Can acupuncture treat psoriasis effectively
psoriasis (Psoriasis vulgaris): Chronic, mostly intermittent skin disease with severe flaking. Often there are also abnormal nail changes. The cause is assumed to be a hereditary autoimmune disease that breaks out in the event of bacterial infections, stress, the use of certain drugs or other triggers and leads to a massively accelerated cell renewal in the epidermis. About 2-3% of the population suffer from psoriasis.
The course of the disease varies from person to person. In around a quarter of those affected, psoriasis occurs only once, in others relapses and stress-free phases alternate. Psoriasis cannot be cured, but it can be treated quite well. In severe cases, those affected often suffer greatly from their external appearance. It is also important to know that the disease is not contagious for other people.
- Sharply demarcated, reddened herd with silvery-gray scales, v. a. on the extensor sides of the arms and legs (elbows, knees), the palms of the hands and soles of the feet, the nails and the hairy head
- Sick looking nails
- Sometimes itching.
When to the doctor
In the next days, if
- the skin suddenly flakes clearly as described above.
Even today, if
Psoriasis is a genetic condition; H. the predisposition for this is inherited. However, this does not mean that everyone with a corresponding genetic make-up will also get it. When the disease breaks out, however, the body's own immune system, in particular the T lymphocytes, turns against the cells of the epidermis. This leads to inflammation in the epidermis. The body reacts to this by producing many new skin cells (accelerated cell proliferation) - although there are actually still enough skin cells in the affected area. While an epidermal cell in healthy skin migrates from the germinal layer to the surface of the skin within about 30 days, this process is shortened to about 4–8 days in psoriasis. The skin thickens and begins to flake off a lot. The result is the typical accumulation of silvery-white scales on sharply delimited, round, slightly raised, reddish spots. Such Shed stoves are also called plaques. Overall, the skin is dry and prone to painful cracks.
Clinic and course
There is no such thing as psoriasis - on the contrary, it varies greatly from person to person. It is particularly common for it to appear for the first time during puberty or between the ages of 40 and 50. It can be recognized by the typical shed herds, which are usually the size of a coin or a palm, sometimes significantly smaller. They can appear as individual, sharply delimited spots as well as flow together over a large area (confluence) and cover entire parts of the body. Typically, the foci are symmetrical on both halves of the body. Often there is itching. In about half of the patients, there are pathological changes to the nails in the form of yellowish discolouration (oil stain nails), dimple-shaped depressions (speckled nails) or, in the worst case, crumbling nails.
Two thirds of those affected show a chronic course with recurring attacks. The flare-ups occur v. a. in autumn and winter, when the skin is stressed by dry heating air and adverse weather conditions. In the summer months, on the other hand, there is often an improvement.
Despite the genetic predisposition, the disease does not always break out. It is often triggered by certain factors, for example stress, infections or underlying diseases such as diabetes or an infection. Other influences can also trigger acute flare-ups or worsen an existing flare-up, for example
- physical factors such as excessive sunbathing, pressure, or injury
- chemical stimuli such as cosmetics or solvents
- Medicines such as beta blockers, ACE inhibitors, lithium, anti-malarial drugs or anti-rheumatic drugs
- Luxury foods such as alcohol and nicotine.
Psoriasis arthrosis (psoriasis arthropathica) occurs as a complication of psoriasis in at least 5% of those affected, i.e. a painful inflammation of the joints, especially on the fingers and toes, knee and hip joints, in pronounced form there is even a risk of joint deformation. Patients with a are particularly at risk Inverse psoriasis, the V. a. affects the anal fold, genital region, navel, palms of the hands, soles of the feet and nails. Other, extremely rare, but difficult special forms are the psoriatic erythrodermain which the entire skin is reddened and covered with scales, and which Pustular psoriasis (0.5–2.5%), which is associated with the formation of pus pustules and can be fatal if the entire body is affected.
Patients with psoriasis also have a higher risk of cardiovascular diseases. Scientists found a 10 to 30 percent higher risk of suffering or dying of a heart attack or stroke compared to healthy people. The more severe the symptoms of psoriasis, the greater the risk. Patients with psoriasis are also more likely to develop Crohn's disease or celiac disease.
The medical history and the typical skin changes are usually sufficient to make the diagnosis. Psoriasis shows some characteristic phenomena that the dermatologist can provoke:
- Candle stain phenomenon. Here the cuticle becomes lighter when scratched lightly and can be easily removed, similar to a candle wax stain.
