The Rationale Behind Topical Vitamin D Analogs in the Treatment of Psoriasis

1. Rizova E, Corroller M. Topical calcitriol—studies on local tolerance and systemic safety. Br J Dermatol. 2001;144(Suppl 58):3–10. [PubMed] [Google Scholar]

2. Langner A, Ashton P, Van De Kerkhof PC, Verjans H. A long-term multicentre assessment of the safety and tolerability of calcitriol ointment in the treatment of chronic plaque psoriasis. Br J Dermatol. 1996;135(3):385–389. [PubMed] [Google Scholar]

3. Lebwohl M, Yoles A, Lombardi K, Lou W. Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: effects on the duration of improvement. J Am Acad Dermatol. 1998;39(3):447–450. [PubMed] [Google Scholar]

4. Koo J. Population-based epidem-iologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin. 1996;14:485–496. [PubMed] [Google Scholar]

5. Stern RS, Nijsten T, Feldman SR, et al. Psoriasis is common, carries a substantial burden even when not extensive and is associate with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc. 2004;9:136–139. [PubMed] [Google Scholar]

6. Finlay AY, Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol. 1995;132:236–244. [PubMed] [Google Scholar]

7. Rapp SR, Feldman SR, Exum ML, et al. Psoriasis causes as much disability as other major medical disease. J Am Acad Dermatol. 1999;41:401–407. [PubMed] [Google Scholar]

8. Javitz HS, Ward MM, Farber E, et al. The direct cost of care for psoriasis and psoriatic arthritis in the United States. J Am Acad Dermatol. 2002;46(6):850–860. [PubMed] [Google Scholar]

9. National Psoriasis Foundation. [August 21, 2004]. Benchmark survey on psoriasis and psoriatic arthritis. Summary of top line results. http/www.psoriasis.org/files/pdfs/press/npfsurvey.pdf.

10. Nagpal S, Lu J, Boehm MF. Vitamin D analogs: mechanism of action and therapeutic applications. Curr Med Chem. 2001;8(13):1661–1679. [PubMed] [Google Scholar]

11. Wolverton SE. Comprehensive Dermatologic Drug Therapy. 2nd Edition. Phildephia, PA: Saunders Elsevier; 2007. [Google Scholar]

12. Patel V, Horn EJ, Lobosco SJ, et al. Psoriasis treatment patterns: results of a cross-sectional survey of dermatologists. J Am Acad Dermatol. 2008;58(6):964–969. [PubMed] [Google Scholar]

13. Tanghetti EA. The role of topical vitamin D modulators in psoriasis therapy. J Drugs Dermatol. 2009;8(Suppl8):S4–S8. [PubMed] [Google Scholar]

14. Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. J Am Acad Dermatol. 2005;53(Suppl 1):S50–S58. [PubMed] [Google Scholar]

15. Lebwohl M, Ali S. Threatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol. 2001;45(4):487–498. [PubMed] [Google Scholar]

16. Charman CR, Morris AD, Williams HC. Topical corticosteroids phobia in patients with atopic eczema. Br J Dermatol. 2002;142(5):931–936. [PubMed] [Google Scholar]

17. Fouere S, Adjadj L, Pawin H. How patients experience psoriasis: results from a European survey. J Eur Acad Dermatol Venereol. 2005;19(Suppl 3):2–6. [PubMed] [Google Scholar]

18. Afifi T, de Gannes G, Huang C, Zhou Y. Topical therapies for psoriasis: evidence-based review. Can Fam Physician. 2005;51:519–525. [PMC free article] [PubMed] [Google Scholar]

19. Abramovits W. Calcitriol 3µg/g ointment: an effective and safe addition to the armamentarium in topical psoriasis therapy. J Drugs Dermatol. 2009;8(Suppl 8):S17–S22. [PubMed] [Google Scholar]

20. Lehmann B. Role of vitamin D3 pathway in healthy and disease skin—facts, contradictions and hypotheses. Esp Dermatol. 2009;18(2):97–108. [PubMed] [Google Scholar]

21. Van de Kerkhof PC. An update on vitamin D3 analogues in the treatment of psoriasis. Skin Pharmacol Appl Skin Physiol. 1998;11:2–10. [PubMed] [Google Scholar]

22. Yawalker N. Management of psoriasis. Current Probl Dermatol. 2009;38:37–58. [PubMed] [Google Scholar]

23. Kircik L. Efficacy and safety of topical calcitriol 3µg/g ointment, a new topical therapy for chronic plaque psoriasis. J Drugs Dermatol. 2009;8(Suppl8):S9–S16. [PubMed] [Google Scholar]

24. Pearce Dj, Stealey KH, Balkrishnan R, et al. Psoriasis treatment patterns: results of a cross-sectional survey of dermatologist. J Am Acad Dermatol. 2008;58(6):370–374. [Google Scholar]

25. Veien NK, Bjerke JR, Rossmann-Ringdahl I, Jakobsen HB. Once daily treatment of psoriasis with tacalcitol compared with twice daily treatment with calcipotriol. A double-blind trial. Br J Dermatol. 1997;137(4):581–586. [PubMed] [Google Scholar]

26. British Association of Dermatologists. Clinical Guidelines. [March 9, 2009]. Topical Vitamin D Analogues. http://www.bad.or.uk/healthy-care/guidelines/psorvitamin.asp.

