How Is Psoriasis Treated?
From an autoimmune perspective, psoriasis is treated by targeting the immune mechanism that drives the condition. Abnormal activation of T lymphocytes, particularly Th17 cells, leads to the production of IL-17 and IL-23, which stimulate excessive keratinocyte proliferation and chronic inflammation.
This central autoimmune mechanism is the main target of the biologic agents that have transformed the treatment of psoriasis.
Psoriasis is not exclusively a skin disease. The systemic inflammation associated with it increases cardiovascular risk and may also manifest as psoriatic arthritis in a significant proportion of patients.
Its management therefore requires a holistic approach that addresses both the cutaneous and systemic aspects of the condition.
Characteristics of Psoriasis
An autoimmune psoriatic plaque is characterised by a particularly hostile biological environment, with high concentrations of IL-17, IL-22 and TNF-α, increased oxidative stress, pathological neovascularisation involving dysfunctional vessels and chronic activation of dendritic cells that sustain the inflammatory cycle. Suppressing this environment requires intervention at multiple levels.
An imbalance between Th17 cells and regulatory T cells is a central immunological feature of psoriasis. While Th17 cells are overactive, the regulatory T lymphocytes that would normally limit the autoimmune response are impaired.
Correcting this imbalance is a common therapeutic objective of both biologic agents and adjunctive interventions.
Scientific Studies
From an immunological perspective, studies have reported that hyperbaric oxygen therapy suppresses the IL-17/IL-23 axis, which is central to the pathophysiology of psoriasis, and enhances regulatory T-cell function.
At the same time, its antioxidant effects reduce oxidative stress within psoriatic plaques, while improved vascular function may help limit the pathological neovascularisation associated with the condition.
Clinical studies using the Psoriasis Area and Severity Index (PASI) have reported improvements in certain patient subgroups, particularly among those with moderate disease who do not respond fully to topical treatment.
The Role of Hyperbaric Oxygen Therapy
From an autoimmune perspective, hyperbaric oxygen therapy may be used as an immunomodulatory adjunct in psoriasis, targeting the underlying immune mechanisms of the disease alongside dermatological treatment.
Suppression of the IL-17/IL-23 axis, enhancement of regulatory T-cell activity and reduction of oxidative stress represent the principal therapeutic mechanisms.
Treatment is planned in collaboration with the dermatologist and, in patients with psoriatic arthritis, the rheumatologist. A typical course consists of 20 to 30 sessions.