- Last membrane phenomenon. If scales are removed, a shiny last skin appears, after further scratching, tiny punctiform hemorrhages appear (bloody dew, Auspitz sign).
If the dermatologist still doubts the diagnosis, she will take a small skin sample (biopsy) under local anesthesia.
PASI index. The extent of psoriasis will go with the Psoriasis Area and Severity Index (PASI) determined. The doctor assesses the herd in terms of redness, flaking, skin thickness, extent and body region. A total of 0 to 72 points are possible, with ≤ 10 points it is a mild form, with> 10 points it is moderate to severe psoriasis. The PASI is not only used for therapy planning - measured regularly, it can also be used to assess the course and response of psoriasis to treatment.
Differential diagnosis. The untreated, typical psoriasis can hardly be confused with any other skin disease. It is more difficult with the special forms such as B. arthropathic psoriasis. If only a few scales form here, the disease is often misinterpreted as arthritis of another origin.
For the treatment of psoriasis, a variety of active ingredients and procedures are available that are used depending on the severity of the skin symptoms. In addition to the basic therapy, external, local treatment with creams and ointments is recommended in the case of a mild course (PASI ≤ 10 points); in the case of moderate to severe course forms, physical measures and internal therapy with medication are also recommended.
In all degrees of severity of the disease, it is important to remove the scales and soften the thickened skin. For this purpose, we recommend, for example, 5% salicylic petroleum jelly or 10% urea ointment. Different oil mixtures also help to loosen dandruff and soften the skin.
Once the dandruff has been removed, the actual psoriasis therapy begins with external agents.
- Vitamin D derivatives. Vitamin D3 slows down the accelerated formation of new skin and curbs chronically recurring herds just as well as a medium-strength cortisone preparation. In contrast to cortisone, it is better tolerated; the most common side effects are temporary skin irritation. Vitamin D derivatives should not be combined with salicylic acid, otherwise the effectiveness is reduced. Frequently used representatives are tacalcitol, calcitriol or calcipotriol.
- Calcineurin inhibitors. These active ingredients modulate the immune system and have a similar effect on the scaly foci as medium-strength cortisone. Their advantage is that they can also be used on sensitive skin areas such as the face and genital area. Side effects include burning sensation and sometimes skin infections. The active ingredients tacrolimus and pimecrolimus are available. However, both are not yet approved for psoriasis, so their use is off-label.
- Vitamin A derivatives. With the locally active retinoid tazarotene, 70 percent of the stubborn dandruff foci are supposed to heal. However, annoying side effects such as skin burning and itching often occur. Tazarotene is no longer sold in Germany, Switzerland and Austria and is only available from international pharmacies. It must not be taken during pregnancy because as a retinoid it damages the unborn child.
- Cortisone. Cortisone has a strong anti-inflammatory effect and also inhibits excessive cell division. Active ingredients such as betamethasone therefore often help the dandruff to heal well. However, with prolonged use, cortisone makes the skin thinner and therefore more vulnerable. Cortisone should therefore not be applied to the face, neck or genitals. For use on the hairy head and on diseased fingernails or toenails, however, it can be used well, as these areas are less sensitive. If treatment is required over a longer period of time, this is done alternately with a basic preparation that does not contain active ingredients. Long-term cortisone treatment must be gradually ended. This means that the dose is gradually reduced or the patient first switches to a weaker cortisone. Otherwise, the skin changes will otherwise reappear in the same place (rebound phenomenon). Cortisone must not be used during pregnancy and breastfeeding.
- Dithranol. This preparation is administered in high concentration as "minute therapy", so it only remains on the skin for 1–20 minutes. In classic therapy, the concentration is lower, which is why it is applied half a day or all day. Dithranol is known for its intense brown discoloration of skin and clothing on contact. As a finished cream or ointment, Dithranol is no longer on the market in Germany. If the doctor prescribes this active ingredient, the ointment with the active ingredient must be mixed individually in the pharmacy.
- Tar. Tar preparations have proven themselves in the treatment of psoriasis for over 100 years. Recently, however, they have fallen into disrepute for their potentially carcinogenic effects. Some "unsuspicious" preparations are sometimes still in use. They show a good effect on the inflammatory activity and the accompanying itching. They must not be applied to red, weeping areas. They are also prohibited for pregnant women, breastfeeding women and babies.
