Psoriasis is a very difficult condition to manage; nevertheless, with a systematic approach doctors at German clinics achieve good results (lasting remission).
At specialised dermatology clinics in Germany, treatment is always preceded by a comprehensive work-up aimed at identifying the «triggers» of the disease, that is, the factors that set the pathological processes in motion.
German clinics treat psoriasis with combinations of different methods, including:
Topical treatment:
- salicylic acid preparations;
- baths with exfoliating additives;
- salt baths;
- vitamin D analogues, for example calcipotriol;
- topical corticosteroids at the lowest effective potency, for example, 0.1% tacrolimus ointment;
- dithranol-containing preparations, topical retinoids
Ultraviolet treatment:
- narrowband UVB-311 irradiation;
- broadband UVB irradiation;
- SUP (selective phototherapy);
- systemic PUVA therapy;
- PUVA creams.
Laser treatment:
treatment of the affected areas with a 308 nm excimer laser (compared with ultraviolet therapy, fewer sessions are needed for the same effect).
Systemic therapy
with systemic immunosuppressants or immunomodulating drugs (for example, methotrexate, ciclosporin, a TNF-alpha inhibitor):
- retinoids;
- antibiotics to treat the underlying streptococcal infection;
- methotrexate;
- ciclosporin A;
- fumaric acid derivatives;
- biologics – monoclonal antibodies, "biologicals" (for example, alefacept).
Innovative monoclonal antibodies in the treatment of psoriasis
Drug therapy for psoriasis has changed dramatically with the arrival of the new biologics – monoclonal antibodies. However, data from long-term (three-year) clinical follow-up of patients receiving these innovative biological agents – interleukin inhibitors – have shown that taking them does not remove the need for older medicines such as steroids (corticosteroids) or courses of phototherapy.
Biological treatment regimens for psoriasis that include at least one biologic can and should therefore be supplemented with topical steroids or phototherapy, since monoclonal antibodies do not eliminate the need for corticosteroids in psoriasis.
As for the monoclonal antibodies, the ones prescribed most often were:
- adalimumab (Humira, AbbVie);
- etanercept (Enbrel, Amgen);
- ustekinumab (Stelara, Janssen);
- infliximab (Remicade, Janssen);
- secukinumab (Cosentyx, Novartis);
- ixekizumab (Taltz, Eli Lilly).
