental illnesses
• High blood pressure and heart medicines, including propranolol (Inderal) and other beta-blockers, angiotensin-converting enzyme inhibitors, and quinidine
• Antimalarial medicines, including chloroquine, hydroxychloroquine (Plaquenil), and quinacrine
• Indomethacin (Indocin), which treats inflammation

Steroid withdrawal: Topical steroids (medications that fight inflammation, in forms that you put on your skin) are some of the most common psoriasis treatments. But they can also cause symptom flares if you stop using them too quickly.

HIV: Psoriasis usually is worse in the beginning stages of HIV infection, but it gets better after you start certain treatments.

Other infections: Strep infections, in particular, are linked to guttate psoriasis, which looks like small red drops. Kids often have strep throat before their first flare. Earaches, bronchitis, tonsillitis, or a respiratory infection such as a cold or the flu may also be triggers.

Sunlight: A little natural light is good for most people with psoriasis. But for a few, the sun makes their condition worse and so can a bad sunburn. Hence, protect your skin if you’re going to be outside.

Skin injuries: A cut, scrape, bug bite, infection, or too much scratching can trigger the condition.

Weight: People who are obese tend to get plaques in their skin creases and folds.

Weather: Your psoriasis might get worse in the winter. Dry air, less natural sunlight, and cold temperatures can make symptoms worse. Keep your skin moist, and try a humidifier at home.

There’s no cure, but treatment greatly reduces symptoms, even in serious cases. Recent studies have suggested that when you better control the inflammation of psoriasis, your risk for heart disease, stroke, metabolic syndrome, and other diseases associated with inflammation goes down.

Psoriasis affects:

• 2%-3% of people throughout the world
• About 3% of people in the United States
• Some cultures more than others. Worldwide, psoriasis is most common in northern Europe and least common in eastern Asia.

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Psoriasis: clinical and therapeutic aspects | Fedorov S.

M.

Central Research Institute of Dermatovenereology, Ministry of Health of the Russian Federation, Moscow

P Soriasis is a chronic recurrent dermatosis of a multifactorial nature, characterized by a rash on the skin of abundantly scaly epidermal-dermal papules. With psoriasis, it is possible to involve the joints in the process, as well as various organs and systems of the body. In various countries, psoriasis affects from 1 to 3% of the population. This disease is rare in Eskimos, Japanese, and West Africans, and extremely rare in North American and South American Indians. Men and women get sick equally often. The disease can begin at any age.

The hereditary factor is one of the most significant in the development of psoriatic disease. If one of the parents is sick, the risk of psoriasis in a child is 8%; if the father and mother suffer from psoriasis – 41%. The mode of inheritance is probably polygenic. HLA class I is often found in patients: HLA-B13, HLA-B17, HLA-Bw57, HLA-Cw6.

Depending on the age at which the disease began, psoriasis is divided into 2 types . Although psoriasis can begin at any age, there are two age peaks when the onset of the disease is most likely. The first is in adolescence and in young people (from 16 to 25 years old), and the second in people of middle age (from 50 to 60 years old). The first type includes patients who fell ill at a young age. It was noted that in this group, the hereditary nature of the disease is more often traced, rashes are more common, in a greater percentage of cases joint damage is added. In patients of the second group, a more favorable course of the disease is noted.

In the pathogenesis of psoriatic disease, the leading role belongs to a genetically determined disorder of keratinization caused by hyperproliferation and impaired differentiation of keratinocytes. In psoriasis, violations of almost all links of the immune regulation of the skin were revealed, leading to the release by activated keratinocytes, lymphocytes, macrophages and resident cells of the dermis of various mediators of the immune response and inflammation: polyamines, proteases, cytokines. They stimulate the proliferation of defective keratinocytes and the development of inflammatory changes in the skin, including infiltration of the dermis and epidermis by polymorphonuclear and mononuclear leukocytes.

Clinical picture

The so-called vulgar (ordinary) psoriasis is the most common. It is characterized by rashes of flat, slightly raised above the surface of apparently healthy skin papules, with clear boundaries, pink-red color, rounded outlines, prone to merging into plaques. The surface of the elements of the rash is covered with small silvery-white scales that easily fall off when scraped. The size of the rash varies from a few millimeters to the size of a palm or more. Rashes may spontaneously regress without a trace after weeks, months or years.

Plaster psoriasis.

Psoriasis vulgaris.

Psoriatic erythroderma.

Exudative psoriasis.

The most common localization of rashes is on the elbows, knees, shins, buttocks, scalp and areas of local injury (Koebner phenomenon). With psoriasis, nail damage can often be observed, and sometimes isolated. There are three forms of psoriatic nail lesions: hypertrophic, dystrophic and atrophic.

