Psoriasis (psoriasis) and its treatment

What is psoriasis?

Psoriasis is a permanent, recurrent skin disease. It is known that 7.5 million people in America have psoriasis, and this figure is estimated to be close to 1 percent of the population in Turkey.

Why does psoriasis occur?

Although the cause of psoriasis is not known exactly, we are getting closer to the result with new scientific researches and we can treat especially severe psoriasis and psoriasis rheumatism more effectively and without side effects with drugs that act with completely different mechanisms than previous psoriasis drugs, which we call biological treatments.

Psoriasis is an immune system disease. T lymphocytes in our immune system have an important role in the formation of psoriasis. The complete resolution of psoriasis, especially after bone marrow transplants for other diseases, confirms this.

When skin is damaged or a germ settles, skin cells have to multiply more to repair it. The aim is to encourage cells to proliferate to repair the wound in a shorter time. However, in psoriasis patients, these cells, called T lymphocytes, of the immune system are out of balance and normally, when everything is fine, they begin to secrete substances that increase skin cells.

As a result, the functions of the skin cells that multiply rapidly in certain areas are also impaired and increase before they are fully matured. They cannot fully establish the connection between them and form layers that dry out and fall off.

The belief that psoriasis is a disease originating from the liver is not true. It has nothing to do with the food eaten.

Genetics and heredity of psoriasis (Will my children also have psoriasis?)

1/3 of psoriasis patients have psoriasis in their families. Psoriasis is more common in identical twins than in fraternal twins (Identical twins: 71%, fraternal twins: 28%)

The gene known to be related to psoriasis is PSORS1 and is located in the gene region that regulates the work of the immune system, which we call MHC. Other PSORS genes have also been identified.

The only way to identify these genes is to analyze blood from psoriasis patients. The more psoriasis patients are investigated in terms of this issue, the faster the exact cause of the disease can be reached. In fact, the National American Psoriasis Association has created a biobank for this reason.

Psoriasis is not an inherited disease. Although the rate of catching psoriasis in the children of families with psoriasis has increased by 1-2% compared to the children of normal families, this does not mean that they will definitely catch psoriasis.

Causes that increase psoriasis

Since psoriasis is a disease related to the immune system, some infections and drugs can increase psoriasis. At the same time, psychological stress and climate changes also affect psoriasis.

Psychological Stress

Studies have shown that psoriasis changes especially in serious life changes. In some recent studies, it has been determined that some substances that have the feature of triggering the immune system in the body increase in the blood with stress.

Bacterial and viral infections

It is known that psoriasis exacerbates especially in children with streptococcal bacterial infections in the throat. For this reason, patients who have persistent tonsillitis should receive a complete treatment. Often, dermatologists ask for an antibiogram test by taking a culture from the throat with the help of a cotton swab, even if the person does not have any complaints. Apart from these, the treatment of diseases in which there is a constant source of infection in the body (for example, decayed teeth) is essential.

Climate

Psoriasis decreases in sunny climates and increases especially in winter. Again, psoriasis is less common in low altitude areas. Since the humidity is low in dry climates, patients feel more itching in the crusted areas. For this reason, psoriasis patients can be more comfortable in areas with a humid climate. Again, in winter, the air dries up with the effect of heating and stoves and itching increases in crusts. Psoriasis patients should use plenty of moisturizer in winter.

Medicines

Drugs That Increase Psoriasis:

l Antimalarial drugs (Treatment of malaria and rheumatism): chloroquine – Chloroquine

l Lithium (Treatment of psychiatric diseases)

l Propanolol (Treatment of blood pressure and cardiovascular diseases)

l Anti-inflammatory (NSAID) drugs: Although they are thought to increase psoriasis, it has been observed that the effects of painkillers on psoriasis are very low, so they are not restricted in psoriasis patients.

There are scientific studies showing that smoking and alcohol increase psoriasis.

Koebner phenomenon:

Injury to psoriasis-free skin can cause new psoriasis lesions to form in this area. This phenomenon is called the Köbner phenomenon. Sunburn and cuts can cause this condition. Although the sun is very good for psoriasis, prolonged sun exposure should be avoided. Psoriasis patients should definitely not have permanent tattoos because psoriasis can also occur in tattooed areas. Intense itching in psoriasis wounds can lead to the formation of new psoriasis wounds with the effect of Köbner phenomenon in the surrounding skin, so it should be treated. In addition, most psoriasis patients play with the crusts and break them. This can also cause the same problem.

