Thoughts and practical advice

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Psoriatic skin under a magnifying glass

When psoriasis affects the skin or nails, it interrupts the process of keratinisation: i.e. the process that gives rise to the thin and compact stratum corneum of the epidernis, and the compact and transparent laminar covering of the nails.A compact stratum corneum is plastic (i.e. it can flex without cracking), whereas one that is affected by psoriasis is stiff and and subject to cracking upon movements. A healthy stratum corneum acts as a barrier against harmful external agents, whereas one that is psoriatic is permeable to everything: micro-organisms, environmental pollutants, and even water.









  NORMAL NAIL                                        PSORIATIC NAIL 

 All of the above explains why psoriatic skin, regardless of therapeutic treatments, needs particular care and attention in order to minimise possible inconveniences in everyday life.



The same goes for the nail plate: when it is healthy, it is compact and impenetrable; when it is psoriatic, it becomes delaminated and can be easily penetrated by micro-organisms, dirt and water.

When psoriasis affects the scalp 

 Psoriasis often affects the scalp, which may even be the only affected site.







Scalp psoriasis is particularly irritating and uncomfortable:  it is often itchy, continuously releases scales that can be seen on one’s clothes, it extends from the edge of the hairline and is thus visible, and makes people unwilling to visit a hairdresser.  








Scalp psoriasis is difficult to treat but, if you do not want to use drugs, natural reducing agents are an alternative.Natural reducing agents work well in the treatment of scalp psoriasis.  The most widely used are colloidal sulphur (see page 20) and salicylic acid (see page 20) formulated in evanescent creams without vaseline. [1] The cream is applied in the evening and massaged in until it is completely absorbed.

The advantages are:
• it is safe to use
• there is no rebound effect when it is discontinued
• the treatment has no time limits.

The disadvantages are:
• there is a slight smell of sulphur (similar to sulphurous water).

Sea bathing (thalassotherapy) and bathing in sulphurous spa waters have an anti-psoriatic effect on the scalp.

Anyone who is affected by scalp psoriasis should take particular care over hair washing.


When psoriasis affects the scalp

Shampoos are mixtures of tensioactive ingredients intended to de-grease and wash the hair. However, such ingredients are also irritants, particularly in the case of a psoriatic scalp.

Shampoos medicated with ichthyol sulphonated

Ichthyol sulfonated, a natural reducing agent, can be usefully incorporated in a shampoo to reduce inflammation, itching and scaling.

 Shampoos medicated with mineral tar (coal tar) Coal tar is  a reducing agent that has an almost immediate capacity to bind to the stratum corneum, are the most effective but are not marketed in Europe because it is now prohibited to use coal tar in cosmetics. Look out for shampoos medicated with vegetable tars, which are marketed but are not efficacious in treating scalp psoriasis. Oil-based shampoos

Finally, there are oil-based shampoos that are intended to reduce scalp dryness. Once again, the irritating action of the tensioactive ingredients prevails over the emollient action of the oils.  

In order to have less irritation when washing your hair, try using a cleansing cream instead of a shampoo   

The shampoo for psoriasis
When psoriasis affects the scalp, it is mandatory to pay attention at detergents contained in a shampoo. In fact, the majority of detergents has an irritant action when in contact with skin. The shampoo for psoriasis has to contain, besides antipsoriatic active principles, selected ingredients that do not produce irritation (2).

An alternative to shampoo

An alternative to the use of shampoo may be the use of a cleansing cream.

Cleansing creams

Cleansing creams are emulsions made of fats similar to the cutis held together by tensioactive ingredients. They are used as substitutes for normal detergents by subjects with problems of dry skin. People with scalp psoriasis can benefit from using a lauryl sulphate-free washing cream [3] also to wash their hair because it manages to clean hair as well as shampoo without causing dryness or irritation. It reduces itching and scaling.


The rules for hair washing are:
• wet the hair
• put the shampoo or the washing cream on the hair
• rinse
• if necessary, cream the hair a second time
• avoid rubbing the scalp with the shampoo or the washing cream
• avoid detaching the scales from the scalp during washing
• dry the hair preferably using a cotton sponge towel
• use a hair dryer only to complete the drying and without directing hot air onto the scalp·

Hair cosmetic treatments are allowed.



When psoriasis affects the nails


Leonardo da Vinci - Dama Con Ermellino


Nails affected by psoriasis undergo the same alteration as the stratum corneum.

The laminar plates making the nails become detached from each other, and the whole nail becomes detached from the ungueal bed. The consequences are that the nail becomes permeable to external agents such as water, detergents, dirt and micro-organisms. As a result of the delamination, it becomes opaque and more fragile; as a result of the penetration of dirt or micro-organisms, it changes colour and takes on different shades of yellow, brown or black.


















These changes cause discomfort, particularly if they affect the finger nails.







