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Psoriasis: What are the existing treatments?

Psoriasis is a disease that can affect the skin and joints. Sometimes stigmatized, it can have psychological consequences for patients. Therefore, management is crucial. What are the proposed treatments? Elements of response in this article.

Summary
Published September 21, 2023, updated on January 22, 2024, by Sandrine, Scientific Editor — 7 min read
Psoriasis
Version relue et validée par la dermatologue, Dr. B. LEVY GAREL (France).

The various medicinal treatments for managing psoriasis.

There exists a broad therapeutic arsenal for psoriasis, which includes local treatments (topically applied) or general treatments (orally administered), which can be used alone or in combination.

  • Local treatments for psoriasis:

    These treatments are intended to be applied to the patches. They can be found in the form of creams, ointments, or lotions.

  1. The dermocorticoids : these are local anti-inflammatory agents containing cortisone derivatives. They are the go-to local treatment for psoriasis. Their very rapid action allows patients to find relief without waiting for the effects of more specific treatments.

  2. Keratolytics :On the market, there are local treatments that combine a dermocorticoid and salicylic acid, which is a keratolytic active ingredient. Keratolytic active ingredients help to dissolve intercellular bonds, thus facilitating the removal of scales.

  3. Vitamin D analogues : Vitamin D analogues, such as calcipotriol or calcitriol, are anti-proliferative, meaning they combat the excessive multiplication of certain skin cells. Therefore, they act against hyperkeratosis.

  • General treatments for psoriasis:

  1. Methotrexate : this is a anti-inflammatory and immunosuppressive agent.

  2. Ciclosporin : Ciclosporin is an immunosuppressive drug

  3. Retinoids : the substance used in the treatment of psoriasis is acitretin. It belongs to the family of retinoids. It normalizes the processes of cell proliferation, differentiation, and keratinization of the epidermis.

  4. Biotherapies : these medications are very recent. They target specific stages of inflammation.

  5. Theapremilast : reduces inflammatory processes by inhibiting an enzyme called phosphodiesterase that plays a role in the production of cytokines, which are inflammatory molecules.

Medicinal treatments for psoriasis can reduce symptoms, but they do not cure the disease.

Non-pharmaceutical treatments for psoriasis.

  1. PUVA Therapy : This is a treatment that utilizes UVA rays. Prior to this, the patient takes methoxsalen, a substance that photosensitizes the skin and enhances the action of UV rays.

  2. The UVB phototherapy with narrow spectrum : the UVB rays used are highly controlled. The treatment involves 3 sessions per week, followed by 1 to 2 maintenance sessions per week for several months.

Regarding phototherapy, Dr. LEVY GAREL explains the difference from UV tanning booths: "Phototherapy sessions take place in specialized medical centers. Thus, the UV rays used do not have the same wavelength as the UV rays used for aesthetic purposes (tanning booths), which are dangerous. However, phototherapy is not recommended for light phototypes (1 and 2) and is contraindicated in cases of a history of skin cancer."

  • The emollients.

    Although psoriasis does not necessarily equate to dry skin, the use of emollients can help reduce the scales present at the site of psoriasis lesions.

Dermatologist Dr. LEVY GAREL explains the importance of emollients in psoriasis: "In eczema, we observe an alteration of the skin barrier. Thus, the role of emollients is very important. In the case of psoriasis, emollients are not always useful. However, they can help to reduce scales and are particularly useful in case of treatments that dry out the skin, such as retinoids or PUVA therapy."

  • Products promoting skin exfoliation.

    As mentioned earlier, psoriasis is characterized by an overly rapid cell turnover. The dead cells that are formed are immature, and they lack the ability to naturally eliminate themselves, thus they are very adhesive.

    Products based onkeratolytic active ingredients that promote desquamation are particularly useful in order to facilitate the removal of scales. Among these active ingredients, we can mention salicylic acid, lactic acid or even urea.

  • Thermal spa treatments.

    Thermal treatments can alleviate dryness and enhance skin healing. Due to the high salt concentration, thermal treatments at the Dead Sea promote skin exfoliation.

  • The psychological care.

    Although psoriasis is characterized by visible lesions on the skin, this disease has a significant psychological impact .Indeed, those affected may suffer from stigmatization or poor self-esteem, sometimes leading to depression. Therefore, psychological support may be necessary.

  • Relaxation techniques.

    Stress is a clearly established trigger for psoriasis, and certain techniques such as yoga, acupuncture, massages etc can help prevent the onset of flare-ups.

    Please note : thatphysical exercise is highly recommended as it helps to release endorphins, which are molecules responsible for the feeling of well-being.

Source

  • OHTSUKI M. & al. Risk factors for the development of psoriasis. International Journal of Molecular Sciences (2019).

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