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Psoriasis is one of the inflammatory skin diseases that has benefited the most from therapeutic progress. It affects approximately 4% of the general population.

The choice of the most appropriate type of treatment varies, depending on the form and severity of the disease, the size and extent of the plaques, the patient’s response to a given treatment and their preferences.

The Swiss Society of Dermatology has issued official recommendations regarding the treatment of the disease. When your dermatologist examines you, he or she calculates the psoriasis score (PASI). This score is fundamental because it makes it possible to be objective in calculating the extent of the disease. It is estimated that a PASI score of less than 10 means that your psoriasis is rather modest, so in this case, the doctor will favourlocal (topical) treatments. If the PASI score exceeds the threshold of 10, your psoriasis is considered to be moderate to severe. Other therapeutic approaches can then be discussed.

The dermatologist may change a patient’s treatment dose, combine one type of treatment with another, or switch treatments to find one that works better for the patient.

1. Local treatments

Topical treatments, such as creams and ointments, are usually recommended first, especially for people with mild psoriasis (PASI < 10). The main objective of this type of treatment is to slow down and regulate the renewal of skin cells, thereby reducing inflammation. Topical treatments include topical corticosteroids and vitamin D3 derivatives, which currently exist most often in combined forms.

The dermatologist may recommend a combination of local treatments or combine them with oral therapy or phototherapy.

2. Phototherapy

Both natural light and artificial ultraviolet (UV) light are used in the treatment of psoriasis. One form of phototherapy, narrow-band UVB phototherapy (TL01), emits a short wavelength (311nm) of UV light that penetrates the epidermis, the outer layer of the skin. This light differs from that emitted by tanning lamps and research indicates that it does not significantly increase the risk of skin cancer.

Phototherapy remains an excellent approach in moderate to severe psoriasis and specifically against a particular form of psoriasis: guttate psoriasis (which often follows an infectious episode such as angina).

This requires 2 to 3 short sessions per week, and the number of sessions necessary to treat psoriasis is usually around 15 sessions.

3. Medications administered orally (or subcutaneously)

Several medications taken by mouth can help control psoriasis. They are generally reserved for the treatment of more severe forms or those presenting symptoms spread over a large area of the body.

These medications include methotrexate, cyclosporine, acitretin, dimethyl fumarate and apremilast.

These drugs have been around for a long time. Most of them require regular monitoring, coordinated with regular check-ups from the physician (for example: liver monitoring for methotrexate, renal monitoring and blood pressure for cyclosporine, monitoring of blood lipids for acitretin).

4. Biological agents (biotherapy)

Biological agents are innovative treatments administered by subcutaneous injections. These are large molecules that block inflammatory pathways. These treatments are often extremely effective. They are expensive and reserved for severe forms (PASI >10) that have not responded to phototherapy and/or other systemic treatment.

It is after a detailed request to your insurance and the approval of the medical advisor that this type of treatment can be initiated.

These treatments can potentially lower your immunity.  Adetailed blood test must be carried out by the dermatologist in order to exclude a latent or dormant infection (for example tuberculosis).

Biological agents approved for the treatment of psoriasis in Switzerland include etanercept and the monoclonal antibodies adalimumab, infliximab, ustekinumab, secukinumab, ixekizumab, bimekizumab, risankinumab, guselkinumab, tildrakizumab. Multiple factors come into play when choosing one or the other of these medications. The dermatologist will guide you in these choices.

Nowadays, thanks to biological treatments, many patients see psoriasis completely disappear from the surface of their skin. They regain normal skin. It is imperative to explain that theinterruption of treatment can often lead to a gradual return of the disease after a few months. 

The challenge, for both the dermatologist and the patient is to find what is the most effect treatment. Often, the doctor may choose to combine two or more treatments to achieve the best result.  Psoriasis, however, remains a chronic disease.  Even if the new treatments are very effective, the disease returns when treatment is stopped.  It is therefore necessary to discuss the best strategy with patients on a case-by-case basis. 

