Topical Steroid Potency Chart: National Psoriasis Foundation

Topical Steroid Potency Chart

Curious about the potency of topical steroids? Perhaps your health care provider prescribed you a treatment and you’d like to know how potent it is.

Below you will find a chart of topical steroids classified by their potency. Both the brand names and generic names are listed.

Are you looking for non-steroid or over-the-counter options? While topical steroids require a prescription from a health care provider, there are over-the-counter and non-steroid treatment options available to you without a prescription.

NPF’s Seal of Recognition has a searchable list of products like shampoos and moisturizers, and even household items, all of which are made or intended to be non-irritating to your sensitive skin.

Steroid Potency Chart

This chart is for educational use only. Please read the full prescription insert for known side effects, precautions, or warnings. Also, please talk with your health care provider for the specific dose and frequency that is right for you. The National Psoriasis Foundation does not endorse any specific treatment for psoriatic disease.

Potency Strength	Brand Name	Generic Name
Super-potentUltra-high	Diprolene Ointment, 0.05%	Augmented betamethasone dipropionate
	Cormax Cream/Solution, 0.05%	Clobetasol propionate
	Clobex Lotion/Spray/Shampoo, 0.05%	Clobetasol propionate
	Olux Foam, 0.05%	Clobetasol propionate
	Olux E Foam, 0.05%	Clobetasol propionate
	Temovate Cream/Ointment/Solution, 0.05%	Clobetasol propionate
	Topicort Topical Spray, 0. 25%	Desoximetasone
	Psorcon Ointment, 0.05%;	Augmented diflorasone diacetate
	Psorcon E Ointment, 0.05%	Diflorasone diacetate
	Vanos Cream, 0.1%	Fluocinonide
	Cordran Tape, 4mcg/sq. cm.	Flurandrenolide 4 mcg/cm2
	Lexette Foam, 0.05%	Halobetasol propionate
	Ultravate Cream/Ointment, 0.05%	Halobetasol propionate
	Ultravate Lotion, 0.05%	Halobetasol propionate
	Bryhali Lotion, 0.01%	Halobetasol propionate
High	Cyclocort Ointment, 0.1%	Amcinonide
	Diprolene Ointment, 0.05%	Betamethasone dipropionate
	Diprolene Cream/Lotion, 0. 05%	Augmented betamethasone dipropionate
	Topicort Cream/Ointment, 0.25%	Desoximetasone
	IMPOYZ Cream, 0.025%	Clobetasol Propionate
	Topicort Gel 0.05%	Desoximetasone
	Florone Cream, 0.05%	Augmented Diflorasone diacetate
	Florone Ointment, 0.05%	Diflorasone diacetate
	Lidex Cream/Gel/Ointment/Solution, 0.05%	Fluocinonide
	Halog Ointment/Cream, 0.1%	Halcinonide
	Elocon Ointment, 0.1%	Mometasone furoate
	Cyclocort Cream/Lotion 0.1%	Amcinonide
	Diprolene AF Cream 0.05%	Betamethasone dipropionate
	Diprolene Lotion 0.05%	Betamethasone dipropionate
	Psorcon Cream, 0. 05%	Diflorasone diacetate
	Cutivate Ointment, 0.005%	Fluticasone propionate
	TRIDERM	Triamcinolone acetonide 0.5%
Moderate(Medium)	Luxiq Aerosol Foam 0.12%	Betamethasone valerate
	Topicort LP Cream, 0.05%	Desoximetasone
	Synalar Ointment 0.025%	Fluocinolone acetonide
	Cordran Ointment, 0.05%	Flurandrenolide
	SERNIVO Spray, 0.05%	Betamethasone Dipropionate
	Westcort Ointment, 0.2%	Hydrocortisone valerate
	Elocon Cream/Lotion, 0.1%	Mometasone furoate
	Kenalog Cream/Ointment, 0.1%	Triamcinolone acetonide
	Kenalog Spray, 0. 2%	Triamcinolone acetonide
	CREAM: BETA-VAL/BETADERM; LOTION: VALISONE/BETA-VAL	Betamethasone valerate 0.1%
	Cloderm Cream, 0.1%	Clocortolone pivalate
	Synalar Cream 0.025%	Fluocinolone acetonide
	Capex Shampoo	Fluocinolone acetonide
	Derma-Smoothe/FS	Fluocinolone acetonide
	Cutivate Cream/Lotion 0.05%	Fluticasone propionate
	Cordran Cream/Lotion, 0.05%	Flurandrenolide
	Locoid Cream/Lotion/Ointment/Solution, 0.1%	Hydrocortisone butyrate
	Pandel Cream, 0.1%	Hydrocortisone probutate
	WESTCORT Cream	Hydrocortisone valerate 0.2%
	DermAtop Cream/Ointment, 0. 1%	Prednicarbate
Low	Aclovate Cream/Ointment, 0.05%	Alclometasone dipropionate
	LOTION, CREAM, OINT: DESOWEN; GEL: DESONATE/DESRX; FOAM: VERDESO 3	Desonide 0.05%
	Synalar Cream/Solution, 0.01%	Fluocinolone acetonide
	LOTION, GEL, CREAM, OINT: CORTIZONE 10; SOLUTION: SCALPICIN/TEXACORT 7	Hydrocortisone 0.5% – 2.5%
	Cetacort Lotion, 0.5%/1%	Hydrocortisone
	Cortaid Cream/Spray/Ointment	Hydrocortisone
	Hytone Cream/Lotion, 1%/2.5%	Hydrocortisone
	Micort-HC Cream, 2%/2.5%	Hydrocortisone
	Nutracort Lotion, 1%/2.5%	Hydrocortisone
	Synacort Cream, 1%/2. 5%	Hydrocortisone

