Psoriasis treatment

Psoriasis is a genetically determined disorder. It is associated with 50+ gene defects which cause metabolic disorders and defective biological processes. The sooner these defects and disorders are identified, the sooner they can be corrected. The three major disorders are:

• Disorder of carbohydrate metabolism (diabetes),
• Changes in cholesterol levels (due to vascular damage – pressure, potency, heart attack, stroke),
• Overactive immune system response – the body “attacks” its own tissue, not just the disease or disease-inducing microorganisms (bacteria).

Learning how to cope with psoriasis is crucial. By making lifestyle changes and choosing an appropriate diet, it is possible to control the visual manifestation of the disease (the rash can disappear completely). Controlling the disease also prevents potential health complications that are caused by lipid synthesis disorders, carbohydrate metabolism disorders and immune system disorders.

Psoriasis guidelines

Depending on the severity of the disorder, psoriasis is classified as mild, moderate or severe. The classification measures:

• The area of the body covered (in percentage),
• The colour of the rash,
• Epidermal thickness of the rash,
• The degree of scaling.

How the rash affects the quality of life is also taken into consideration. Invisible (covered) rash has a lesser impact than psoriatic rash on the face, palms or genitals.

The psoriasis treatment method is determined by guidelines that have been approved by the Latvian government. These guidelines describe the most suitable treatment course for each form of psoriasis and/or its severity. The guidelines were developed under the supervision of Prof. J. Kisis and were officially accepted in Latvia in 2013. The guidelines are also used for determining state-paid medication during treatment. Read the full content of guidelines here.

Treating psoriasis

Since psoriasis is a genetically determined disorder affecting the entire body, it is important to evaluate all connected processes that may benefit the treatment and prognosis. Treating the rash alone gives insufficient and short-term results. Comprehensive psoriasis treatment includes a number of aspects which help to control the disorder:

• Skin care – only dermatologist-prescribed products should be used, following the doctor’s instructions; not all pharmaceutical skin care products are suitable for all types of psoriasis. Chronic skin inflammation promotes tumour development.
• Diet – the presence of any digestive disorders (i.e. metabolic disorders, such as insufficient secretion of digestive juices or allergic reaction to certain food products) that cause intolerance should be identified. Patients have a high risk of developing diabetes; in order to prevent it, the patient should have meals that are light in calories and refrain from drinking alcohol (damaging the pancreas).
• Physical exercise – doing sports or physical activities can decrease heart problem (cardiac) risk – a rhythmic heart promotes lipid metabolism (lipids or fat make up the blood vessel membrane and act as the intercellular binder of the epidermis). Research shows that physically active people suffer from psoriasis less.
• Acknowledging the psoriasis trigger factors – weather conditions and seasons can induce undesirable reaction (sensitivity, allergies). In autumn, it can be temperature changes, but in spring – pollen.

Psoriasis treatment methods

In treating psoriasis, both topical treatment (applied directly on the rash) and medication (i.e. peroral medicine) can be prescribed. In order to choose the most suitable treatment method, not only the psoriasis type and severity should be taken into account, but also the patient’s age, sex, occupation, overall health and other factors.

Phototherapy in treating psoriasis

The beginnings of phototherapy can be traced to Ancient Egypt 2000 years ago when photosensitising plant extract (photosensitising plants contain substances that increase UV-light sensitivity) was used in combination with sunlight for treating skin diseases. Today, it is one of the most popular methods for treating psoriasis. It:

• Suppresses overactive immune system (immunosuppressive effect),
• Reduces inflammation,
• Inhibits increased cell proliferation (anti-proliferative effect),
• Has antibacterial effect.

For psoriasis treatment, special narrow-spectrum UVB and UVA radiation lamps are used. UVA/UVB therapy can be used on children and during pregnancy. The therapy is often combined with other treatment methods and medication.

Laser therapy in treating psoriasis

Laser therapy in its essence is similar to narrow-spectrum UVB-radiation phototherapy (ultra-violet light wavelength - NB-UVB 311 nm), and it is used for treating clearly defined psoriatic foci.

Cryotherapy in treating psoriasis

Therapy with cold is mostly applied for treating small foci. Very few studies have been published on this particular therapy method, and it has low-efficiency rate, making it a less popular treatment method.

Medicine for treating psoriasis

Any medication should be taken only under dermatologist’s supervision, following the doctor’s instructions. Self-administered treatment of psoriasis can only exacerbate the disorder, prolong the treatment course, as well as cause significant health complications.

