What are the key factors contributing to psoriasis development. How does diet and lifestyle impact psoriasis severity. What natural remedies and treatments can help manage psoriasis symptoms. How is psoriasis linked to other health conditions. What are the latest research findings on psoriasis management.

Understanding Psoriasis: A Chronic Inflammatory Skin Condition

Psoriasis is a persistent inflammatory skin disorder characterized by thick, raised, bright red and pink plaques covered with silvery scales. Plaque psoriasis, the most common form, typically affects the scalp, elbows, knees, and back. The condition impacts between 1% and 8.5% of adults worldwide, with higher prevalence rates observed farther from the equator. In the United States, approximately 2% of the population is affected.

The onset of psoriasis often peaks during the fourth decade of life, with a second peak occurring between ages 50 and 69. While less common in children, psoriasis can affect individuals of all ages. Understanding the nature of this condition is crucial for effective management and treatment.

What causes psoriasis?

Psoriasis is primarily considered an immune system disorder that leads to the production of proinflammatory cytokines and abnormal skin cell production and maturation. While genetics play a significant role in psoriasis development, various behavioral and environmental factors can influence the disease’s course:

• Infections
• Stress
• Physical trauma
• Certain medications
• Smoking
• Obesity
• Alcohol consumption

Interestingly, smoking cessation has been linked to a decrease in psoriasis incidence, highlighting the importance of lifestyle factors in managing the condition.

Psoriasis and Associated Health Conditions

Psoriasis is not just a skin-deep issue. The condition has been associated with several comorbidities that can significantly impact overall health and quality of life. These associated conditions include:

1. Psoriatic arthritis
2. Cardiovascular disease
3. Depression
4. Diabetes
5. Metabolic syndrome
6. Nonmelanoma skin cancer

Given these associations, it’s crucial for individuals with psoriasis to undergo regular screenings for these conditions and address them promptly when present. A holistic approach to psoriasis management should consider not only skin symptoms but also overall health and well-being.

Holistic Skin Care Approaches for Psoriasis Management

Effective psoriasis management often begins with gentle, nurturing skin care practices. These approaches can help minimize itching and reduce the risk of trauma-induced flares:

How can bathing practices benefit psoriasis patients?

Bathing in lukewarm water using non-detergent-based cleansers, such as soapless cleansers or glycerin-based soaps, can be beneficial. It’s important to avoid abrasive cleansing devices, as these can traumatize the skin and exacerbate psoriasis symptoms.

What role do moisturizers play in psoriasis care?

Applying thick moisturizing creams or ointments, especially while the skin is still damp, can help keep psoriatic skin soft and less vulnerable to itching and trauma. Natural oils like avocado, coconut, almond, or olive oil can be particularly helpful in this regard.

Are there natural remedies that can soothe psoriasis symptoms?

Colloidal oatmeal, used as an emollient or bath powder (such as Aveeno), can help soothe itching and irritation associated with psoriasis. This natural remedy has been used for centuries to calm inflamed skin and provide relief from various skin conditions.

The Impact of Diet on Psoriasis Management

While dietary studies specifically focused on psoriasis are limited, emerging research suggests that dietary choices can play a significant role in managing the condition. An anti-inflammatory or Mediterranean-style diet has been found to enhance many aspects of health, especially in the context of inflammatory diseases like psoriasis.

How can an anti-inflammatory diet benefit psoriasis patients?

An anti-inflammatory diet may contribute to less severe psoriasis symptoms. This dietary approach focuses on foods that inhibit rather than promote inflammation in the body. Some key components of an anti-inflammatory diet include:

• Fruits and vegetables
• Whole grains
• Lean proteins
• Healthy fats (e.g., olive oil, avocados, nuts)
• Omega-3 fatty acids (found in fatty fish, flaxseeds, and walnuts)

Additionally, a plant-based, anti-inflammatory approach to diet can help manage comorbidities associated with psoriasis, providing a comprehensive health benefit.

Can weight loss diets improve psoriasis symptoms?

For overweight and obese patients with psoriasis, diets that promote weight loss (e.g., low-calorie diets) have been found to be beneficial. However, it’s crucial to ensure that any weight loss diet provides adequate nutritional intake. Consulting with a registered dietitian can be helpful in developing a balanced, psoriasis-friendly eating plan.

Is there a connection between gluten and psoriasis?

Some patients with psoriasis have reported improvement in their symptoms when following a gluten-free diet. While the connection between gluten and psoriasis is not fully understood, individuals with elevated markers for celiac disease (such as tissue transglutaminase antibodies) may benefit from eliminating gluten from their diet. However, it’s important to consult with a healthcare provider before making significant dietary changes.

Lifestyle Modifications for Psoriasis Management

Beyond diet, several lifestyle factors can significantly impact psoriasis severity and overall health. Addressing these factors can lead to improved psoriasis management and better quality of life.

How does smoking affect psoriasis?

Smoking has been clearly implicated in both the onset and severity of psoriasis. Studies have shown that the incidence of psoriasis decreases after successful smoking cessation. For individuals with psoriasis who smoke, quitting can be an important step in managing their condition.

What role does alcohol consumption play in psoriasis?

Increased alcohol intake has been associated with more severe psoriasis symptoms. Reducing alcohol consumption or abstaining entirely may help improve psoriasis management and overall health.

How can stress management benefit psoriasis patients?

Stress is a known trigger for psoriasis flares. Implementing stress-reduction techniques such as meditation, yoga, deep breathing exercises, or regular physical activity can help manage stress levels and potentially reduce the frequency and severity of psoriasis flares.

Medications and Psoriasis: Understanding the Connection

Certain medications have been known to worsen psoriasis symptoms. It’s important for individuals with psoriasis to be aware of these potential interactions and discuss them with their healthcare providers.

Which medications can exacerbate psoriasis symptoms?

Several medications have been associated with psoriasis flares or worsening of symptoms:

• Lithium
• Beta-blockers
• Antimalarials
• Interferon
• Rapid tapers of systemic corticosteroids

If you’re taking any of these medications and experiencing worsening psoriasis symptoms, it’s important to consult with your healthcare provider. They may be able to adjust your treatment plan or suggest alternative medications that are less likely to impact your psoriasis.

Innovative Approaches in Psoriasis Research and Treatment

As our understanding of psoriasis continues to evolve, researchers are exploring new avenues for treatment and management of this complex condition. Some of the most promising areas of research include:

What role do microbiome studies play in psoriasis research?

Recent studies have begun to explore the relationship between the skin microbiome and psoriasis. The microbiome refers to the community of microorganisms that live on and in our bodies. Researchers are investigating how changes in the skin microbiome may contribute to psoriasis development and whether manipulating the microbiome could offer new treatment possibilities.

How are targeted therapies changing psoriasis treatment?

Advancements in our understanding of the immune pathways involved in psoriasis have led to the development of targeted therapies. These treatments, often in the form of biologic drugs, aim to block specific components of the immune system that contribute to psoriasis symptoms. While these therapies can be highly effective, ongoing research is focused on improving their efficacy and minimizing potential side effects.

What potential does personalized medicine hold for psoriasis treatment?

The field of personalized medicine, which tailors treatment to an individual’s genetic profile and specific disease characteristics, holds great promise for psoriasis management. Researchers are working to identify genetic markers that could predict treatment response, allowing for more targeted and effective treatment strategies.

The Psychological Impact of Psoriasis: Addressing Mental Health

While the physical symptoms of psoriasis are often the primary focus of treatment, the psychological impact of the condition should not be overlooked. Psoriasis can significantly affect an individual’s mental health and quality of life.

How does psoriasis affect mental health?

Living with psoriasis can lead to various psychological challenges, including:

• Low self-esteem
• Anxiety
• Depression
• Social isolation
• Stigma and discrimination

These psychological effects can, in turn, exacerbate psoriasis symptoms, creating a vicious cycle. Addressing mental health is crucial for comprehensive psoriasis management.

