Salicylic acid
It is primarily used to remove dandruff and
used in concentrations ranging from 5 to 15 percent in oil (for the scalp) or ointments.
Urea
It is primarily found in skin care products (in concentrations ranging from 8 to 12 percent) and also helps loosen dandruff. It also acts as a natural moisturizing factor for the skin.
Cortisone
Available in various strengths and formulations (lotion, cream, ointment, foam, patch, shampoo), cortisone is the most commonly used substance for treating psoriasis. Cortisone inhibits inflammation and excessive cell division in the epidermis. They are characterized by excellent efficacy and tolerability, as well as few adverse effects when used properly. Long-term, continuous use of corticosteroid medications can lead to side effects such as thinning of the skin and signs of aging; therefore, their use should be monitored regularly. When used properly, however, corticosteroid medications are of great benefit to many patients. Caution is advised when using this product on the genital area, the face, and on children.
Vitamin D supplements
They also affect inflammation, cell division, and skin desquamation, but their onset of action is delayed compared to cortisone. However, they often have a more lasting effect. Vitamin D supplements are available as ointments and lotions for the body and scalp. The combination of calcipotriol and cortisone is particularly effective. Please note the maximum weekly intake limits, as vitamin D affects calcium metabolism
Tacrolimus/Pimecrolimus
These are two immunomodulatory agents that are approved for the treatment of atopic dermatitis. Studies have shown that, particularly for psoriasis on the face, in skin folds, and in the genital area, a comparable effect to that of cortisone-based preparations can be expected. Because the skin is thinner in these areas, tacrolimus and pimecrolimus can also be used over the long term.
Light Therapy
Phototherapy plays a key role in the treatment of moderate-to-severe psoriasis. It’s easy to use. Finally, it can be effectively combined with topical treatments (creams, solutions, ointments). Today, UVB lamps that emit 311 nm are primarily used. UVA rays can also be highly effective in the treatment of psoriasis. In some cases, it is combined with photosensitizing substances (psoralens), which increases its effectiveness.
Systemic Therapies
Internal treatment methods (systemic therapies). Internal or systemic therapies are also used for extensive or severe forms of psoriasis—especially when the joints are also affected. Their use requires certain prerequisites and, above all, a careful assessment of the risk-benefit ratio by an experienced specialist. A distinction is made between traditional systemic therapies (methotrexate, acitretin, cyclosporine, and fumaric acid esters) are distinguished from the newer small molecules (apremilast) and biologics (adalimumab, etanercept, infliximab, ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab).
Methotrexate
Originally developed for cancer treatment, this substance has also proven effective in treating chronic inflammatory diseases at significantly lower doses. It is effective in treating both skin and joint psoriasis. Caution is advised in cases of liver disease, as the medication can cause liver damage over the long term.
Cyclosporine
It is a medication used in transplant medicine to prevent the immune system from rejecting transplanted organs. It is also highly effective in treating psoriasis, particularly severe and highly inflammatory forms. The duration of use is limited by the risk of kidney damage caused by the medication.
Fumaric acid esters
A medication commonly used in Germany for the systemic treatment of plaque psoriasis. It has also just received approval in Switzerland. This class of drugs is a byproduct of the citric acid cycle and has the advantage of a very safe side effect profile, although it is often associated with bothersome side effects at the start of treatment, such as flushing (sudden reddening of the face), headaches, nausea, diarrhea, and transient lymphopenia (a decrease in certain white blood cells). However, if it is tolerated, it can be taken for decades and completely suppress psoriasis.
Apremilast
It is an oral medication that causes mild suppression of general inflammation. It requires only a few laboratory tests and has moderate efficacy. Apart from temporary nausea and diarrhea, it offers a high level of safety.
Biologics
This is a new generation of biotechnologically produced antibodies with a more specific mechanism of action against psoriatic inflammation. They are usually administered by injection. Currently, TNF-alpha inhibitors (infliximab, etanercept, adalimumab) and one IL-12/23 inhibitor (ustekinumab), 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 highly effective biologic. Additional novel small molecules are currently in development. Due to their high production costs, biologics are reserved only for psoriasis patients with a body surface area affected by the condition of >10% or higher, or with a PASI score of 10 or higher, or in specific, disabling locations (e.g., the palms of the hands and soles of the feet), where conventional therapies have failed.