Psoriasis Treatment

Psoriasis wounds can be treated. But there is currently no method in the world to treat the recurrence of wounds. We can collect the methods used in the treatment of psoriasis in several categories:

· Ointment treatments:

Ointments are also divided into several groups according to the substances contained in them. We use ointments especially for limited psoriasis that does not cover the entire body.

Ointments containing cortisone:

They are drugs that are used with great fear among our patients, but whose side effects are exaggerated, especially because they contain the phrase cortisone. Treatment of cortisone-containing drugs begins in a short time. They are very effective in passing the redness and heal the psoriasis wounds that are not densely crusted in a short time. However, they should be used under the supervision of a dermatologist. Because psoriasis provides resistance to cortisone and does not show the healing effect it showed at first when used for a long time. For this reason, your medications should be changed at intervals by your dermatologist. Cortisones are not equally effective. Some cortisone ointments show a stronger therapeutic effect in a shorter time than others, but when used uncontrolled for a long time, they cause side effects such as skin thinning and vascularization in the skin more frequently.

When cortisone drugs are checked regularly by your dermatologist, they are drugs that take effect in the shortest time between treatments and control psoriasis. They do not cause side effects when used under the supervision of a doctor.

When ointments containing strong cortisone are used for a long time without the supervision of a doctor and in common psoriasis, they are absorbed from the skin and may cause side effects such as weight gain and osteoporosis due to cortisone treatment.

· Humidifiers:

It is one of the most important elements of psoriasis treatment. The crusting of psoriasis causes itching and prevents other creams from reaching the psoriasis wounds by forming a layer. Moisturizers reduce crusting and prevent itching in psoriasis. Humidifiers have no side effects. They can be used comfortably for a long time. The simplest and cheapest of the moisturizers is undoubtedly Vaseline.

Calcipotriol:

It is more effective in psoriasis wounds that do not progress with crusting. We can use it to maintain well-being, especially during periods when psoriasis heals. The amount to be applied to the body is limited, so it is not used in common psoriasis wounds. It is not used in areas with sensitive skin such as the groin and armpits, genitals.

· Tar derivatives:

Tar-derived drugs correct psoriasis by suppressing the growth of skin cells. There are types obtained from coal and plants. There are scientific publications stating that the long-term use of charcoal without the control of a doctor will increase some types of cancer. Although this side effect is not encountered in herbal tars (such as Juniper tar), it is very important to use them under the supervision of a doctor. Especially odors and skin dyeing cause problems when used. New drugs have tried to reduce these properties. They are not used because they cause irritation in areas where the skin is thin, such as the armpits, groin, genital area.

Tar is one of the main drugs used by those who claim to treat psoriasis with plants. Since most patients are not warned about the above issues, they think that the dry, red, and peeling skin that the treatment has done incorrectly is normal, and they endure these side effects, thinking that they will get permanent results.

Anthraline:

The feature of this drug, which acts in a different way, is to regulate the treatment by leaving it on the skin for a certain period of time. Burn-like side effects such as redness and burning may occur if the skin may dye or if the patient accidentally keeps the drug on the skin for a long time. But it is especially effective in psoriasis wounds that are resistant to treatment. Since the timing of the treatment is very important, it should be used under the control of a dermatologist. It is not used in places where the skin is thin such as armpits, groin and genital area.

· Pimecrolimus and Tacrolimus:

Since these newly emerging drugs do not contain cortisone, they can be used in the treatment of psoriasis for a long time. They can be used for a long time, especially in areas where the skin is thin, such as the face and eyelids. Since blood cancer develops in a few patients with long-term widespread use in infants, you should definitely use it under the control of your doctor.

· Light Therapies (Phototherapy: PUVA, Narrow Band UVB, Microphototherapy, Targeted Phototherapy and Laser):

Light therapy, in other words phototherapy, is based on copying the healing effect of the sun on psoriasis and applying it with special devices. Ultraviolet light is the type of light that is effective on mother-of-pearl and is found in the sun. UVA is the first type of light found, UVB and Narrowband UVB were later discovered and have fewer side effects than UVA treatment. The side effect that every patient fears in light therapy is the development of skin cancer. However, as a result of a recent study at Hacettepe Faculty of Medicine, psoriasis patients treated in this center did not develop skin cancer during the treatment, only harmless sunspots developed.

With the advancement of technology, it has become possible to give ultraviolet light only to psoriasis wounds with fiberoptic systems (Microphototherapy, Targeted Phototherapy). In this way, only the problematic area can be treated without the entire skin receiving light. Lasers are slightly more effective than other treatments, but the application costs are very high.