For Patients: Please read the full prescription insert for known side effects, precautions, or warnings. Also, please talk with your provider about the specific dose and frequency that is right for you.

About Psoriasis

Psoriasis affects more than 3% of the US adult population. That is more than 7.5 million US adults.

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Learn about different treatment options for psoriasis and psoriatic arthritis and talk to your doctor about what might be right for you.

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What Can You Get Over-the-Counter?

While topical steroids require a prescription from a health care provider, there are over-the-counter treatment options that may help reduce the symptoms you are experiencing.

Learn about options that do not require a prescription

The National Psoriasis Foundation (NPF) is a 501(c)(3) organization governed by a Board of Directors and advised on medical issues by the Medical Board and the Scientific Advisory Committee.

National Psoriasis Foundation education materials are reviewed by the NPF Research Team and by lead Medical/Scientific advisors as appropriate and are not intended to replace the counsel of a health care provider. The Foundation does not endorse any medications, products, or treatments for psoriasis or psoriatic arthritis and advises you to consult with a physician before initiating any treatment.

Last updated on 10/25/2022 by the National Psoriasis Foundation.

Topical Steroids for Psoriasis: National Psoriasis Foundation

Topical Steroids

Topical steroids are one of the most common topical treatments for psoriasis. They are derived from the natural corticosteroid hormones produced by the adrenal glands. Corticosteroids control inflammatory responses in the body, among other important functions, making them an ideal anti-inflammatory agent to reduce swelling and redness/discoloration caused by lesions.

Steroids come in various strengths, ranging from very strong or “superpotent” to very weak or “least potent. ” You can learn more about potency classification and which steroids fit each classification by looking at the National Psoriasis Foundation’s Topical Steroid Potency Chart.

Things to keep in mind when using a topical steroid:

• Apply a small amount of the steroid on the affected areas only.
• Don’t use a topical steroid for longer than three weeks without consulting your health care provider.
• Refrain from abruptly discontinuing a topical steroid as it can cause your psoriasis to flare.
• Unless the medication is formulated for the eye area, do not use steroids on, in or around the eyes, as cataracts and glaucoma can result.
• The more potent the steroid, the more effective it is in clearing psoriasis, but the risk of side effects is greater.
• Low-strength steroids are good for treating the face, groin and breasts, but care must be taken as the risk of side effects is greater in sensitive skin areas.