27. Bruner CR, Feldman SR, Ventrapragada M, et al. A systemic review of adverse effects associated with topical treatments for psoriasis. Dermatol Online J. 2003;9(1):2. [PubMed] [Google Scholar]

28. Nagpal S, Lu J, Boehm MF. Vitamin D analogs: mechanism of action and therapeutic applications. Curr Med Chem. 2001;8(13):1661–1679. [PubMed] [Google Scholar]

29. Bruce S, Epinette WW, Funicella T, et al. Comparative study of calcipotriene (MC 903) ointment and fluocinonide ointment in the treatment of psoriasis. J Am Acad Dermatol. 1994;31:755–759. [PubMed] [Google Scholar]

30. Wall AR, Poyner TF, Menday AP. A comparison of treatment with dithranol and calcipotriol on the clinical severity and quality of life in patients with psoriasis. Br J Dermatol. 1998;139:1005–1011. [PubMed] [Google Scholar]

31. Menter A, Korman NJ, Elemets CA. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol. 2009;60:643–659. [PubMed] [Google Scholar]

32. Marty JP, Lafforgue C, Grossiord JL, et al. Rheological properties of three different vitamin D ointments and their clinical perception by patients with mild to moderate psoriasis. J Eur Acad Dermatol Venereol. 2005;19(Suppl 3):7–10. [PubMed] [Google Scholar]

33. Barclay L. [February 12, 2010]. www.medscape.com/ http://www.medscape.com/viewarticle/587894.

34. Gottlieb AB, Ford RO, Spellman MC. The efficacy and tolerability of clobetasol propionate foam 0.05% in the treatment of mild to moderate plaque-type psoriasis of nonscalp regions. J Cutan Med Surg. 2003;7(3):185–192. [PubMed] [Google Scholar]

35. Lebwohl M, Menter A, Weiss J, et al. Calcitriol 3µg/g ointment in the management of mild to moderate plaque type psoriasisi: results form two placebo-controlled, multicenter, randomized, double-blind, clinical studies. J Drugs Dermatol. 2007;6(4):428–435. [PubMed] [Google Scholar]

36. Lebwohl M, Ortonne JP, Andres P, et al. Clacitriol ointment 3mg/g is safe and effective over 52 weeks for the treatment of mild to moderate plaque psoriasis. Cutis. 2009;83(4):205–212. [PubMed] [Google Scholar]

37. Ortonne JP, Humbert P, Nicolas JF, et al. Intra-individual comparison of the cutaneous safety and efficacy of calcitriol 3µg/g ointment and calcipotriol 50µg/g ointment on chronic plaque psoriasis localized in facial, hairline, retroauricular or flexural areas. Br J Dermatol. 2003;148(2):326–333. [PubMed] [Google Scholar]

38. Camarasa JM, Ortonne JP, Dubertret L. Calcitriol show greater persistence of treatment effect than beta-methasone dipropionate in topical psoriasis therapy. J Dermatolog Treat. 2003;14(1):8–13. [PubMed] [Google Scholar]

39. Ring J, Kowalzick L, Christophers E, et al. Calcitriol 3mg/g ointment in combination with ultraviolet B phototherapy for the treatment of plaque psoriasis: results of a comparative study. Br J Dermatol. 2001;144(3):495–499. [PubMed] [Google Scholar]

40. Koo JY. New developments in topical sequential therapy for psoriasis. Skin Therapy Lett. 2005;10(9):1–4. [PubMed] [Google Scholar]

41. Gold LS. Calcitriol ointment: optimizing psoriasis therapy. J Drugs Dermatol. 2009;8(Suppl8):S23–S27. [PubMed] [Google Scholar]

42. Kowalzick L. Clinical experience with topical calcitriol (1,25 di-hydorxyvitamin D3) in psoriasis. Br J Dermatol. 2001;144(Suppl 58):21–25. [PubMed] [Google Scholar]

43. Vectical Ointment 3µg/g [package insert] Fort Worth, TX: Galderma Laboratories; 2009. [Google Scholar]

44. Barker JN, Berth-Jones J, Broves R, et al. Calcium homeostasis remains unaffected after 12 weeks’ therapy with calcitriol 3µg/g ointment; no correlation with extent of psoriasis. J Dermatolog Treat. 2003;14(1):14–21. [PubMed] [Google Scholar]

