What is psoriasis. How does it affect the body. What are the main triggers for psoriasis flare-ups. How can diet and lifestyle changes help manage psoriasis symptoms. What are the most effective natural remedies for psoriasis. How is psoriasis linked to other health conditions. What are the latest treatment options for severe psoriasis.

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. The most prevalent form, plaque psoriasis, typically affects the scalp, elbows, knees, and back. This condition impacts between 1% and 8.5% of adults globally, with higher prevalence rates observed in regions farther from the equator. In the United States, approximately 2% of the population is affected by psoriasis.

While psoriasis can occur at any age, it is less common in children. The onset of psoriasis tends to peak during two distinct periods: in the fourth decade of life and again between the ages of 50 and 69. This pattern suggests that age-related factors may play a role in the development and progression of the condition.

The Immune System’s Role in Psoriasis

At its core, psoriasis is considered a disorder of the immune system. This dysregulation leads to the overproduction of proinflammatory cytokines, which in turn causes an accelerated and abnormal maturation process of the skin’s outer layer cells. The result is the characteristic thickened, scaly patches of skin that define psoriasis.

Genetic and Environmental Factors

While genetics plays a significant role in determining an individual’s susceptibility to psoriasis, various behavioral and environmental factors can influence the course of the disease. Some key triggers include:

• Infections
• Stress
• Physical trauma to the skin
• Certain medications
• Smoking
• Obesity
• Excessive alcohol consumption

Interestingly, studies have shown that the incidence of psoriasis decreases following successful smoking cessation, highlighting the importance of lifestyle factors in managing the condition.

The Impact of Psoriasis on Overall Health

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

• Psoriatic arthritis
• Cardiovascular disease
• Depression
• Diabetes
• Metabolic syndrome
• Nonmelanoma skin cancer

Given these potential complications, it is crucial for healthcare providers to screen for these conditions in patients with psoriasis and address them promptly when present.

Holistic Approaches to Psoriasis Management

Managing psoriasis effectively often requires a multifaceted approach that addresses both the physical symptoms and the underlying factors contributing to flare-ups. Here are some holistic strategies that can complement traditional medical treatments:

Gentle Skin Care Practices

Proper skin care is fundamental in managing psoriasis symptoms and preventing exacerbations. Consider the following tips:

1. Use lukewarm water for bathing to avoid irritating the skin.
2. Opt for non-detergent-based cleansers, such as soapless cleansers or glycerin-based soaps.
3. Avoid abrasive cleansing devices that can traumatize the skin and worsen psoriasis.
4. Apply thick moisturizing creams or ointments, especially while the skin is still damp, to lock in moisture.
5. Consider natural oils like avocado, coconut, almond, or olive oil for additional moisturization.
6. Try colloidal oatmeal products (e.g., Aveeno) to soothe itching and irritation.

The Role of Diet in Psoriasis Management

While research on the direct impact of diet on psoriasis is limited, emerging evidence suggests that certain dietary approaches may help alleviate symptoms and improve overall health in individuals with psoriasis.

Anti-inflammatory Diets

Anti-inflammatory or Mediterranean-style diets have shown promise in managing inflammatory conditions, including psoriasis. These dietary patterns emphasize:

• Fruits and vegetables
• Whole grains
• Lean proteins
• Healthy fats (e.g., olive oil, avocados, nuts)
• Limited processed foods and refined sugars

By reducing overall inflammation in the body, these diets may help decrease the severity of psoriasis symptoms and improve associated comorbidities.

Weight Management

For overweight or obese individuals with psoriasis, weight loss can lead to significant improvements in symptoms. Low-calorie diets have been found to be beneficial, but it’s crucial to ensure adequate nutritional intake. Consulting with a registered dietitian can help develop a personalized, balanced weight loss plan.

Gluten-Free Diet

Some patients with psoriasis have reported symptom improvement after adopting a gluten-free diet. While more research is needed to establish a definitive link, individuals with elevated markers for celiac disease may particularly benefit from this dietary approach.

Lifestyle Modifications for Psoriasis Management

In addition to dietary changes, several lifestyle modifications can help manage psoriasis symptoms and reduce the frequency and severity of flare-ups:

Stress Management

Stress is a known trigger for psoriasis flares. Incorporating stress-reduction techniques into daily life can be beneficial. Consider trying:

• Meditation
• Deep breathing exercises
• Yoga
• Regular physical activity
• Adequate sleep

Smoking Cessation

Given the clear link between smoking and psoriasis severity, quitting smoking can lead to significant improvements in symptoms. Seek support from healthcare providers or smoking cessation programs to increase the chances of success.

Moderate Alcohol Consumption

Excessive alcohol intake has been associated with more severe psoriasis. Limiting alcohol consumption or abstaining altogether may help manage symptoms and improve overall health.

Natural Remedies and Complementary Therapies for Psoriasis

While scientific evidence is limited for many natural remedies, some individuals with psoriasis report benefits from the following approaches:

Herbal Supplements

• Aloe vera: May help reduce redness, scaling, and itching
• Oregon grape (Mahonia aquifolium): Contains compounds that may help slow skin cell growth
• Turmeric: Has anti-inflammatory properties that may benefit psoriasis symptoms

It’s important to note that herbal supplements can interact with medications and may have side effects. Always consult with a healthcare provider before starting any new supplement regimen.

