15 best non-hormonal remedies for psoriasis

*Review of the best according to the editors. About the selection criteria. This material is subjective, not an advertisement and is not a guide to purchase. Consultation with a specialist is necessary before purchase.

Many people are familiar with psoriasis. These are spots that are covered with silvery, flaky scales. During growth, these spots are ring-shaped, festooned, and cause intense itching, usually around the edges of the spot. The central part of the spot may be relatively clear of scales. During growth, these spots merge, forming circular, bizarre structures.

If you scratch the surface of such a psoriatic spot, under the removed scales you will find a smooth, shiny red skin, which may be a few drops of blood, the so-called phenomenon of “bloody dew”. During an itching attack, a person with psoriasis, scratching the spots, can “cover” the entire floor of the room with the tiniest dried scales within a week. But despite the itching that occurs during periods of exacerbation, psoriasis belongs to the group of itchy dermatoses, and not at all to the dermatitis.

This means that at the heart of the disease is not an inflammatory phenomenon, but pathologically rapid cell growth. That’s why most of the time psoriasis patients may experience pain of a cosmetic, social nature, but the debilitating and constant skin itching they have almost no. Of course, this does not apply to periods of exacerbation, severe course of psoriasis, as well as psoriatic erythrodermia, when the entire skin is affected.

According to contemporary data, one out of fifty people taken at random will suffer from psoriasis. But it is not only skin rashes that are dangerous for this disease. Psoriasis affects the hair, scalp, nails, affects the joints, and a pronounced form of widespread psoriatic arthritis in many cases leads to permanent disability. But for all its faults, psoriasis is the proving ground in which patients of all countries have tried thousands of varieties of different creams, ointments, folk remedies, lotions, injections, wraps, and other treatments.

However, there is a not so large, but constant group of patients who need expensive treatment. Maybe in Germany or the United States it would not be considered expensive, and the patient could well afford to purchase once a month a drug costing about $500. But for Russia it is expensive. That is why in Russia modern treatment is accessible for only 18% of patients, of the number of those who need it. This is not enough, and such patients can only be sympathetic. But still some drugs from the category of expensive, were included in the list.

What remedies are not on the list and why?

There are medications that are either too dangerous in the wrong hands, or simply cannot be used outside of institutions. For example, there are no hormonal medications for psoriasis in this review. Why?

Hormones are really some of the strongest remedies that can help a psoriasis patient very quickly. If to spread a good strong hormonal ointment or cream on psoriatic plaque itching (which is categorically forbidden to do without prescription of doctor), then literally in the morning there will be visible excellent result. The intensity of inflammation will decrease, the spot will become paler, and the scales will stop forming for a while. If you smear hormonal products on your rashes regularly, the effect can be tremendous. All elements of the rash will turn pale, and an outsider who is unaware of the use of potent hormones would think that the patient had spent six months in a special resort.

However, hormones also have a downside. After some time of such improper use of hormones, you may find that the aggravation has started again, but: no medications other than hormones work anymore. Anything that helped before will not work! And the hormonal ointment, which used to work wonders overnight, now has to be used in huge quantities, as its effectiveness has been reduced to almost zero. At the same time, hormones in high doses also have systemic effects: increase blood sugar, destroy bone tissue, causing osteoporosis, reduce immunity, and increase the risk of gastric and duodenal ulcers.

Therefore, hormones in psoriasis should only be prescribed by a doctor, and the intake should also be monitored by him. There are several immutable conditions:

1. Hormones should be prescribed by a doctor only when other drugs are powerless, and non-drug methods, such as giving up bad habits and normalizing body weight, stress reduction did not lead to the desired result;
2. Hormones should be prescribed first from the weakest to the strongest, and in no case vice versa;
3. Finally, the hormones should be prescribed in as short a course as possible, and in as low a dosage as possible. When applied to the skin, even a half dose can be used by combining it with heparin ointment. Heparin “thins the blood,” improves blood flow, and facilitates absorption. This will reduce the dose of the hormone.

Homeopathic remedies will also not be considered. Homeopathy has widely “introduced its hands” in human affairs, and completely undeservedly. And now those hands are stuck there, apparently for a long time. Homeopathic preparations contain no substances in the concentration in which they can not only show their action in the body, but even be detected by the most modern methods. However, homeopathy can be used in the treatment of psoriasis if it has a psychogenic and neurotic cause. If a person firmly believes that he will be cured, anything can be a cure. For obvious reasons, here we enter the slippery slope of occultism, parapsychology, divination, magic, all sorts of rituals and healing, and so this review of homeopathy will not.