Nail psoriasis can modify the plates in an even more glaring manner:
• vertical growth: i.e. with thickening
• plate loss or erosion. 
Nail psoriasis can also cause deformity of the distal phalanges of the hands and feet.







In addition to the above-mentioned unaesthetic effects, psoriasis of the nails also causes function defects and complications. The main functional defect is loss of grip in the case of a deformed distal phalanx or the   loss of an entire plate.

The main functional defect affecting the feet is a difficulty in walking when the big toenail becomes thickened, interferes with shoe uppers, and causes pain.










One complication that affects both hands and feet is perionyxis: i.e. infection of the tissue around the nail. This occurs because the cuticles do not form and the perionychia becomes permeable to water,detergents, dirt and micro-organisms.


How to manage psoriatic nails 

Proposed treatments:  
1) the use of natural reducing agents
2) exposure to the sun and UV rays
3) washing with cleansing cream
4) smoothing with a nail-file
5) smoothing with a turbine micromotor
6) hiding under coloured nail varnish
7) hiding under false resin nails


1) Locally applied drugs have little effect on the course of nail psoriasis and are therefore of little help to patients. This is because the alterations in psoriatic nails are due to an alteration in the ungueal matrix. The matrix is located deeply, above the phalangeal bone, and can hardly be reached by drugs applied to the skin. As drugs are not effective, it is better to use natural reducing agents. Both sulphur and salicylic acid have considerable affinity for nails and peri-ungueal corneum tissue, and exert a reducing, antimicrobial and exfoliative action. Although it does not have any real therapeutic effect on nail psoriasis, vaseline-free, evanescent sulphur-salicylic cream [1] contributes to softening the laminar plate, facilitating the detachment of the accumulated scales underneath the nails, and protecting both the nail and perionychium from infections. Sulphur-salicylic cream [1] is applied once a day in small amounts, beginning the massage from the free border, then on the nail and finally the perionychium. The duration of treatment is unlimited.

2) It is known that exposure to the sun during the summer tends to lead to the regression   of the nail damage caused by psoriasis. In order to improve the nails, the exposure does not have to be prolonged; the light energy of the summer is sufficient and so, if the affected nails are on the feet, it is advisable to wear sandals that allow the light to reach the toes. On the contrary, UV lamps are not very practical because, in order to obtain a positive result, it is necessary to attend a large number of sessions and, in the end, there is a risk of inducing damage caused by the UV rays

3) To wash hands and feet whose nails are affected by psoriasis, it is better to use a cleansing cream free of lauryl sulphate [3] instead of soap, and to wash them briefly and infrequently in order to avoid soaking the tissue and worsening the psoriasis. 

4) In order to eliminate the longitudinal streaks, depressions and opacity, and improve the look of the nails, a professional nail-file should be used; there are some on the market coated with sapphire that are particularly efficient.




5) If the nail tends to grow vertically in an exaggerated manner, it is not possible to use a nail-file but necessary to consult a podologist. Podologists have special high-rotation, water-cooled files of various makes, which are capable of remodelling both the thickness and free border of the nail plate.






6) In addition to the above treatments, it is possible to try to hide the nail. The most common way (conventionally reserved for women) is to use nail varnish. In order to ensure a good result, it is necessary to file the nails using a standard or rotating nail-file before applying the varnish, which is better if it is dark and opaque.








7) However, when the nail is severely damaged by psoriasis, varnish is not enough and it is necessary to construct an artificial nail made of liquid resins that harden when they are heated or exposed to UV rays. Once hardened, a nail shape can be cut out.

In addition to its aesthetic function, the application of a resin nail also serves to keep the ungueal bed flat, otherwise the distal phalanx would tend to curve upwards obstructing the growth of the mail itself. If this happens to the big toe, it can cause pain on walking because of the opposition between the pulp of the toe and the edge of the nail.













When psoriasis affects the body



Psoriasis affects the body in various forms and in various areas;  the most common form is plaque psoriasis, which mainly affects the elbows, knees and sacral region.

However, psoriasis can present polymorphously:

• as a single patch or plaque










• as small but grouped plaques










• as even smaller and disseminated plaques (drop-shaped) 









• as large plaques in abstract configurations.











If we look at a psoriatic plaque through a magnifying glass, we can see an inflammatory base covered by scales, some of which are adhering to the skin, some are raised, and some already detached. The whole forms microfissures that intermingle with each other.














• Once dried, the plaque should be treated with a polyethylene glycol (PEG) or polydecene (D) ointment – so-called Emollient Ointment – Extreme - [4] that are simultaneously capable of absorbing residual dampness, reducing bacterial growth, restoring flexibility to the stratum corneum, and favouring the detachment of the scales. 
• This plaque begins to lack the flexibility typical of the compact stratum corneum, and so every movement leads to the creation of a new  microfissure. 
• The altered barrier function allows the penetration of water, detergents, dirt and micro-organisms.   
• The inflammatory state of the plaque bears witness to the stress undergone by the living cells that are no longer protected by a compact stratum corneum. In their everyday lives, psoriatic patients have to ensure that the plaque does not suffer further stress, and one of the most difficult moments is when washing because both water and detergents penetrate and remain in the microfissures and beneath the partially raised scales.

