Effective Management of Psoriasis With Advanced Treatments
Effective management of psoriasis requires expertise and many years of experience. Our Medical Team offers comprehensive solutions for adults and children with psoriasis, applying safe and innovative treatments, with personalized therapy protocols tailored to each patient’s needs, aiming for the best possible outcomes.
- Maximum Effectiveness
- FDA-Approved Treatments
- Suitable for All Skin Types
- No Side Effects and Immediate Recovery
- Adaptable According to Treatment Progress
- Complete Monitoring
What is Psoriasis?
Psoriasis is a chronic autoimmune skin condition that causes rapid growth of skin cells, leading to thick, white or red patches (plaques) mainly on the knees, elbows, scalp, and back. Although more common in adults, it can affect younger ages as well. The condition is not contagious.
Symptoms of Psoriasis
Symptoms vary depending on severity, ranging from small rashes to extensive red plaques with silvery scales that cause itching and sensitivity. Severe cases may cause joint pain and swelling (psoriatic arthritis), as well as nail changes. Symptoms appear in cycles of remission and flare-ups. Psoriasis severity is classified as follows:
- Mild Psoriasis: Covers less than 3% of body surface area.
- Moderate Psoriasis: Covers 3% – 10% of skin surface.
- Severe Psoriasis: Covers more than 10% of the body, often causing intense symptoms.
Etiology of Psoriasis
Psoriasis results from an overactive immune response causing inflammation and excessive production of skin cells. The main mechanism is the activation of T-cells, which stimulate the production of new cells to address skin injuries.
Triggers such as stress, cold, infections, and certain medications can cause flare-ups. Genetic factors also play a role, as about one-third of patients have relatives with psoriasis. Possible triggers include skin injuries, hormonal imbalances, smoking, and obesity.
Forms of Psoriasis
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- Plaque Psoriasis: The most common form, with red, scaly plaques in areas such as the scalp, elbows, and knees.
- Guttate Psoriasis: Common in children and young adults, presenting with small spots 2-3 cm in size on the trunk.
- Pustular Psoriasis: Characterized by pus-filled blisters and redness, mainly in adults.
- Inverse Psoriasis: Appears in body folds (armpits, groin) with red, dry patches resembling seborrheic dermatitis.
- Erythrodermic Psoriasis: A rare and severe form affecting large areas, causing intense redness, fever, and systemic symptoms.
- Psoriatic Nail Disease: Affects nails causing thickening and detachment, often linked with psoriatic arthritis.
- Psoriatic Arthritis: Causes joint inflammation.
Identifying the type of psoriasis is important for choosing the appropriate treatment, as management varies.
Diseases Associated with Psoriasis
Psoriasis is linked with several other conditions. The main comorbidity is Psoriatic Arthritis, affecting about 30% of people with psoriasis, causing pain, stiffness, and joint swelling. Other related diseases include:
- Metabolic Syndrome
- Non-Alcoholic Fatty Liver Disease
- Cardiovascular Diseases
- Autoimmune Disorders
- Inflammatory Bowel Disease
- Malignancies
- Psychiatric Disorders
Early diagnosis and combined treatment of comorbidities can improve quality of life for psoriasis patients.
Innovative Treatments for Psoriasis
Treatments include phototherapy, topical or systemic therapies, aiming to improve patients’ quality of life by:
➢ Slowing the rapid multiplication of skin cells, reducing inflammation and plaque formation.
➢ Removing excess scales and smoothing the skin.
The choice of treatment depends on psoriasis severity, type, and individual patient needs.
Phototherapies
Excimer Light for Limited Psoriasis
Excimer Light therapy uses a monochromatic light beam targeting overactive T-cells, promoting their apoptosis.
- Light dose is adjusted according to skin type, psoriasis characteristics, and patient response.
- Typically requires 4-10 sessions, 2-3 times per week.
- FDA-approved Excimer laser emits a strong UVB beam designed for psoriatic plaques and is effective on areas like the scalp, especially when combined with topical steroids.