Finally, this list does not include medicines that are called psoralen. These are photosensitizers, which are needed for puva therapy or special ultraviolet irradiation. Since puva therapy is prescribed and carried out in dermatological and venereological hospitals, or in special rooms at dermatological dispensaries, for obvious reasons, these drugs will not be mentioned here. Puva therapy and all associated medications are prescribed by a dermatologist, who is engaged in the treatment of psoriasis in a particular patient.

Pharmacotherapy of psoriasis without the use of hormones

Below we will consider a dozen and a half drugs that are effective in the treatment of psoriasis. These are topical remedies in the form of creams, ointments, gels and aerosols. They can be used for any form of disease. Oral medications will be considered. They are prescribed by the doctor in severe forms of the disease, these drugs are called, unlike the first group of drugs, means of systemic therapy. Finally, the article will conclude with preparations for injectable, or parenteral administration. They are the most expensive part of treatment for patients with severe, systemic psoriasis, affecting the entire skin, joints, and even internal organs.

Some drugs that have an active ingredient are first named by it, that is, by the international nonproprietary name (INN). Then the individual trade names are given, and for a number of these drugs, the price at which the drug can be purchased in pharmacies of all forms of ownership in the Russian Federation in the summer of 2020.

The listing of these drugs is not an advertising ploy, does not invite purchase, and all of them, from the second and third sections refer to prescription drugs, and should be prescribed only by the attending physician. Topical medications are over-the-counter and available to all.

Rating of the best non-hormonal remedies for psoriasis

Topical psoriasis medications

Topical medicines enable manufacturers and pharmacies to make money. Various ointments, pastes, creams, gels, boltushkas are used to treat more than 80% of all patients. Some manufacturers go for tricks that patients are well aware of. For example, the very popular “Zorka” cream and the very “smelly” Yam-BK ointment are only available in special veterinary pharmacies, and that is where psoriasis patients go, who account for 70% of the total production of these drugs.

Calcipotriol-Daivonex

Rating: 4.9

Calcipotriol is represented on the market in Russia by Daivonex. This medication is used only for vulgar psoriasis, that is, when there is a characteristic rash on the skin but no systemic symptoms. This is a synthetic analog of cholecalciferol, that is, vitamin D3, and not so much an analog as a derivative, that is, a metabolite. Doctors found out a long time ago that in summer, when psoriasis patients spend a lot of time in the sun, their condition significantly improves. Sometimes the plaques even disappear altogether, leaving so-called duty plaques in the knee and elbow area. But this significant improvement occurs only if the patient has no vitamin D deficiency.

It is to regulate the growth rate of skin cells that the drug Daivonex is needed. It is known that psoriasis is caused by rapid cell division, and daivonex suppresses the rapid reproduction of skin cells and improves their differentiation. In psoriasis, the proper differentiation of skin cells does not occur, and they quickly exfoliate, with no benefit. An immunosuppressive reaction occurs after application of Dyvonex, and the pool of cutaneous T lymphocytes responds especially to Dyvonex.

Apply daivonex to the skin once or twice a day, only on the affected areas, and in a thin layer. Noticeable effect of treatment will be seen after about 7-10 days, the treatment course without medical supervision should not last longer than 6 weeks, which means more than a month and a half. Deivonex is made in Ireland by Leo Pharmaceutical. The cost of one pack of 30 g is, on average, 1070-1700 rubles.

Advantages and disadvantages

It’s a non-hormonal medication, so it’s still safe. Numerous treatment regimens have been developed where Dyvonex is used in the treatment of psoriasis. In some cases, it is relevant to apply Daivonex together with hormones, and even created such preparations as Xamiol and Daivobet, in which calcipotriol is combined with the corticosteroid – the hormone betamethasone.

Dyvonex interaction with salicylic acid should be avoided, it is contraindicated in children, up to the age of eighteen. It should not be prescribed in disorders of calcium metabolism in the body, as well as pregnant and lactating women. It is not used if it is facial psoriasis, in case of too large lesion areas. If psoriatic rashes affect more than 30% of the total skin area, Daivonex should be applied in parts, otherwise a systemic effect may develop, which will result in the disruption of calcium metabolism. Patients should also be advised to avoid exposing themselves to the sun for a long time during the treatment.

