Salicylic acid
Is essentially used to remove the scales and
in a concentration of between 5 and 15 percent in oil (for the scalp) or ointments.
Urea (urea)
Is primarily found in skin care products (concentrations between 8 and 12 percent) and also helps to loosen dandruff. It is also a natural moisturizing factor for the skin.
Cortisone
In various strengths and bases (lotion, cream, ointment, foam, plaster, shampoo), cortisone is the most commonly used substance for the treatment of psoriasis. Cortisone inhibits the inflammation and the hasty cell division of the epidermis. They are characterized by excellent efficacy and tolerability and, when used properly, low undesirable effects. Prolonged and continuous use of cortisone preparations can lead to side effects such as skin thinning and signs of ageing; they should therefore be reviewed regularly However, when used correctly, cortisone preparations are of great benefit to many patients. Caution is advised when applying to the genital area, face and children.
Vitamin D supplements
They also have an influence on inflammation, cell division and scaling of the skin, but have a delayed onset of action compared to cortisone. However, they often have a more lasting effect. Vitamin D preparations are available as ointments and lotions for the body and scalp. The combination of calcipotriol with cortisone is particularly effective. The maximum quantities for weekly use must be observed, as vitamin D influences the calcium balance
Tracrolimus/Pimecrolimus
Are two immunomodulating active ingredients that are approved for the treatment of atopic dermatitis. Studies have shown that psoriasis on the face, body folds and intimate areas in particular can be expected to have a comparable effect to preparations containing cortisone. Due to the thinner skin in these areas, tracrolimus/pimecrolimus can also be used for longer periods.
Light therapy
Phototherapy is of great importance in the treatment of moderate and severe psoriasis. It is easy to use. Finally, it can be advantageously combined with external treatments (creams, solutions, ointments). Today, UVB lamps that emit 311 nm are mainly used. UV-A waves can also be highly effective in the treatment of psoriasis. In some cases, a combination with light-sensitizing substances (psoralen) is used, which increases the effectiveness.
System therapies
Internal treatment methods (systemic therapies). Internal or systemic therapies are also used for extensive or severe forms of psoriasis – especially if the joints are also affected. Their use requires certain prerequisites and, above all, careful consideration of the risk-benefit ratio by the experienced specialist. A distinction is made between traditional systemic therapies (methotrexate, acitretin, ciclosporin and fumaric acid esters) and the newer small molecules (apremilast) and biologics (adalimumab, etanercept, infliximab, ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab and risankizumab).
Methotrexate
Initially developed for the treatment of cancer, this substance also proved to be effective in the treatment of chronic inflammatory diseases in significantly lower doses. It is effective in the treatment of both skin and joint psoriasis. Caution is advised in the case of liver disease, as the drug can cause long-term liver damage.
Ciclosporin
Is a drug used in transplantation medicine, where it is used to prevent the immune system from rejecting transplanted organs. It also has an excellent effect on psoriasis, especially on severe and highly inflammatory forms. The duration of use is limited by the risk of kidney damage from the drug.
Fumaric acid ester
Drug frequently used in Germany for the systemic treatment of plaque psoriasis. It has also just received approval in Switzerland. This class of substances is a by-product of the citrate cycle and has the advantage of a very safe efficacy profile, although it often manifests itself with annoying side effects at the start of therapy, such as flushing (seizure-like reddening of the face), headaches, nausea, diarrhea and temporary lymphopenia (reduction of certain white blood cells). However, if it is tolerated, it can be taken for decades and completely suppress psoriasis.
Apremilast
Is an oral medication that causes mild suppression of general inflammation. It requires only a few laboratory controls and is of medium potency. Apart from temporary nausea and diarrhea, it offers great safety.
Biologics
This is a new generation of biotechnologically produced antibodies with a more specific mechanism of action against psoriatic inflammation. They are usually injected. There are currently TNF-alpha inhibitors (infliximab, etanercept, adalimumab) and an IL-12/23 inhibitor (ustekinmab) on the market for psoriasis, as well as the two highly effective IL-17 inhibitors secukinumab and ixekizumab. The most recently approved biologic is the IL-23 inhibitor guselkumab, which is also a very effective biologic. Other novel small molecules are currently being developed. Due to the high production costs, biologics are only reserved for psoriasis patients with a surface infestation of >10% or PASI 10 or more or in special, disabling localizations (e.g. palms of the hands and soles of the feet) where conventional therapies have failed.