Light treatments can be applied in the form of cabin, hand-foot units, hair treatment unit and targeted (microphototherapy) phototherapy.

· PUVA:

PUVA therapy, which is the first of the phototherapies to be used, is a treatment that is often applied in the form of a cabin. The patient is taken into a cabinet resembling a solarium, and the cabinet is closed and the patient is given ultraviolet A light for a certain period of time with the fluorescent lamps inside. In PUVA treatment, the patient is given a medicine in pill form or a special medicine is applied to the wounds so that the ultraviolet A light is better absorbed by the psoriasis wounds. After leaving the treatment after the medication applied in the form of pills, the patient should go out by using sunglasses and a hat, except for these, by applying sunscreen. The effects of the drugs will wear off after a certain period of time.

The treatment is applied 2 or 3 times a week. In general, treatment is started with 20 sessions and phototherapy is continued according to the patient’s response to treatment. Although its side effects are more than other light treatments, it suppresses the emergence of psoriasis for a long time in successful cases.

· UVB – Narrow Band UVB Treatment:

This treatment is applied similarly to PUVA, but because the fluorescents are different, the light they produce is also different. In this type of treatment, there is no need to take pills or apply a medicine to the skin beforehand.

· Targeted phototherapy, Microphototherapy:

In this newly applied phototherapy method in Turkey, the operator can give the light directly to the problematic skin areas with the special head of the device. Intense light can be given in a shorter time. In this way, especially in psoriasis in the limited area, it is possible to heal without applying medication 2-3 times a week. The period of silence after psoriasis treatment starts from 2-3 months. The advantage of this treatment is that phototherapy can be applied even if the patient does not have extensive psoriasis. This treatment can be easily applied to heart patients and patients who cannot enter the cabin. This treatment offers an alternative to patients who have applied cream for a long time, developed cortisone resistance and are bored with this treatment, and causes long-term remission (no recurrence of the disease).

· Laser treatments:

In such treatments, excimer lasers in which ultraviolet light is concentrated or lasers that burn the vessels feeding the psoriasis are used. Although they offer psoriasis-free time for a little longer than other treatments, the treatment costs are quite high.

· Pill and injection treatments (Systemic treatments)

Undoubtedly, the request of each of our patients is that we recommend a medicine for psoriasis in the form of pills or injections. Because it is difficult to apply cream treatments, especially in very common psoriasis, it is not possible anyway. However, no pill or injection with mild side effects has been released for psoriasis so far. Below we will list the most commonly used treatments for this disease. Remember that the treatment of psoriasis is variable in each of our patients. Our desire in choosing the treatment is to provide the maximum benefit to our patient with the least side effects.

· Methotrexate:

This drug is also used in the treatment of cancer, and for this reason, most of our patients hesitate when using the drug in the first place. However, with the emergence of new needle-shaped forms that can be administered subcutaneously, the drug is generally used very comfortably by our patients. The way of use is usually once or twice a week and the dose is calculated according to the weight of the patient and the prevalence of psoriasis. With the use of the drug in pill form, stomach and digestive system side effects may occur frequently. With the use of the new subcutaneous injection once a week, this side effect has also disappeared. Methotrexate shows its effect by reducing the wrongly functioning immune system cells in psoriasis. It can be used easily for months under dermatologist control. What should be considered is that you have regular tests recommended by your dermatologist. Apart from this, health personnel and those whose relatives have tuberculosis (TB disease) should be followed carefully. Patients using methotrexat should protect themselves when there are people around them who have the flu, and should consult their doctor without waiting for the fever to rise when complaints such as fatigue and cough occur. Methotrexate may hide the signs of a simple infection and cause an increase in the disease. Since it may cause side effects on the liver in long-term use, your doctor may request a liver biopsy in some cases. You should consult your doctor when using other medicines while using methotrexate. The effect of the drug usually occurs within 1 month and continues with the newly administered doses.