Histologically, psoriasis vulgaris is characterized by pathological hyperproliferation of the epidermis and inflammation of the epidermis and dermis. In the lesions of psoriasis, a large number of mitotic figures in the basal layer, acanthosis, hyper- and parakeratosis, agranulosis (absence or thinning of the granular layer) are found. The proliferative activity of the psoriatic epidermis is many times higher than usual, the migration of keratinocytes from the basal layer to the surface of the epidermis is faster, and the duration of the cell cycle of keratinocytes is shortened from 28 days normally to 3-4 days.

Exudative psoriasis is less common than psoriasis vulgaris. This is a more severe form of the disease. As a result of impregnation with exudate, psoriatic elements are covered with grayish-yellow cortical scales. In rare cases, with this form of psoriasis, exudation is so pronounced that cavity elements appear on the skin. Rashes are accompanied by itching and may be covered with purulent-hemorrhagic crusts. Exudative psoriasis is sometimes common and can be combined with other forms, such as psoriatic arthritis. In a number of patients, the phenomena of exudation are transient, and after their resolution, the psoriatic process acquires typical features.

Increasingly common pustular forms of psoriasis are also characterized by a severe course: palmoplantar pustular psoriasis (Barber type), generalized pustular psoriasis (Zumbusch type) and pustular psoriasis proceeding as centrifugal annular erythema.

The most severe form of psoriatic disease is psoriatic erythroderma . Most often, it develops as a result of irrational therapy that does not correspond to the stage of the course of psoriasis. This is facilitated by intense insolation, the use of tar preparations in the progressive stage of the disease, the irrational use of methotrexate or steroid hormones, etc. Strong emotional experiences can also provoke erythroderma.

As a result of the fusion of large plaques into continuous diffuse lesions in psoriatic erythroderma, the entire skin or its extensive areas are involved in the process (partial erythroderma). The skin is hyperemic, infiltrated. Peeling is pronounced, scales can be typical for psoriasis – small, silvery-white or lamellar, large-lamellar. The skin of the face in such patients is tightened, the lower eyelids in some patients are extropized. Lymph nodes are usually enlarged. Patients complain of chills, a feeling of tightness of the skin, itching and burning.

In some patients with psoriasis, the joints are involved – psoriatic arthropathy or arthropathic psoriasis. The severity of psoriatic arthropathy often determines the prognosis of the disease, because. involvement in the process of the joints often leads to disability. Initially, the small joints of the hands and / or feet, the hip, sacroiliac joints are involved in the process, then (without a specific sequence) – the large joints of the limbs and trunk. Arthralgia increases with movement and is characterized by varying intensity: the pain may be mild, quickly passing, or it may be intense, incessant. Soreness is noted not only in the joints, but also in the muscles. The skin in the area of ​​the affected joints is edematous, hyperemic, the temperature of the tissues is increased. There is limited mobility. In a number of patients, more or less pronounced phenomena of osteoporosis can be observed. Bone changes are irreversible. The severe course of psoriatic arthritis is accompanied by common phenomena: temperature reaction, malaise, headache, etc. In an unfavorable course, the process leads to severe deformation, contractures, and ankylosis.

As manifestations of the systemic process in psoriasis, one can see the phenomena of nephropathy, dysfunction of the liver and gastrointestinal tract, and the cardiovascular system.

An objective indicator of the course of the process is PASI – lesion severity index , which is calculated taking into account the size of the affected area, the severity of hyperemia, infiltration and desquamation. The maximum PASI index is 72; mild, moderate and severe forms of psoriasis are defined by numbers: 0-10, 10-50, 50 or more, respectively.

In the course of psoriasis, 3 stages are distinguished : progression stage, stationary stage and regression stage. The first stage is characterized by the appearance of new elements, their growth and merging into large plaques. Rashes in this stage are not completely covered with scales – a zone free of scales remains along the periphery, indicating the growth of elements. In the second stage, new rashes are usually not noted, the elements are completely covered with scales, which indicates the cessation of their growth. At the end of this stage, under side illumination, a narrow rim of pseudoatrophy (Voronov’s rim) can be seen around the elements. In the stage of regression, hyperemia and infiltration decrease, the elements become thinner, free from scales and gradually completely resolve, leaving areas of temporary hyperpigmentation.

Medical tactics

Treatment tactics depend on the stage of the process, as well as the characteristics of the course of the disease in each individual patient. When choosing a treatment method, it is necessary to take into account the prevalence of the process, its clinical form, the presence of visceral pathology, as well as laboratory examination data. Therapeutic and preventive measures should be aimed not only at eliminating this exacerbation of the disease, but also at reducing the frequency of relapses, maximizing remissions, preventing complications, and social rehabilitation of the patient.