Potential side effects of topical steroids include skin damage, such as skin thinning, changes in pigmentation, easy bruising, stretch marks, redness and dilated surface blood vessels. Steroids can be absorbed through the skin and affect internal organs when applied to widespread areas of skin, used over long periods of time, or used with excessive occlusion.

There are some combination treatment options available. For instance, calcipotriene combined with the steroid betamethasone dipropionate slows skin cell growth, flattens lesions, removes scale and reduces itch and inflammation. Common side effects of this treatment include itching, rash, skin thinning and burning. Less common side effects include redness of the skin, folliculitis, skin irritation, worsening of psoriasis, skin color changes and swollen fine blood vessels at the application site.

Have more questions about whether a topical treatment is for you? Your health care provider can provide you with more information related to these treatments, and discuss if they are a fit for your treatment plan. Please speak with your health care provider about the use of topical steroid treatments on children affected by psoriasis.

Learn More About Topical Treatments

Learn more about topical treatments for psoriasis, including who can use them, how to use them, and associated risks. Contact the Patient Navigator Center to request your free copy of our Topical Treatment booklet.

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Last updated on 10/08/20 by the National Psoriasis Foundation.

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Experience with the use of 0.1% hydrocortisone-17-butyrate ointment in the treatment of psoriasis in children

Psoriasis is considered as a hereditary disease, in the development of which both genetic factors and the environment play a role. Psoriasis occurs in 2-3% of the population. In about 31-45% of adults, the disease begins in the first two decades of life. Psoriasis that began in childhood demonstrates a more familial nature of the disease than psoriasis that debuted at an older age. Thus, more than 70% of children have a family history of the disease. Patients with early-onset psoriasis have HLA B57, Cw6, and DR7 alleles [1-3].

Clinical diagnosis of the disease is based on characteristic papular elements covered with thick silvery scales and typical localization of lesions, including smooth skin of the extensor surfaces of the extremities and nail lesions. Localization of the process on the scalp, behind the ears, on the elbows, knees, around the navel and on the genitals is characteristic. Psoriasis is characterized by the Koebner phenomenon, which develops a few days after physical trauma, insect bites, sunburn, scratches. In children, the disease is often accompanied by itching [1, 4].

In childhood, the most typical form is psoriasis vulgaris, and guttate psoriasis is common, which develops 2-3 weeks after suffering streptococcal tonsillitis, exacerbation of chronic tonsillitis or perianal streptococcal infection. In the future (after an average of 5 years), children who have had guttate psoriasis develop rashes characteristic of psoriasis vulgaris.

The defeat of the anogenital region is observed in 44% of young children. This may be a manifestation of the Koebner phenomenon in response to skin irritation with feces and urine. In most children, the scalp is involved in the pathological process, while the hair does not fall out. The defeat of the palms and soles for children is not typical. According to the literature [5-7], nail plates change in 15% of children, joint lesions in children are rare. Differential diagnosis of psoriasis is carried out with other papulo-squamous dermatoses, such as lichen planus, lichen pink, lichen striatus, parapsoriasis [6-8].

The treatment of psoriasis can be divided into three components: local, physiotherapeutic and systemic effects. Tactics of therapy depends on the severity of the course of the disease. In most children, psoriasis can only be controlled by external therapy, and steroids are an important component of it. According to the literature, an improvement in the course of the disease is observed with the use of medium-strength steroids (according to the European classification of topical glucocorticosteroids – groups II-III), 1-2 times a day. Topical steroids are more often used in the form of an ointment, as it provides better penetration into the skin. Steroids of weak strength – for example, 1% hydrocortisone ointment – are ineffective in the treatment of psoriasis. The maximum duration of treatment of psoriasis in children with topical corticosteroids is usually 2 weeks [9-12].

Topical corticosteroids have been used in dermatology since 1952, and the development of topical corticosteroids with potent anti-inflammatory and antiproliferative effects was then one of the most important stages in the development of dermatology. However, already in 1955, the first reports of undesirable side effects with topical corticosteroids appeared.

