Psoriasis, here are the drugs and therapies

It affects over two and a half million Italians, who in addition to physical discomfort, often also face a strong psychological impact: it is psoriasis, a chronic disease that attacks the skin causing the formation of red spots (called plaques) that tend to scale.

This pathology is caused by an abnormal activation of the immune system that determines a greater growth of the cells of the epidermis, keratinocytes.

While not compromising health, often those who suffer from it still decide to start a therapy because of the shame and embarrassment caused by these imperfections.

The treatments available are now really many and different from each other: it is therefore important to identify together with your doctor the most suitable therapy based on the characteristics of the disease (type of psoriasis, severity and location of plaques, etc.) and the patient (age, any comorbidities, degree of psychological discomfort, etc.).

Topical treatments

Creams or ointments, to be applied topically on plaques, are generally reserved for milder forms of psoriasis.

You can use both emollient creams based on natural products, which help to make the plaques softer, facilitating desquamation, and real drugs: ranging from corticosteroids with anti-inflammatory and immunosuppressive action, to vitamin D analogues (for example calcipotriol and tacalcitol) that inhibit the proliferation of keratinocytes, up to vitamin A derivatives, Like tazarotene.

Often corticosteroids and vitamin D analogues are used in combination as they guarantee greater effectiveness, but above all the former should not be administered for too long periods due to the side effects they can cause.

Systemic treatments

In patients with more severe forms of psoriasis, or if no improvement in symptoms has been observed with topical treatments and phototherapy, it is possible that the doctor may propose to resort to taking systemic medications (pills or injections) that offer good control of the disease, but can cause important side effects.

The most frequently used drugs are:

• cyclosporines, which reduce the immune response mediated by T lymphocytes; However, its administration must be carefully evaluated both for possible side effects (for example on renal function and blood pressure), and for the possible interaction with other drugs.
• methotrexate, which reduces both inflammation and abnormal keratinocyte growth. But also in this case attention to side effects, which in some cases can be serious
• oral retinoids, or synthetic derivatives of vitamin A, among which acitretin is often chosen.

Biologics

Among the systemic treatments, biological drugs, i.e. monoclonal antibodies capable of selectively hitting a certain target, deserve a separate chapter.

In the case of psoriasis, most biological drugs have been “designed” with the aim of specifically inhibiting certain cytokines, i.e. molecules capable of triggering the inflammatory process; one of the most widely used targets is tumor necrosis factor (TNF).

Phototherapy

During the summer season most patients observe an improvement in plaques; This is because the sun’s rays have a positive effect on this pathology.

This is the principle on which another treatment for psoriasis is based, phototherapy, or exposure to ultraviolet light sources A or B, to be carried out naturally in specialized centers and under strict medical supervision.

Balneotherapy

Numerous inflammatory diseases, such as psoriasis, can benefit from immersion of the patient in a tank where there is thermal water at a certain temperature.

Spa treatments are in fact often recommended in combination with topical or systemic treatments, or during periods in which these are suspended.

The patients who benefit most from it are those with forms that are not too serious, and in any case this therapy must also be prescribed by the doctor, as there are conditions, such as pregnancy or cardiovascular disease, in which spa treatments are not recommended.

The waters most frequently used in the case of psoriasis are sulphurous, bicarbonated, calcium and magnesium, which have soothing and emollient properties, but also anti-inflammatory.