Zinc pyrithione (SkinCap, Cinocap)

Rating: 4.8

Skin-Cap is a long-used imported drug that contains zinc pyrithione. Skin-Cap itself is produced by the Spanish company Cheminova, but there is a domestic analog of the company Lekko, which is cheaper. Here are some prices: SkinCup 0,2% 15,0 cream – from 814 rubles., SkinCap 0,2% 70,0 aerosol can – from 3020 rubles., Cinocap 0.2% 50.0 cream – from 498 rubles., Cinocap 0,2% 58,0 aerosol can – from 674 rubles.

What does zinc pyrithione work?? It is an antibacterial protector, with broad antimicrobial activity, which allows suppressing the development of pathogenic flora, and especially fungi. Psoriatic rashes can affect not only the exposed areas of the skin, but also the so-called intertriginous areas, i.e. areas of natural rubbing and folds. There can develop mucous membranes, and create conditions conducive to the development of various fungi. Skin-Cap and Cinocap “works” with such “problem” places.

The product contains Dexpanthenol, i.e. pantothenic acid, which heals the skin faster. Skin-Cap is prescribed for psoriatic process exacerbations, for increased plaques, especially in the presence of secondary mucous membranes. In this case it is better to use the aerosol, and when the situation stabilizes, and the disease passes into the subacute period – then recommend the cream. If the aerosol is simply sprayed from a close spot for 3 seconds, the cream is rubbed into the desired spot, 1 to 3 times a day. Course of treatment – 1 month. In the case of the aerosol, the application frequency is the same.

Advantages and disadvantages

Cinocap and SkinCap can be applied to the skin not only for psoriasis, but also for various types of dermatitis, such as seborrheic and atopic. It can be safely used even in babies, since it does not contain any corticosteroid hormones. Unlike Daivonex, Skin-Cap can be freely applied to large areas, including, even on the face. It can also be used for a long period of time, longer than even 2 months. Zinc pyrithione has a special astringent quality, which prevents it from being absorbed and entering the systemic bloodstream.

Ichthyol ointment (complex composition)

Rating: 4.8

Ichthyol ointment has nothing to do with fish or itology. Its main constituent – a mineral oily substance, ichthamol, which is produced from oil shale, as a result of semicoke. The scientific name for ichthamol is ammonium bituminosulfonate. This odorous and oily substance fights germs, has a bactericidal effect, especially against streptococci and staphylococci, irritates the skin, after some time of application it is anaesthetic, affecting nerve endings, and has a keratoplastic effect. When ichthyol ointment acts on the skin, it first irritates the nerve fibers and then, on the contrary, reduces their sensitivity.

Ichthyol ointment is used both rectally and for external use. In addition to the stationary stage of psoriasis, ichthyol ointment is prescribed for pyoderma, furunculosis, eczema and horny inflammation. In psoriasis, ichthyol ointment should not be used in the case of an exacerbation, only in the stable phase or the phase of regression. The modern Russian pharmaceutical industry produces several varieties of the drug, such as ointment, paste and cream, with different concentrations of ichthammol. But for a patient with psoriasis, it is advisable to use the 5% ointment or 10% and apply it to the lesion up to twice a day. The course length is individual. Many Russian pharmaceutical factories produce ichthyol ointment. Here are some prices: Ichthyol 10% 25 g ointment – from 27 rubles., Ichthiol 10% 40 g paste – from 86 rubles.

Advantages and disadvantages

The disadvantage of ichthyol ointment is its specific, strong smell, something between the smell of oil and creosote, which impregnate sleepers. Ichthyol ointment or cream can stain clothes, and therefore it is better to use it in the evening, after showering or bathing, when blood circulation in the skin is increased. Ichthyol ointment can cause allergic reactions, so for external use should be limited in age: at least 12 years. Ichthyol ointment should not be used, especially applied to large areas during pregnancy and breastfeeding. On the other hand, ichthyol ointment will be useful in every home medicine cabinet, because when applied externally it can enhance and accelerate the maturation of boils. But on the other hand, ichthyol ointment can not be considered as a means that can completely and alone clear the skin from psoriatic rashes.

Birch tar (complex composition)

Rating: 4.7

Birch tar has long been used in dermatology, and its properties are truly diverse. Tar soothes itching, relieves pain, narrows skin vessels, reduces redness, and fights parasites and germs. In addition, it restores the normal keratinization process in the skin. Hemlock is used both in pure form and in many other medicines. These are Vishnevsky’s ointment, sulfur and tar ointment, or veterinary ointment Yam-Bk, which will be discussed below. As a result of birch bark distillation, the resulting tar contains phenols, organic acids, their esters, polycyclic carbons and many more different compounds.