PUVA therapy. The active ingredient psoralen makes the skin more sensitive to UVA light and then irradiates it (PUVA = psolaren + UVA). In tablet form, as a bath additive or cream, psoralen inhibits the formation of skin cells under the influence of UV rays. PUVA therapy is carried out four times a week in the initial stage, later two to three times a week. Itching, nausea and reddening of the skin can occur as side effects. PUVA is contraindicated in pregnant women, breastfeeding women and people with an increased risk of skin cancer. In addition, it should always be done by professionally trained staff, as there are some forms and stages of psoriasis for which light therapy is not suitable.
Balneophototherapy. Balneophototherapy, a combination of medicinal baths and UV-B radiation, achieves similar successes as PUVA therapy. Both herbal and mineral additives such as carbon dioxide, sulfur or brine ensure the therapeutic effect of the baths. During or immediately after the twenty-minute bath, the patient is irradiated with UV-B. 3 to 5 treatments a week are ideal. The therapy is covered by the health insurance fund, a series of 35 treatments is paid for, whereby a new series of treatments can be started after six months. The Federal Association of German Dermatologists keeps a list of dermatologists who use the therapy (link under "Further information").
Selective UVB therapy or narrowband UVB radiation. This irradiation with UVB light is also possible as a home treatment and is as effective as in the therapy center.
Heliotherapy. Natural sunlight is used in this light therapy; the UV-B component is effective. It is carried out without sun protection, which is why particular care should be taken to avoid sunburn.
Dead Sea Therapy. A cure at the Dead Sea works like a "natural" balneophototherapy. In addition to the "light therapy" by staying in the blazing sun (which should increase from a few minutes to hours every day), two or three times a day you have to bathe in the salty Dead Sea. Many of those affected benefit from a four-week cure stay carried out in this way.
Systemic drug therapy
From a PASI of 10 and in the presence of psoriatic arthritis, the doctors recommend systemic therapy for psoriasis. The drugs used for this are highly effective, but also contain numerous, z. T. significant side effects. This is why treatment with it is often carried out in special outpatient departments that are connected to university hospitals. Regular therapy controls and monitoring of blood pressure, blood count, liver and kidney function are essential for most active substances. Since many of the active ingredients are forbidden during pregnancy, pregnancy must be ruled out in women of childbearing potential before treatment and a safe method of contraception must be used during and sometimes for weeks after treatment.
First-line therapy. These drugs are considered the first choice for treating moderate to severe psoriasis.
- Acitretin. The retinoid acitretin inhibits the growth of horn-forming skin cells, is anti-inflammatory and interferes with the immune system.
- Cyclosporine. This calcineurin blocker has a strong anti-inflammatory effect on the immune system. Since there is a risk of significant side effects such as hypertrichosis, kidney damage and an increased risk of cancer, the doctors primarily use cyclosporine for short periods of time.
- Fumaric acid ester. Fumaric acid esters also have an anti-inflammatory effect on the immune system. Changes in the blood count and kidney damage are important side effects. Before the actual therapy, a careful tolerance adjustment with low-dose active ingredient is necessary.
- Methotrexate. Methotrexate is a folic acid antagonist that is also used in severe rheumatism. The highly effective drug, which is administered subcutaneously on a weekly basis, has serious side effects and is toxic to the liver, kidneys and bone marrow.
- Adalimumab. This TNF-alpha antagonist can reactivate tuberculosis in addition to other serious adverse effects, and the risk of serious infections is increased during the treatment. Adalimumab is injected subcutaneously.
- Seculimumab. Sekulimumab is anti-inflammatory by blocking interleukin-17. Typical side effects are fungal infections, diarrhea and the flare-up of chronic inflammatory bowel diseases such as Crohn's disease and ulcerative colitis.
Second line therapy. If the first-line active ingredients do not work or if they are not allowed to be given (e.g. because there is a chronic infection), the guidelines recommend the use of the following second-line active ingredients:
- Apremilast. Apremilast is a phosphodiesterase IV inhibitor approved in 2015 that significantly improves the appearance of the skin, even in difficult cases. The effects of the drug on the psyche are dangerous. Some people treated develop suicidal ideation and behavior, especially if they have had psychiatric symptoms in the past. The attending doctor must therefore always be informed if mood swings occur.