Acne is one of the most common inflammatory dermatological conditions seen in daily consultations. As many as 90% of the adolescent and adult population will be affected by acne at some point in their lives. The mechanisms of acne genesis are well known and are described in another article (see Dr Marangon’s article on acne, link here).

Lasers have been used for over thirty years in the treatment of acne, in two main forms. This is either by application of visible light, which is used to target the bacteria responsible for the inflammation (Cutibacterium Acnes), or by infrared light which attacks the sebaceous glands with a thermal effect

1. Visible light lasers: these machines can be either real lasers emitting a single wavelength (e.g. pulsed dye) or flash lamps (IPL or Intense Pulsed Light), emitting several wavelengths. The advantages of IPL are the ease of use and lower running costs. Results can be seen within a short period of time after using this technology on inflammatory acne.  With one session per week, after two or three sessions, an improvement will already be visible. However, the clinical effect is short-lived (a few weeks) and more frequent maintenance sessions are necessary to maintain the improvement as the culprit bacteria often recur.

2. Infrared lasers: these lasers emit wavelengths in the near infrared from 1064nm (Nd: YAG) to 1540nm (ICON XF and XD for example). They are able to go deeper than visible light lasers or IPL and can reach the sebaceous glands, which are responsible for acne due to their excessive excretion of sebum. These lasers will heat the glands, shrinking them and thus reducing their sebum production. The advantage of these lasers is that they can be used to treat all skin types, even black skin, and the beneficial effect lasts longer. The new ProDeep® 1340nm laser is particularly appreciated by patients because the results are excellent, while the pain and after-effects minimal. 

A new laser for acne treatment will arrive in Europe in 2023. This laser targets sebum directly by emitting a very specific wavelength at 1726nm. It is currently too early to judge the long-term results.

Laser https://marketing.cynosure.com/tempsure-rf-uk.html

Acne vulgaris is a common and frequent condition in the general population.

The most common form is adolescent acne, which usually begins around puberty. It is estimated that 90% of the adolescent population has acne of various severity.

The psychological repercussions of this condition are variable but can greatly alter the quality of life of patients with sometimes a real alteration of self-image, mood disorders and an impact on social relations.

The duration of the condition varies between individuals and their family history, sometimes with later development of some forms in young women due to the involvement of female hormones.

The clinical presentation is variable, generally with the association of hyperseborrhoea (oily skin), and several lesions ranging from open and closed comedones to papulopustules.

The most severe form is called nodulocystic acne or acne conglobata which, if not treated quickly, will be accompanied by scarring in adulthood.

Other forms of acne can be seen under certain conditions: adult acne rosacea, drug acne, exogenous acne due in particular to the application of unsuitable cosmetics and hormonal acne.

Therapeutic management must be personalized and depends on the severity of the clinical presentation, but also on the specific requests of patients, often minors, and their families.

The treatments are to be carried out over time and should be adapted to the evolution of the acne.

External treatments combine different molecules for greater effectiveness in the form of soap, creams or gels.

Internal treatments, excluding hormonal treatment, are mainly:

Courses of antibiotics from the tetracyclines family, which have a narrow therapeutic range. 

Treatments last two to four months but may be repeated if further treatment is necessary. 

Finally, the most effective and only curative treatment, in 80% of cases, is Isotretinoin.

This molecule derived from Vitamin A is reserved for the most serious cases or for patients with whom other treatments have failed. It is a major treatment that has many contraindications and must be carried out under strict medical supervision.

A new technique to combat aging and sagging skin joins the portfolio of therapies offered by the Skinpulse dermatology center in Geneva.

The Profhilo ® treatment, unique in its kind, aims to bio-remodel and tone your skin and its tissues by injecting mini doses of hyaluronic acid (HA) hybrid complex.

What is Profhilo ®?

Profhilo® is a revolutionary injectable product based on hyaluronic acid (HA) without the addition of other chemical additives. Launched in 2015, it is used to treat sagging skin and stimulate skin regeneration. Unlike usual classic fillers, it has the ability to bio-remodel the skin by stimulating the synthesis of fibroblasts and adipocyte cells, which allows hydration, an increase in skin tone and a ”  plumping » underlying subcutaneous tissues.

