Psoriasis part 2 – topical treatment, phototherapy and skin care

Abstract

Psoriasis is a chronic inflammatory disease that requires the selection of appropriate pharmacotherapy and skin care. Topical treatment should be added in pharmacotherapy of every patient with psoriasis. It may be the basic therapy regimen for psoriatic lesions of low severity. However, topical agents should be combined with phototherapy and/or systemic therapy in patients with moderate to severe psoriasis. This second part of the article presents the current options for topical treatment. Calcipotriol in combination with betamethasone dipropionate is mainly used as the first choice of topical psoriasis treatment. The Polish Society of Dermatology also recommends vitamin D3 derivatives such as tacalcitol and calcipotriol, glucocorticoids, keratolytic substances, dithranol, tazarotene, tars and calcineurin inhibitors (pimecrolimus, and tacrolimus). In 2022, FDA approved two new substances for topical psoriasis pharmacotherapy: tapinarof and roflumilast. Both drugs have unique mechanisms of action and are first-in-class formulations for topical psoriasis therapy. Moreover, phototherapy is also an important element of psoriasis therapy, especially narrowband UVB (311 nm) phototherapy. Photochemotherapy with psoralens as photosensitizing compounds (PUVA) is recommended as the second choice. Furthermore, home and professional psoriatic skin care is an important element supporting psoriasis therapy. Properly selected active ingredients can reduce transdermal water loss, exfoliate the accumulated stratum corneum and improve the functioning of the hydrolipid barrier. Cosmetics dedicated to psoriatic skin should include popular ingredients such as emollients, humectants, keratolytic ingredients and lipids. In addition, properly selected professional care in cosmetology salons could be an important complement to the pharmacotherapy because it is usually more effective than home care. Beauty treatments that improve the permeability of active substances are recommended for psoriatic skin i.e. needle-free mesotherapy, sonophoresis and oxygen infusion. Moreover, carboxytherapy or treatments related to gentle exfoliation, e.g. oxybrasion, cavitation peeling, enzymatic peels or peelings with alpha hydroxy acids or beta hydroxy acids can also be used.

Keywords

• psoriasis
• phototherapy
• topical treatment
• skin care