• Retinoid or synthetic vitamin A vitamer. High therapeutic activity – it can affect immunity cells, renew keratinocyte (cells that synthesise keratin – a protein that protects epithelial cells from damage) synthesis within normal levels. It can be used over long periods, and it is suitable for children.
• Cyclosporine A is an immunosuppressant. Its efficiency for treating psoriasis is related to its effects on immune system and its ability to reduce pathological proliferation of keratinocytes.
• Methotrexate is a cellular metabolism suppressant that was initially used for treating oncologic diseases; since the 1970s, it has been approved for psoriasis treatment.
• Wobenzym is peroral non-prescription medication. It has anti-inflammatory properties, it reduces swelling, normalises the body’s defence mechanisms, as well as has blood-thinning properties that facilitate the renewal of digestive enzyme levels for minimising the impact of chronic diseases, incl. psoriasis.

Biologic medication for treating psoriasis

Biologic medication includes viruses, serums, toxins, anti-toxins, vaccines, blood, blood components and other similar agents that can be used for treating diseases and disorders and as a preventive measure. The medication boosts or renews the immune system and its ability to fight infection and other diseases. The molecule size is usually large, which is why the medicine is injected in the connective tissue, muscle or vein.

Biologic medication therapy is often applied when other treatment methods for treating moderate or severe psoriasis have proven to be ineffective. The cost of the therapy, in comparison to other treatment methods, is high.

Injections for treating psoriasis

Injections contain corticosteroids – specific steroid hormones that are widely used in medicine for treating various immune and inflammatory diseases. The injection of these steroids is particularly effective for treating small skin lesions on a clearly defined area of the body, e.g. surface of palms or fingers. The effect is long-lasting, requiring repeated injection months later.

The latest methods in treating psoriasis

The latest therapy methods focus on boosting the cellular interaction (lymphocytes etc.) in the pathological psoriasis processes with biologically active ingredient signals. The biologics either block the pathogens (antibody properties) or contain receptors that block the pathological processes. The particular method is rarely applied due to its high costs and restrictions (absence of inflammatory processes or tumours, thorough exclusionary factor control, etc.).

State-paid psoriasis medication

The list of state-paid medication does include medication for treating psoriasis. For more information on the medication listed and to what extent it is paid by the state, consult your treating dermatologist.

Non-prescription medication for treating psoriasis

This category covers chiefly skin care products. These products are suitable for symptomatic care only (i.e. treating the visible part of psoriasis, neglecting metabolic process corrections etc.) – such medication does not treat psoriasis as a whole. It is advised to choose fragrance-free skin moisturisers.

Shampoos for treating psoriasis

For treating the scalp, various shampoos containing salicylic acid, urea, tar or corticosteroids are used. Shampoos containing tar reduce the scaling of the skin, softens it, prevents it from thickening and relieves itchiness. Shampoos containing salicylic acid makes the skin soft and descales it. Shampoos containing corticosteroids are used for short periods only for reducing swelling and skin redness.

Soap for treating psoriasis

It is advised to avoid using harsh soaps since they tend to dry out and irritate the skin.

Skin care for psoriasis patients

An important component of the skin is lipids (intercellular binder), but conventional body wash and soap tends to degrease the skin, interfering with the development of the skin’s microbiome. This individual set of microbes together with the immune system ensures the stability of skin’s protective barrier and protects the body from the environment. It is important to not to traumatise the skin or to destroy the protective barrier of the skin with skin care products.

Psoriasis patients’ skin is dry, scaly and virus-infested; the presence of the scales facilitates the development of psoriatic rash. The skin should be washed with pharmaceutical soap that is gentle to the skin, removing the dirt but improving the skin’s protective barrier instead of eliminating it. After bathing, showering or washing up, dermatologist-recommended skin moisturisers – creams, lotions – should be used right away every time.

Nail care for psoriasis patients

80% of patients have damaged nails. It is advised to keep the nails short in order to prevent fungal infections underneath the nail. Gentle hand soap should be used, always followed by moisturising hand cream or lotion. Healthy nails require unsaturated fats, vitamin B complex, vitamin A and D.

Ointments, creams and lotions for treating psoriasis

Psoriatic processes are categorised in three stages of activity:

• The appearance of new, pink rash with larger scales in the middle (progressive stage),
• The appearance of rash has stabilised, its surface is covered with smaller scales (stationery stage),
• The rash sinks in, scales recede and become ring-like (regressive stage).