In children, the risk of developing systemic reactions with external use of medicinal substances exceeds the risk in adults due to a higher ratio of body surface area to its mass (approximately 2.5-3 times compared with adults). However, local adverse reactions in the treatment of topical corticosteroids are much more common than systemic ones. The most common complication of steroid therapy is the development of atrophic skin changes (steroid atrophy, telangiectasia, striae). Various infectious complications can occur – bacterial, viral and fungal. Possible development of steroid acne, perioral dermatitis, rosacea and hypertrichosis. In addition, with prolonged use of corticosteroids, tachyphylaxis may develop, characterized by a decrease in the effectiveness of the drug due to a decrease in the sensitivity of skin steroid receptors. Along with local, systemic side effects can also be observed, consisting mainly in the suppression of the “hypothalamus-pituitary-adrenal” system and the development of changes in the eyes – the formation of glaucoma and cataracts. Systemic effects when using topical steroids are relatively rare and are associated mainly with the use of very strong and fluorinated steroids when applied to large areas of the skin [5, 6, 13].

An FDA review conducted a post-marketing safety review of 24 topical corticosteroids in children and adolescents aged 0 to 18 years. We analyzed 202 reports of adverse events associated with topical corticosteroid therapy. The mean age of the children was 7.7 years, and the mean time to skin changes was 169.3 days. Most adverse events were reported between 1987 and 1997. The most common cause of adverse reactions were drugs containing betamethasone. The authors [14] concluded that long-term use of topical corticosteroids should be avoided, especially when applied to the skin of the gluteal folds, genitals, and groin in children. Treatment with corticosteroids should also be discontinued if the patient does not respond to therapy.

The base of a topical corticosteroid affects its absorption and activity. So, in the presence of infiltration and peeling, it is preferable to use an ointment, since it promotes the penetration of the medicinal substance into the skin due to the effect of occlusion and increased hydration of the stratum corneum. Short-term use of external corticosteroids, especially those with weak and moderate activity, is usually not accompanied by undesirable effects.

From the point of view of the ratio of efficacy and safety, the drug 9 is of undoubted interest0021 Lokoid (hydrocortisone-17-butyrate). Despite the rather high activity (more than 100 times higher than that of conventional hydrocortisone), hydrocortisone-17-butyrate is a non-halogenated glucocorticosteroid, i.e. its molecule contains neither fluorine nor chlorine atoms. It is obtained by esterification of the hydrocortisone molecule with a butyric acid residue at the C17 position. This modification, due to the increase in lipophilicity, significantly improved the absorption of the drug into the epidermis, where it forms a long-lasting depot and is metabolized to a less active form – hydrocortisone-21-butyrate, and at the same time allowed to reduce its systemic absorption. At the final stage, this compound breaks down into hydrocortisone and butyric acid. Only a small amount of hydrocortisone-17-butyrate enters the systemic circulation, where it is rapidly metabolized in the liver to hydrocortisone and butyric acid. According to G. Pierard [15], despite more than 30 years of existence, Lokoid retains its innovative properties and is one of the most commonly used and highly effective drugs in the treatment of steroid-sensitive dermatoses. The special structure of the Locoid molecule ensures good absorption in the area of ​​the pathological focus with minimal systemic absorption, which contributes to the high efficiency of the drug with minimal side effects. The efficacy and safety of Locoid in the treatment of psoriasis and other dermatoses has been repeatedly confirmed by numerous clinical studies [16-18]. In particular, a number of studies [20, 21] have shown that in the treatment of psoriasis Locoid has an efficacy similar to betamethasone valerate, a fluorinated glucocorticosteroid that causes adverse drug reactions much more often.

As is known, according to the classification of J. Miller and D. Munro, according to activity, all local corticosteroids are divided into 4 classes: weak (1st class), medium (2nd), strong (3rd) and very strong (4 th). According to this classification, Locoid belongs to the 3rd class.

