Skin with typical psoriasis symptom. Image: Icefields,
Reading aloud Psoriasis can no longer be treated as a skin disease only from the outside. New medicines called biologics fight the disease before the first symptoms appear. However, since the disease varies greatly from patient to patient, the treatment must be individually tailored. For a long time, psoriasis was considered a pure skin disorder. Since it is known that the chronic inflammation is not limited to the body surface, the treatment of psoriasis has changed. New drugs have led to new therapeutic strategies. A current guideline therefore informs physicians about scientifically proven findings. For patients, a generally understandable version of this treatment guideline has now appeared.

The colloquial name "psoriasis" describes the typical symptoms that patients suffer from psoriasis vulgaris. On the skin form strong scaly, inflammatory reddened areas. These are very sensitive, can itch or bleed. Psoriasis has nothing to do with the known skin disease eczema. Experts speak of a "rheumatism of the skin", because their causes and consequences of rheumatoid arthritis resemble.

Like rheumatoid arthritis, psoriasis is an inflammatory disease of the immune system. The inflammatory processes lead to an excess reaction in the skin, whereby the skin cells renew themselves much faster than in healthy people. Dead cells repel the body in the form of silver scales. The underlying skin is red and may itch.

Although psoriasis is a skin disease, inflammatory processes are not limited to the body surface. For example, new data show that sufferers are more likely to have high blood pressure, diabetes and dyslipidemia and are at an increased risk of suffering a stroke or heart attack. Inflammatory messengers such as tumor necrosis factor alpha (TNF alpha) play an important role in this process. display

Against these messenger substances and other inflammatory processes, a new class of psoriasis drugs. The so-called biologics are known from rheumatism and have been used against psoriasis for about five years. They influence the communication of the immune system in different ways and thus directly intervene in the inflammatory processes.

Therefore, researchers suspect that they can not only counteract the superficial dermatitis, but also the comorbidities of psoriasis. "There are initial indications that long-term therapy with certain biologics, the TNF-alpha inhibitors, can reduce the risk of heart attacks, " explains Ulrich Mrowietz from the Psoriasis Center of the University Hospital Schleswig-Holstein in Kiel. "Large studies that prove this sufficiently are still missing." Currently, four different biologics are approved in Germany.

As psoriasis varies greatly from patient to patient, doctors and sufferers must work together to determine which treatment is most appropriate. For patients with a mild psoriasis already rich medicated ointments. At a certain level of severity, radiation and medicines that affect the entire body can also be considered.

Only when these do not seem sufficient or the patient can not tolerate them does the health insurance pay for the much more expensive biologics. "Since many dermatologists are not yet familiar with the new forms of therapy and the conditions for reimbursement, biologics are so far rarely prescribed, " reports Christiane Rose of the German Psoriasis Association (DPB). But this is also due to the lack of experience with biologics.

To help physicians choose an appropriate treatment strategy, a panel of experts agreed on a common guideline in November 2006. This assesses the effectiveness of various medications, radiation and accompanying measures, such as bathing in mineral waters or staying in sunny regions. In order for those affected to gain an overview, the DPB has now published a generally understandable version of this guideline.

Overall, the treatment of psoriasis has changed significantly in recent years. While earlier efforts were made to alleviate the acute symptoms, newer treatment strategies are designed to prevent a recurrence of disease at all. The affected person must therefore go on a permanent basis and not only in acute attacks in treatment. It is also important to keep an eye on common comorbidities. Because these not only worsen the already limited quality of life, they can also lead to irreversible damage.

This is particularly clear in the case of psoriatic arthritis, a joint inflammation affecting about twenty percent of patients with psoriasis. "If it is detected too late or not treated, it can, in the worst case, damage the joints, " explains Rose. However, it is not uncommon that joint inflammation is discovered only after years. Because just like psoriasis, psoriatic arthritis has many faces.

ddp / - Larissa Kessner

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