Psoriasis vulgaris plaque type L40.0

The most common, stable, localized form of plaque-type psoriasis that occurs at the predilection sites of psoriasis. Psoriasis that occurs inversely, e.g. on the palms of the hands and soles of the feet, is not referred to as "psoriasis vulgaris" but as psoriasis palmaris et plantaris or palmoplantar psoriasis.

S.u. psoriasis

S.u. psoriasis

Infestation pattern (MAPP study - 3,426 patients): elbows (46%), capillitium (45%), knees (31%), trunk (24%), face (15%), palms (12%), soles (11%), nails (11%), genital area (7%).

Joint symptoms in psoriasis patients with primary skin involvement: knee (45%), fingers (19%), hip (16%), spine (14%), ankle (11%), wrist (8%)

Few to numerous, localized or disseminated, usually symmetrically distributed, whitish scaling with little or no pretreatment, differently elevated (infiltrated), sharply defined plaques of varying size (0.5cm to 10.0cm and >) and configuration (roundish or oval, map-like). Extirpation phenomenon can be triggered in herds.

With local pretreatment the clinical picture changes significantly. Flocks appear as scaleless or slightly scaly, red, sharply defined, differently raised plaques or as red spots (patches) with a smooth surface.

There is usually a low endogenous eruption pressure.

Thrust-wise progression with different thrust frequencies is characteristic.

In most cases, the Koebner phenomenon cannot be triggered in the chronic starionic form of plaque psoriasis

• Coronary heart disease: Recent evidence suggests that psoriasis is an independent risk factor for coronary heart disease. Only 40% of psoriatics are free of coronary calcifications compared to 72% of the control group with non-psoriatics. Moreover, among psoriatics, the proportion of severe calcifications and stenoses as well as of myocardial infarctions is much higher than among non-psoriatics. An analogous risk spectrum, which is reduced during therapy with TNF-alpha blockers, is also found in patients with rheumatoid arthritis.
• Obesity: An increased BMI as well as an increased abdominal and hip circumference is significantly increased in psoriatics.
• Psoriatic patients are more likely to meet criteria for metabolic syndrome (MetS) than the average population; further, increased insulin resistance.
• Psoriatics are at increased risk for hypertension. The use of beta blockers appears to further increase the risk.
• Patients with psoriasis are more likely to develop enteritis regionalis (Crohn's disease).
• Alcohol and smoking are trigger factors for psoriasis.

Mahonia, phytotherapeutically used is the bark of mahonia(Mahoniae cortex), no positive monograph from ESCOP, HMPC or Commission E despite numerous positive clinical studies, but recommended by Commission D, available as ^Rubisan® cream or ointment. In a randomized, double-blind, placebo-controlled study with 200 patients in 2006, Bernstein et al demonstrated a statistically significant improvement in the PASI index and quality of life. An improvement of up to 50 % was demonstrated. Mahonia preparations do not discolor the skin, generally do not irritate and can also be used in the intertrigines and anal folds, application 2-3 x / day.

Aloe vera, Aloe barbadensis: Aloe vera gel on the market, indication as cooling gel e.g. for burns. Some studies show a very good reduction of the PASI index by 83.3 %, other studies by 72.5 % without significance compared to the placebo arm. Contradictory studies on effectiveness.

Indigo naturalis: Very good study results at a concentration of 200 µg/g with an improvement in the PASI index of 75 - 90 %. Currently no finished preparation on the market.

Boswellia serrata: Hardly any clinical studies for local therapy. A significant change for LTB 4, TNF-alpha and VEGF (Vascular Endothelial Growth Factor (VEGF) and PGE2, clinically a corresponding reduction in the PASI value. Togni S et al demonstrated a 70 % reduction in scaling and a 50 % reduction in erythema. Commercial preparation: e.g. Eupilen or Sana Vita Boswellia 4 + Lotion.

Betulin
In animal models, a reduction in IL17A production and an increase in the cytokine IL 10 level in serum could be demonstrated. In the skin, reduction of IL 17 A, IL 6 and TNF alpha. Commercial preparation: ^Imlan® cream (currently not available), various birch cream preparations also available in pharmacies, e.g. Birch Cream St. Bernhard.

On 24.06.2022, the EMA granted the birch bark extract Filsuvez® from Amryt Pharmaceuticals marketing authorization for the treatment of superficial wounds associated with dystrophic and junctional epidermolysis bullosa from the age of 6 months.

Witch hazel preparations, particularly suitable for the treatment of intertriginous lesions.

Dulcamarae stipites: the anti-inflammatory, cortisone-like effect can be used for itchy, irritated psoriasis, if necessary also to counteract the irritation caused by other external agents.

The antipsoriatic effect of black cumin oil (Nigellae sativae oleum) with a corresponding reduction of IL 17 has been proven in studies (Vihal S et al. 2025)

see also under plant tars, see also Pix, allantoin

For itching see Capsici fructus acer

Studies: allicin, curcumin, ginger, aloin, berberine, boswellic acids, see also anthocyanins,

Black cumin oil: Nigellae sativae oleum

1. Evensen K et al. Increased subclinical atherosclerosis in patients with chronic plaque psoriasis. Atherosclerosis 237:499-503
2. Gisondi P (2014) Hyperuricemia in patients with chronic plaque psoriasis. Drug Dev Res 75 Suppl 1:70-72
3. Mrowietz U et al. (2014) Pruritus and quality of life in moderate-to-severe plaque psoriasis: post hoc explorative analysis from the PRISTINE study. J Eur Acad Dermatol Venereol doi: 10.1111/jdv.12761
4. Vihal S et al. (2025) Nigella sativa Oil-loaded Ethanolic Vesicular Gel for Imiquimod-induced Plaque Psoriasis: Physicochemical Characterization, Rheological Studies, and In vivo Efficacy. Curr Drug Deliv;22(1):80-91. doi: 10.2174/0115672018246645231019131748. PMID: 38956909.