45. Queille-rouseel C, Duteil L, Parneix-spake A, et al. The safety of calcitriol 3µ/g ointment. Evaluation of cutaneous contact sensitization, cumulative irritancy, photoallergic contact sensitization, cumulative irritancy, photoallergic contact sensitization and phototoxicity. Eur J Dermatol. 2001;11:219–224. [PubMed] [Google Scholar]

46. Fouere S, Adjadj L, Pawin H. How patients experience psoriasis: results from a European survey. J Eur Acad Dermatol Venereol. 2005;16(Suppl):2–6. [PubMed] [Google Scholar]

47. Du Vivier A, Stoughton RB. Tachy-phylaxis to the action of topically applied corticosteroids. Arch Dermatol. 1975;111:581–583. [PubMed] [Google Scholar]

Psoriasis treatment: Synthetic vitamin D

Diseases & conditions

• 
  
  Coronavirus Resource Center
  
• 
  
  Acne
  
• 
  
  Eczema
  
• 
  
  Hair loss
  
• 
  
  Psoriasis
  
• 
  
  Rosacea
  
• 
  
  Skin cancer
  
• 
  
  A to Z diseases
  
• 
  
  A to Z videos
  

• DIY acne treatment
• How dermatologists treat
• Skin care: Acne-prone skin
• Causes
• Is it really acne?

• Types & treatments
• Childhood eczema
• Adult eczema
• Insider secrets

• Types of hair loss
• Treatment for hair loss
• Causes of hair loss
• Hair care matters
• Insider secrets

• What is psoriasis
• Diagnosis & treatment
• Skin, hair & nail care
• Triggers
• Insider secrets

• What is rosacea
• Treatment
• Skin care & triggers
• Insider secrets

• Types and treatment
• Find skin cancer
• Prevent skin cancer
• Raise awareness
• Español

Featured

Reduce summertime rosacea flare-ups

The sun, heat, and humidity can all trigger rosacea and lead to flare-ups. Find out how you can enjoy summer while reducing flare-ups.

JAK inhibitors: A newer type of medication

JAK inhibitors are helping patients with alopecia areata, eczema/atopic dermatitis, psoriasis, and vitiligo. Here’s what you need to know.

Everyday care

• 
  
  Skin care basics
  
• 
  
  Skin care secrets
  
• 
  
  Injured skin
  
• 
  
  Itchy skin
  
• 
  
  Sun protection
  
• 
  
  Hair & scalp care
  
• 
  
  Nail care secrets
  

• Basic skin care
• Dry, oily skin
• Hair removal
• Tattoos and piercings

• Anti-aging skin care
• For your face
• For your skin routine
• Preventing skin problems

• Bites & stings
• Burns, cuts, & other wounds

• Itch relief
• Poison ivy, oak & sumac
• Rashes

• Shade, clothing, and sunscreen
• Sun damage and your skin
• Aprenda a proteger su piel del sol

• Your hair
• Your scalp

• Nail care basics
• Manicures & pedicures

Featured

Practice Safe Sun

Everyone’s at risk for skin cancer. These dermatologists’ tips tell you how to protect your skin.

Relieve uncontrollably itchy skin

Find out what may be causing the itch and what can bring relief.

Darker Skin Tones

• 
  
  Skin care secrets
  
• 
  
  Hair care
  
• 
  
  Hair loss
  
• 
  
  Diseases & Conditions
  

• Acne
• Dark spots
• Dry skin
• Light spots
• Razor bumps

• Caring for Black hair
• Scalp psoriasis
• Weaves & extensions

• Central centrifugal cicatricial alopecia
• Frontal fibrosing alopecia
• Hairstyles that pull can cause hair loss

• Acanthosis nigricans
• Acne keloidalis nuchae
• Hidradenitis suppurativa
• Keloid scars
• Lupus and your skin
• Sarcoidosis and your skin
• Skin cancer
• Vitiligo
• More diseases & conditions

Featured

Fade dark spots

Find out why dark spots appear and what can fade them.

Untreatable razor bumps or acne?

If you have what feels like razor bumps or acne on the back of your neck or scalp, you may have acne keloidalis nuchae. Find out what can help.

Cosmetic treatments

• 
  
  Your safety
  
• 
  
  Age spots & dark marks
  
• 
  
  Cellulite & fat removal
  
• 
  
  Hair removal
  
• 
  
  Scars & stretch marks
  
• 
  
  Wrinkles
  
• 
  
  Younger-looking skin
  

Featured

Laser hair removal

You can expect permanent results in all but one area. Do you know which one?

Scar treatment

If you want to diminish a noticeable scar, know these 10 things before having laser treatment.

Botox

It can smooth out deep wrinkles and lines, but the results aren’t permanent. Here’s how long botox tends to last.