Tar in psoriasis should be applied to the affected areas for 20-30 minutes, once or twice a day, and then washed thoroughly with warm water and soap, perhaps even several times. Only if there will be a feeling of dry skin or tightness, you can eliminate them by applying an ointment with 5% urea, or even simple petroleum jelly. In some cases, at the beginning of treatment, there may be a clear aggravation. So, can psoriatic rash look brighter, it will become drier, increased flaking. But later, if the treatment with tar is not interrupted, there is a steady improvement, and the itching decreases or even disappears. In some cases, you can try a short-term application of tar, for 5 minutes daily. You can buy tar in many pharmacies, and the most convenient packaging – a volume of 100 ml, and its cost will be from 80 to 200 rubles.

Advantages and disadvantages

If tar is stored for a long time, then the aromatic phenols and other substances in its composition may have a carcinogenic effect, so watch the expiration date. In psoriasis, tar should not be applied to large areas of skin. The main disadvantage of tar can be considered its brown color, which stains all things and linen, including the skin, as well as the pungent smell. Hemp, applied in the complex treatment of psoriasis, can help the patient save money on other, including expensive means, and is itself a component of many effective topical drugs from psoriasis and other dermatoses. You can also use tar ointment in a concentration from 5 to 7%, which should be applied to the elements of the rash from 1 to 2 times a day.

Cartalin (complex compound)

Rating: 4.7

Kartalin is much loved by psoriasis patients, and refers to bee products. But in addition to bee honey, it has eucalyptus and lavender oil, chamomile, vitamin A and succession. Salicylic acid helps to fight against excessive keratinization and the appearance of scales typical of psoriasis, but the main “highlight” of Carthalin is solidol. Ordinary, only purified solidol is very good for psoriasis, and the merit is its mineral origin. Recall that ichthyol ointment is also a mineral ointment.

As a result, Kartalin has an antipruritic effect, wonderfully exfoliates plaques, eliminates inflammation and stops the progression of the disease. Spring and fall, when psoriasis is seasonally exacerbated, are very useful for applying Kartalin. The cream itself is a dark brown mass with a specific odor, and Cartalin should be applied to the skin for at least 12 hours in psoriasis. The best way of application is an overnight bandage. But in summer, if the psoriatic plaques are on the hands, on the knees, and on other exposed areas of the body, you can just lightly smear these places, so that the combined action time of the cream is just 12 hours. You can divide this time interval in two, you apply the cream in the morning and evening, for 6 hours each.

Kartalin is produced by the domestic company Astropharma, and one pack of Kartalin 100 ml will cost from 800 to 1600 rubles. But if you consider that many creams and ointments packaged in tubes of 30 grams or even 15 grams, with a price of 400-500 rubles, then the cost can hardly be considered high.

Advantages and disadvantages

Cartalin is one of the few almost folk remedies that can sometimes lead, with systematic use, to a stable and prolonged remission. The psoriatic plaques disappear completely, and in their place remain so-called dyschromic spots due to a change in pigmentation, but the skin in this place is absolutely healthy. If Cartalin continues to be applied to such spots, they become lighter, and the plaques usually do not return.

The cream is perfectly tolerated, and, perhaps, of contraindications may be only an individual intolerance, and intolerance of bee products. As in the case of birch tar, at the beginning of treatment there may be a short period of aggravation during the disease, but this is a normal reaction. If you use the cream long term, 4 months daily, you can achieve a sustained remission even up to 5 years or longer. Only of course this statement is true if a person tries to follow the principles of a healthy lifestyle, and not to have initially psoriatic erythrodermia, or severe forms, with lesions of the joints and nails.

NM-BC (complex compound)

Rating: 4.6

NM-BK is the leader in “fragrance” and it’s quite strong, but you won’t find it in pharmacies. Yam-BK ointment is a veterinary remedy, but it is well known to patients with long-term psoriasis. It is even sometimes prescribed by dermatologists, and there is no shame in the doctor sending the patient to the veterinary pharmacy.