A simple open prospective clinical study of the effectiveness of the drug was conducted at the Clinic for Skin Diseases of the Pediatric Medical Academy of St. Petersburg Locoid (hydrocortisone-17-butyrate) in children with psoriasis vulgaris. As part of this study, 20 patients (8 girls and 12 boys) aged 4 to 16 years with psoriasis vulgaris were observed. In the course of treatment, the effectiveness of the drug, its tolerability, and the speed of relief of the inflammatory process were evaluated. The study period included 4 visits with an interval of 5 days. The treatment period lasted from 7 to 15 days depending on the severity of the disease. Locoid in the form of a 0.1% ointment was applied 1-2 times a day.

Calcium preparations, ascorutin, antihistamines and sedatives were used as concomitant therapy. Outwardly, along with Locoid , lanolin cream and 2% salicylic ointment were used. The effectiveness of treatment was assessed by the dynamics of the RASI index and the Dermatology Life Quality Index (DLQI), adapted for children and adolescents [19].

Measuring the quality of life involves assessing the patient’s well-being in physical, mental, social and economic terms. There are many questionnaires, scales, indices. They are divided into non-specific, i.e. independent of the nosological form, and specific in relation to a certain nosological form. We consider specific questionnaires to be the most convenient for use. An example of a simple practical questionnaire for daily use in clinical practice is the Child Dermatology Life Quality Index (CDLQI). For a child, this is an important independent indicator of the patient’s condition, and its dynamics during treatment can be no less, and sometimes even more important than the usually estimated parameters. This is a variant of a reliable assessment of subjective factors related to experiences, sensations; self-assessment by the patient of his own condition.

Before treatment, the PASI index in patients averaged 24 (gradations from 18 to 39). When assessing the subjective state of patients, the average CDLQI index turned out to be 15. The minimum values ​​were observed in children aged 4-5 years (5 and 6). The highest rates (21-25) were observed in children of senior school age and were associated with their negative attitude towards their appearance and the disease in general, they deliberately limited contact with peers, avoided playing sports and attending school. This was especially true for those children whose rashes were localized on the face and other open areas of the skin. Significant correlations between the PASI and CDLQI indices were not found, with the exception of adolescent girls, in whom these relationships were more pronounced.

In the process of treatment with ointment Locoid , a fairly rapid positive dynamics of the skin process was noted, which was primarily manifested by a decrease in inflammatory changes in the lesions, psoriatic plaques became less bright, and peeling decreased. After only 5 days, the PASI index decreased from 24 to 18, and with further treatment by the 4th visit, it decreased to 6.6. As a result of the treatment in areas with the thinnest skin (face and folds), the rashes regressed almost completely, leaving behind only a slight dyschromia. Elements on the trunk and extremities resolved more slowly, infiltration in the foci persisted for the longest time, while inflammatory changes disappeared already by the 2nd visit. The CDLQI index decreased from an average of 15 to 5, which indicated an improvement in the quality of life of patients. The children’s emotional tone increased, their mood improved, they became more sociable, resumed sports and school attendance.

All patients tolerated external therapy well, during the observation period, no side effects were observed in any case.

Treatment of psoriasis with topical corticosteroids in children requires adherence to certain rules. The choice of corticosteroid should be determined by the pharmacological properties of the drug, taking into account the form and stage of the disease, as well as the age of the patient. Topical corticosteroid should combine sufficient efficacy and high safety.

Based on this study, as well as the data array accumulated in previous years, it can be argued that the drug of choice with the above qualities is Locoid . External therapy of psoriasis vulgaris in children with ointment Lokoid leads to a rapid improvement in the clinical picture of the disease within 2 weeks. This is confirmed by a significant decrease in both the PASI index and the CDLQI index, which reflects an objective assessment of the skin condition and the impression of the patient and his parents about the disease.

Treatment of psoriasis / skin and allergic diseases

Today, medicine has not yet found the only “correct” remedy that would save mankind from psoriasis once and for all – this is a matter for the future. Therefore, the goal of treating this disease is to alleviate the patient’s condition, achieve remission, relieve symptoms, reduce the area of ​​plaques and manifestations on the skin. Traditional medicine uses a wide range of methods and means for this: from “medieval” sulfur and tar, to the latest developments in modern medicine.