Public health programs

• 
  
  Skin cancer awareness
  
• 
  
  Free skin cancer screenings
  
• 
  
  Kids’ camp
  
• 
  
  Good Skin Knowledge
  
• 
  
  Shade Structure grants
  
• 
  
  Skin Cancer, Take a Hike!™
  
• 
  
  Awareness campaigns
  
• 
  
  Flyers & posters
  
• 
  
  Get involved
  

• Lesson plans and activities
• Community grants

Featured

Free materials to help raise skin cancer awareness

Use these professionally produced online infographics, posters, and videos to help others find and prevent skin cancer.

Dermatologist-approved lesson plans, activities you can use

Free to everyone, these materials teach young people about common skin conditions, which can prevent misunderstanding and bullying.

Find a dermatologist

• 
  
  Find a dermatologist
  
• 
  
  What is a dermatologist?
  
• 
  
  FAAD: What it means
  
• 
  
  How to select a dermatologist
  
• 
  
  Your digital health
  
• 
  
  Prior authorization
  
• 
  
  Dermatologists team up to improve patient care
  

• Finding accurate health information
• Health apps
• Wearable medical devices
• Telemedicine
• Taking pictures of your skin
• Protect your information

Featured

Find a Dermatologist

You can search by location, condition, and procedure to find the dermatologist that’s right for you.

What is a dermatologist?

A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Dermatologists care for people of all ages.

Treatment of psoriasis

Aesthetic Dermatology Clinic

Educational materials

Encyclopedia

Procedures

Treatment of psoriasis

Psoriasis is a disease associated with a change in more than 50 genes and subsequent changes in body processes and metabolism. The sooner these shifts are recognized, the sooner they can be corrected. There are three main areas of violations:

• Disorders of carbohydrate metabolism (diabetes),
• Changes in cholesterol levels (associated with damage to blood vessels – pressure, potency, heart attacks, strokes),
• Enhanced immune response – the body fights its own tissues, not just diseases or the micro-organisms (bacteria) that cause them.

It is important to learn to live with psoriasis. By changing your lifestyle and choosing an appropriate diet, you can control the visual manifestations of the disease (the rash may disappear altogether). Also, when controlling the disease, possible complications that can be caused by disorders of carbohydrate and fat metabolism and the functioning of the immune system, characteristic of scaly lichen, are eliminated.

Guidelines for psoriasis

Depending on the severity of the disease process, psoriasis is divided into mild, moderate and severe forms. For classification purposes, evaluate:

• Area of ​​affected skin in percent,
• Redness of existing rash,
• Rash Density,
• Number of scales.

The impact of the rash on quality of life is also evaluated, as an inconspicuous (hidden) rash is much less of a concern than lesions on the face, palms, and genitals.

The most appropriate therapy for psoriasis is determined by the methodological recommendations approved in Latvia, which highlight the types of therapy that are best suited to a particular type and/or severity of psoriasis. These guidelines were developed under the guidance of prof. J. Kisis and were officially adopted in Latvia in 2013. The Guidelines determine which medicines for the treatment of psoriasis are covered by the government. The full contents of the guidelines can be found here.

Therapy of psoriasis

Since psoriasis is a genetically determined general disease of the body, it is important to evaluate all possible processes that improve the effect and prognosis of therapy. A simple treatment of the rash gives only a short-term and insufficient effect. A complete psoriasis treatment includes many factors that can be used to control the disease:

• Top skin care – use only the products and drugs prescribed by your doctor, follow the instructions of the dermatologist, as pharmacy products may not be suitable for all types of psoriasis. Chronic inflammation of the skin contributes to the development of tumors.
• Diet – should be checked for certain digestive disorders (i. e. metabolic disorders, such as insufficient secretion of gastric juices or an allergic reaction to various foods), expressed in intolerance to various substances. There is a risk of developing diabetes. To avoid this, the patient should not take many calories at a time, and should refrain from drinking alcohol (pancreatic disorders).
• Physical activity – varied sports or physical activity can reduce the risk of heart problems (cardiac) – the rhythmic work of the heart contributes to lipid metabolism (lipids or fats are involved in the process of forming the lining of blood vessels, and are also part of the binders of skin cells). Studies have shown that sports people suffer from psoriasis much less.
• It is necessary to be aware of the factors that exacerbate psoriasis, both weather conditions and the change of seasons can cause adverse reactions (allergies, sensitivities). In autumn it can be a temperature difference, and in spring it can be pollen.

Treatments for psoriasis

Treatments for psoriasis are used either directly at the site of the rash or in general (eg medicines for internal use). In order to choose the most appropriate treatment method, it is necessary to take into account not only the type and severity of psoriasis, but also age, gender, occupation, general health, and other factors.

