Dr Nikolay Podoleshev
Specialist dermatologist

Psoriasis is a dermatological disease. Its name originates from the Grecian word “psora” that means peeling. The disease can appear at any age, but most often is manifested between 20 and 40, where both sexes are equally affected. In Bulgaria about 1-2% of the population are suffering from psoriasis. What causes this very common disease is not yet completely clear. Heredity is of a great importance (in about 60% of the cases, according to the statistical data), but mostly the hereditary susceptibility of the skin to react with psoriatic eruption than the inheritance of the disease itself. Various infectious diseases (cold, angina etc.), physical and psychological trauma, prolonged exposure to sunlight, pigment deficiency, different medicines (antibiotics, beta-inhibitors and others) etc., are most often indicated as triggering causes.

Initially the disease manifests through red coloured, round in shape skin patches that gradually cover with great number of silvery-white flakes. Later the patches get thicker, rise over the skin and spread peripherally. These pathological changes are most often localized to the skin areas, where micro-traumas are being easily developed due to cricks – on the elbows and knees. Of course, larger areas of the body can be affected. Typically in the limbs the opening surfaces are mainly affected. The psoriasis often covers also the scalp (in the hair are observed plenty of silvery-white scales that resemble dandruff), as well as the nails, upon which point-like grooves or yellowish spots are visible. The more severe cases of the disease can be complicated due to affection on the joints. The options of course are numerous, but generally the chronic- relapsing forms prevail. Individual deviations, however, can widely vary both in the frequency of the relapses (only one outburst in life, one or two outbursts, continuously relapsing flare-ups) and in the duration of the clear periods – systematic clear periods of weeks, but also of years and decades are observed.

After a generalized flare-up continuing for months, improvement may occur that may be reduced to a partial residual affection on the elbows and knees, but also a complete clearance may occur. It should be considered that sometimes during the eruption of fresh rash itching can also occur, but most of all psoriasis is dermatosis that does not causes itching.

Psoriasis treatment is not always easy. Various means can be used - most of them are intended for application on the skin and other are oral. 

Medications for direct application on the skin:

• Ointments, unguents, solutions and other, containing corticosteroids (Betnovat, Diprosone, Diprosalic, Sinalar, Flucinar, Dermatop, Elocom, Lorinden etc.). They are efficient, easy to apply and acceptable from a cosmetic point of view. Unfortunately after cessation of the treatment, psoriasis manifests again very soon and in a much more severe form than before treatment. These medications make the skin thinner and may provoke formation of stretch marks etc. Moreover, when these are applied on the skin of the face for a longer period, an increased hair growth appears that is completely unacceptable especially for women.

• Daivonex is in the form of unguent that is similar to vitamin D. Since it does not contain corticosteroids it can be applied continuously, provided that the quantity used unguent does not exceed 100 g per week.
• Coal tar is known as Psanol in our country, which is very effective in psoriasis treatment. Disadvantages – makes the skin and cloths foul (it is difficult to remove), smells unpleasant, makes the skin sensitive to light and acts as a carcinogen.
• Ditranol (synthetic chemical) is perhaps the most effective medication for local treatment of psoriasis but makes the skin, linen and cloths foul. Moreover, it can be irritating to the skin, and if not applied carefully it may even burn it, especially in the area of the groins and armpits, where the skin is very delicate.

Oral medications:

• Neotigason (vitamin A derivative). It is most suitable for treatment of larger skin areas, particularly in cases of ineffective local therapy. Disadvantages – gradually increases the feeling of dryness in the eyes and mouth. Increases the levels of cholesterol and other fats in blood. May damage germ cells (ova and spermatozoa), therefore it is recommended to postpone pregnancy for 2 years after cessation of the treatment.
• Cyclosporine – effective but also dangerous, because it can raise the blood pressure, distorts the function of kidneys and increases the hair growth.
• Methotrexate has a powerful effect, but can damage the bone marrow and liver. 
• Corticosteroids tablets - should not be used. The condition is rapidly improving, but after cessation of the treatment it is quite probably that the psoriasis will manifest again even in a much more severe form than the previous one.
• Recently the oral immunomodulatory agents or those for direct application on the skin has acquired great popularity - they are welcomed with great enthusiasm, but some of them have not been registered in Bulgaria yet and others are so expensive, that only a limited range of patients can afford them.

Without claiming comprehensiveness, the review made herein above shows that the medications for psoriasis treatment have both positive and some unacceptable effects. This limits the options for longer application of some of them; others are completely unusable under certain conditions (for example, if a patient suffering from psoriasis develops hepatitis he cannot be treated with methotrexate). That’s why all products characterized by a low risk potential at long-term use have caused deserved interest. It is well known that such are the phytotherapeutic preparations, especially those with multi-component formulations. These formulations allow to achieve not only maximal interaction between active components of the different herbs, but also to stimulate selectively the action of some of the herbal substances. At present the herbal products are offered in the form of tablets, capsules, syrups, ointments, shampoos, balsams and toothpaste, as well. To achieve optimal effect it is recommended a long-term treatment that normally should exceed 2-3 months. This approach is perfectly acceptable since the products are harmless, do not have undesirable side effects and are affordable from a financial point of view.

