Clinic of Dermatology

Psoriasis is a chronic inflammatory skin disease. We have various effective treatments today, which moderate the disease process and improve the quality of life of the affected person. 1-3% of the bulgarian population suffers from psoriasis.

How does Psoriasis develop?

The exact causes of psoriasis remain unknown. We only know that its onset may be hereditary. A misdirected immune system plays role in the disease course. White blood cells and their defense cytokines are important in this inflammatory process. Environmental factors or seasonal fluctuations, trauma, such as pressure or mechanical load, medications and alcohol or psychological stress may influence the course of the disease.

What is the disease evolution?

Sharply defined red plaque develops first, afterwards the skin thickens, becomes rough and begins to shed. Elbows, knees and scalp are the most frequently affected locations. In some patients, psoriasis involves nails additionally; in rare cases, patients complain from joint pain – the so-called psoriatic arthritis.

How does the illness develop?

The last skin layer consists of dead cells (horny layer), which are continuously renewed. The deepest part of the epidermis, the so-called basal cell layer, regenerates and pushes the older cells upwards. In the psoriatic skin this turnover is strongly increased in the basal layer. Too many cells are pushed to the horny layer; they cannot be repelled rapidly enough and remain as silvery, shining scales on the skin surface. Psoriasis runs a chronic course and worsens frequently in autumn or winter.

Skin care is the basis of psoriasis treatment. If this is not sufficient, different therapeutical modalities come into consideration, depending on the disease stage: light and bath therapies (balneo-therapy), topically applied preparations, such as creams and ointments, and in severe cases- therapy with tablets or injections as well.

Skin care?

Skin care plays an important role in psoriasis patients. It is important that the natural protective film of the skin remains undamaged. Therefore, patients must use alkali-free cleansing lotions or wax protective shower oils. Baths with oil or salt additives speed up the healing process: they loosen the adhesion of scales and suppress the inflammatory process.

How can psoriasis be treated?

A combination of bath, light and topical ointment treatment modalities should be considered. Treatment with UV-irradiation brings a good therapeutical response. We use UVB (300-320 nm) irradiation, in combination with high concentrated salt-water baths. Besides that a combined treatment with UVA and systemic or topical psoralens (photo-sensitive chemical additives) – PUVA may lead to a significant improvement of psoriasis.

Another well-approved treatment is the so-called balneo-photo therapy: it is a combination of salt baths with subsequent UVB irradiation. The results are comparable with thalassotherapy at the Dead Sea.

Topical modalities for psoriasis treatment:

Salicylic acid in ointments helps to remove the scales before initiation of the active treatment.

Urea

Urea is a natural moisturizing factor and urea-containing preparations improve the symptoms via reduction of inflammation and itching.

Corticosteroids

Corticosteroids are very potent anti-inflammatory drugs. Corticosteroids are rarely used because of their side effects after long-term application. However, the new preparations are usually well compatible, if correctly applied. For many patients they offer a large therapeutical spectrum when combined with other topical products (caution is required when applied on the genital area and in children).

Vitamin D derivatives

Vitamin D reduces the shortened turnover time of the skin cells, which is responsible for scaling. Three OTC preparations with similar effect are currently available: tacalcitol, calcitriol and calcipotriol. All of them proved to be very effective. A combination between calcipotriol and topical corticosteroid has been developed recently and is available now. Calcium levels in the patient’s serum should be measured, in order to consider the maximum weekly quantity of the vitamin D derivative.

Dithranol

Dithranol is successfully used in psoriasis therapy since the beginning of the last century. It is usually provided inward and in combination with UV light and emollients. Dithranol proved to be very safe and effective medicine, even within long-term application regimen. Its disadvantage is coloring of the laundry and that is the reason for its inward application.

Vitamin A derivatives lead to a decreased growth rate of the skin cells and, thus to an improvement.

Biologicals or the so-called immune modulators

A new generation of protein products, which specifically restrain the psoriatic inflammation is available. These products proved to be very effective in moderate and severe psoriasis.

Internally administered medicines (systemic therapies)

In certain cases with joint involvement and severe symptoms, initial systemic therapy may help. The following substances are used today: methotrexate, retinoids, cyclosporin. Because of their potential side effects, they should only be used, if other treatments appeared to be unsuccessful.

The chances of success of the different methods depend strongly on the individual patient. After a careful diagnosis, the physician team in compliance with the patient decides the most suitable and promising therapeutic regimen.

The development of new treatment strategies, in the context of clinical studies open further possibilities, which we are ready to offer to psoriasis patients.

Ambulatory treatment

The dermatology team offers a comprehensive ambulatory consultation and different topical therapies in cases with relatively mild symptoms.

Balneo-phototherapy

Balneo-phototherapy (balneo – “water”, photo - “light”) recreates the elements of the Dead Sea therapy. Bathing in water with a high salt concentration is safe, effective, and pleasant for healing and recovery. Patients in high concentration salts solution for 10 min. and after that are radiated with UVB-light (300-320 nm).

PUVA

PUVA (psoralen plus ultraviolet light A) combines the light-sensitizing medication, called psoralen with ultraviolet light A (UVA). The procedures are performed four times a week.

The number of procedures varies between 20 and 30 depending upon the clinical evaluation. Patients must wear UVA-blocking glasses for at least 12-16 hours after treatment in any place where the sun shines.

Stationary treatment

In severe cases patients must be treated in the hospital.

Our clinic has large experience in the treatment of patients with psoriasis.