Phototherapy for psoriasis

The beginnings of phototherapy date back to 2000 years ago in ancient Egypt, where a combination of photosensitizing plant extracts (photosensitizing plants contain substances that increase sensitivity to ultraviolet radiation) and sunlight were used to treat skin diseases. Currently, it is one of the most widely used methods in the treatment of psoriasis, which:

• Reduces excessive immune activity (immunosuppressive effect),
• Reduces inflammation,
• Reduces cell overgrowth (antiproliferative effect),
• Has an antibacterial effect.

Narrow spectrum UVB and UVA radiation is used to treat psoriasis with special lamps. UVA/UVB therapy can be used for children and pregnant women and is often combined with other treatments and medications.

Laser therapy for psoriasis

Laser therapy is similar in principle to narrow spectrum UVB phototherapy (NB-UVB 311 nm) and is used to treat localized lesions of psoriasis.

Cryotherapy for psoriasis

Cold therapy is mainly used to treat small lesions. There are few publications on the use of this therapy, and its effectiveness is low, so it is not widely used.

Medicines for psoriasis

Any medicines and preparations should be used only under the supervision of a dermatologist, carefully following the instructions of the doctor. Self-medication of psoriasis can exacerbate the disease, prolong the course of therapy, and also create serious complications.

• Retinoids or synthetic derivatives of vitamin A. They have a high therapeutic activity – they can affect immune cells, return the reproduction and development of keratinocytes (cells that synthesize keratin – a protein that protects the epithelium from damage) within normal limits. They can be used for a long time, and they are suitable for children.
• Cyclosporine A is an immunosuppressive drug. Its effectiveness in psoriasis is associated with its effect on the immune system and the ability to reduce the pathological increased reproduction of keratinocytes in the skin.
• Methotrexate is a drug that inhibits cell metabolism (metabolism), it was originally used to treat cancer, but since the 1970s it has also been approved for the treatment of psoriasis.
• Wobenzym is an over-the-counter drug available in tablet form. It has an anti-inflammatory, anti-edema effect, normalizes the body’s defenses, thins the blood, which allows you to restore the level of digestive enzymes (enzymes) in the body in order to reduce the manifestations of chronic diseases, including psoriasis.

Biological psoriasis medicines

Biological medicines are viruses, serums, toxins, antitoxins, vaccines, blood and blood components or other similar products used to treat or prevent a disease. They improve or restore the body’s ability to fight infection and other diseases. Usually, the drug molecules are large, so they are injected into the subcutaneous layer, muscles or vein.

Biological therapy is used when other treatments for moderate to severe psoriasis have failed. The cost of therapy is high compared to other treatments.

Psoriasis injections

Corticosteroids, a type of steroid hormone used in medicine for various immunological and inflammatory diseases, are used for injections. Injections of these steroids are a suitable method for treating small lesions in a well-defined area of ​​the body, such as the outer surfaces of the hands or fingers. The effect is stable, and a second injection may be needed only after a few months.

Latest treatments for psoriasis

The latest therapy is associated with increased interaction between cells involved in the pathological process of psoriasis (lymphocytes, etc.) using signals from biologically active substances. Biological preparations either block pathological substances (the effect of antibodies) or contain receptors that block the pathological process. The use of this method is limited by its high cost and conditions of use (there should be no inflammatory processes or tumors, an extremely detailed control of exclusion factors, etc.) is required.

State-reimbursed medicines for psoriasis

The list of state-reimbursed medicines includes certain medicines for the treatment of psoriasis. For more information about these medicines and the amount covered by the government, please consult a dermatologist.

OTC psoriasis medicines

This group mainly includes skin care products. Such funds are intended only for symptomatic care (i.e. care for the “visible part” of psoriasis, without correcting metabolic processes, etc.) – they do not treat the psoriasis process in the whole body. It is recommended to choose fragrance-free skin moisturizers.

Shampoos for psoriasis

Various shampoos containing salicylic acid, urea, resin and corticosteroids are used for scalp care. Resin-containing shampoos reduce skin flaking, moisturize the skin, prevent its thickening and reduce itching. Shampoos containing salicylic acid help soften the scalp and remove flakes. Shampoos containing corticosteroids are used briefly to reduce swelling or redness.

Psoriasis soap

It is recommended to avoid detergents that are too aggressive to avoid drying and irritating the skin.

Psoriasis Skin Care

Lipids (the intercellular binder in the skin) are one of the most important constituents of the skin, but conventional cleansers tend to degrease the skin, disrupting the development of the skin’s unique microbial population (the microbiome) which, along with the immune system, provides stability protective barrier of the skin and protects the body from the environment. When caring for the skin, it is important to avoid injury to the skin and not to destroy the protective barrier.

The skin of patients with psoriasis is dry, scaly, contains many viruses. The presence of scales contributes to the development of a psoriatic rash. You should wash yourself with therapeutic cosmetics that spare the fat layer of the skin – they do not destroy it, but cleanse and improve it. After washing, the skin should always be moisturized with products prescribed by a dermatologist – cream, lotion, etc.