Waldmann Cabin for Extensive Psoriasis
For patients with extensive psoriasis, phototherapy is performed using the special Waldmann cabin that ensures uniform and safe light application over the entire body.
- Sessions repeated 2-3 times weekly.
- Patient stands in the cabin wearing underwear and protective glasses. Session lasts seconds to minutes.
- Light energy is monitored and adjusted based on skin condition and disease progression.
Patients report relief and reduced anxiety post-phototherapy. Flare-ups are effectively controlled, reducing itching and pain, lowering medication doses, and improving mental well-being.
UVB Phototherapy
Highly effective, UVB penetrates the epidermis and slows pathological skin cell growth. The skin is exposed to artificial UVB light for a scheduled time.
➢ Broad-spectrum UVB: Emits a wide range of ultraviolet light.
➢ Narrow-spectrum UVB: More targeted, with faster improvement and longer remission periods compared to broad-spectrum UVB, often requiring fewer sessions weekly.
Psoralen + UVA (PUVA)
UVA radiation is also in sunlight but is less effective for psoriasis unless combined with a photosensitizing drug, psoralen, given topically or orally. PUVA therapy combines UVA with psoralen for treatment.
The main advantage of phototherapy is the use of narrow-band monochromatic light applied to skin lesions for a set time depending on the patient.
✓ Limits rapid keratinocyte renewal: light energy slows this, reducing plaque formation.
✓ Clinical studies show regular phototherapy under medical supervision quickly reduces symptoms and maintains remission.
✓ Phototherapy can be done with or without medication.
Topical Treatments for Psoriasis
Effective for mild to moderate psoriasis and include:
- Moisturizing creams and lotions: Available over-the-counter, help retain skin moisture and reduce flare-ups.
- Salicylic acid: Available in lotions and shampoos, used with other therapies for better results.
- Coal tar: Slows skin cell growth and improves skin appearance, commonly used for scalp psoriasis.
- Topical corticosteroids: Creams or ointments that reduce inflammation and slow skin cell growth.
- Vitamin D analogs: Products like calcipotriol slow skin cell growth, safer for long-term use than corticosteroids but may cause irritation.
- Topical retinoids: Some like tazarotene aid skin cell growth and apoptosis, used daily in small amounts.
- Anthralin: Reduces inflammation and inhibits cell growth without serious side effects.
- Calcineurin inhibitors: Reduce inflammation, often used when other treatments fail.
Systemic Drug Therapy for Psoriasis
Recommended for moderate to severe cases, especially when over 5-10% of skin is affected and other treatments fail. These drugs may cause serious side effects, so regular doctor monitoring is essential. Examples include:
- Methotrexate: Suppresses immune system and slows skin cell growth. Taken once weekly, requires regular blood tests to monitor liver and blood cells.
- Cyclosporine: Also suppresses the immune system, taken orally for severe cases.
- Hydroxyurea: Causes fewer side effects than other systemic drugs but is less effective.
- Biologics: Target specific parts of the immune system rather than the entire system. Biologics used for psoriasis block immune proteins like tumor necrosis factor-alpha (TNF-a), interleukin 17-a, interleukins 12 and 23, or interleukin 36, or block action of a type of immune cell called T-lymphocytes. Used in moderate to severe cases not responding to other treatments, with fewer side effects than traditional systemic drugs.
- Ustekinumab targets and inhibits interleukins 12 and 23.
- Secukinumab, ixekizumab, and bimekizumab inhibit interleukin 17-a.
- Guselkumab selectively binds interleukin 23.
- JAK inhibitors: Target Janus Kinase enzymes in cells, interrupting inflammatory pathways and controlling excessive skin cell growth in psoriasis. Upadacitinib and tofacitinib are approved for psoriasis treatment.
Combining Phototherapy with Topical or Systemic Therapy Offers:
✓ Enhanced effectiveness
✓ Reduced drug doses
✓ Fewer sessions
The treatment approach is personalized to ensure it is appropriate and safe for each patient based on individual needs, with the ultimate goal of improving patients’ quality of life.