- Etanercept. The TNF-alpha inhibitor has a strong anti-inflammatory effect and thus also curbs pronounced herds. It is injected under the skin once or twice a week. Serious infections threaten the side effects. Sometimes the immune system also forms antibodies against the active ingredient or the body's own structures after administration. There is also evidence that lymphomas occur more frequently under the active ingredient.
- Infliximab. This TNF-alpha antagonist is given as an infusion every 2 weeks (later at longer intervals). There is an increased risk of serious infections and malignant diseases such as lymphoma, leukemia or cervical cancer during therapy.
- Ustekinumab.The antibody against interleukin 12 and 23 is injected under the skin. The undesirable effects are nausea and diarrhea, itching and wheals. In addition, the risk of infections is increased.
Psoriasis is a chronic disease that occurs in attacks of varying severity and at different intervals. Lighter forms can be treated well with the measures mentioned. With severe psoriasis, the quality of life of those affected is often severely impaired, which is why many sufferers also develop severe depression.
Your pharmacy recommends
What you can do yourself
Skin care. In the case of psoriasis, thorough cleaning and care of the skin is particularly important in order to gently remove the flakes of skin, add moisture to the skin and protect it from cracks and irritation. Often, preparations with urea (urea) are recommended for care, as these penetrate well into the outer skin layers and bind moisture there. Whether ointments, creams or lotions are used depends on the individual skin feel. When choosing cleaning and care products, those affected should seek advice from a dermatologist or a pharmacy.
Use summer. Psoriasis usually improves in the summer months. It should be noted, however, that you have to get used to the sun step by step and avoid sunburns at all costs.
Stay by the sea. Sea air and bathing in the sea are also said to have a beneficial effect on psoriasis. If you can't go to the sea, you can take a bath with salt from the Dead Sea in your own bathtub.
Dress. Dandruff is common where clothing scratches and rubs against the skin. Soft, non-abrasive clothing therefore helps to contain the spread of the disease.
Nutrition. Every psoriasis is different - accordingly there is no one right diet for sufferers. It is important to observe yourself carefully, e.g. B. also with the help of a food diary. This is a good way to find out whether certain foods trigger a surge. Alcohol in particular should generally only be consumed with caution - it is not uncommon for an acute flare-up to follow after extensive consumption of alcohol.
Relax. Stress and psychological problems can also increase or even trigger flare-ups. Relaxation and stress reduction are therefore important components of self-treatment. In addition to getting enough sleep and plenty of exercise in the fresh air, it is also advisable to learn a relaxation method. Those who practice regularly can switch off when the living conditions are a little more turbulent.
Searching for help. Psoriasis is a very stressful disease. Because of the clearly visible skin symptoms, those affected are often stigmatized. Support is provided by self-help groups where you can exchange ideas with fellow sufferers and give advice, e. B. the German Psoriasis Bund or the Psoriasis Network.
Treat depression. If the level of suffering is very high, many sufferers develop depression or other psychological problems. Psychotherapy can help to accept the illness and thereby make it more bearable.
Complementary medicine sees psoriasis as a result of a metabolic imbalance and offers appropriate therapeutic approaches.
Hydrotherapy. In particular, baths with the addition of brine or sulfur are recommended because of their dandruff-releasing effect. Milk-whey baths relieve itching, moist compresses with nettle tea reduce inflammation. The fact that visits to the sauna can improve the symptoms is attributed to their blood circulation-stimulating and sweat-inducing effect.
Herbal medicine. In order to normalize the metabolism, tea mixtures made from senna leaves, caraway seeds, chamomile flowers and bittersweet or alternatively made from bittersweet, nettle leaves, dandelion root, senna leaves, fennel and sand sedge, which should be drunk twice a day for 4 weeks. Outwardly, the active ingredients of aloe vera and mahonia, a type of barberry, have proven themselves in the form of ointments.
Acupuncture. Acupuncture therapy is assessed differently, and itching can sometimes be suppressed. Acupuncture may only be performed in non-relapsing intervals with the aim of extending these intervals.
- Website of the association www.Psoriasis-Netz.de, Berlin: Information portal operated by self-help groups with extensive information on psoriasis and its treatment.
- www.psoriasis-bund.de - German Psoriasis Association V., Hamburg: Information and contact to self-help groups.
- Up-to-date list of dermatologists offering balneophototherapy
- www.psonet.de - Website with a list of doctors and clinics with a high level of expertise in psoriasis.
AuthorsDr. Ute Koch, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 08:58
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