Care of nails affected by psoriasis

Nail damage is possible in 80% of patients. Nails are recommended to be cut as short as possible to avoid the appearance of fungus under the exfoliated nail. It is necessary to use gentle detergents, after washing the hands, it is always necessary to apply a moisturizer or lotion. Unsaturated fatty acids, B vitamins, vitamins A, D are important for nail health.

Ointments, creams and lotions for psoriasis

There are three active stages in the process of psoriasis:

• The appearance of a new, bright red rash, among which large scales appear (progressive stage),
• The rash stabilizes and the surface is covered with smaller scales (stationary stage),
• The rash deepens, the scales decrease and take the form of rings (regressive stage).

Appropriate topical agents must be used for each stage. For the progressive stage, these are water-based creams and liquids, for the stationary stage, thicker creams and pastes, and for the progressive stage, fatty creams and ointments. These preparations serve as the main masses to which active medicines are added:

• Salicylic acid is used in combination with other treatments as it removes scales, allowing the drug to penetrate deeper layers. It is offered in concentrations from 2% to 10% and in different forms, and is allowed for use if the area of ​​​​psoriatic lesions does not exceed 20%, since in high doses it can have a toxic effect. Not suitable for diabetics.
• Lactic acid is a keratolytic – a substance that removes large horny formations (dead cells). It is used to exfoliate scales. Alternative product if more than 20% of the skin area needs to be covered, or for diabetic patients.
• Corticosteroids are widely used to treat localized psoriatic rashes, as they constrict blood vessels, suppress inflammation and itching, and slow cell reproduction.
• The action of resin preparations is based on the suppression of cell growth. Most often, such preparations contain birch tar (Oleum Rusci) and pine tar (Pixliquida), less often coal tar (Pixlithanthracis).
• The action of the synthesized vitamin D3 (calcitriol, calcipotriol) is based on the effect on the immune system and a decrease in the reproduction of keratinocytes.
• Tacrolimus and pimecrolimus (topical calcineurin inhibitors) are effective in the treatment of psoriasis on the face, neck, genitals, folds. The drugs do not cause muscle relaxation, so they are suitable for long-term use.
• Magnipsor ointment does not contain hormonal additives and toxic substances. The active substances are mineral components, Dead Sea salt, salicylic acid, tea tree, pumpkin, sea buckthorn oils, burdock root extract, etc.

The choice of remedy depends on the rash in a specific area of ​​the body.

Traditional methods and natural remedies for psoriasis

Always consult a dermatologist before using any natural preparations, as in combination with the medications taken, they can cause unwanted reactions. The effect of these drugs has not been proven, and it must be taken into account that natural remedies can also cause allergic reactions.

• Aloe – has properties that reduce redness and peeling.
• Apple Cider Vinegar – used by ancient cultures as a disinfectant, may help relieve itchy scalp.
• Chile pepper contains capsaicin – it blocks the nerve endings responsible for the conduction of the pain signal. Products containing it can reduce pain, inflammation, redness, peeling.
• Bath with Dead Sea salt dissolved in warm water can remove scales and reduce itching in 15 minutes. After taking a bath, apply a moisturizer to the skin.
• Oats are considered the best natural skin soothing agent. A bath with oats in water can reduce itching and redness.
• Tea tree oil has antiseptic properties. Shampoos containing it fight the manifestations of psoriasis on the scalp.
• Turmeric or yellow ginger has anti-inflammatory and antioxidant properties. Curcumin, which is part of it, can counter flare-ups of psoriasis. Turmeric can be used in capsules, in concentrated form, or added to food (various curry dishes, etc.).
• Flax seeds contain Omega-3 fatty acids, fiber and other important nutrients. Omega-3 fatty acids improve the functioning of the immune system and skin condition. They are essential fatty acids that the body cannot synthesize on its own and can only be taken in through food. Omega-3s are also found in hemp seeds, walnuts, leafy greens, and various fish.

Diet for psoriasis

Psoriasis is associated with lipid (fat), carbohydrate (sugar) and sometimes gluten (grain) metabolism problems caused by inborn changes in metabolism (gene disorders).

Metabolism begins with the release of digestive enzymes (enzymes), the interaction of the totality of microbes (microbiome) of the intestinal tract with the body, the absorption of nutrients by the body. Energy is needed to process substances and use them in processes.

If the characteristics of the body, digestion and metabolism are not studied, it is recommended to eat small portions at least 4 times a day. It is recommended to use unsaturated fatty acids (Omega-3, etc.), B vitamins, vitamin D. With psoriasis, you should stop eating easily digestible carbohydrates – white bread, potatoes. Alcohol, nicotine and preservatives harm the flora of the intestinal tract – moderate consumption of probiotic bacteria or probiotics (cultures of living organisms that favorably affect the digestive tract) is recommended to care for it.

