Psoriasis is an immune-mediated disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis are often called psoriasis plaques or lesions. Psoriasis plaques are areas of excessive skin cell production and inflammation. Skin rapidly accumulates at these sites and sometimes takes a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals. Psoriasis is not contagious; it cannot be passed from person to person.
Psoriasis is usually graded as mild (affecting less than 3% of the body), moderate (affecting 3-10% of the body) or severe. Several other scales exist for measuring the severity of psoriasis. These scales are generally based on the following factors: the proportion of body surface area affected; disease activity (degree of plaque redness, thickness and scaling); response to previous therapies; and the impact of the disease on the person.
Bath solutions and moisturizers help sooth affected skin and reduce the dryness which accompanies the build-up of skin on psoriasis plaques. Medicated creams and ointments applied directly onto psoriasis plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques. Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids, vitamin D3 analogues (for example, calcipotriol), and retinoids are routinely used. The mechanism of action of each is probably different but they all help to normalise skin cell production and reduce inflammation.
-- A new anti-inflammatory drug may help treat people suffering from a certain type of psoriasis, a new German study suggests.
Reporting in the September issue of the Archives of Dermatology, researchers from Ruhr University in Bochum, and their colleagues studied the effects of four treatments -- 1 percent pimecrolimus (a new, steroid-free anti-inflammatory drug), 0.005 percent calcipotriol (a nonsteroidal treatment), 0.1 percent betamethasone (a topical corticosteroid) and a placebo cream -- in 80 people who had been diagnosed with "intertriginous" psoriasis.
Intertriginous psoriasis is an inflammatory skin disease that affects the skin folds of the underarms, breasts, groin, buttocks and genitals. It is usually treated with topical corticosteroids, but the medications may have adverse effects when used for long periods.
The researchers found that after four weeks of treatment, all four creams -- even the placebo -- resulted in significant decreases in the severity of psoriasis.
The 0.1 percent betamethasone was significantly more effective than the 1 percent pimecrolimus. Pimecrolimus was associated with an increase in itching and burning shortly after application, but most of these reactions lasted less than 30 minutes and resolved in a few days.
The study's authors concluded that since betamethasone was more effective than pimecrolimus, topical corticosteroids are still the most effective treatment for intertriginous psoriasis. But, they suggest, a short-term application of topical steroids followed with treatment by a less potent agent, such as pimecrolimus or calcipotriol, may help avoid the long-term effects of corticosteroid use.
This study was supported by a financial grant from Novartis Pharma GmbH, the pharmaceutical company that manufactures pimecrolimus
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