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Vitamin d cream for psoriasis: The Rationale Behind Topical Vitamin D Analogs in the Treatment of Psoriasis

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

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Psoriasis treatment: Synthetic vitamin D

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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.

Ointments with vitamin D for psoriasis

Ointments with vitamin D are non-hormonal ointments that have an anti-inflammatory effect. As you know, severe inflammation occurs in the foci of psoriasis, which causes skin cells to rapidly divide and accumulate on the surface in the form of scales. In the course of scientific research, it was found that after application to the skin, vitamin D (D3) preparations inhibit the division of cells in the surface layer of the skin and reduce the intensity of inflammatory reactions in the skin.

When treating psoriasis with vitamin D preparations , the following rules must be followed:

  • Wash hands thoroughly with soap and water before applying the medicine;
  • The product should only be applied to areas of skin affected by psoriasis;
  • After applying the product to the skin, allow it to absorb on its own. No need to rub it in until completely absorbed;
  • After applying the product, wait at least 30 minutes before bathing, showering or bathing, or before applying any other product to the skin;
  • Avoid getting the medicine in your mouth, nose, eyes, anus, or vagina. If this happens, rinse the area where the medicine has got into with running water;
  • If 2-3 weeks after the start of treatment with these products, the skin condition does not improve, be sure to consult a doctor;
  • Seek immediate medical attention if, after starting treatment, you notice that the psoriasis lesions are getting larger, redder, or itchy;
  • Vitamin D topical preparations should not be used to treat pustular psoriasis.

Currently, the following preparations containing vitamin D derivatives for the treatment of psoriasis can be found on the market: The drug not only removes skin manifestations, but also participates in interrupting the pathological process. It can be used for a long time. Its mechanism of action is to slow down the accelerated division of skin cells. Treatment with Psorkutan begins with the fact that it is applied to several plaques for 1-2 days and the reaction is observed. If there is no allergy, therapy is continued according to the scheme: applying the ointment 2 times a day.

Daivonex is an effective formulation containing calcipotriol for the long-term maintenance treatment of psoriasis vulgaris. It is not accepted during exacerbation and other forms of the disease. The agent is applied to the affected areas, but not more than 30% of the skin surface (1% – 1 of your palm), a larger percentage will increase the absorption surface of the drug, which can lead to negative consequences. Daivonex is applied 2 times a day. During the course of daivonex, sessions of phototherapy and keratolytics should be avoided, a prominent representative of which is salicylic acid. The drug is contraindicated in pregnant and lactating women, children under 6 years of age.

Ointments and lotions containing tacalcitol

Curatoderm (Curatoderm) — inhibits the proliferation of keratin cells, reduces inflammation. When applied topically to psoriatic skin, about 0.5% of its amount is absorbed. It is used for mild and moderate psoriasis once a day at bedtime (up to 8 weeks). The lubricated surface should not exceed 20% of the body surface each time. The drug is contraindicated in pregnant and lactating women, children.

Ointments with calcitriol

Silkis – causes inhibition of keratinocyte proliferation and normalizes their differentiation. It also affects the immune processes in the skin: it inhibits the proliferation of T-lymphocytes and normalizes the production of various anti-inflammatory factors. It is used for mild to moderate severity. The ointment is applied in a thin layer to the affected areas of the skin (on pre-cleansed and dried skin) 2 times a day (morning and evening). Daily use of the ointment should not exceed 35% of the skin surface.