What strategies can help manage the psychological impact of psoriasis?

Several approaches can help individuals cope with the psychological aspects of psoriasis:

1. Cognitive Behavioral Therapy (CBT): This form of therapy can help individuals develop coping strategies and change negative thought patterns associated with their condition.
2. Support Groups: Connecting with others who have psoriasis can provide emotional support and practical advice for managing the condition.
3. Mindfulness Practices: Techniques such as meditation and mindfulness can help reduce stress and improve overall well-being.
4. Body Image Work: Working with a therapist to improve body image and self-acceptance can be beneficial for many individuals with psoriasis.
5. Education: Understanding psoriasis and its treatments can help individuals feel more in control of their condition and reduce anxiety.

By addressing both the physical and psychological aspects of psoriasis, individuals can work towards better overall health and improved quality of life.

Complementary and Alternative Therapies for Psoriasis Management

While conventional medical treatments remain the cornerstone of psoriasis management, many individuals also explore complementary and alternative therapies to help manage their symptoms. It’s important to note that while some of these approaches show promise, more research is often needed to fully understand their efficacy and safety.

Can herbal remedies help manage psoriasis symptoms?

Several herbal remedies have been traditionally used to manage psoriasis symptoms:

• Aloe vera: Known for its soothing properties, aloe vera gel may help reduce redness and scaling associated with psoriasis.
• Oregon grape (Mahonia aquifolium): This herb contains compounds that may help slow skin cell growth and reduce inflammation.
• Turmeric: The active compound in turmeric, curcumin, has anti-inflammatory properties that may benefit psoriasis patients.

While these remedies may offer some relief, it’s crucial to consult with a healthcare provider before using any herbal treatments, as they can interact with other medications and may not be suitable for everyone.

What role does acupuncture play in psoriasis management?

Acupuncture, a key component of traditional Chinese medicine, has been explored as a complementary therapy for psoriasis. Some studies suggest that acupuncture may help reduce inflammation and itching associated with psoriasis. However, more research is needed to fully understand its effectiveness in psoriasis management.

How can mind-body practices benefit individuals with psoriasis?

Mind-body practices such as yoga, tai chi, and qigong can offer several benefits for individuals with psoriasis:

1. Stress reduction: These practices can help manage stress, a known trigger for psoriasis flares.
2. Improved circulation: Gentle movement can enhance blood flow, potentially benefiting skin health.
3. Enhanced overall well-being: Regular practice of these techniques can contribute to better physical and mental health.

While these practices may not directly treat psoriasis, they can be valuable components of a holistic approach to managing the condition and its associated stress.

The Future of Psoriasis Research and Treatment

As our understanding of psoriasis continues to grow, researchers are exploring new avenues for treatment and management. These emerging areas of research hold promise for improving the lives of individuals with psoriasis.

How might nanotechnology impact psoriasis treatment?

Nanotechnology is an exciting frontier in psoriasis research. Scientists are exploring ways to use nanoparticles to deliver medications more effectively to the skin, potentially improving treatment efficacy while reducing side effects. This approach could lead to more targeted and efficient psoriasis therapies in the future.

What role might artificial intelligence play in psoriasis management?

Artificial intelligence (AI) and machine learning are beginning to make inroads in psoriasis research and management. These technologies could potentially:

• Improve diagnosis accuracy by analyzing skin images
• Predict treatment responses based on patient data
• Personalize treatment plans by analyzing vast amounts of clinical data

While still in its early stages, the integration of AI into psoriasis care could lead to more precise and effective management strategies.

How might gene therapy shape the future of psoriasis treatment?

Gene therapy represents a cutting-edge approach to treating genetic conditions like psoriasis. Researchers are exploring ways to correct or modify the genes associated with psoriasis, potentially offering a long-term solution for managing the condition. While gene therapy for psoriasis is still in the experimental stages, it represents an exciting frontier in psoriasis research.

As research in these areas continues to progress, individuals with psoriasis can look forward to potentially more effective and personalized treatment options in the future. However, it’s important to remember that current management strategies, including lifestyle modifications, appropriate skin care, and existing medical treatments, remain crucial in managing psoriasis symptoms and improving quality of life.

Psoriasis – Whole Health Library

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Psoriasis

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Background

Psoriasis is a chronic inflammatory skin disease that is characterized by thick, raised, bright red and pink plaques with a silvery scale. The most common form is plaque psoriasis, which typically involves the scalp, elbows, knees, and back. It is estimated to affect between 1% and 8.5% of adults worldwide and becomes more common with increased distance from the equator. In the United Sates, it affects about 2% of the population. Psoriasis is much less commonly seen in children. The onset of psoriasis peaks in the fourth decade and again between the ages of 50 and 69.

Psoriasis is generally regarded as a disorder of the immune system that leads to the production of proinflammatory cytokines and overproduction and abnormal maturation of the outer layer of skin cells. While genetics plays a big role in the development of psoriasis, behavioral and environmental factors clearly influence the course of the disease. Infections, stress, trauma, and certain medications are known to initiate or worsen flares in people who have a genetic predisposition to developing psoriasis. Additionally, smoking is clearly implicated in the onset and severity of psoriasis, with the incidence of psoriasis decreasing after successful smoking cessation. Psoriasis has been linked with higher body mass index and increased alcohol intake as well. Finally, some medications are known to worsen psoriasis. These include lithium, beta-blockers, antimalarials, interferon, and rapid tapers of systemic corticosteroids.

Psoriasis is associated with several comorbidities including arthritis (psoriatic arthritis), cardiovascular disease, depression, diabetes, and metabolic syndrome, and nonmelanoma skin cancer.[1] It is important to screen for these and address them when present.

Treatment

Skin Care

Gentle skin care can help minimize itching and limit trauma-induced flares. Bathing in lukewarm water using non-detergent-based cleansers such as soapless cleansers or glycerin-based soaps is an important first step. Abrasive cleansing devices should be avoided because these can be traumatic to the skin and actually worsen psoriasis. Finally, applying thick moisturizing creams or ointmentsespecially while the skin is still dampwill help keep psoriatic skin soft and less vulnerable to itching and trauma. Natural oils such as avocado, coconut, almond, or olive can be very helpful. Colloidal oatmeal in the form of an emollient or bath powder (such as Aveeno) can also help soothe itching and irritation from psoriasis.

Food & Drink

Healthy dietary choices are important for overall health. Anti-inflammatory or Mediterranean-style dietary approaches have been found to enhance many aspects of healthespecially in the setting of inflammatory diseases. Psoriasis is an inflammatory condition and will likely improve when dietary choices better align with foods that inhibit rather than promote inflammation. Dietary studies in psoriasis are limited, but there are a few that indicate an anti-inflammatory diet contributes to less-severe disease. [2] Additionally, a plant based, anti-inflammatory approach to diet will help with the comorbidities associated with psoriasis. More information about these dietary approaches can be found in the Whole Health tool Choosing a Diet.

Diets that promote weight loss (e. g., low-calorie diets) have been found to be beneficial in overweight and obese patients with psoriasis.[3] It is important to make sure that the specific diet followed ensures adequate nutritional intake. Involving the aid of a dietician may be helpful.

Additionally, some patients with psoriasis have experienced improvement on a gluten-free diet.[4] Elevated markers for celiac disease (tissue transglutaminase antibodies and endomysial antibodies) have been found in some patients with psoriasis as well, and in these patients, disease severity appears to correlate with circulating levels of these markers.[5][6] Asking about family history of gluten sensitivity and about gastrointestinal symptoms of flatulence, diarrhea, and iron deficiency anemia may suggest sensitivity to gluten. Testing for these markers may help identify those patients who are most likely to benefit from a gluten-free diet. Find more information about how to eliminate gluten refer to the Whole Health tool Elimination Diets.

