We are a competence center with great experience in the treatment of psoriasis.
Over 20,000 patients treated to date, many of whom are extremely satisfied, bear witness to our great experience.
What is Psoriasis?
Psoriasis is a chronic inflammatory skin disease. It often affects not only the skin, but the entire body, and therefore belongs to the systemic diseases. Psoriasis is chronic and cannot be cured.
However, it can be treated well. That is why people with psoriasis can live largely symptom-free in many cases. As a rule, psoriasis occurs in episodes: Periods in which it is active alternate with symptom-free phases.
There are different forms of psoriasis. The most common is psoriasis vulgaris or plaque psoriasis. It is characterized by typical skin complaints: reddened areas of skin covered with white scales that often itch - the so-called plaques. The cause is a congenital malfunction of the immune system. Up to eight times as many horn-forming cells (keratinocytes) are produced as in healthy skin. The cells cannot mature properly, accumulate on the skin surface and form the characteristic plaques.
In addition to a genetic predisposition, certain triggering factors (such as tonsillitis, stress,
mechanical stimuli, smoking, alcohol consumption, or certain medications (e.g. beta-blockers, ACE inhibitors, lithium).
In Germany, about 2-3% of people suffer from psoriasis.
Therapy for psoriasis
Everyday life with psoriasis often requires discipline and patience from you: regular treatment, doctor's visits and check-ups are part of it. Because: Your cooperation is particularly important for a successful therapy. It also helps to be well acquainted with your own disease, to know what is going on in your body and why we recommend a certain medication or treatment method.
What are the goals of our treatment
- Healing of the plaques
- Preventing new relapses
- A largely normal life without restriction of the quality of life due to psoriasis.
- For psoriatic arthritis: effective systemic therapy that prevents progressive joint destruction.
- Alleviation of concomitant diseases, if any.
Last but not least, a change in lifestyle can help, as, for example, sport and exercise as well as a balanced diet, including weight reduction, have a positive effect on psoriasis, the risk of concomitant diseases as well as general well-being.
What are the treatment options?
In general, we can distinguish between three types of therapy:
a) the external or topical treatment (e.g. by creams),
b) internal or systemic therapy (e.g. with tablets or injections),
c) the light treatment (physical therapy).
For mild psoriasis, treatment guidelines recommend external or physical therapy. For moderate to severe psoriasis, treatment with systemic medications is recommended. Often, the different forms of therapy are combined.
Topical therapy involves treating the skin externally, for example by applying a cream, ointment or lotion to the affected areas. This form of treatment is usually chosen for mild plaque psoriasis.
Cortisone preparations (e.g. betamethasone), also known as corticoids or glucocorticoids, are among the most frequently used external agents. They are used particularly in cases of severe inflammation and on specific areas of the body. They have a strong anti-inflammatory effect, suppress the reaction of the immune system and act quickly. There are different strengths of action, ranging from weak to very strong.
Corticosteroids should not be administered permanently, as side effects such as thinning or reddening of the skin may occur in the long term. In addition, they should not be discontinued abruptly, as this can lead to a severe flare-up of psoriasis.
Vitamin D3 derivatives (e.g. calcipotriol) inhibit inflammation and excessive cell growth. As a rule, the therapy is also well tolerated in the long term. However, vitamin D3 derivatives are not suitable for large-scale application.
Thorough skin care is an integral part of treatment, regardless of the severity and further therapy. Active substance-free ointment bases are used, to which either urea or salicylic acid is then added. They are used for skin care and prepare the skin for other therapies.
Dithranol and tar ointments are practically no longer used in our clinic.
Light therapy and bath-light therapy (also balneo-photo therapy) are no longer performed in our clinic because of the promotion of premature skin aging of the increased risk of developing skin cancer.
PUVA (also photochemotherapy) is a combination of UV-A light and psoralen, an active ingredient that increases the skin's sensitivity to light. Psoralen is administered as a cream. PUVA therapy increases the risk of developing skin cancer. For this reason, we only apply it to small areas with a low risk of cancer, such as the palms of the hands and soles of the feet.