· Acitretin (Neotigason):

Acitretin type drugs are obtained by replacing vitamin A. They are drugs used in pill form. The dose and duration of use are calculated according to your weight and the weight of your psoriasis. These medications correct psoriasis by exfoliating the skin and adjusting the skin’s regeneration time. For this reason, the side effect that we see in almost every patient using this drug is drying and cracking of the lips. However, it can cause peeling on the skin of the hands and feet, thinning and mild dryness in the whole body. Nail changes and hair loss are common side effects. Since the facial skin also dries out and becomes sensitive, sunscreen with a high protection factor should be used, especially in summer. The use of lenses is not recommended, as dry eye during the use of the drug will cause problems in patients who wear lenses. Acitretin can raise your blood fats and cause increased liver function. For this reason, your doctor will ask you for some tests at intervals. Acitretin is a drug that can be used safely in the long term. The most important side effect of acitretin is on the baby in the womb. If pregnancy occurs in women using acitretin, there is a very high risk of giving birth to a disabled baby. For this reason, it is not recommended for women to have children while using the drug and up to 2 years after stopping it. At the same time, they cannot breastfeed. It is inconvenient for all patients who use acitretin, male and female, to donate blood because of this side effect of the drug, as the blood they will give may go to a pregnant woman. After the drug is started, it begins to show its full effect within 1-2 months.

· Cyclosporine:

This treatment, taken in the form of capsules, corrects psoriasis by suppressing the immune system cells that are effective in the formation of psoriasis. Cyclosporine is a drug that prevents rejection of the organ by the body in transplant patients. Since the drug may have long-term side effects on the kidneys and some elements in the blood, regular tests should be performed while using the drug. Cyclosporine shows its healing effect on psoriasis in about 1-2 months.

Biological treatments:

They are the last drugs on the market in the treatment of psoriasis. Although it has an effect on the cause of psoriasis, some of them have been withdrawn from the market due to the serious side effects they cause. They are treatments applied in the form of needles. Depending on the type of drug, they can be applied once a week or once every 2 weeks. Similar to methotrexat, they suppress the immune system, so patients using them should protect themselves against infections. As with other systemic treatments, tests and controls should be done at regular intervals. Biological treatments are covered by SGK (SSK, Bağkur and Yeşilkart) with health reports issued by training and research hospitals or university hospitals in our country. In general, we use these treatments, which are quite new, in our patients who used certain drugs before and did not benefit.

· Climate treatments (Balıklı lake, Dead lake and others)

The fish lake and other regions in Sivas are undoubtedly one of the most frequently asked treatments by our patients. The wisdom of the fish in the fish lake is actually to reduce the thickness of the wound by eating the mother-of-pearl shells. The patient, whose psoriasis wounds are examined, sunbathes in the open pools and actually applies the light therapy that we do in hospital conditions under natural conditions. The ultraviolet light in sunlight is a weak light, but it easily penetrates the wound thinned by fish. We provide this effect by giving peelers to our patients with thick wounds before phototherapy. But the most important effect of the fish lake is undoubtedly on psychology. Our patient, who thinks he is alone and alone in his world, encounters many psoriasis patients here, talks to him and shares his life. He sees patients who are worse off than himself and is grateful for his situation. Our Ministry of Health covers this treatment, which it considers as a spa treatment, with a certain percentage on the condition that a health report is issued. Of course, the issue mentioned negatively is hygiene. Theoretically, fish that bite wounds in crowded ponds can transmit disease among patients. Theoretically, although there is this risk, it has not been proven in a scientific publication. Dead Sea is a lake located in Israel, and ultraviolet light is intense in its atmosphere, thus it is beneficial for psoriasis wounds. In other words, we can already provide the elements that are beneficial in climate treatments under hospital conditions.

How does your doctor choose the right treatment for you?

The prevalence of psoriasis, your age, your gender and the resistance of your psoriasis to treatments play a major role in treatments such as Neotigason. Generally, we apply microphototherapy and ointment treatment for psoriasis in limited areas in our hospital, and pill and needle treatments for more common psoriasis. Systemic treatments can also be used in psoriasis that has become resistant to long-term ointments.

The golden rule in psoriasis treatment: It is to come to follow-ups

It is unknown how psoriasis will progress in every patient. Therefore, after recommending the necessary treatments to our patients, we invite them for control. Medications given may not correct psoriasis in the first place. When we see this, we make a medication change and get one step closer to correcting psoriasis scars. For this reason, our patients should definitely follow up.

Psoriasis and Psychology

Psoriasis is a disease of sensitive and thoughtful people. Psoriasis has an intense course and recurs frequently in people who are generally thoughtful, do not reflect their feelings, and worry about certain issues in daily life and lose their sleep. A psychologist or an urgent vacation may be the best prescription for unresolved problems. Still, the best advice for our patients with this kind of mindset is to be a little more “blind”.

Reach & Share Psoriasis

The best way to overcome your problems and illness is to share your life with other psoriasis patients. Don’t forget to be a member of the psoriasis forums on Yalnizgilim.com and on Doktorsite.com.