Each stage requires particular topical treatment – the progressive stage requires runny creams or liquids, the stationary stage – thicker creams or pastes, whereas the regressive stage – oily creams and ointments. The creams serve as the medium to which active ingredients are added:

• Salicylic acid is used in combination with other locally applied medication – the acid peels off the scales, allowing the medication to absorb in the deeper layers of the skin. The salicylic acid is available in concentrated form, from 2% to 10%, and is suitable for treating rash that covers less than 20% of the surface of the body, since large doses may be toxic. Not suitable for patients with diabetes.
• Lactic acid is a keratolytic agent – it removes the horny layer of the skin (dead skin cells). It is used for exfoliating the scales. Suitable for rash that covers more than 20% of the surface of the body or for patients with diabetes. 
• Corticosteroids are widely used for treating clearly defined psoriatic patches – they have vasoconstrictive, anti-inflammatory, itchiness-reducing and anti-prolific properties.
• Tar has anti-prolific properties. Bitch tar (OleumRusci) and pine tar (Pixliquida) is commonly used; coal tar (Pixlithanthracis) is used less frequently.
• Synthesised vitamin D3 analogue (calcitriol, calcipotriol) affects the immune system and suppresses the keratinocyte synthesis.
• Tacrolimus and pimecrolimus (topical calcineurin inhibitors) are effective for treating psoriasis on face, neck, genitals and skin folds. The medication does not cause muscle atrophy, making it suitable for prolonged use.
• Magnipsor ointment does not contain hormonal additives or toxic components. Its active ingredients are mineral components, Dead Sea salts, salicylic acid and various extracts – tea tree, pumpkin, sea buckthorn oil, burdock root, etc.

The location of the psoriatic rash determines the choice of the product.

Natural remedies for treating psoriasis

It is mandatory to consult the dermatologist before using any natural remedies since combined with the medication they may cause undesirable reaction. The efficiency of natural remedies has not been clinically proven. Note that natural ingredients may cause allergic reaction.

• Aloe – reduces skin redness and scaling.
• Apple cider vinegar – used as a disinfectant by the ancient cultures; can relieve scalp itchiness.
• Chili peppers contain capsaicin – it blocks nerve endings which send pain signals. Products containing capsaicin can relieve pain, reduce inflammation, skin redness, scaling.
• Dead Sea salt, when added to warm bath, helps to remove scales and reduce itchiness within 15 minutes. Moisturiser must be applied after bathing.
• Oats are considered to be the best remedy for soothing the skin. When added to a warm bath, oats can relieve itchiness and reduce skin redness.
• Tea tree oil has antiseptic properties. Shampoos with tea tree oil can reduce psoriasis symptoms on the scalp.
• Turmeric has anti-inflammatory and antioxidant properties. Curcumin can reduce psoriatic outbreaks. Turmeric can be used as a supplement (capsules) or as a spice (commonly used in various curry recipes).
• Flax seed or linseed contains Omega-3 fatty acids, fibre and other important nutrients. Omega-3 fatty acids improve the immune system and the condition of the skin. These are essential fatty acids that the body cannot synthesise and are available in food. Hemp seeds, walnuts, green vegetables and various fish all contain Omega-3.

Psoriasis diet

Psoriasis is associated with lipid (fat), carbohydrate (sugar) and sometimes gluten (grains) metabolism problems that cause congenitally determined metabolic changes (gene disorders).

Metabolism starts with digestive ferment (enzyme) secretion, gastrointestinal microbiome interaction with the body, the absorption of nutrients. The process of processing, absorbing and utilising the nutrients requires energy – without the energy, these processes cannot happen. 

If the biological, digestive and metabolism processes have not been examined, it is advised to have small meals at least 4 times a day. It is recommended to use unsaturated fat (Omega-3 etc.), vitamin B complex, vitamin D supplements. Easily-absorbing carbohydrates that are found in products such as white bread and potatoes should be avoided. Alcohol, nicotine and preservatives damage the gastrointestinal microbiome. Moderate use probiotics (live bacteria that is good for the digestive system) is recommended.

Acupuncture for treating psoriasis

Acupuncture as psoriasis treatment is widely popular in China and other Asian countries. During the therapy, a needle that is no wider than a hair is pricked in the skin. The prick triggers the release of adenosine, endorphins, serotonin and other chemicals that have analgesic effect. The method is especially suitable for psoriatic arthritis cases.

Does change of seasons affect psoriasis?

As the outside temperature changes, the metabolism changes, too. The skin starts to lack unsaturated fatty acids, and the skin’s protective barrier becomes weaker. When the skin is lacking in vitamin D, it becomes dry, does not renew normally, and is more susceptible to the impact of the environment. The conditions become favourable to chronic skin disease (dermatosis) outbreaks.