Which areas can be treated with Profhilo ®?

Basically, a treatment with Profhilo® could be used in any areas where the skin needs a “cooling off”. The body parts mainly suggested by us to benefit from this new bio-remodeling technology are among others:  

• The face
• The neck
• The neckline
• The hands
• And in some cases the arms ( bat effect)

How does the therapeutic gesture take place?

After disinfecting the chosen area, Profhilo® is injected using very fine needles. A 0.2 ml dose of Profhilo® is scrupulously injected into several specifically selected bio-aesthetic points (BAP), thus allowing a natural distribution of the product. This technique is highly safe and allows a massive reduction in the risk of damage to blood vessels and nerves.

Once administered, the product immediately begins to distribute evenly to the different tissue layers and begins its role as a regenerative bio-remodeling agent.

Immediately after the treatment, you can usually resume your usual daily life.

The treatment usually consists of at least two sessions at an interval of 4 weeks. The stability of the results is assessed over 6 – 12 months.

Are there any side effects?

The absence of additives is synonymous with better tolerance and drastically minimizes the possible risk of adverse effects, particularly allergies. From the point of view of the injections themselves, as with any treatment with an injectable product, bruises (bruises) as well as redness may appear temporarily. These will disappear spontaneously in a few days.

The HydraFacial® allows to cleanse, scrub, exfoliate imperfections, moisturize, and unify the skin.
 
Thanks to its nutrient antioxidant components, HydraFacial® helps restore new, healthy skin.
 
This treatment brings a boost of radiance and a better skin tone. This aesthetic medical treatment brings together several techniques.  It is considered the most efficient on the market.
 
The results are quickly visible and long-lasting.

OPERATION

Technique and procedure of a session:

This skin treatment uses patented vortex-fusion technology which allows the face, neck and décolleté to be treated non-invasively.

Hydrafacial® care is the most efficient and safest product on the market, its 24 registered patents attest to its effectiveness.

A session lasts between 30 and 75 minutes, depending on the need.

A HydraFacial® session takes place in 4 stages:

1. Cleaning : Deep cleansing of the skin “& nbsp; of the stratum corneum of the epidermis & nbsp;” thanks to Hydropeel, an exfoliant that destroys dead cells and renews tissue for new skin. This peel acts gently with glycolic and salicylic acids. & nbsp;
2. Extraction + Hydration : A suction & nbsp; to remove comedones, blackheads, excess oil and impurities from the skin. All while hydrating the skin. & Nbsp;

3. Infusion + Protection : An infusion of serums repairs the surface of the skin with anti-oxidants based on powerful peptides and hyaluronic acid. This allows for detoxification, rejuvenation and restoration of healthy skin structure and function.

For this, Boost serums are available and adapt to each skin type and the need to be treated. We distinguish:

• Boost Dermabuilder : Peptides treat signs of aging (skin aging), stimulate collagen production (anti-aging) and firm the dermis.
• Boost Britenol : Antioxidants clarify dull complexion (linked to tobacco and pollution)
• Boost Glysal : Treats acne and skin problems like scars, restores large pores and regulates sebum production.
• Boost BrightAlive : Unification and Hydration of the skin.
• The Red LED bring benefits to the skin by regenerating, soothing and toning it.
• The Blue LEDs have an anti-bacterial effect, they correct the appearance of the skin especially those of oily and acne-prone skin.
• For a classic cleansing , one treatment per month.
• For a treatment of imperfections and complexion, 3 to 6 sessions are needed.

Dermatologist – Geneva, Switzerland

Combining Treatments with ETHEREA-MX^® Source https://www.vydence.com/

10 minutes about Dr. Adatto’s experience with the treatment of various indications and the combinations of IPL-Sq^®, DualMode^®, ACROMA-QS^® and ProDeep^® handpieces.