And this is no coincidence, since psoriasis is diverse and very common. Almost 300 million [1] people suffer from its unpleasant manifestations on the planet, and the search for methods of treatment (as well as the search for the root cause of its occurrence) does not stop for a second.

[1] According to statistics, psoriasis affects 2-4% of the total population of the Earth, which in 2018 is at least 7.5 billion people. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team (February 2013). “Global epidemiology of psoriasis: a systematic review of incidence and prevalence”. J Invest Dermatol 133(2): 377–85.

The choice of the type of treatment for psoriasis depends on the form and stage of the disease, as well as on the individual characteristics of the patient (does he still suffer from some chronic diseases; is he susceptible to allergies, etc. )

When treating mild forms of psoriasis, dermatologists tend to use products with minimal risk of side effects. And only if the effect of their use is hardly noticeable, or is completely absent, others are tried, more effective, but at the same time potentially more toxic to the body as a whole.

This approach to the treatment of psoriasis is referred to in medical parlance as the ‘therapeutic ladder’. Usually, as a first step on this ladder, topical treatment with external agents is offered: ointments, creams, lotions.

IMPORTANT! Although the drugs for this disease are divided into over-the-counter and prescription, each of them should be prescribed only by a dermatologist.

Self-treatment of psoriasis under the slogans:

– And I’ll try to smear the plaques with a “stronger” ointment!

— I’m going to buy pills, oh dear, the doctor didn’t prescribe them for me, but they helped Masha so much!

Unfortunately, it does not give a long-term effect, but it inexorably destroys the liver (it is it that takes all the toxic blows), and in many cases leads to painful consequences. Psoriasis can begin to develop with renewed vigor, ceasing to respond to the measures used against it, and, as a result, to capture “new territories”: both on the skin and penetrating into the depths of the body. And if you add to this the very likely risk of developing psoriatic arthritis?

STAGE I.

Topical treatment (topicals)

Topical (doctors also call them topical) preparations for psoriasis include creams, ointments, gels, lotions. With a stable condition and at the stage of persistent improvement (remission), usually those that help resolve the rash, eliminate itching, soften and moisturize the skin are usually used. And in moments of exacerbation, the dermatologist prescribes stronger hormone-based drugs.

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Non-hormonal external agents

Traditional ointments, creams, lotions used for psoriasis for many decades (some even centuries) contain tar, naftalan, ichthyol, salicylic or lactic acid, zinc. Their use is designed to soften the thickened and keratinized layer of the skin, relieve irritation and inflammation, level out the external manifestations of the disease, thereby improving the patient’s quality of life. Perhaps the most famous substance for the manufacture of such products is naftalan, obtained from a unique variety of Azerbaijani oil. Unfortunately, these legendary drugs often become the object of falsification, so you can be 100% sure that you are offered this particular remedy only by arriving at the Naftalan resort of the same name.

In the treatment of psoriasis, non-hormonal ointments based on a synthetic analog of vitamin D3 (calcipotriol) are also widely used, which slow down cell growth, accelerate their maturation, and help restore the normal structure of the skin at the site of the lesion.

There are fairly authoritative studies, both Russian and foreign, confirming the effectiveness in reducing psoriatic plaques, brightening rashes, increasing skin elasticity, healing cracks when using creams / gels / ointments based on retinol (vitamin A). True, researchers openly write that the best effect is manifested in psoriasis that exists for one year or less, and these drugs are not able to completely “remove” the rash. Therefore, topical retinol-based products for psoriasis are recommended mainly as a supplement. Also in the treatment of psoriasis, drugs based on retinol in tablets and capsules are used, but we will talk about them in the Systemic Treatment section (see below).

Hormonal topical agents

These are ointments and lotions based on glucocorticosteroids (GCS), drugs that have anti-inflammatory, anti-edematous and immunomodulatory effects: hydrocortisone, flumethasone, triamcinolone, clobetasol, etc. These remedies relieve itching, eliminate the feeling of tightness, and have an anti-allergic effect. It would seem – in fact, a panacea for psoriasis!