In case of mild psoriasis, which is of a limited nature, or in the presence of single “duty” plaques, external treatment, balneo and spa therapy, diet, work and rest are often enough.

Moderate and severe forms of the disease require complex treatment on an outpatient basis, and in the period of exacerbation of symptoms – treatment in a hospital. In order to prolong remission, courses of anti-relapse therapy (vitamins, biostimulants, physiotherapy) should be carried out.

Often in the treatment of psoriasis, hydrating agents are used , softening the flaky surface of psoriatic elements: creams based on lanolin with vitamin supplements, Unna cream, Psoriaten ointment, which, in addition to softening action, also has anti-inflammatory and antiproliferative effects. In approximately 35% of patients, itching, soreness, redness, and flaking are reduced after the use of these therapeutic agents. An ointment containing salicylic acid (2 to 5 percent) is the most widely used keratolytic agent. It is used alone or in combination with coal tar, tar, or topical corticosteroids. Salicylic acid ointments soften the scaly layers of psoriatic plaques and accelerate their resolution. They also enhance the effect of topical corticosteroids or charcoal by enhancing their absorption.

Starting from the second stage, anthralin (cygnoline, dithranol) is one of the most popular topical treatments for psoriasis in many European and some American centers. The mechanism of action of anthralin is to inhibit the synthesis of DNA in the nucleus and mitochondria, as well as to slow down the activity of cellular enzymes, polyamines and phosphorylation processes, resulting in a decrease in cell proliferation. Anthralin is applied for 1 hour and then quickly washed off, penetrating only into the affected skin, without loss of effectiveness. This regimen is as effective as the traditional (overnight) regimen and can be compared to topical corticosteroids in terms of effectiveness.

Effective, starting from the second stage, also tar preparations , whose action is based on its keratoplastic, anti-inflammatory and antipruritic action. Despite the fact that preparations containing tar or coal tar help to cleanse the skin of psoriatic rashes and when used independently, they are sometimes used in combination with ultraviolet phototherapy. The use of these products is limited due to the unpleasant smell and because sometimes even in low concentrations they can cause irritation or acne on the skin. Coal tar and tar are often used in medicated shampoos to prevent or reduce scalp flaking. Tar preparations are contraindicated in exudative psoriasis, kidney disease.

Corticosteroid ointments are often used to treat psoriasis . Potent topical corticosteroids act as quickly or faster than tar preparations or anthralin, but are much more convenient for daily use for patients, as they are odorless, do not cause skin irritation and stains on the body and clothes.

The effectiveness of topical corticosteroid therapy can be enhanced by applying an ointment under a plastic wrap, but at the cost of increased local and systemic side effects. Currently, there is no convincing evidence that the relationship between the effectiveness of any topical corticosteroid drug and its local or systemic side effects can be broken. In psoriasis, preference is given to creams and ointments containing, in addition to steroid hormones, salicylic acid (diprosalik, belosalik, lorinden A), tar (locacorten Tar, lorinden T). In areas with the most delicate epidermis and in children, the use of non-halogenated corticosteroids (advantan) is recommended.

Irrational therapy with corticosteroid ointments can lead to the transition of psoriatic disease to a more severe form that is difficult to treat (to a pustular form, psoriatic erythroderma), cause thinning of the skin, the appearance of areas of atrophy, sluggish local infections, hypopigmentation and tachyphylaxis (decreased effect).

Psorkutan ointment containing calcipotriol 9 is most commonly used for psoriasis.0109 Vitamin D derivative for topical use. This is an analogue of vitamin D3, which has a minimal effect on calcium metabolism. The efficacy of calcipotriol ointment in patients with plaque psoriasis is similar to that of a mild to moderate corticosteroid ointment such as betamethasone valerate 0.1%. The ointment is colorless and does not stain clothes, but sometimes its use causes irritation of the skin of the face.

Widely used in the treatment of psoriasis vitamins group B (B ₁ , B ₂ , B ₆ , B ₁₂ ), ascorbic acid, folic acid, vitamins A, E, PP.

Psychotropic drugs (tranquilizers, antidepressants, neuroleptics) are an important adjuvant for the treatment of psoriasis patients who have elements of asthenia and neurotization in their psychosomatic status. It is desirable that the correction of these conditions be carried out with the participation of a psychoneurologist.

In order to detoxify the body, enterosorbents are prescribed (activated carbon, polyphepan, enterosgel, etc.). Their appointment is especially indicated for patients with psoriasis with concomitant pathology of the gastrointestinal tract. It is recommended to prescribe enzyme preparations during or after meals and hepatoprotectors .

