Psoriasis. What it is, how it manifests, how to treat it.

To help us understand what psoriasis is, how it manifestsand how it is treated, we asked one of Europe's leading experts in thermal dermatology, Dr. Mauro Zanoni, who has been head of the dermatology clinic at Terme di Comano for over 35 years.

In addition to the classical form, psoriasis can manifest with different appearances, sometimes creating serious diagnostic problems: from the more frequent inverse psoriasis, which affects the inguinal, axillary, popliteal folds and the neck, to pustular psoriasissuch as Barber's psoriasisor Zumbusch's psoriasis, up to severe conditions like psoriatic erythrodermawith widespread lesions affecting the entire skin, sparing no area, including the nails. Also worth noting is psoriatic arthropathy,a specific clinical picture in which a joint disease not attributable to other arthritic forms is associated with the skin lesion, and whose onset may follow, be concurrent with, or precede the skin manifestations with a course often parallel to the dermatological condition.

• mechanical, chemical, allergic, or other types of trauma
• pyogenic germ infections causing purulent inflammatory reactions
• drugs such as lithium salts, beta-blockers used as antihypertensives, and interferons.
• systemic and topical steroids, which can induce an acute psoriatic eruption upon discontinuation or dosage reduction
• emotional factors: difficult to evaluate, but it is known that psychological stress triggers flare-ups in a large number of psoriatic patients.
• obesity, alcoholism, and smoking.

• Local therapiesranging from keratolytic substances(salicylic acid, urea, etc.) to reducing substances (eosin, tar, cignolin or dithranol), to mild or very potent topical corticosteroids, to vitamin D derivatives, to tazarotene.
• Ultraviolet light treatmentsthat involve exposure to the sun's ultraviolet rays or those emitted by specific narrowband UVB lamps used for balneophototherapy, which is also performed at Terme di Comano.
• Systemic treatments,which have seen the greatest progress in recent years with highly effective molecules in the clinical control of the disease. Conventional treatments include: methotrexate, cyclosporine, acitretin, fumaric acid, while "targeted" treatments include so-called "biologics" produced through sophisticated biotechnologies and represented by monoclonal antibodies and fusion proteins.
• Spa therapy.In the jungle of therapies just listed, which focus on pharmacological interference and aim to bring skin reactivity to zero, spa treatments, and specifically balneotherapy, are authoritatively included. Balneotherapy is par excellence performed at Terme di Comano, now unanimously recognized in the national spa landscape for its specificity in the dermatological field. The therapeutic approach that combines thermal water with anti-inflammatory, soothing, moisturizing and regenerating properties, the keratolytic effect of the bath, phototherapy, the opportunity to engage in relaxing activities in a natural environment, educational meetings with experts from the spa center for a more serene and conscious management of psoriasis, and the deep experience of the medical team composed of dermatologists, nutritionists and psychologists, leads patients to a better acceptance of their condition and a greater possibility of partial or total regression of psoriatic manifestations. Patients generally do not associate any type of pharmacological treatment with this natural cure, which usually has no contraindications or side effects, and this results in a very advantageous "break" for the entire organism, which is subjected to chronic application of medications.

The answer depends on several factors: considerations regarding the severity of the disease at a given time, the degree of efficacy and safety of available treatments, the characteristics and preferences of patients (considering previous treatments), to which are added treatment costs and the organization of the healthcare system. All this often generates a sense of distrust and discomfort, not only in the patient but also in the doctor himself, who tends to underestimate the pathology and its serious implications. Psoriatic disease is, in fact, accompanied by a broad spectrum of comorbiditieswhich includes chronic inflammatory bowel diseases, celiac disease, non-alcoholic fatty liver disease, metabolic syndrome, an increased risk of traditional cardiovascular diseases, obesity, diabetes, and anxietyand depression. In reality, it is important to know that it is possible to tackle the disease and reduce its manifestations and exacerbations through an integrated multidisciplinary, and even educational, approach that also takes lifestyle into due consideration.

For more information on psoriasis treatment at spas, visit the page dedicated to the Comano Spa Psoriasis Pathwayor contact our center:

You may also be interested in the article on Psoriasis and Nutritionby Laura Giglia, nutritionist at Terme di Comano.