The heating in the colder months, the artificial ventilation, covering clothing, sweating, being in a crowd with a diverse microflora – these factors aggravate the skin’s physiology and self-regulation. As the spring approaches, skin’s protective barrier has become weaker than in autumn, making it more susceptible to various springtime allergens – blossoming trees, pollen, grass.

A small percentile of psoriasis patients (up to 20%) suffers from UV-radiation sensitivity. The psoriasis summer type is characterised by antioxidant deficiency – antioxidants protect the skin from the free radicals of the sunlight and rash in the areas of the body exposed to sunlight.

Recognising the outbreaks associated with the change of seasons can help control the symptoms of the skin disorder by vacationing in resorts.

Psoriasis resorts or balneotherapy

The benefits of climatotherapy have been recognised and described in literature for over 200 years. Such therapy is associated with particular geographic regions and specific places. The effect of climate therapy is primarily associated with the opportunity to relax from daily stress and to avoid conditions that aggravate the skin (i.e. the central heating-dried air). The routine and meal schedule can be regulated as well.

Certain procedures can increase skin’s moisture levels, peel off dead skin cells, reduce cell multiplication rate and insufficient cell life cycle. The water and mud procedures provided by the resort nourish the skin cells with the lacking nutrients and increase their life span.

The most significant resort for treating psoriasis is the Dead Sea. It is the lowest point on Earth (360 m below sea level), and it contains high concentration levels of natural minerals; the mineral-rich air filters the narrow spectrum UVB rays (similar to phototherapy). Studies have shown that psoriasis patients that sunbathe and swim in the Dead Sea salts experience improved health in 83% of cases, patients that only sunbathe– 73% of cases, whereas patients that only bathe in the Dead Sea – in 28% of cases.

Balneotherapy (set of various therapeutic activities for moisturising dry skin) holds a special place in the long-term treatment of psoriasis, although it is not recommended for patients with increased sunlight sensitivity (psoriasis summer type) and diseases with high risk of skin cancer. This method is not applied for acute treatment or short-term therapy.

Psoriasis prevention 

For preventing an outbreak or development of the skin disorder, a number of factors should be taken in consideration, including lifestyle changes and various activities:

• Physical activities (exercise, workout, etc.),
• Vacations to resorts,
• Avoiding stress,
• Limited use of coffee, cocoa, alcohol, also limited smoking,
• Thoughtful diet (avoiding fatty foods),
• Avoiding freezing,
• Limited use of household chemicals and cosmetics,
• Improving metabolism (drinking a lot of liquids, etc.),
• Controlling vitamin D, folic acid, vitamin B12 and lipid levels (under doctor’s supervision),
• Using Omega 3/6,
• And other activities as recommended by the treating dermatologist. 

Can psoriasis be cured?

No. The current advancement of medicine does not allow us to change our genetic code. Receding or disappearing rash indicates that the psoriatic processes have come to a hold. An experienced dermatologist can help to determine the most suitable lifestyle changes (diet, physical activities, skin care) based on the peculiarities of the patient’s metabolism as well as the treatment course.

Early diagnosis and the right lifestyle, skin care and therapy increase the patient’s life expectancy (statistics show that psoriasis patients, suffering from the disorder since childhood, struggle to live past 60-years-old due to vascular diseases).

Where to treat psoriasis?

The skin is human’s largest organ. Proper skin care prevents further development of the disease (pathological processes). The first psoriasis symptoms affect the skin; the functional state of the skin and nails is directly connected to the treatment course (both local and internal) – the efficiency of which is best understood and assessed by an expert on skin – a dermatologist.

Treating psoriasis is very difficult. Its level of difficulty isn’t related to its diagnostics (determining the psoriasis type), but to understanding it and its regularities. Only highly qualified doctors can analyse the data in a way to understand the interconnection of the processes.

Our clinic’s doctors continuously improve their knowledge of the micro-symptoms (small symptoms that are difficult to notice and are not previously associated with the disease) of the disorder, being able to diagnose psoriasis in its early stages. During the treatment process, the doctors understand the interconnection of the disorder with the body, biological processes and metabolism disorders. The specialists are equally knowledgeable in the peculiarities of psoriasis in children.

In 2013, the Latvian government accepted guidelines on treating psoriasis. These guidelines were the first of their kind in Latvia and were developed under the supervision of Prof. J. Kisis (see the beginning of the article for more on the guidelines). In 2016, Professor Kisis participated in developing guidelines on the application of biologic medication for treating psoriasis. The clinic has taken part in multiple clinical studies (see the full list here), 6 of which were on psoriasis.

Professor J. Kisis is the leading specialist in Latvia on psoriasis, and the clinic always has the latest information on global novelties on treating psoriasis.