Phospholipid preparation Essliver Forte has a hepatoprotective and epidermis-directed effect. Essliver Forte contains essential phospholipids (phosphatidylcholine and polyunsaturated fatty acids: oleic, linoleic, linolenic) and therapeutic doses of vitamins (B ₁ , B ₂ , B ₆ , B ₁₂ , E and nicotinamide), which provides the drug with a wide range of therapeutic properties. In addition to stimulating regenerative processes in the liver tissue, Essliver Forte has a therapeutic effect on skin diseases, accelerates the healing of wounds and scars. Essential phospholipids restore the barrier functions of the skin, replenishing the lack of lipids, leading to dry skin and disruption of its barrier functions. Essliver Forte corrects psoriasis disorders in the cell membranes of the epidermis. The essential phospholipids included in its composition, being the structural units of all cell membranes, restore the structure, barrier and metabolic functions of cells, normalize the processes of keratinization and regeneration of the epidermis.

Calcium, sodium and magnesium preparations are used in the acute stage of psoriasis. They have a hyposensitizing, detoxifying and anti-inflammatory effect, reduce the permeability of the vascular wall, increase diuresis.

Angiotropic agents (xanthinol nicotinate, theophylline, papaverine, etc.) are widely used in psoriasis, because, by stimulating microcirculation in the lesions, they accelerate the resolution of the lesions.

The combination of psoriasis with food, drug allergies or atopic conditions, as well as itching, burning in the lesions, are indications for the use of antihistamines .

Patients with severe and atypical forms of the disease are indicated for the appointment of cytostatic drugs (methotrexate). Methotrexate is a folate antagonist. The proposed mechanism of action of the drug is the blockade of DNA synthesis, the suppression of the proliferative activity of cells. Before prescribing methotrexate, a thorough examination of the patient is necessary to identify contraindications.

For the treatment of severe forms of psoriasis, when conventional therapy is ineffective or impossible, use cyclosporine A , which inhibits the development of cell-type reactions, as well as T-lymphocyte-dependent antibody formation. The mechanism of therapeutic action of cyclosporine A in psoriasis has not yet been fully elucidated.

Synthetic retinoids are one of the most effective agents in the treatment of severe forms of psoriasis. They can be used externally in the form of ointments or taken orally. The action of these drugs is based on the normalization of differentiation and keratinization of skin cells in psoriasis, they have keratolytic and anti-inflammatory effects. The effect of synthetic retinoids in psoriasis is symptomatic. Contraindications to the appointment of synthetic retinoids are acute and chronic diseases of the liver, kidneys, etc.

The only indication for systemic corticosteroid therapy in psoriasis is severe psoriatic erythroderma. Such a narrow scope of use of these drugs is explained by a large number of side effects and the risk of transformation of psoriasis into more severe forms.

Patients with psoriatic arthritis require a special therapeutic approach . One of the ways to alleviate the condition of these patients is the appointment of non-steroidal anti-inflammatory drugs (indomethacin, diclofenac, piroxicam, etc.). Another promising direction is the use of alfacalcidol, a synthetic analogue of the active form of vitamin D. The drug enhances the absorption of phosphorus and calcium in the intestine, enhances their reabsorption in the kidneys, increases bone mineralization, and reduces the level of parathyroid hormone. Especially important is the early detection of articular pathology, which can significantly slow down its progression with the help of this drug. Treatment with alfacalcidol is carried out under strict control of blood calcium levels. In psoriatic arthritis without exacerbation, ultrasound is prescribed to the area of ​​the affected joints and the paravertebral region of the segmental zone.

Ultraviolet irradiation in erythemal and suberythemal doses, which has a weak cytostatic and antimitotic effect, is used to treat patients with psoriasis in the stationary stage and in the regression stage. An important condition for the effectiveness of the procedures is the removal of parakeratotic layers with the help of keratolytic agents, since they are a barrier to UV radiation. When treating with UV rays, it must be remembered that an overdose of UV radiation can cause a severe exacerbation of the disease.

The ability of some derivatives of furocoumarins under the influence of long-wavelength UV rays to enter into a photochemical reaction with target molecules, and primarily with pyrimidine bases of nuclear DNA, underlies the method of photochemotherapy (PUVA therapy). Photosensitizers when using this method can be administered both externally in the form of ointments and inside. Contraindications to PUVA-therapy are all general diseases and blastomatous processes, acute and chronic diseases of the liver and kidneys, pregnancy, diabetes mellitus, cataracts, hypersensitivity to sunlight, indications of the use of arsenic preparations and x-ray therapy in the past.

Significantly reduces the likelihood of side effects and enhances the effectiveness of treatment method that combines the use of photochemotherapy and the use of synthetic retinoids inside ( method Re-PUVA-therapy ).