What is included in the ointment? It is sulfur and zinc oxide. It contains salicylic acid as a keratolytic, skin-softening and exfoliating ingredient, plus petroleum jelly and lanolin for softening, and even creolin, coal tar and turpentine. This “infernal mixture” as a result fights germs as an antiseptic, exfoliates, has a drying and astringent property. Turpentine and creolin irritate the surface capillaries of the skin, improve blood circulation. The ointment should preferably be applied to the skin after bathing, then it consumes less, because NM-BK is a rather “sticky” ointment and is poorly applied. After the ointment has been on the skin for 15-20 minutes, it must be removed by washing the skin several times with hot water and soap. Produces this ointment factory “Veterinary preparations”, and costs a small jar of 50 g about 180 rubles.

Advantages and disadvantages

NM-BK can reduce symptoms of exacerbations very quickly, eliminate itching and reduce flaking. Already after 3-4 days of use there is a significant improvement. The ointment is well tolerated, but sometimes you might have a burning sensation at the beginning of the treatment, and you can also be “dumbed down” by the smell of the ointment when it is applied to steaming hot skin. Thus, the very great “stinkiness” of this ointment is its main negative feature. “Fragrance” of creolin, turpentine, tar and sulfur, hovers not only over the patient, but also spreads several dozen meters around. It is therefore advisable to apply this ointment to the skin in the evening, and after removing it, not only thoroughly wash the skin many times, but also ventilate the room.

Salicylic Acid

Rating: 4.5

You won’t see salicylic acid in liquid form in the pharmacy, it will always be in thick form, and it will most likely be salicylic ointment. We have already become familiar with it above, as it is part of some topical preparations. But salicylic ointment is also used in pure form, because it perfectly softens the rough horny layer of skin, that is, is a keratolytic, and shows antiseptic effect, but weak. But psoriasis patients sometimes need to soften rough crusts, especially if we are talking about rough scales, and if we need to suppress the secretion of sebaceous and sweat glands. In addition to psoriasis, it is used for oily seborrhea, chronic eczema, ichthyosis, and to soften calluses. Salicylic ointment shall be applied to the required skin areas no more than 3 times a day. Tula Pharmaceutical Factory manufactures salicylic acid ointment-based salicylic ointment 2% 50 g – from 141 rubles., Salicylic ointment 5% 25 g can from 146 rubles.

Advantages and disadvantages

Salicylic ointment containing the same name acid will only help if there is concomitant pronounced peeling. If the patient is at a stage of fading exacerbation, or remission, and plaques peeling little, then this drug can be saved until the stage of exacerbation. The medication may be contraindicated in children, in the presence of individual sensitivity, and of the side effects may be an allergic reaction, skin rash and local reaction in the form of burning and itching.

Cream “Zorka”

Rating: 4.4

Needless to say, this cream is also only sold in veterinary pharmacies. It is only officially used to treat cracks in the cow’s udder and to prevent and treat mastitis. It is also used by people, the cream perfectly moisturizes dry skin, promotes healing of various micro-traumas, abrasions, scratches and cuts. The active ingredient in this cream is floralizine. The cream itself perfectly protects the skin, but when applied regularly and daily at night to psoriatic plaques, it is able to turn the stage of exacerbation first into a subsiding exacerbation, and then into remission, within two to three weeks.

A patient with vulgar psoriasis, by applying Zorka cream regularly for a month, can achieve that the rash elements become faded, inconspicuous, and the intensity of inflammation and peeling decreases significantly, so that inactive foci form as a result. Produces this cream ZAO Farmax, and a large jar (do not forget, after all, it is designed for cows), will cost only about 100 rubles for a volume of 200 ml. Apply it normally, once or twice a day, you can also use it at night, since the cream is quite greasy.

Advantages and disadvantages

It is very well tolerated, moisturizes and softens well even when the skin is healthy, which is why it is even available in human pharmacies. Floralizin is not prohibited for human use, but in the case of the veterinary drug, the preservative is kerosene, which is why the cream smells a little like kerosene, and why its price is so cheap: cows and goats do not care. But once kerosene was replaced with a cosmetic preservative along with a fragrance, and the cream began to smell like regular cosmetics, its price to people increased tenfold, and it is sold in pharmacies for 600 rubles. And even higher. But even if you smear psoriatic plaques with a cream that smells faintly of kerosene, after a few minutes the smell will disappear. Also, it is mild, and perhaps not even unpleasant. It does not compare with the powerful “ambre” of NM-BK or ichthyol ointment.