Supplements

Note: Please refer to the Passport to Whole Health, Chapter 15 on Dietary Supplements for more information about how to determine whether or not a specific supplement is appropriate for a given individual. Supplements are not regulated with the same degree of oversight as medications, and it is important that clinicians keep this in mind. Products vary greatly in terms of accuracy of labeling, presence of adulterants, and the legitimacy of claims made by the manufacturer.

Omega-3 Fatty Acids

Omega-3 fatty acids have been shown to decrease the production of inflammatory compounds. Studies looking at the effects of increased intake of fish high in omega-3 fatty acids and at the effects of omega-3 fatty acid supplementation on psoriasis have found benefit.[7][8][9] However, the data is not entirely supportive. A recent meta-analysis concluded that fish oil supplementation does not result in significant improvement in psoriasis. [10] Another review looked at 12 articles and found the evidence to be inconclusive.[11] It appears that the ratio of omega-3 to omega-6 fatty acids is important and dietary differences of the subjects could explain why the results are inconclusive.

Ideally, omega-3 fatty acids should come from foods such as fatty fish (salmon, mackerel, and sardines), flaxseeds, and walnuts. When that is not possible, supplements can be helpful. Fish oil has also been shown to minimize the side effects of systemic therapies for psoriasis.

• Dose: 640-3,500 mg EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) daily[12][13]

Curcumin

Curcumin is the active component of turmeric. It has been shown to inhibit proinflammatory pathways important in psoriasis.[14] Studies evaluating clinical use have been limited, but the spice is very safe. Clinical studies have found it safe at doses up to 8-12 gm/day with the only side effects being reversible gastrointestinal problems (nausea and diarrhea). [15]

• Dose: 1,500 mg up to three times a day[16]

Vitamins and Minerals

Vitamin D

One study found that vitamin D levels were decreased in patients with psoriasis when compared to age-matched controls, and it appears that the level of vitamin D deficiency correlates with disease severity.[17] For patients who are deficient in vitamin D, supplementation can be helpful, but it is not recommended for people with psoriasis who are not found to be deficient.[18] Given the role vitamin D plays in other chronic inflammatory diseases such as cardiac disease, autoimmune diseases, and diabetes, checking a patients vitamin D level and/or conservative supplementation may be helpful.

• Dose[19]:
  • 600 IU/day for supplemental uses
  • 1,000 IU/day for treatment of vitamin D deficiency
  • 4,000 IU/day is the current suggested upper limit*

*More recent research suggests that doses up to 10,000 IU/day are safe and that the upper limit should be set at this level. [20] Above 10,000 IU/day a person should be in the care of a physician and monitored for signs of vitamin D toxicity, which includes of hypercalcemia (headache, nausea, vomiting, abdominal pain, increased urination, and thirst).

Zinc

Zinc is a cofactor in many reactions important in maintaining skin health and immune function and has been shown to have anti-inflammatory properties. Most clinical studies looking at zinc supplementation for treatment of psoriasis have not shown benefit. However, there are case reports of zinc therapy resulting in improvement of psoriasis, and some clinicians who have used zinc supplements for patients with psoriasis feel strongly that it can be beneficial for some patients.

It is likely that the formulation of zinc is important, and it appears that effervescent preparations of zinc, zinc picolonate, and methionine-bound zinc are more bioactive than other formulations such as zinc gluconate.

• Dose:
  • 30-50 mg elemental zinc a day[21]*
  • 220 mg zinc sulfate (50-90 milligrams elemental zinc depending on the preparation) 1-3 times a day[22]

*At doses higher than 30 mg a day, zinc can induce a copper deficiency; 2 mg of copper should be added for every additional 30 mg of elemental zinc.

Food sources: oysters, beef, poultry (dark meat), pork, beans, nuts

Selenium Topical Botanicals

Aloe Vera

Aloe vera is a succulent plant whose thick leaves contain an inner pulpy mucilaginous gel. The compounds in aloe vera have been found to have anti-inflammatory and anti-itch properties, as well as pain reduction and wound healing effects. Various preparations have been found effective in the treatment of psoriasis.

Development of contact dermatitis is possible but appears to be rare.

• Dose:
  • Aloe vera gel applied two to multiple times a day[23]
  • 0.5% extract in cream applied three times a day[24]
  • Cream containing 70% aloe mucilage applied twice a day[25]

Indigo Naturalis Extract

Indigo naturalis extract has been shown to decrease markers of cell proliferation and inflammation seen in psoriasis. An 8-week, side-by-side trial where 14 people with chronic plaque psoriasis applied either 5% indigo or vehicle placebo to contralateral sides of the body were evaluated with both objective measures of psoriasis severity as well as with biopsies. Ki-67 (a marker for skin cell proliferation) and CD3 (an inflammatory marker seen in psoriasis) were both decreased.[26]

• Dose: 3%-7% ointment, cream, or oil applied 1-2 times a day

Glycerrhetinic Acid

Glycyrrhetinic acid is a component from licorice root that has inhibitory activity on the enzyme 11-beta-hydroxysteroid dehydrogenase which is responsible for inactivating cortisol. It has been shown to potentiate the action of hydrocortisone in the skin. [27] Glycyrrhetinic acid has also been shown to have anti-inflammatory properties as well [28]. One review looked at 11 randomized controlled trials in which topical glycyrrhetinic acid was used along with conventional therapy for psoriasis. The glycyrrhetinic acid enhanced the response, with a greater number of people experiencing significant improvement. Adverse reactions were the same with and without the addition of glycyrrhetinic acid. [29]

• Dose: 2% glycyrrhetinic acid cream or ointment once to twice a day

Mahonia Aquafolium

Also known as Oregon grape, Mahonia aquafolium contains berberine, which has anti-inflammatory and antimicrobial activities. It is a compound that can be helpful in treatment of psoriasis. It has been shown to decrease 5 lipoxygenase activity, reduce levels of inflammatory cytokines, and decrease expression of keratins 6 and 16, which are overexpressed in psoriatic plaques. Berberine also appears to decrease keratinocyte proliferation.[30] Topical treatment with M. aquafolium appears to surpass treatment with calcipotriene, and it is safe. Potential side effects reported include itching, burning, and rash.

• Dose: 10% Mahonia aquafolium cream or ointment once or twice a day.

Capsaicin

Itching is caused by a compound called substance P, which has been found to be higher in skin affected by psoriasis. Capsaicin is a compound extracted from the red pepper that causes depletion of substance P. It has been shown to decrease the sensation of itch in psoriasis.

It can cause a burning sensation that usually only lasts a few days with continued use.

• Dose:
  • 0.025% cream applied 4 times per day[31]
  • 0.075% cream is also available

Topical Over-the-Counter Medications

Keratolytics

Keratolytics are compounds that break down the outer layers of the skin. This class of compounds includes salicylic acid (2%-10%), urea (20%-40%) and alpha-hydroxy acids (glycolic and lactic acids). They can help to decrease the thickness of psoriatic plaques, which can lead to increased comfort, decreased itching as well as better absorption of other topical medications.

• Dose: Compounds with 2%-10% salicylic acid, 20%-40% urea, or alpha-hydroxy acids applied once to several times a day as long as they do not cause irritation

Tar

Tar-based products are either derived from coal or from wood (pine, birch).

A precise mechanism of action is difficult to determine because of the large number of compounds present in tar-based products. Possible mechanisms of action include anti-inflammatory properties, anti-itch properties, and the ability to slow down the increased rates of cell turnover seen in psoriasis. Side effects are infrequent and potentially include local irritation or allergic reactions, folliculitis or acne-like eruptions, and increased photosensitivity. Prolonged use of high concentrations in sun-exposed areas may result in an increased risk of skin cancer. If the formulation is too strong or irritating, it can worsen psoriasis.