Internal (systemic) treatment
In systemic treatment, drugs are administered internally, for example as tablets or injections. They dampen the body's immune system in various ways and thus the inflammatory process of psoriasis. Some systemic therapies also affect the joint symptoms of psoriatic arthritis. These treatments must be given with special care to avoid possible side effects or to detect them at an early stage. Therefore, regular check-ups with us are necessary. Any moderate to severe plaque psoriasis should usually be treated systemically. We distinguish:
a) the conventional systemic treatment, and
b) the newly developed therapies with biologics.
Immunosuppressants are drugs that suppress the immune system.
Methotrexate (MTX) belongs to this group of agents. they have an anti-inflammatory effect and are used when the disease is severe. They are also effective against psoriatic arthritis. The effect appears only after 4 to 8 weeks. It may therefore be necessary to bridge the time until the onset of action. Immunosuppressants are given as tablets or injections. Some can also be used long-term to prevent a recurrence. Regular check-ups are important, as long-term use may be associated with side effects.
Fumarates, also known as fumaric acid preparations, influence certain messenger substances of the immune system that play a role in the disease process of psoriasis. The effect usually occurs after about six weeks. Fumarates can also be used for longer periods of time, but they are not effective against psoriatic arthritis. Regular check-ups are important, as long-term use may be associated with side effects.
Retinoids are vitamin A acid derivatives and inhibit excessive cell proliferation as well as inflammation. Acitretin is a drug from this group. They are frequently used to treat psoriasis of the hands and feet. Because retinoids can be harmful to fertility, women of childbearing age should take them only if safe contraception is used.
Biologics are the new stars of systemic psoriasis treatment.
They are biotechnologically produced drugs that suppress the immune system by specifically interfering with the misdirected immune system. They block certain messenger substances through which inflammation is triggered and promoted. As a result, the inflammatory process can be stopped and the disease controlled in the long term.
Biologics are used in moderate to severe psoriasis and when other systemic therapies have not worked, have not been tolerated, or may not be used for certain reasons. They are usually injected under the skin by the patient. If a biologic works and is well tolerated, it can be used long-term. Many biologics also work excellently against psoriatic arthritis and stop the progressive destruction of the joints. Here, too, regular check-ups are important in order to detect any (rare) side effects in good time.
Biologics are by far the most expensive systemic drugs (cost per quarter approx. 3700-7000 Euro). However, treatment is usually covered by health insurance companies if all prescribed guidelines are followed. However, treatment with these drugs requires a great deal of bureaucratic time from us treating dermatologists, especially for the prescribed documentation and reports.
Diagnosis for psoriasis
The following signs are typical for psoriasis and can be used to make a diagnosis:
- Candle wax phenomenon: by scratching the scale layer, the upper scale loosens similar to the wax of a candle
- Phenomenon of the last cuticle: if the scales are removed further, a shiny "last cuticle" can be seen
- Auspitz phenomenon (bloody dew): if scratched even further, small punctiform hemorrhages occur
- In some cases, taking a skin sample may be necessary to make a diagnosis.
The skin shows sharply defined red and raised skin lesions of varying size, which are often covered by silvery scales of varying thickness. In some cases there is severe itching. About every 5th patient with psoriasis suffers not only from the typical plaques but also from joint involvement, the so-called psoriatic arthritis. The nails also show changes in at least 50% of those affected ("spotted nails", "oil spots", etc.).
The course of psoriasis varies greatly from person to person and its severity varies from barely visible skin changes to an infestation of the entire skin.
From the "ordinary psoriasis" (psoriasis vulgaris) is distinguished, among other things, the "pustular psoriasis" (psoriasis pustulosa), which is accompanied by small pustules. Both forms can also occur simultaneously.
Psoriasis can have considerable consequences for health, occupation and quality of life. It is not uncommon for sufferers to be stigmatized due to the often clearly visible skin changes. Psoriasis is not contagious!
The genetic predisposition to psoriasis cannot be influenced. However, a healthy lifestyle (e.g. normal weight, avoidance of nicotine and alcohol) can prevent or weaken a severe outbreak of the disease. Regular skin care in times when the disease is not present is also indispensable to prevent new psoriasis foci.
The medical history and the familial predisposition can provide an initial indication of the presence of psoriasis. In addition, there are characteristic sharply defined red and raised skin lesions, which are covered by a silvery-white scaling. Most often, elbows, knees or lower legs, scalp, buttocks and/or palms and soles are affected.