Pimecrolimus (Elidel)

Rating: 4.4

The review of topical remedies for psoriasis is completed by Elidel. This drug weakens the ability of T-lymphocytes and mast cells to produce bioactive substances, cytokines, and inflammatory mediators. Pimecrolimus, and its precursor, tacrolimus, work through inhibition of calcineurin, which is how they inhibit the secondary immune response. After topical application the product ensures high anti-inflammatory activity, without causing skin disorders and atrophy.

The highlight of this medication is that it selectively suppresses inflammatory reactions in the skin, but has virtually no effect on these same reactions occurring elsewhere in the body. The drug is indicated for both short-term and long-term use in adults and children from three months of age. The cream is applied twice a day to the desired areas of the skin, and gently rubbed in until it is absorbed. The drug should be used up to 6 weeks, and then again to see the doctor.

Pimecrolimus is commonly used for atopic dermatitis and eczema, but in some cases, it is also used for psoriasis. This medication is prescribed by a dermatologist, and it is placed at the end of the list of topicals, just as a reminder that there is a backup medication. Elidel dosage of 1% is the most expensive in this list, as one small tube of 15g will cost from 800 to 1000 rubles. This medication is manufactured by the German company Meda Pharma.

Advantages and disadvantages

This drug should be prescribed if there are limited rashes, and mainly when it comes to psoriasis on the face. Both tacrolimus and pimecrolimus, as topical medications, are not prohibited for use on the face, unlike many of the topical agents discussed above. Of the disadvantages we can name the contraindication for application to areas of the skin with suppuration, streptodermia, signs of viral and fungal infection, with hypersensitivity to the drug. The most frequently cited side effects were burning sensation at the application site, reddening of the skin, and transient swelling.

Products for systemic psoriatic process

All the agents described below are prescribed for severe psoriasis, with lesions of joints, nails, internal organs, in patients with disabilities. These drugs can be divided into two groups: oral tablets, and injectable forms. Oral agents include cytostatics, which slow down the division of skin cells, as well as eliminate or reduce the autoimmune process that occurs in severe forms of psoriasis. Injectable forms of drugs are modern monoclonal antibodies, which are also able to suppress autoimmune processes with high selectivity, since psoriatic arthritis is considered an autoimmune pathology. But if psoriatic arthritis is also combined with psoriasis vulgaris, the topical agents described above are also used in all these patient groups. Cyclosporine and methotrexate may also be prescribed as shots, but may also be used as tablets. Let’s take a closer look at them.

Cyclosporine (Sandimmune Neoral)

Rating: 4.9

Cyclosporine A. It is a special substance with a strong immunosuppressive effect, isolated from a specific type of fungus. It inhibits the activity of T-lymphocytes, inhibits the mechanism of interleukin release, and, as a result, decreases the sensitivity of T-cells. This drug is highly effective if the patient is diagnosed with widespread but sluggish psoriasis, or if there is psoriatic erythroderma, that is, a condition in which almost the entire skin is involved in the psoriatic process. Cyclosporine should be used in a dose of 2.5 mg per kilogram of body weight per day in two doses, and in severe cases the dosage can be doubled. It is necessary to use cyclosporine during the acute phase, for serious indications, in order to induce a slowing of the acute exacerbation and remission.

Advantages and disadvantages

Cyclosporine is a serious immunosuppressant. A plasma creatinine test should be done before starting, and monitored throughout treatment, as cyclosporine can have toxic effects on the kidneys. Blood pressure, uric acid, potassium, transaminases, and lipid profile need to be determined. The drug can not be canceled quickly, and you need to reduce its dose by 1 mg per kilogram of weight weekly, for a month. If no results are obtained after 6 weeks, the treatment must be cancelled. Just remember that cyclosporine treatment increases the risk of developing various lymphomas, and malignant skin neoplasms. Cyclosporine is produced under the brand names Sandimmune Neoral and Ecoral by Swiss company Novartis Pharma and by Czech company Teva. Here are some summer 2020 prices: Sandimmune Neoral 0,025 #50 in capsules – from 1251 rubles., 0,05 № 50 – 2415 rubles, 0,1 № 50 – 4450 rubles, Ecoral 0,1 № 50 – 3349 rubles per unit.