• Dose: 1%-5% crude tar or 10%-20% tar extract (LCD)[32]

Other Therapies to Consider

Lifestyle Choices

Regular exercise and good sleep are important for all aspects of overall health. One large population-based study found a decreased risk of psoriasis in people who engage in vigorous physical exercise for at least 3-4 hours per week,[33] and other studies have found improvement in psoriasis with exercise. Other health problems should be considered when starting a new exercise program, but it is reasonable for most otherwise healthy people with psoriasis to consider adding or increasing regular vigorous exercise in their daily lives.

Ultraviolet (UV) exposure can also help minimize psoriatic flares and phototherapy is often used in the clinical setting for treatment of psoriasis. Spending time engaged in outdoor activities may help improve psoriasis by UV exposure as well as by increasing physical activity levels. Overall risks for developing skin cancer including skin type, family history, and past sun exposure should be taken into account when determining how long a person with psoriasis should be in the sun without UV protection.

Mind-Body

Stress plays a strong role in psoriatic flares.[34] There are a wide range of mind-body approaches that can be beneficial for people who have psoriasis.[35] Mindful awareness meditation has been shown to help alleviate symptoms of psoriasis in some people. Medical hypnotherapists help guide people into a deeply relaxed trance state. They make suggestions with specific intentions regarding the alleviation of suffering and promotion of healing. Hypnosis has been shown to improve psoriasis in patients who are highly hypnotizable. Biofeedback uses technology to help patients learn to relax by learning to control their autonomic nervous system, and can be particularly helpful to people who have lower hypnotic abilities.[36] Cognitive Behavioral Therapy (CBT) has been found beneficialespecially in patients with moderate to severe psoriasis.[37]

The relationship between practitioner and patient is extremely important for any mind-body therapy, and it is crucial to find a practitioner that one can work with comfortably.

Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is a health system that has been around for over 2,500 years. It is based on the premise that qi is a vital energy that maintains health and balance in the body. Two opposing but complementary forcesyin and yangsupport health when they are in harmony and are responsible for disease when they are out of balance. There are several techniques used in the scope of TCM with acupuncture and herbal medicine being the most common in the United States. As a system, the techniques are best used in combination by skilled practitioners. Acupuncture alone or with TCM herbs has shown effective for treating psoriasis.[38] Other acupoint-related therapies including acupressure (needleless pressure applied at an acupuncture point) and cat gut embedding (catgut is embedded under the skin at acupuncture points providing stimulation for 5-7 days before it is absorbed) have also shown benefit in psoriasis.[39]

When looking for a TCM practitioner, one should inquire about certification and education. Any practitioner should at minimum have state licensure. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has strict certification requirements, and members are required to recertify every 4 years. Refer to the NCCAOM website for a directory of certified practitioners. For more information, refer to Whole Systems of Medicine, Chapter 18 in the Passport to Whole Health.

Homeopathy

Homeopathy is a medical system that uses highly diluted substances to treat disease with the intention of triggering the bodys innate ability to heal. Remedy selection takes into consideration the patients symptoms, personality traits, physical and psychological states, and life history. Although research is limited, homeopathy has been shown effective at treating psoriasis.[40] Because worsening of a condition is possible with homeopathic treatment, it is important to work with a well-trained and qualified homeopathic practitioner. One should look for a practitioner who is certified by at least one of the following organizations: Council for Homeopathic Certification (CHC), North American Society of Homeopaths (NASH), American Board of Homeotherapeutics (ABHt), or Homeopathic Academy of Naturopathic Physicians (HANP). For more details, refer to Whole Systems of Medicine, Chapter 18 of the Passport to Whole Health.

Prevention Outline: Psoriasis

• Maintain a balanced lifestyle including regular exercise and adequate sleep
• Eat a high-quality anti-inflammatory or Mediterranean-style diet
• Eat foods high in omega-3 fatty acids (salmon, nuts, flax) or take a supplement
• Consider a trial of a gluten-free dietespecially if you have GI symptoms.
• Maintain a healthy body weight
• Find ways to better manage stress
• Avoid alcohol overuse
• Avoid tobacco
• Avoid or minimize medications known to exacerbate psoriasis: lithium, beta-blockers, antimalarials, interferon, and rapid tapers of systemic corticosteroids
• Practice good skin hygiene and use emollients liberally to minimize itch.
• Consider topical aloe and indigo

Author(s)

Psoriasis was written by Apple Bodemer, MD (2014, updated 2020).

References

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20. Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr. 2007;85(1):6-18. ↵
21. Verma S, Thakur BK. Dramatic response to oral zinc in a case of subacute form of generalized pustular psoriasis. Indian J Dermatol. 2012;57(4):323-324. ↵
22. Haase H, Overbeck S, Rink L. Zinc supplementation for the treatment or prevention of disease: current status and future perspectives. Exp Gerontol. 2008;43(5):394-408. ↵
23. Paulsen E, Korsholm L, Brandrup F. A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2005;19(3):326-331. ↵
24. Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health. 1996;1(4):505-509. ↵
25. Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J Eur Acad Dermatol Venereol. 2010;24(2):168-172. ↵
26. Lin YK, Wong WR, Chang YC, et al. The efficacy and safety of topically applied indigo naturalis ointment in patients with plaque-type psoriasis. Dermatology. 2007;214(2):155-161. ↵
27. Teelucksingh S, Mackie AD, Burt D, McIntyre MA, Brett L, Edwards CR. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet. 1990;335(8697):1060-1063. ↵
28. Shin YW, Bae EA, Lee B, et al. In vitro and in vivo antiallergic effects of Glycyrrhiza glabra and its components. Planta Med. 2007;73(3):257-261. ↵
29. Yu JJ, Zhang CS, Coyle ME, et al. Compound glycyrrhizin plus conventional therapy for psoriasis vulgaris: a systematic review and meta-analysis of randomized controlled trials. Curr Med Res Opin. 2017;33(2):279-287. ↵
30. Janeczek M, Moy L, Lake EP, Swan J. Review of the efficacy and safety of topical mahonia aquifolium for the treatment of psoriasis and atopic dermatitis. J Clin Aesthet Dermatol. 2018;11(12):42-47. ↵
31. Ellis CN, Berberian B, Sulica VI, et al. A double-blind evaluation of topical capsaicin in pruritic psoriasis. J Am Acad Dermatol. 1993;29(3):438-442. ↵
32. Paghdal KV, Schwartz RA. Topical tar: back to the future. J Am Acad Dermatol. 2009;61(2):294-302. ↵
33. Frankel HC, Han J, Li T, Qureshi AA. The association between physical activity and the risk of incident psoriasis. Arch Dermatol. 2012;148(8):918-924. ↵
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6 Too-Good-To-Be-True Psoriasis Treatments

Effective medications exist to help manage psoriasis, but many people are still tempted to try alternative approaches. Beware of psoriasis scams that could hurt, not heal.

By Madeline R. Vann, MPHMedically Reviewed by Niya Jones, MD, MPH

Reviewed: January 7, 2015

Medically Reviewed

Thinkstock

If you’re hoping for a magic pill to keep your psoriasis under control, beware: Scammers are out to fool you.

Do your research and talk to your doctor to find out whether you’re considering bogus psoriasis treatments and would do better with a prescription psoriasis medication. “In general when I talk to patients about treatment, I tell them that over-the-counter remedies are not particularly effective,” explained dermatologist Junko Takeshita, MD, PhD, a clinical instructor in the dermatology department at the University of Pennsylvania in Philadelphia.

What’s more, miracle cures or supplements promoted by scam artists could be downright dangerous. “I think people are always looking for alternative treatments because the systemic medications can have adverse side effects,” Dr. Takeshita said, but she noted that even treatments called natural approaches could be psoriasis scams and may actually lead to more severe side effects than you might expect. Read on to know when to be leery.

Skin-Cap, Blue-Cap, and Psor-Val

Different names, same idea. Manufacturers of these products tried flying under the radar of agencies like the Food and Drug Administration (FDA), putting prescription-strength active ingredients in their products. Not really bogus psoriasis treatments, they can work — but they can also be extremely dangerous because of high levels of topical steroids. “At the right dose, these are used to help control flares of psoriasis,” explained Takeshita. “It’s not surprising it would be effective.” But ongoing use of strong topical steroids, especially without your doctor’s supervision, can lead to adverse effects such as thinning skin, skin infections, and other complications.