Topical Treatments

• Tea tree oil: Has antimicrobial and anti-inflammatory properties
• Dead Sea salts: May help exfoliate and soothe inflamed skin when used in baths
• Apple cider vinegar: Some people find it helpful for scalp psoriasis when diluted and applied topically

Mind-Body Therapies

While not directly treating the physical symptoms of psoriasis, mind-body therapies can help manage stress and improve overall well-being, which may indirectly benefit psoriasis symptoms. Consider exploring:

• Acupuncture
• Hypnosis
• Biofeedback
• Tai chi

Conventional Medical Treatments for Psoriasis

While holistic approaches can be beneficial, many individuals with psoriasis require conventional medical treatments to effectively manage their symptoms. These may include:

Topical Treatments

• Corticosteroids
• Vitamin D analogues
• Retinoids
• Calcineurin inhibitors
• Coal tar
• Salicylic acid

Phototherapy

Controlled exposure to ultraviolet light can help slow skin cell growth and reduce inflammation. Options include:

• Narrowband UVB therapy
• Broadband UVB therapy
• Psoralen plus ultraviolet A (PUVA) therapy

Systemic Medications

For moderate to severe psoriasis, systemic medications may be prescribed. These include:

• Methotrexate
• Cyclosporine
• Oral retinoids

Biologic Drugs

These newer treatments target specific parts of the immune system and can be highly effective for severe psoriasis. Examples include:

• Tumor necrosis factor-alpha (TNF-alpha) inhibitors
• Interleukin-17 (IL-17) inhibitors
• Interleukin-23 (IL-23) inhibitors

The Importance of a Personalized Treatment Plan

Psoriasis is a complex condition that affects individuals differently. What works for one person may not be effective for another. Therefore, it’s crucial to work closely with healthcare providers to develop a personalized treatment plan that addresses individual symptoms, triggers, and overall health status.

This plan may incorporate a combination of conventional treatments, lifestyle modifications, dietary changes, and complementary therapies. Regular follow-ups and adjustments to the treatment plan are often necessary to achieve optimal management of psoriasis symptoms and improve quality of life.

By taking a holistic approach to psoriasis management that addresses both the physical symptoms and underlying factors, individuals with psoriasis can often achieve significant improvements in their skin health and overall well-being. Remember that managing psoriasis is an ongoing process, and patience and persistence are key to finding the most effective combination of treatments for each individual.

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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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

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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. —
e-mail: [email protected]

Psoriasis / Diseases / Clinic EXPERT

Psoriasis is a chronic non-infectious skin disease, most often manifested in the form of rashes and peeling of the skin. Psoriatic rashes most often appear on the elbow and knee joints, on the scalp, but can occur on any other area of ​​the skin. The rash may be accompanied by itching.

The disease can begin at any age, but most often it is detected in patients aged 15 to 25 years.

The causes of psoriasis

The causes of psoriasis have not yet been fully identified. It is generally accepted that the disease is multifactorial, that is, it is based on several causes at once. Among them:

• immunological disorders, incl. hereditary
• metabolic disorders
• endocrine disorders
• neurological disorders
• liver diseases

Stress, nervous shocks, dietary disturbances, pregnancy and childbirth, decreased immunity after infectious diseases (tonsillitis and influenza) and injuries.

Symptoms of psoriasis

It is recommended to consult a dermatologist for the following symptoms:

• red or burgundy raised patches (plaques) covered with grayish scales that are easily scraped off
• itching resulting in scratching and tendency to bleed 9 0199
• deformed and exfoliating nails
• Koebner’s symptom – the occurrence of psoriatic plaques on the injured area of ​​the skin (scratches, cuts)
• cracks and suppuration in the affected areas of the skin
• occurrence of pain in the joints against the background of skin manifestations
• aggravation of these symptoms in the autumn-winter period.

Diagnosis

Diagnosis of psoriasis is often limited to a skin examination by a qualified dermatologist. There are no specific tests for the diagnosis of psoriasis, however, the doctor may prescribe clinical and biochemical blood tests to detect an active inflammatory, autoimmune, rheumatic process, as well as endocrine and metabolic disorders. Sometimes a skin biopsy is performed to clarify the diagnosis.

Treatment of psoriasis

Psoriasis is a chronic skin disease and there is no cure. However, there are a number of methods that can facilitate its course for the patient.

1. Topical products: ointments and creams, both hormonal and non-hormonal. May contain vitamins, activated zinc, tar.
2. Preparations for internal use: corticosteroids for the regulation of metabolism; cytostatics; immunomodulators; non-steroidal anti-inflammatory drugs.
3. Physiotherapy: cryotherapy, plasmapheresis and ultraviolet radiation.

Important: all of the listed drugs have contraindications! In no case do not self-medicate psoriasis!

Prognosis

Despite the fact that psoriasis is an incurable chronic disease, it should by no means be ignored. Slow progression can lead to a worsening of not only the physiological state (increased itching of the skin, in advanced stages – joint pain and psoriatic arthritis), but also psychological.