Acupuncture for psoriasis

Acupuncture is widely used to treat psoriasis in China and other Asian countries. During therapy, a needle is inserted into the skin, with a diameter no larger than the hair of the head. As a result of the injection, adenosine, endorphins, serotonin and other substances with analgesic properties are released in the body, so this method can be used for psoriatic arthritis.

Influence of the seasons on psoriasis

When the external temperature changes, the metabolism also changes, and the skin begins to lack fatty acids, and the skin’s protective barrier is weakened. As soon as there is a lack of vitamin D in the skin, it becomes drier, recovers worse and is more susceptible to environmental influences – prerequisites for an outbreak of chronic skin diseases (dermatoses) appear.

Heating in the winter season, artificial ventilation, the need for clothing, sweating, being in a crowd with different microflora impair the physiology and self-regulation of the skin. With the advent of spring, the skin barrier becomes weaker than in autumn, and it is easily overcome by spring allergens – flowering trees, pollen, grasses.

In a small percentage of patients with psoriasis (up to 20%), the skin condition worsens from UV rays. The summer type of psoriasis is characterized by a lack of antioxidants that could protect the skin from increased free radicals resulting from sun exposure and rashes in sun-exposed areas.

Being aware of the exacerbations caused by the change of seasons, the manifestations of the disease can be controlled by relaxing in the resorts.

Psoriasis resorts or balneotherapy

The beneficial effects of climatherapy throughout the world have been described for over 200 years, and are associated with certain geographical regions and specific places located in them. The effect of spa therapy is primarily associated with the ability to relax from daily stress and avoid factors that worsen the condition of the skin (for example, dry air due to central heating). It is also possible to adjust the mode and rhythm of food.

Certain procedures can replenish the amount of water in the skin, exfoliate old skin, slow down cell reproduction and defective cell cycles.

The most important resort for the treatment of psoriasis is the Dead Sea, the lowest point on earth (360 m below sea level), it has a high concentration of natural minerals, and mineral vapors filter out narrow spectrum UVB rays (as in phototherapy). Studies have shown that patients who sunbathe and bathe in the Dead Sea salts experience an improvement in psoriasis in 83% of cases, those who only sunbathe – in 73% of cases, and those who only bathe in the Dead Sea – in 28% of cases.

Balneotherapy (a set of various therapeutic actions aimed at moisturizing dry skin) has a special place in the long-term treatment of psoriasis, but is not recommended for patients with increased photosensitivity (summer type of psoriasis) and diseases with a high risk of skin cancer. This type of therapy is not used for acute treatment or short-term therapy.

Prevention of psoriasis

In order to avoid exacerbation or development of a skin disease, many factors must be taken into account, both lifestyle changes and different activities:

• Physical activity (exercise, etc.),
• Holiday resorts,
• Avoid stress,
• Limit coffee, cocoa, alcoholic beverages and smoking,
• Thoughtful nutrition (avoid too fatty foods),
• Avoid hypothermia,
• Restrict the use of household chemicals and cosmetics,
• Improve metabolism (drink more fluids, etc.),
• Monitor vitamin D, folic acid and lipids by a physician,
• Consume Omega 3/6,
• And other actions prescribed by the treating dermatologist.

Is psoriasis curable?

No, because medicine has not yet found a way to change the human genetic code. The disappearance of the rash means the suspension of the disease process. An experienced doctor can help choose the most suitable lifestyle (diet, exercise, skin care) and the necessary treatment regimen for the patient’s metabolic characteristics.

Early diagnosis and correct lifestyle, skin care and therapy prolong life (statistics show that psoriasis patients who develop the disease in childhood find it difficult to reach the age of 60, mainly due to diseases of the circulatory system ).

Where to treat psoriasis?

The human skin is its largest organ, and proper care of it prevents the further development of the disease (pathological process). Symptoms of psoriasis initially appear on the skin. The functional state of the skin and nails is directly related to the course of therapy (both local and internal), the effectiveness of which is evaluated by a skin expert – a dermatologist.

The treatment of psoriasis is very difficult. It is not diagnostics (determining the type of scaly lichen) that makes it difficult, but precisely its understanding and consideration of patterns. Only highly qualified doctors can recognize patterns after analyzing the data.

The doctors of our clinic have knowledge of the microsymptoms of the disease (small, hardly noticeable and previously unrelated symptoms), which allows them to recognize the disease already at the initial stage. In the process of treatment, doctors determine the relationship of a skin disease with the body, its activities and metabolic disorders. Our specialists are also well versed in the features of scaly lichen in children.

In 2013 in Latvia, developed under the guidance of prof. J. Kisis first guidelines for psoriasis ( for explanations of the guidelines, see the beginning of article ). In 2016, Professor J. Kisis participated in the development of guidelines for the use of biological agents in the treatment of psoriasis. The clinic has participated in many clinical trials (full list here), of which 6 were related to psoriasis.