Miralex

Not to be confused with the fiber product Miralax, this is another topical treatment with high levels of steroids, specifically clobetasol. Miralex, which was made in Canada, was the subject of a class action lawsuit in 2002 after the Canadian government issued a warning that included the risk of plaque psoriasis turning into the pustular form after stopping Miralex. If you’re tempted to seek out stronger meds like this in another country, don’t: “They don’t provide the same level of regulation that we have here,” Takeshita warned.

Exorex

Exorex is a line of expensive gels and shampoos advertised as containing emulsified coal tar to treat psoriasis. But there’s no magic here — emulsifying coal tar usually just means processing it with emollients. The FDA allows coal tar to be marketed for psoriasis treatment, and coal tar treatments have long been used to manage plaques, but many common drugstore brands contain as much or more coal tar as Exorex. Prescription topical treatments might be more effective. So talk to your doctor about whether coal tar products are appropriate for you.

Zinc Supplements

Though zinc pyrithione is a common ingredient in topical psoriasis creams and may offer some relief for psoriasis plaques, a 1994 clinical trial found no benefits of taking zinc orally for psoriasis. Yet bogus psoriasis treatment centered on zinc supplements is still circulating. “I’m not aware of any studies showing that zinc is effective in treating psoriasis,” emphasized Takeshita. “It doesn’t make sense to me why zinc would help.” She said that you could feel better with a healthy, balanced diet and by losing weight if needed, but there’s no reason to spend money on zinc specifically.

Neem Oil

Found in a variety of cosmetics, neem oil is also used as a pesticide, made from the seeds of the neem tree. The oil is touted as a skin soother for psoriasis. “If a product is truly an oil and doesn’t have any other ingredients, it might not be treating the psoriasis as much as cosmetically making sure the skin doesn’t look as flaky,” said Takeshita. Also, beware that even herbal products, including neem oil, have the potential to irritate skin. Takeshita advised discontinuing the use of any item that makes your skin worse or less comfortable.

Nystatin

Small studies on oral nystatin for psoriasis done in the 1980s and ’90s might have been behind this bogus psoriasis treatment. Nystatin is an antifungal cream, but while psoriasis plaques itch and irritate, they aren’t caused by a fungus. People who have used this might have found some benefit if they were experiencing a co-occurring fungal infection, but it’s unlikely that you’d otherwise see a benefit from an antifungal treatment. Before you add another topical treatment to the mix, check with your doctor to make sure you really need it, and it won’t interact with other treatments you are using.

How to Tell If a Psoriasis Treatment Is a Scam

If you’re considering a product and concerned that it’s a scam, pick up the phone. Takeshita suggested talking to your doctor about possible new treatments. If you suspect you’ve been prey to a bogus psoriasis treatment, you can report it to the health care section of your state attorney general’s office for investigation. According to Joe Peters, a spokesman for the New Jersey Attorney General’s office, “the complaints surrounding these products usually include allegations of misrepresentations surrounding a so-called free trial offer, deceptive or useless return policies, unauthorized charges, refusal to accept returns or refund money, and issues with efficacy, such as the product not working as advertised. ”

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Evaluation of the effectiveness of the use of activated zinc pyrithione in the treatment of patients with psoriasis

The achievements of modern medical science have significantly expanded our understanding of the pathogenetic mechanisms of psoriasis (Pso), which is considered from the standpoint of systemic inflammation and the implementation of the pathological process due to an aberrant immune response in the skin to various exogenous and endogenous triggers. At the same time, the pathognomonic clinical picture (psoriatic papule) of psoriasis is a reflection of pathomorphological changes in the epidermis and dermis with implementation in the form of increased proliferation of keratinocytes and their incomplete differentiation.

The results of epidemiological studies show that, despite the growth of severe forms of dermatosis, limited psoriasis prevails and accounts for up to 60-70% of all cases [1]. The tactics of managing patients, regardless of the clinical form and severity, involves the use of external therapy. In Pso, topical preparations are recommended: corticosteroids, calcipotriol and its combination with corticosteroids, zinc pyrithione preparations, keratolytics, tar; in certain clinical situations (with localization of the process on the face and genitals) – a group of calcineurin inhibitors [2]. Due to the accumulated positive experience, a special place in the topical therapy of psoriasis is occupied by a preparation with activated zinc pyrithione ( Skin cap ), which is due to the effectiveness and safety of its use, as well as the presence of various forms of release (aerosol, cream, shampoo), the possibility of both short-term and long-term use at different localization and stage of the process [3].

Scientific literature data and own clinical experience indicate that topical therapy should be used regardless of the clinical situation (severity, stage of the disease) [2]. In patients with a limited process, external therapy of psoriasis, both for the relief of the inflammatory process and for long-term control, remains a priority. It should be noted that for long-term control of psoriasis, it is justified to use external preparations as needed, while in order to achieve a “manageable level”, it is preferable to prescribe agents with zinc pyrithione or calcipotriol [3, 4]. This is due to the safety of these drugs even with prolonged use.

Particular attention in the arsenal of external therapy deserves activated zinc pyrithione (ACP), the main mechanism of action of which can be considered the regulation of the work of immunocompetent skin cells and the processes of apoptosis of keratinocytes, which play a significant role in the pathogenesis of psoriasis [5, 6]. The ability of APC to influence the functional activity and apoptosis of cells is determined by the uniqueness of the chemical structure of the APC molecule, which, to a greater extent than other zinc compounds, has the ability to integrate into cell membranes by binding to phospholipids and act as an ionophore, which ultimately leads to a change in their permeability and polarization, followed by the release of mitochondrial cytochrome C and increased expression of proapoptogenic factors [5–7]. The implementation of the action of APC is noted already 48 hours after the start of the drug due to the normalization of apoptosis of cells in the basal layer, and a clinically pronounced effect on symptoms is observed after 14 days [6, 7]. An important factor in the implementation of the therapeutic effect of APC is the proven ability to increase the number of dermal macrophages, thereby indirectly affecting the proliferation and differentiation of T cells [8, 9]. In addition, the APC of the original drug Skin-cap is characterized by a high stability of the molecule, which predetermines a higher clinical efficacy compared to analogues [10].

To date, a fairly extensive experience has been accumulated in the use of preparations of the series Skin-cap for various dermatoses, including psoriasis [3, 4, 11, 12].

The purpose of this observational study was to evaluate the effectiveness of monotherapy of psoriasis using drugs Skin-cap , as well as in combination with phototherapy and systemic therapy in patients with limited and widespread forms of dermatosis.

Material and methods

Outpatient follow-up for 6 months included 94 patients with psoriasis, including 49 (52.1%) men and 45 (47.9%) women aged 18 to 72 years. The duration of the disease varied from several months to 38 years. Thirty-two (34%) patients were diagnosed with limited psoriasis (BSA<10%, lesion less than 10%) with PASI 9,1±0.7 points, 62 (66%) patients had a common form (BSA>10%, affected area more than 10%) — PASI index 24.7±2.9 points. 57 (60.6%) had a progressive stage, 37 (39.4%) had a stationary stage.

Inclusion criteria: diagnosed psoriasis vulgaris, limited/common process, age over 18 years, informed consent. Exclusion criteria: contraindications to zinc pyrithione, other clinical forms of psoriasis (exudative, pustular, guttate, erythroderma), use of topical corticosteroids less than 6 months before the study, age under 18 years, pregnancy, low compliance, comorbid somatic pathology in decompensated state.

