Centro Studi GISED

Psoriasis

Is a chronic genetically-based disease of the skin with multiple clinical expressions. The most frequent form is psoriasis vulgaris – a process that manifests itself in the form of erythemous- scaly patches with characteristic localisations, especially in places of repetitive trauma: scalp, elbows, lumbar-sacral region, knees, hands and feet. In Western countries it affects 1.5-2% of the population.

I suffer from psoriasis of the hands and feet. What can I use to treat it? Thank you.

Dear Sir, the localisation of your psoriasis can be rather sore and interfere with everyday activities. Localisation at the extremities (acral) is more common among smokers. Treatment, considering the usual extent of the problem, can consist of, in the first instance, application of a vitamin D based ointment (e.g. cholecalciferol) or topical steroids. In cases a bit more difficult, systemic or local vitamin A derivatives can be used (e.g. retinoids) and PUVA therapy (treatment with UV light and psoralens). Best regards, Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia – GISED.

I’ve had psoriasis of the left elbow for many years, For a few months now, I have been suffering from pain in my left knee and ankle. The symptoms are: swelling, reddening, very painful nodules that appear without reason and disappear again without reason a few days later. Is it possible that I’m suffering from psoriatic arthritis? Do any medicines exist that can cure it? Thank you.

Dear Writer, psoriatic arthritis affects around 2-3% of psoriasis patients (even if it’s present in the 20% of psoriasis patients that the dermatologic services deal with) and it can present itself in various forms. At least 3 different forms can be distinguished: 1. Oligo- or monoarticular that affect some or few joints without any particular pattern, 2. the more classic psoriatic poliarthritis that affects the small joints of hands and feet and resembles rheumatoid arthritis, 3. psoriatic spondiloarthritis that affects sacro-illiac joints in a way very similar to that of ankylosing spondylitis. You can’t, therefore, exclude that you are suffering from psoriatic arthritis. I advise you to go for a check up either by a dermatologist or a rheumatologist. Medicines exist to a degree, which can control many of the cutaneous inflammatory manifestations of that joint. Specialised medicines used include: sulfasalazine, methotrexate and cyclosporine. On suspension of the medicines, the clinical manifestations can reappear. Best regards, Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia. – GISED.

Thank you for this website. I suffer from psoriasis of the fingers and I kindly ask you which treatments and ointments I should use. Thank you from (…)

Dear Writer, thank you for the message. Various treatments are available for psoriasis of the hands. Psoriasis acroposta (distributed at the extremities) is strongly associated with cigarette smoke: In case you smoke, it’s advisable to reduce or give up such a habit. With regard to medicines, the following are recommended in the first instance; vitamin D derivatives (cholecalciferol, tacalcitol etc) alone or in association with potent topical steroids. Best regards, Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia - GISED

I’m writing to ask you a question. My husband has been suffering from psoriasis (covering 90% of his body) for a few years. He’s in the care of a dermatologist, who has prescribed... for the last 3 years. He takes it for 3 or 4 months every year. My question is, would there be any problems if I was pregnant? Are there any contraindications? Thank you and best regards.

Not enough clinical experience of cyclosporin use during pregnancy exists to be absolutely sure, studies until now haven’t demonstrated any particular risks. However, the use of cyclosporin on the part of your husband shouldn’t carry any risks of the partner. Best regards, Dr Lorenzo Peli – GISED.

Dear Doctor, is it true that most people who have psoriasis are immune to tumours?

Dear Friend, what you said isn’t exactly correct. Those who have psoriasis have, in general, a similar risk to others who develop tumours. A few types of skin tumours can be more frequent in patients with psoriasis who have undergone long courses of PUVA therapy. Best regards, Dr Luigi Naldi, coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia – GISED.

I would like to ask a question: I suffer from psoriasis of the toenails. My toes are also swollen and at times I can’t walk properly. For a year now I have been taking..., but I don’t see any signs of improvement. I was hoping that you could give me some advice. I live in Germany. Thank you.

Dear Sir, thank you for the message. It’s possible that, on the basis of what you have said, that you suffer from psoriatic arthritis, a form of arthritis associated with psoriasis of which there exists various forms. One of these affects the joints of the hands and/or feel. They can be linked to dystrophy (distortion) of the nails. I advise you to pay a visit to a dermatologist about this problem and the lack of response to the treatment your following. Alternative medicines, for cases of psoriatic arthritis, are sulfasalazine or new medicines which modify the biological response like infliximab, etanercept and others. Best regards, Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia – GISED.

Dear Doctor, I’m 22 and I’ve suffered from psoriasis of the elbows since i was a child. For about 3 months it spread to the palms of my hands and for more than a month now I’ve been using Tacalcitol with no results; what can I use instead?

Dear Writer, thank you for the letter. The localisation of your psoriasis on the palms of your hands is particularly uncomfortable and interferes with normal everyday activities. For reasons not totally clear, this localisation is particularly common in smokers. If you smoke, it would be a good reason to give it up. Treatments should be continued over longer periods. When good results are not achieved from one single medicine, strategies of treatment using combinations of medicines can be considered: for example, daily treatment with a vitamin D derivative (calcipotriol) and cortisone for 4-6 weeks with a follow up treatment of 2 applications a week. Other treatment strategies use tazarotene with cortisone and phototherapy. In more resistant cases you can also consider using oral fumaric acid derivatives or other systemic medicines. Best regards, Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia - GISED

Dear Doctor, my name’s … and I’m writing for some information. I’m 30 and for about the last 10 years I have been suffering from psoriasis of the scalp. It’s quite uncomfortable and I have to say that over the years I have tried more-or-less everything. I’ve seen various dermatologists who gave various diagnoses and treatments that were all useless, up to the last, who gave me cyclosporin. The marks on my scalp seem to me to be increasing more and more in number and size and my worry is that sooner or later they’ll spread to other parts of my body. I would like to ask if there’s a specialist centre somewhere in Italy for cases like mine? Bearing in mind that I’ve already been to the... a couple of times, is there maybe a dermatologist who could help me, if not to cure my psoriasis, bring in under control? Thank you.

Dear Writer, Psoriasis of the scalp is fairly frequent. In general, it’s reddened patches covered with scales slightly itchy. Proposed treatments are, in general, local. In cases where a single medicine isn’t effective, 2 or 3 medicines can be used together: for example, vitamin D derivatives and topical steroids. The treatment should be continued daily for a few weeks and can be followed by a follow up treatment applied twice a week. Psoriasis is an illness of the inside of the skin at it’s genetic base and currently no treatments exist which can stop it spreading to other parts of the body. That aside, in general, in every single individual, areas affected are usually limited. I’m not in a position to recommend a single specialist centre to you. Most dermatological services can provide a satisfactory treatment for the disease. Best regards, Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).