Professor J. Kisis is the leading Latvian specialist in psoriasis, and the clinic always has the latest information about innovations in the treatment of psoriasis around the world.

Experience with vitamin D in the treatment of psoriasis

Psoriasis is one of the most common immunological diseases in the practice of a dermatologist. To date, more and more techniques are being developed to treat psoriasis, influencing various mechanisms of its development.

One such remedy is vitamin D and its analogues in various forms (ointment, lotion, cream). The mechanism of action of this vitamin is associated with inhibition of the proliferation of pathological keratinocytes and an increase in their differentiation, as well as with a weakening of the immune response in psoriasis.

Modern approach to the cause of psoriasis

Various approaches and options for the treatment of psoriasis

Experience in the use of vitamin D and its analogues for the treatment of psoriasis

Modern approach to the cause of psoriasis

At the moment, most specialists immune skin diseases . Moreover, the role in pathogenesis is assigned, first of all, to T-lymphocytes, which receive information about their own keratinocytes as antigens, as a result of which the production of autoantibodies to them occurs, which is carried out in the epidermis and papillary dermis.

In response to this, due to the constant destruction of the skin, there is a constant stimulation of cell division in the pathological focus, which leads to hyperproliferation.

It has also been proven that psoriasis is inherited – the formation of autoantigens is due to the major histocompatibility complex (HLA). The implementation of the autoimmune process in manifestations on the skin is completed by antigen-presenting cells and anti-inflammatory mediators (cytokines).

In the development of psoriasis, the main place is given to autoimmune mechanisms based on the production of autoantibodies to the cells of the epidermis and the papillary layer of the skin. Inheritance of the major histocompatibility complex (HLA) plays an important role in the mechanism of psoriasis development.

Accounting for clinical features in the treatment of psoriasis

To select a method for treating psoriasis, one should take into account the most well-known clinical features in dermatology:

• Koebner’s phenomenon – a tendency to increased formation of psoriatic plaques in places that are often amenable to traumatization.
• Frequent spontaneous recurrence of psoriatic lesions
• Visible effect of treatment (absence of characteristic manifestations and inflammation) only after a decrease in the overall proliferation activity of the skin (usually temporary, until the next relapse).

Psoriasis of the scalp: diagnosis and methods of its treatment?

Such features of the inflammatory process are due to the autoimmune mechanism of psoriasis development described above. However, one should not forget about the possibility of a cross-reaction to antigens in the tissue components of the joints, or streptococcal proteins, which also makes the role of the microbial focus in the body in the development of psoriasis important.

Various approaches and options for the treatment of psoriasis

Taking into account the above factors of pathogenesis and clinical forms of psoriasis of different severity (dot-shaped, drop-shaped, numular, plaque, large-plaque, diffuse-plaque, psoriatic erythroderma), the presence and severity of complications (psoriatic arthropathy, pustular psoriasis, generalized psoriasis) offers various treatment options for psoriasis.

Types of therapy for psoriasis

1. Systemic therapy with glucocorticoids and cytostatics. Among cytostatics, cyclosporine is most often used, which has an immunosuppressive effect and thus regulates the immune response in psoriasis. In this case, the drug acts on the T-cell link of immunity. However, the use of such powerful cytostatics entails the risk of infectious diseases and malignancies.

2. In addition to systemic therapy, topical (local) therapy with corticosteroids aimed at immunosuppression and anti-inflammatory action.

Stress and its role in the development of psoriasis?

ation and keratinization in the affected layers of the skin. However, therapy with these drugs, due to increased resorption of the drug through the skin, has a number of side effects – a teratogenic effect when used in pregnant women, as well as a weak irritant effect on the skin, therefore, at the moment, topical treatment is limited to them.

4. One of the promising and effective methods of topical therapy of psoriasis at the moment is the treatment of with vitamin D preparations , primarily calcipotriol, as well as its analogues – tacalcitol and calcitriol. The advantage of these drugs lies primarily in their antiproliferative and prodifferentiating action, which is carried out through a specific action on vitamin D receptors.

Experience with the use of vitamin D and its analogues for the treatment of psoriasis

The positive results of treatment with vitamin D preparations are described in numerous studies and confirmed by practice. Inhibition of the proliferation of pathological keratinocytes, which play an important role in the development of psoriasis, is carried out due to the direct binding of vitamin D to the receptors of these cells.

The advantage of vitamin D preparations is that they easily penetrate the cell membrane due to the production in optimal dosage forms of topical action – ointments, creams, lotions.

Three main modern treatments for psoriasis?

The anti-inflammatory effect of vitamin D preparations is also important, which are realized by inhibiting the production of inflammatory mediators in the skin – interleukins and interferons.