Depending on the method of therapy, patients were divided into three groups: in the 1st group ( n = 32/34%), patients with limited psoriasis (BSA<10%) received monotherapy with Skin-cap , in the 2nd group – group 9 ( n = 27/28.7%) patients with advanced psoriasis (BSA>10%) were prescribed a combined use of topical therapy Skin-cap and UVB 311nm; in the 3rd group ( n = 35/37.2%), which included the same patients, the combined use of topical therapy Skin cap and systemic basic anti-inflammatory therapy (methotrexate).

As a topical therapy, all the observed patients on the smooth skin and scalp used an aerosol Skin-cap containing 0.2% APC, 1-2 times a day when the process was localized on the scalp, additionally used shampoo Skin – cap (1% activated zinc pyrithione) 1 time in 2-3 days. In palmoplantar localization of the process after application of the aerosol form without a time interval, a cream (0.2% activated zinc pyrithione) was used. Duration of use of external preparations of line Skin-cap was determined according to the regression of clinical symptoms. In the 2nd group, patients received UVB 311nm phototherapy with the frequency of procedures 3-5 times a week (No. 25-30). The initial dose was determined in accordance with the skin phototype and amounted to 0.1-0.3 J/cm², the dose was increased at each subsequent procedure or after one by 0.1 J/cm². In the 3rd group, patients received methotrexate at a dose of 15–20 mg/week as subcutaneous injections, the duration of the course was 6 months on average. Topical therapy in the 2nd and 3rd groups was carried out according to the same principles as in the 1st.

The effectiveness of therapeutic measures was evaluated taking into account the dynamics of the index of severity and prevalence of the psoriatic process PASI (Psoriasis Area and Severity Index, T. Fredriksson, U. Pettersson, 1978). Clinical remission was noted with a decrease in PASI by 90% or more, a significant improvement – by 75-89%, improvement – by 50-74%, an insufficient effect was noted with a decrease in the index by less than 49%. To assess the impact of complex treatment on the quality of life of patients, a standardized questionnaire was used – the Dermatological Quality of Life Index (DQLI, A. Finlay, 1994).

Indicators of clinical research methods were recorded in the patient’s individual record, then combined in Excel tables for subsequent statistical processing using the SPSS 14 version package (MS Office Excel). Quantitative data were presented as median (Me), where the upper and lower quartiles were 25%; 75%. Qualitative variables were compared using the χ ² test or Fisher’s exact test. Comparison of quantitative variables with a normal distribution of a trait was carried out using t – Student’s test. Correlation analysis was used to study the relationships between traits using the nonparametric Spearman test. Differences were considered statistically significant at a significance level of p <0.05.

Results and discussion

In the 1st group ( n =32) patients with limited psoriasis (BSA<10%) received monotherapy with Skin cap preparations. The average PASI index for the group was Me=9.1 points [7.9; 10.0]. A sufficiently significant clinical result (PASI reduction by at least 25%) was obtained in most patients after 2 weeks of using Skin-cap preparations, all patients were regarded as “responders to therapy”, and therefore the tactics of conducting to the end observation period did not change. Clinical remission or significant improvement was observed in the majority of patients (75%) within 1–2 months. After 1 month of therapy, the PASI index in the group decreased by 52.8% on average and amounted to Me = 4.2 points [3.9; 4.6]. After 2 months of therapy, PASI on average for the group decreased by 90.1% and amounted to Me=0.9 points [0; 1.6]. Long-term follow-up (6 months) showed no negative dynamics (Fig. 1). Rice. 1. Data of the PASI index and VIC in patients of the 1st group (p<0.05), immediate and long-term results of observations. The indicator of the quality of life of DIQL averaged Me=13.4 points for the group [12.9; 14.3]. After 1 month of therapy, the DIQI index decreased by 35.8% on average in the group and amounted to Me = 8.6 points [6.9; 10.5]. After 2 months, the course of therapy with DICV decreased by 79.9% on average in the group and amounted to Me = 2.7 points [1.5; 3.6]. There was no negative dynamics in the long-term follow-up period (6 months) (see Fig. 1).

Correlation analysis showed a direct close relationship between PASI and DIQI not only before therapy ( p = 0. 824), but also during treatment (after 1 month p= 653, 2 months p= 884.6 month p = 821).

The number of patients after a course of therapy (1-2 months, the terms depended on the resolution of rashes) who achieved clinical remission was 20 (62.5%), a significant improvement was noted in 8 (25%), improvement in 2 (6.3 %), insignificant effect — in 2 (6.3%). No effect was noted in any case. Thus, the use of APC in patients with limited psoriasis of various localization and regardless of the stage of the process allows achieving good results (more than 75% reduction in PASI) in the majority (87.5%) of patients.

In group 2 ( n =27) in patients with advanced psoriasis after combination therapy (UVB 311nm and Skin-cap ), the primary endpoint was 1 month from the start of therapy. The duration of the use of topical preparations ranged from 2 to 6 months (depending on the effect achieved), the duration of the phototherapy course was 6–8 weeks. The average PASI index for the group before therapy was Me=18.7 points [17.5; 19.6]. A sufficiently significant clinical result (PASI reduction of at least 25%) was obtained in most patients after 4 weeks, all patients were regarded as “responders to therapy”, and therefore the management tactics did not change until the end of the observation. After 1 month of therapy, the PASI index on average for the group decreased by 36.4% and amounted to Me = 11.9points [10.3; 12.6]; after 2 months PASI — by 71.1% to Me=5.4 points [3.1; 6.5]. In the long-term follow-up period (6 months), no negative dynamics was noted (Fig. 2). Rice. Fig. 2. Data of the PASI index and VIC in patients of the 2nd group (p<0.05), immediate and long-term results of observations. The indicator of the quality of life of DIQOL on average in the 2nd group before treatment was Me=16.2 points [15.1; 17.9]; after 1 month of therapy decreased by 19.1% to Me=13.1 points [10.8; 14.1]; after 2 months — by 63.6% to Me=5.9 points [4. 5; 6.5]. Long-term follow-up (6 months) showed further positive dynamics in terms of quality of life (see Fig. 2).

In the 2nd group in patients with severe forms of the disease, the correlation analysis also revealed a direct close relationship between the PASI and DIQ values ​​not only before therapy ( p= 0.855), but also during treatment (after 1 month p= 737 ; after 2 months p = 716; after 6 months p = 794).

In the 2nd group, the number of patients after a course of therapy who achieved clinical remission was 18 (66.7%) people, significant improvement – 6 (22.2%), improvement – 2 (7.4%), a slight effect was observed in 1 (3.7%) patient. No effect was noted in any case. Thus, the use of APC in combination with UVB 311nm in patients with widespread psoriasis of various localization and regardless of the stage of the process allows achieving high results (more than 75% reduction in PASI) in the majority (88.9%) of patients. Drugs with APC do not have a photosensitizing effect, which allows us to recommend this combination for a wide clinical practice.

In the 3rd group ( n =35) in patients with advanced psoriasis after combined therapy with methotrexate and Skin-cap , the primary end point was 1 month from the start of therapy. The duration of the use of topical preparations ranged from 2 to 6 months (depending on the effect achieved), the duration of the methotrexate course was 6 months. The average PASI index for the group before therapy was Me=29.1 points [21.4; 31.7]. Sufficiently significant clinical result (PASI reduction by at least 20%) was obtained in most patients after 4 weeks, all patients were regarded as “responders to therapy”, and therefore the management tactics did not change until the end of the observation. After 1 month of therapy, the PASI index on average for the group decreased by 23.4% and amounted to Me=22.3 points [20.1; 23.7]; after 2 months — by 51.2% to Me=14.2 points [12.9; 15.8]; after 3 months — by 75.6% to Me=7.1 points [5.1; 8.2]. Long-term follow-up (6 months) showed an increase in the effect (Fig. 3). Rice. 3. Data of the PASI index and VIC in patients of the 3rd group (p<0.05), immediate and long-term results of observations. These data indicate the advisability of continuing methotrexate therapy in responders with PASI=50 points or less, and it is more expedient to use the results of 8–10 weeks from the start of therapy to evaluate the effectiveness. The quality of life index of DIQOL averaged Me=17.2 points in the 3rd group [16.1; 18.7]; after 1 month of therapy, the DIQI index on average for the group decreased by 22.7% and amounted to Me = 13.3 points [10.5; 14.3]; after 2 months — by 55.2% to Me=7.7 points [6.1; 8.9]; after 3 months — by 75.6% to Me=4.2 points [2.9; 5.8]. Long-term follow-up (6 months) showed positive dynamics in relation to the quality of life indicator (see Fig. 3).