It would have been so if not for one “but”: hormonal drugs, despite the seemingly “harmless” form – ointment / gel – have the same serious side effects as hormonal drugs for oral administration (tablets , injections). These adverse events include thinning of the skin and the appearance of striae (stretch marks), hyperpigmentation, burning, the appearance of large and numerous “steroid acne”, hair loss. When using hormonal ointments for longer than 10-14 days, internal organs can also suffer: the mucous membrane of the gastrointestinal tract ulcerates, intraocular pressure rises, body weight increases sharply, and fat is deposited very characteristically: in the face, neck, chest, abdomen, but the arms and legs become thin, because corticosteroids help reduce muscle mass.

IMPORTANT! These drugs are in the class of prescription drugs and must be used under strict medical supervision!

STAGE II.

Photo and physiotherapy

Physiotherapy for psoriasis is very effective for many patients. They provide relief, slow the progression of the disease, and, in some cases, serve as a safe substitute for drugs. Widely used in the treatment of psoriasis and methods of spa treatment, which can also be attributed to physiotherapy. Many sanatoriums that have developed unique programs for patients with psoriasis are located in Sochi, Matsesta, Azerbaijan (the famous Naftalan), Croatia, Israel, etc. The course of therapy, designed for 14-24 days, includes sunbathing (psoriasis responds well to dosed UV radiation , inflammation decreases, plaques decrease), sea bathing, therapeutic mud applications, etc.

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Physicians successfully learned how to “replace” natural solar radiation with artificial, using devices for photo- and photochemotherapy of psoriasis. One technique differs from the other (without going into technical details) for the patient in that during phototherapy, areas of the body affected by psoriasis are “simply” exposed to UV rays, and with photochemotherapy (PUVA) before the session, you need to take a special drug inside that enhances the effect of radiation . Also in phototherapy, an excimer laser is used, which allows the treatment of individual hard-to-reach lesions.

IMPORTANT! When applying methods of physiotherapy and phototherapy, side effects may occur: itching, dry skin (and, accordingly, increased discomfort), headache, nausea. To avoid an overdose of UV radiation, such therapy should be carried out only in a clinic or hospital. Home “irradiators”, as well as a solarium in the nearest beauty salon, are not suitable for this.

STAGE III.

Systemic treatment (oral drugs)

If all the above methods for moderate and severe psoriasis do not give a visible positive result, or it “fades away” very quickly, which is often the case with moderate and severe forms of psoriasis, the doctor will consider more effective drugs – already those that are taken orally: tablets, capsules, injections.

As a rule, such drugs are prescribed during an exacerbation of the disease, the course is started either in a hospital or under the strict supervision of a doctor in a polyclinic in order to be able to quickly monitor any negative changes in the condition and, if necessary, adjust the drug intake.

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Today, several groups of drugs are used for psoriasis:

retinoids (vitamin A in high doses). Examples of drugs: tigason, neotigazone, etc.

They are produced mainly in capsules. Influence the maturation of the surface layer of the skin and eliminate the violations of this process caused by psoriasis. Because their action is based on the use of an analog of vitamin A in high doses – it has a high toxicity.

traditional systemic therapy. Examples of group drugs: methotrexate, neoral, sandimune, etc.

Reduce the activity of immune killer cells, which provoke increased division of skin cells and the appearance of psoriatic plaques. They are used both in the form of tablets and intravenous injections.

The best-known drug in this group is methotrexate, which inhibits the overgrowth and reproduction of atypical skin cells, and one of the longest used and therefore well-studied systemic drugs for psoriasis. It has a wide range of contraindications and undesirable effects.

corticosteroids. An example of group drugs: prednisolone, betamethasone, dexamethasone.