In this relation it is worth recalling that Bulgaria is of world renown as one of the most interesting countries in Europe according to its flora. This is due to the fact that more than 3200 plant species thrive on our relatively small territory. The numerous types of herbs are priceless treasures and over 150 of them are used in the pharmaceutical industry. Our country is also known as a “land of herbs“. This reputation is enhanced with reason also by the fact that in our country grow rare medicinal plants that can be found only here. The names of most of them are associated with the mountain where they grow. Such are the Rhodope haberlea (Haberlea rhodopensis), the Rhodope tulip (Tulipa rhodopea), etc.

Therefore the Bulgarian history of herbalism is very ancient. The outstanding achievements of our phytotherapeutists are universally acknowledged. For instance, treatment of Parkinson’s disease with belladonna introduced by the popular healer Ivan Raev is known as the “Bulgarian cure” (cura bulgara). Academician Paskov gave the world and the patients of poliomyelitis the medicine Nivalin, derived from our snowdrop.

Nowadays, more and more medicinal plants proved to be effective agents in various skin diseases treatment. Particularly appropriate for phytotherapy are the chronic dermatoses that require complex treatment, as well as the cases when traditional medications are incomplete and precarious. It is important to have in mind that the herbal treatment is accompanied by psycho-stimulating impulses that accelerate the healing process. Therefore, it can be applied in many skin diseases – various types of dermatitis, acne, hair loss, varicose veins, eczema, unaesthetic dark spots (freckles and other hyper pigmentation), haemorrhoids, furuncles, herpes, neurodermatitis, etc. Psoriasis responds exceptionally well to phytotherapy, especially its chronic forms. One of the most famous classics of the Bulgarian dermatological school – Professor P. Pophristov recommends the herb sarsaparilla for treatment of psoriasis. He applies it as follows: soak 20 g Sarsaparilla - root (radix sarsaparilla) in the evening in 1 litre of water. Boil the tincture in the morning for 15-20 minutes. Then drink one part of the tincture while still hot and the rest - during the day. Apply this treatment for 20 days. The market offers ready-to-use forms of radix sarsaparilla - tinctures and extracts. Oral treatment with this plant is also recommended in the following form: boil one tablespoon of chopped roots in half a litre of water for 10 minutes and filter it after the tincture cools. Take 1 wineglass 3 times a day. The efficacy of sarsaparilla extract is due to the great number of biologically active substances contained in it, such as saponins, steroids and minerals that improve the purifying functions of the body by stimulating the release of harmful substances. Sarsaparilla has strong anti-allergenic, diuretic and hormone-activating action. Therefore, as well as in cases of psoriasis, it is also applied in eczema, hives and hair loss. It can be used as adjuvant with a general tonic effect.

Relaying exactly on these properties of sarsaparilla, a team of experts of the Bulgarian company VITA HERB Ltd created on its basis the preparation Psoriasal plus, which also include extracts of birch, burdock, nettle and common agrimony.

The birch leaves’ extract contains about 3% of saponins, spiraeoside, glycosides, resins, 9% tannins of the pyrocatechin group, 9% sugar, inositol (Vitamin B8), bitter substances, about 0.05% essential oil, yellow dyes, vitamin C, pro-vitamin A, etc. Its strong dermatological, draining and anti-microbial action is due to all of them.

The burdock extract is rich in mucus, tannin, bitter and resinous substances, palmitic and stearic acids, sulphates and phosphates of calcium, potassium and magnesium and large amounts of proteins (about 12%) and polysaccharides, especially inulin (up to 45%). The burdock roots accelerate the growth of new cells in the body, including healthy skin cells. This action is mainly due to the inulin content. Moreover, they also have dermatotonic, hypoallergenic, antimicrobial and epithelisation action.

The nettle extract contains tannin and protein substances, carotenoids, chlorophyll (about 3%), other acids (formic, ascorbic, pantothenic) and the vitamins K and B2. It has dermatotonic, hypoallergenic, soothing, anti-itching and anti-sclerotic action.

The common agrimony extract contains 0,2% essential oil, tannins (catechines), flavonoids, silicic acid (about 12%), vitamins P (nicotinamide) and C, organic acids and traces of manganese that adds anti-inflammatory and antiviral properties.

Everything said so far shows that Psoriasal plus is a natural product that acts as an auxiliary preparation against inflammatory processes in the skin, helping the blood flow to the skin, favouring the normalization of skin status. That’s why the application of this product in the various forms of psoriasis leads to reduction of the eruptions and relieves the subjective complaints.

Tablets of Psoriasal Plus do not cause irritation and hypersensitivity and can be applied for a long time, along with other medications prescribed by the physician.

To write the article a large number of Bulgarian and foreign literary sources have been used.