Correlation analysis in the 3rd group also revealed a direct close relationship between the PASI and DICI parameters, however, a difference was noted in comparison with the 1st and 2nd groups: for example, before therapy p = 0. 728, and after 1 month therapy, there was some weakening of the relationship p = 524. Subsequently, the correlation was regarded as strong: after 2 months p= 749, 6 months p= 866.

Data on the overall therapeutic efficacy in the 3rd group looked as follows: the number of patients after a course of therapy who achieved clinical remission was 22 (62.9%) people, a significant improvement was observed in 7 (20%), improvement – in 2 (5 .7%), insignificant effect — in 4 (11.4%). Thus, the use of APC in combination with methotrexate in patients with widespread psoriasis of various localization and regardless of the stage of the process allows achieving high results (PASI reduction by more than 75%) in the majority (82.9%) of patients.

Conclusion

Therapy of patients with psoriasis is quite a challenge for practitioners. This circumstance is due to many reasons: a chronic course (frequent relapses of dermatosis) and the importance of achieving a “controlled level”, the presence of various clinical forms and stages of the disease (selection of rational therapy in terms of localization and severity of the process), application of topical agents to lesions of various sizes (the use of the latter and with common forms), possible combinations of methods (increase in efficiency against the background of acceptable safety).

In psoriasis, the following groups of drugs are used: corticosteroids, calcipotriol and its combination with corticosteroids, zinc pyrithione preparations, keratolytics, tar, in certain clinical situations (localization of the process on the face and genitals) – calcineurin inhibitors. Topical corticosteroids show high efficacy in psoriasis, but their use is limited both in terms of area and duration of use due to predicted side effects, a high risk of tachyphylaxis, and an exacerbation effect often observed upon withdrawal [13]. Keratolytic drugs in the form of monotherapy have low efficacy and are mainly indicated for the removal of excessive epidermal desquamation. Tar preparations (mainly in the form of shampoos) are moderately effective and are used as part of complex therapy or as a maintenance treatment for scalp psoriasis. Calcipotriol preparations, including those in combination with betamethasone, are highly effective and safe both for relief of exacerbations and for maintenance therapy, but have age restrictions. A group of calcineurin inhibitors (pimecrolimus, tacrolimus) show moderate efficacy in psoriasis and are mainly used on the face and genitals, which is primarily due to the absence of side effects typical of corticosteroids, and therefore the possibility of long-term use [2, 13].

Against this background, APC ( Skin-cap ) looks very attractive, the mechanisms of action of which are unique in their way. APC is a powerful inducer of apoptosis and has an effect on immunocompetent cells, which makes it possible to influence the main links in the pathogenesis of psoriasis: inflammation and morphological differentiation of keratinocytes in the absence of undesirable effects characteristic of topical corticosteroids. Unlike unstable zinc compounds, APC is 50 times more stable than other zinc compounds and does not dissociate into ions, it maximizes its effect in the focus of inflammation. In accordance with the propaedeutic foundations of dermatology, the presence of various forms of release in the line Skin-cap (aerosol, cream, shampoo) allows you to fully meet the needs of external therapy, depending on the location, stage of the process and the clinical form of dermatosis. The aerosol dosage form is especially attractive: non-contact application to large areas of lesions (up to 30%), the possibility of using it on the scalp (there is a special nozzle) and inverse localizations of psoriasis (folds).

As monotherapy preparations Skin cap showed high efficiency in a limited process, regardless of the stage of the disease (possibility of use in the progressive stage). Thus, a decrease in PASI by more than 75% was observed in the majority (87.5%) of patients. With common forms of psoriasis, topical therapy is also an important component. The main issue of using combined methods is safety. Thus, in combination with phototherapy, not all groups of drugs can be recommended for use due to their photosensitizing effect or the potential risk of reducing efficiency due to the destruction of active molecules under the action of ultraviolet radiation. The safest and most effective method of UV therapy for psoriasis is UVB 311 nm phototherapy. The work showed the high efficiency of the combined use of narrow-band medium-wavelength phototherapy and drugs Skin cap . Thus, the number of patients after a course of therapy who achieved clinical remission was 18 (66.7%) people, significant improvement – 6 (22.2%), improvement – 2 (7.4%), a slight effect was observed in 1 (3 .7%). No effect was noted in any case. Thus, the use of activated zinc pyrithione in combination with UVB 311 nm in patients with widespread psoriasis of various localization and regardless of the stage of the process made it possible to achieve high results (PASI reduction by more than 75%) in the majority (88.9%) of patients. Drugs with APC do not have a photosensitizing effect, which allows us to recommend this combination for a wide clinical practice.

Systemic therapy for psoriasis also involves the use of topical therapy. The most commonly prescribed systemic drug is methotrexate, but its effectiveness in monotherapy, as a rule, is 50-60% of “responders” according to PASI 75 [14]. Combination therapy has been shown in a study to improve efficacy. Thus, after 1 month of therapy, the average PASI index for the group decreased by 23. 4%, after 2 months — by 51.2%, after 3 months — by 75.6%. Long-term follow-up (6 months) showed an increase in the effect, which indicates the feasibility of continuing methotrexate therapy in those who responded with PASI scores of 50 or less, and it is more expedient to use the results obtained 8–10 weeks after the start of therapy to evaluate the effectiveness. Thus, the use of APC in combination with methotrexate in patients with widespread psoriasis of various localization and regardless of the stage of the process allows achieving high results (PASI reduction by more than 75%) in the majority (82.9%) of patients.

Terminals

1. Topical line Skin-cap can be used as monotherapy for mild psoriasis (PASI<10). On smooth skin and scalp, it is recommended to use aerosol Skin-cap containing 0.2% APC, 2 times a day; when the process is localized on the scalp, shampoo Skin-cap (1% activated pyrithione zinc) is additionally used 1 time in 2-3 days. In case of palmar-plantar localization of the process after application of the aerosol form without a time interval, a cream (0.2% APC) was used. Duration of use of external preparations of line Skin-cap is determined in accordance with the regression of clinical symptoms.

2. The combined use of topical agents with APC and UVB 311 nm or methotrexate is a highly effective method that allows achieving regression of clinical symptoms in most patients, which significantly improves the quality of life of this category of patients.

Credits

Kruglova L.S. — https://orcid.org/0000-0002-5044-5265

Petriy M.N. — https://orcid.org/ 0000-0003-2559-1719

Gensler E.M. – https://orcid.org/ 0000-0001-5937-606Х

HOW TO QUOTE:

Kruglova L.S., Petriy M.N., Gensler E.M. Evaluation of the effectiveness of the use of activated zinc pyrithione in the treatment of patients with psoriasis. Clinical dermatology and venereology. 2019;18(5):-622. https://doi.org/10.17116/klinderma201918051

Corresponding author: Kruglova L.S. —
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The use of zinc pyrithione in the treatment of skin diseases

Zinc preparations have been used for many centuries as an effective remedy to help fight various skin problems. Zinc pyrithione is one of the modern forms of this substance, discovered in the 30s of the XX century. Despite the relative “youth” of this component, it is sufficiently studied. Its pharmacological properties have been studied in various studies, which made it possible to include this component in the composition of medicines. And, mainly, preparations with activated zinc pyrithione have found application in cosmetology and dermatology.

What other forms of zinc exist?