Systemic glucocorticosteroids, due to their high toxicity, are prescribed in small courses in severe and very severe disease, most often in psoriatic arthritis. Available in both tablets and ampoules for injection.

targeted synthetic anti-inflammatory drugs. Example of a preparation of the group: apremilast

Tableted medicinal preparations have a specific mechanism of intracellular action due to the small size of the molecules of the active substance. In fact, they selectively “turn off” cell signals that provoke inflammatory processes in the skin and joints. They are prescribed for intolerance / inefficiency / contraindications to traditional systemic therapy.

biological preparations. An example of drugs in the group: etanercept, infliximab, adalimumab, ustekinumab, secukinumab, golimumab, etc.

Biological drugs have been developed relatively recently, and have been used in the form of vaccines for just over 10 years. They are called “biological” because they are synthesized from human or animal protein. These drugs are capable of pointwise (like a “key-lock”) effect on cells that provoke an inflammatory process in the skin. Biological therapy is associated with an increased risk of infectious diseases. For this reason, infections, including tuberculosis, must be ruled out in the patient.

IMPORTANT! These drugs are prescribed by a doctor and are available with a prescription! They require regular monitoring by the attending physician and monitoring of laboratory parameters!

STAGE IV.

Therapy acting on the immune system

Therapy of psoriasis and psoriatic arthritis with genetically engineered biological drugs is one of the most promising advances in pharmacotherapy in the group of immunosuppressive and immunomodulatory drugs. These are drugs made from human or animal cells that act on the immune system. There are several types of biological therapies that act at different stages of the inflammatory process. We can sum them up to:

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• Anti TNF: they block an important protein in inflammation called tumor necrosis factor (TNF). The administration of drugs can be subcutaneous or intravenous, for which you need to go to a hospital or day center.
• Anti IL-12/23: they block proteins called interleukins (IL) 12 and 23, which are also involved in inflammation, but through a mechanism different from TNF. These drugs are administered subcutaneously.
• Anti-IL 17: they block a protein known as IL-17, which is found in several cell types, including keratinocytes, and prevent the development of inflammation. These drugs are administered subcutaneously. 17

Features of this type of therapy are:

1. powerful selective effect on the key links of psoriasis immunopathogenesis;
2. high efficiency and speed of action;
3. a high probability of stopping the progression of the disease and preventing the development of articular and bone destruction, disability;
4. favorable risk/benefit ratio;
5. long-term remission.

Biological therapies should be maintained for a long time, as their suspension usually results in the onset of symptoms in most patients. Before starting biological treatment, some tests, such as tuberculosis, must be performed and some vaccines must be avoided.

ADDITIONAL THERAPIES

Due to the fact that psoriasis “hosts” not only on the skin, but throughout the body, a person may experience concomitant diseases and painful conditions, which also need to be treated with antifungal, antiviral and antibacterial drugs – after all, the skin is often damaged due to scratching, and infection can easily get into these “doors”.

Since psoriatic rashes are almost always accompanied by itching, antihistamines (antiallergic) drugs will have to be used.

Sometimes it is difficult for a person with psoriasis to come to terms with the course of the disease, especially if its manifestations are concentrated on exposed parts of the body: along the hairline, on the face, neck, shoulders, etc. That is why depression is rightfully considered one of the most serious “complications” of psoriasis. And if it is not possible to get rid of it by psychological methods, it is necessary to contact a psychoneurologist, who (if necessary) will prescribe antidepressants.

Description of stage iv

Therapy of psoriasis and psoriatic arthritis with genetically engineered biological drugs is one of the most promising advances in pharmacotherapy in the group of immunosuppressive and immunomodulatory drugs. These are drugs made from human or animal cells that act on the immune system. There are several types of biological therapies that act at different stages of the inflammatory process. We can sum them up to:

• Anti TNF: they block an important protein in inflammation called tumor necrosis factor (TNF). The administration of drugs can be subcutaneous or intravenous, for which you need to go to a hospital or day center.
• Anti IL-12/23: they block proteins called interleukins (IL) 12 and 23, which are also involved in inflammation, but through a mechanism different from TNF. These drugs are administered subcutaneously.
• Anti-IL 17:, they block a protein known as IL-17, which is found in several cell types, including keratinocytes, and prevents inflammation from developing.