Neotigasone (acitretin)

Rating: 4.8

Neotigasone is a drug for treating severe psoriasis when most of the skin is covered with plaques, with frequent relapses, or in patients with psoriatic erythroderma when almost the entire skin is affected. The acitretin as an artificially produced analogue of retinoic acid. When used, it restores normal processes of skin cell differentiation and proliferation. mechanism of action is still unknown, but the drug is highly effective. In addition to psoriasis, Neotigasone is indicated for the treatment of skin keratinization disorders, which include congenital ichthyosis.

Available in capsules: one capsule may contain 10 or 25 mg of acitretin. It should be taken once daily by mouth, with meals. The starting dose for adults is 25 mg. The drug treatment must be prolonged, for at least two months and under a physician’s supervision. Neotigasone is manufactured by the French company Senecy, and the cost of one package for a month’s course averages 3600 rubles.

Advantages and disadvantages

This drug is able to stabilize the severe course of psoriasis, to accelerate the transition to clinical remission, and even to reverse the course of the disease, for example, by changing psoriatic erythroderma into focal psoriasis with spots of light skin. But the treatment must always be under the control of a physician. Thus, adverse reactions have been reported in more than 50% of patients taking Neotigasone. Often a symptom of vitamin A hypervitaminosis. These include dry lips and cracks in the corners of the mouth, dry eyes, while taking this drug it is necessary to refuse contact lenses. Headache, thirst and dry mouth, muscle aches and joint pains may occur.

This drug is absolutely forbidden for pregnant women. It has been proven to cause numerous deformities in the fetus, so the ban on its use applies not only to pregnant women, but also to all women who may become pregnant not only during treatment, but also within 2 years after withdrawal of the drug. A woman who is not just planning a pregnancy, but only able to get pregnant, should be sure to take birth control pills, and must start taking them a month before treatment, during treatment and for 2 years after the end of treatment. Moreover, before the treatment numerous documents are filled out, and even a certificate confirming the absence of pregnancy is presented. Thus, there can be no self-administration of this drug for women.

Methotrexate (Zexat, Metoject)

Rating: 4.7

Methotrexate is a “veteran” in the treatment of severe forms of psoriasis. It has been used for almost half a century. It changes the metabolism of folic acid and inhibits DNA synthesis, which is excessive if the cells are dividing too fast. When prescribing methotrexate in any dose and in any form it is necessary to give the patient high doses of folic acid, which helps to avoid anemia. Methotrexate is effective in forms of psoriasis such as joint psoriasis and erythroderma, a severe form of pustular psoriasis. Each tablet of methotrexate contains 2.5 mg of the active ingredient, and in addition to psoriasis, it is indicated for lymphoblastic leukemia and rheumatoid arthritis. In the case of psoriasis, methotrexate is given in a dosage of 4 to 10 tablets per week, with a constantly increasing dose.

Methotrexate must be prescribed by a dermatologist or rheumatologist. Methotrexate is on the VED list, and is inexpensive: quality methotrexate from the German company Ebeve is available for 320 rub and up. For 50 pills of 5 mg.

Advantages and disadvantages

As with cyclosporine, close monitoring of the patient’s vital signs, liver and kidney enzymes is necessary, and sometimes a chest radiologic examination should be performed. If the number of leucocytes and neutrophils in blood falls, and platelets decrease, it is necessary to stop treatment immediately, since Methotrexate may show hematotoxicity, significantly depressing the function of bone marrow. The drug can also cause diarrhea, ulcerative stomatitis. As mentioned above, it is mandatory to take folic acid in a dose of 5 mg once a week, about three days after taking methotrexate. Once psoriasis patients have a good response to therapy, it is possible to continue treatment at the lowest effective dose, that is, no more than 22.5 mg per week.

Apremilast (OTESLA)

Rating: 4.6

Otesla is a new drug that is also an immunosuppressant. The difference between this medication and all previous ones is that it is intended exclusively for the treatment of psoriasis and psoriatic arthritis (and spondylitis of psoriatic etiology). This medicine inhibits the enzyme phosphodiesterase type 4. As a result, the inflammatory response within cells is reduced through changes in the expression of tumor necrosis factor, and some interleukins. Apremilast can be used in patients with severe to moderate psoriasis, either as monotherapy or as a combination treatment. Otesla also helps with nail problems, erythroderma psoriatica with intense itching. It is mainly indicated for the treatment of active psoriatic arthritis in adults.