If we consider zinc as a whole, then in cosmetology and dermatology it is used in the form of bioactive salts. The substance is relatively safe for the body, therefore, in the production of medicines, caring and decorative cosmetics for the skin, its use in high concentrations is allowed. Most often, for medicinal purposes, zinc salts are added to the composition of creams, shampoos, lotions in a concentration of 0.1 to 5%.

Among zinc compounds, several of the most relevant, actively used in the pharmaceutical and chemical industries, should be distinguished:

• Zinc oxide – provides care for aging skin, effectively soothes it, restores protective functions. It is often included in skin protection products from the sun, as it is considered a natural UV filter.
• Zinc sulfate – the main purpose of this substance is to protect the skin from inflammation and fight pathogenic microorganisms.
• Zinc pyrithione – used to treat various skin diseases, including seborrheic and atopic dermatitis, psoriasis, has a pronounced anti-inflammatory, antibacterial and antifungal properties.

Preparations based on activated zinc pyrithione have recently become especially in demand. The relevance of these funds is due to the fact that they help to deal with serious dermatological problems, being in some cases an alternative to external hormone-containing drugs for the treatment of skin diseases.

Activated zinc pyrithione – what is it?

Products containing this substance are often used in dermatology for the treatment of many skin diseases. This is because zinc pyrithione has the following properties:

• is active against many pathogenic microorganisms (streptococci, staphylococci), inhibits the growth and reproduction of fungi of the genus Malassezia spp., which support inflammation in diseases such as atopic dermatitis, seborrhea;
• has an anti-inflammatory effect;
• has a keratoregulatory and sebum-regulating effect, which is especially important for seborrheic dermatitis;
• helps to eliminate itching.

Zinc pyrithione exerts its action in the skin lesion, while practically does not penetrate into the bloodstream. Preparations based on it are used in the treatment of skin diseases both in adults, including the elderly, and in children older than one year.

Indications for the use of zinc pyrithione

Preparations containing activated zinc pyrithione are used as therapeutic agents for complex diseases such as:

• atopic dermatitis;
• eczema;
• neurodermatitis;
• seborrheic dermatitis;
• psoriasis.

Contraindications and Precautions

Activated zinc pyrithione preparations are generally very well tolerated by patients. The only exception in which these funds are not recommended for use is increased individual sensitivity to individual components in the composition.

In the first days of treatment with a cream or aerosol based on activated zinc pyrithione, a short-term burning sensation may occur at the site of application. This is absolutely normal and does not require discontinuation of the drug.

And yet, it must be remembered that preparations based on activated zinc pyrithione are medicinal, and therefore it is necessary to use them on the recommendation of a doctor.

Line of preparations Skin-cap with activated zinc pyrithione

Today it is not a problem to find preparations containing activated zinc pyrithione among pharmaceutical products. As the best option for the treatment of atopic and seborrheic dermatitis, psoriasis and other skin problems, doctors often recommend the Skin-Cap line of drugs. The tool is available in several forms, which makes the use as convenient as possible, allows you to include these drugs in the treatment regimen at any stage of the disease and for any form of dermatitis.

Shampoo Skin cap

Contains activated zinc pyrithione at a concentration of 1%. The main purpose of this drug is to prevent and treat:

• psoriasis of the scalp;
• atopic dermatitis localized on the scalp;
• seborrheic dermatitis;
• oily and dry seborrhea;
• dandruff and itching;

Shampoo for external use. Before applying the bottle with the drug should be shaken well several times. The product is used in small quantities, applied to wet hair and scalp, distributed with massaging movements, after which it is necessary to rinse the hair with clean water. Next, the shampoo is applied again, lathered thoroughly and left on the hair for 5 minutes. This is necessary in order for the active substances to have their effect. After this time, the product is washed off the hair and scalp with plenty of warm water.

In the treatment of these skin diseases shampoo is used 2-3 times a week. The duration of the course of treatment depends on the disease. For example, shampoo with activated zinc pyrithione for psoriasis is used for five weeks, for seborrheic dermatitis – for two weeks. During the period of remission of the disease and to prevent relapses, shampoo is used as a prophylactic agent at least 1-2 times a week.

Skin cap cream

This preparation contains activated zinc pyrithione at a concentration of 0.2%. It is intended for external use in adults and children over one year old. Used to heal:

• psoriasis;
• atopic dermatitis, neurodermatitis;
• seborrheic dermatitis;
• dry skin.

Apply the cream to the surface of the skin after thoroughly shaking the tube. It is necessary to cover the skin with a thin layer of the drug in the places of localization of skin lesions. Use the cream twice a day. Depending on the disease, the following duration of treatment is recommended:

• for atopic dermatitis – up to 3-4 weeks;
• for psoriasis – up to 4-6 weeks.

If necessary, you can repeat the course of treatment after 1-1.5 months after consultation with your doctor.

The cream has a light texture, easy to apply without leaving a greasy film, ideal for the localization of rashes on the face and exposed skin. Auxiliary components in the composition of the cream have additional caring properties – moisturize and nourish the skin.

Aerosol Skin-cap

The concentration of zinc pyrithione activated in the preparation is 0.2%. The aerosol is used both for the treatment of the scalp (a special nozzle is attached), it is also suitable for the treatment of so-called “weeping” rashes, it is convenient for non-contact application, including in skin folds. Used externally in treatment:

• psoriasis;
• atopic dermatitis, neurodermatitis;
• eczema
• seborrheic dermatitis.

Shake vial several times before use. Spray the aerosol onto the inflammation site from a distance of about 15 cm, holding the bottle in an upright position. If it is necessary to treat the scalp, then for the convenience of applying the product, it is recommended to use a special nozzle that comes with the kit. With exacerbation of these skin diseases, the drug is sprayed 2-3 times a day, the duration of use, depending on the disease, is 1-1.5 months.

Zinc pyrithione activated in the treatment of atopic dermatitis

Atopic dermatitis is a chronic inflammatory skin disease that is characterized by age-related rashes and is accompanied by severe itching.

As a rule, atopic dermatitis proceeds in waves, that is, periods of exacerbation are replaced by relative calm and a decrease in the severity of symptoms.

External therapy is an integral part of the treatment of atopic dermatitis. For this purpose, patients with a severe exacerbation may be prescribed hormonal preparations based on corticosteroids to relieve acute inflammation. The second stage, as a rule, is prescribed more gentle drugs, for example, Skin-cap, as maintenance therapy. It is known that the skin microbiome of a patient with atopic dermatitis has its own characteristics – streptococci and fungi of the genus Malassezia, which abundantly colonize the skin, causing constant irritation and itching. That is why Skin-cap is especially indicated for atopic dermatitis – it not only helps to eliminate inflammation and reduce itching, but also has antibacterial and antifungal effects. Another difficulty in the treatment of atopic dermatitis is that the rashes differ in different periods – weeping rashes predominate in younger children, and peeling, dryness and thickening of the skin in the older age group. The Skin-cap line includes various forms for any type of rashes – it is convenient to apply the aerosol without contact on wet areas, while the cream is suitable for dry rashes. The drugs are approved for use from 1 year old, can be applied to any area of ​​the skin without restrictions.

Zinc pyrithione in the treatment of seborrheic dermatitis

Seborrheic dermatitis, or seborrhea, is a chronic disease that is inflammatory in nature and is accompanied by the formation of inflammation, peeling in places with a high accumulation of sebaceous glands. With seborrheic dermatitis, most often the foci of inflammation are located in the scalp, behind the auricles, in the chest area, as well as in large skin folds (in the groin, under the mammary glands). Inflammation in seborrheic dermatitis is maintained by the activation of fungi of the genus Malassezia on the skin.

Treatment of seborrheic dermatitis is prescribed complex, with mild and moderate course of the disease, preparations with zinc pyrithione activated must be prescribed. They help reduce inflammation, are active against fungi of the genus Malassezia, which allows you to achieve a stable remission. Since the foci of inflammation are usually localized in the area of ​​the scalp, it is recommended to use a special skin-cap therapeutic shampoo.