The drug is prescribed orally, 30 mg, 2 times a day, morning and evening. The first use requires dose titration for a week, the first day is given 10 mg once, and by the sixth day the dosage is raised to 60 mg per day. Maximum effect is seen in the first 6 months of treatment, and if there has been no effect, treatment should be reconsidered. However, such a review can be very, very expensive for the patient. Otesla is produced by the only company in Switzerland, Seljen, and a pack of enough for two weeks of treatment costs 20000 rubles. Accordingly, for a course of six months, you can pay almost a quarter of a million rubles.

Advantages and disadvantages

Yes, for a Russian patient, this drug is very expensive. But, in some cases, only it can save from a severe form of plantar psoriasis, and from a severe form of psoriatic arthritis, which can end not just with intense inflammation, but also with an independent passive amputation of the phalanges of the fingers. On the other hand, prescribing this drug does not require the need to monitor laboratory parameters, as was necessary for cytostatics and immunosuppressants. The drug is contraindicated in pregnancy and breastfeeding, and is not intended for persons under 18 years of age. Side effects should be considered. Bronchitis, decreased appetite, insomnia, and headache are the most common. Diarrhea and nausea and fatigue are very common.

It remains to add that since 2019 there is another indication for this drug: Adult patients with aphthous ulcerations in the mouth in Behcet’s disease. Also of interest may be an economic fact: the Otesla manufacturing company is merging with Bristol-Myers Squibb. And, to eliminate possible antitrust claims, sells the drug and all rights to it to Amgen, a project costing nearly 14 billion. dollars.

Etanercept (Enbrel)

Rating: 4.6

The action of etanercept is based on inhibition of tumor necrosis factor-alpha, which plays a key role in systemic damage. The drug is available as a solution for subcutaneous injection. Four vials in a pack. The cost of these four vials is 26000 rubles. Used in adults with moderate to severe psoriasis, and prescribed twice a week at three-day intervals. Can be administered 2 vials at a time, or 50 mg subcutaneously once a week. The course of treatment with such weekly injections should not exceed 12 weeks, the cost of a monthly course will be approximately 50 000 rub. It is usually advisable to continue treatment until a marked improvement has been achieved (twice a week), but no longer than six months. But in some cases, it is possible to continue treatment even longer, if the doctor decides.

Advantages and disadvantages

Perhaps the most severe disadvantage of this remedy is the high price. There are few contraindications: it is an active infection, sepsis, pregnancy and breastfeeding. The side effects are indeed many, very often there are bronchitis, cystitis and skin infections, sometimes serious infections such as septic arthritis, pneumonia and even tuberculosis. This drug inhibits the production of one of the main protectors against infections, which is also involved in psoriasis. The drug can cause benign, and even malignant tumors, anemia, frequent allergic reactions, seizures, skin itching, fever. It is clear that Enbrel is extremely effective against severe forms of psoriasis, since patients for 50,000 rubles. per month agree to take the risk of such severe side effects. Therefore it is necessary to treat Enbrel only under strict medical supervision, with a preliminary evaluation of the immune status, and complete sanation of all infectious sources in the body, including the teeth.

Guselkumab (Tremfea)

Rating: 4.5

Finally, we look at Janssen’s newest product from the monoclonal antibody group. We will not describe the well-known remedies Humira and Stelar, which are already known and used to treat severe forms of psoriasis. Guselkumab is a monoclonal immunoglobulin G that blocks interleukin-23. As a result, the maturation, viability, and proliferation of T lymphocytes and their subpopulations are reduced, and this reduces the risk of inflammatory diseases, including severe forms of psoriasis. It is interleukin-23 that is elevated in patients with plaque psoriasis, so Tremfea is indicated for the treatment of moderate to severe psoriasis if these patients need systemic therapy. The drug is administered once subcutaneously at a dose of 100 mg every two months, except for the second injection, which is given a month later. The average course of treatment is four months, and if the patient shows no signs of improvement, the drug is withdrawn.

Advantages and disadvantages

The most important disadvantage is the price, because this drug is new, registered since 2017, and the only so far in the world selective interleukin-23 inhibitor. One pack, one syringe, 100 mg, can currently be ordered from abroad for 3450 euros per pack. Accordingly, more than 7,000 euros will be spent in the first month of treatment and half of that in the remaining months.

As a serious drug, guselkumab is not without side effects. As in the past, it is an infection, herpes, bronchitis, gastroenteritis, urticaria, pain at the injection site. There are also contraindications, including clinically significant infections such as tuberculosis. But this drug is so effective that with proper management of the patient and protect it from infectious complications can delay disability for a long time, and achieve a stable remission.