These are the considerations leading to the following rules for everyday washing:

• A shower is better than a bath because contact between the water and the plaques is shorter and the scales absorb less.
• Common soaps and detergents should be replaced by a cleansing cream [3] in order to minimise the irritation of the plaque by tensioactive ingredients.

After washing, it is necessary to dry the plaques carefully in order to remove as much water as possible because dampness favours bacterial growth, which leads to further plaque irritation.

In brief, for everyday hygiene:
• Prefer showers over baths
• Use a lauryl sulphate-free cleansing cream [3] instead of common cleansers
• Dry thoroughly
• Apply Emollient Ointment – Extreme - [4].


When psoriasis affects the body


Using natural reducing agents

When the psoriasis is minimal and it is wanted to avoid having recourse to drugs, or in the intervals between drug treatments, or when drugs are contraindicated or have failed to lead to satisfactory results, it is possible to use natural reducing agents. These are natural active ingredients which, when applied to the skin, reduce psoriatic growth. There are many of these, but the most widely used and the ones for which there is the greatest amount of clinical documentation are:

• sulphur;  • salicylic acid;  • ichthyol sulphonate;  • mineral tar 


Sulfur in National Museum of Natural History at Smithsonian Institution






Sulphur is the oldest anti-psoriatic natural active ingredient. It is known to be rich in keratines, the proteins of the stratum corneum, but it is not known exactly how it is capable of controlling inflammatory states such as seborrhoic dermatitis and psoriasis. Sulphur-based pastes or sulphurous water baths have been used to treat skin conditions and psoriasis since ancient times.









Salicylic acid, which was initially extracted from the bark of willow trees, has been used since ancient times because of its curative properties. On the skin, it has an antiseptic, antifungal, keratolytic and reducing action.

The combination of sulphur and salicylic acid Although chemically very different, sulphur and salicylic acid have similar dermatological curative properties that potentiate each other, which is why they are used together in what is known as sulphur salicylic cream

The sulphur salicylic cream used as a reducing agent in seborrhoic dermatitis and psoriasis must contain sulphur in its colloidal form and be devoid of vaseline [1]. The concentration of the two active ingredients must not be more than 2%. This cream leads to good results in psoriasis affecting the scalp or delicate areas such as the ears, genitals, nails, etc


Ichthyol sulphonate is a compound that first formed 200 million years from marine sediments, and is today extracted from mines in France and the Tyrol. It is a dense and dark liquid with a characteristic smoky odour that has antiseptic, anti-inflammatory and anti-pruritic properties. In psoriasis, it is used in the form of a cream [5] above all on inflamed and itchy areas. It can be used together with other natural reducing agents, or alternated with them.


Mineral tar (commonly known as coal tar) is derived from the distillation of fossil carbon. It is a highly viscous liquid with a characteristic penetrating smell, and is used in an evanescent cream at a concentration of 4% [6]. The potent psoriasis-reducing action of 4% coal tar cream is as active or even more active than cortisone, but there are some drawbacks. It cannot be used on the scalp because it interacts with hair and turns it violet; it is not very well tolerated in delicate areas such as the face and genitals; it has an intense smell; it indelibly stains clothing; and it acts as a potent photosensitiser because it reacts with sunlight. For this last reason, it is only used in the winter.


• Suggestions for treatment with natural reducing agents


Reducing Agent


When applied


Where applied


Positive association

Sulphur salicylic cream (1)





Exposure to sunlight

Ichthyol sulphonate (5)




Exposure to sunlight


Coal Tar Cream (6)


On body,

not scalp or delicate parts

NO exposure to sunlight or UV lamps



• Timing and possible variations – reducing + scaling regimens








Sulphur salicylic cream (1)


Coal Tar Cream (6)

Ichthyol sulphonate (5)


Shower with Cleansing Cream (3)

Shower with Cleansing Cream (3)


Shower with Cleansing Cream (3)

After washing

Emollient Ointment –Extreme (4)

Emollient Ointment –Extreme (4)

Emollient Ointment –Extreme (4)










•  Timing and possible variations – double reducing regimens







Coal Tar Cream (6)


Ichthyol sulphonate (5)


Shower with Cleansing Cream (3)


Shower with Cleansing Cream (3)

After washing

Sulphur salicylic cream (1)


Sulphur salicylic cream (1)





When psoriasis affects the hands and feet                       


Leonardo da Vinci - Mona Lisa



 Psoriasis sometimes preferentially or exclusively affects the palms of the hands, the soles of the feet, or both locations. 










Palmo-plantar psoriasis has various clinical forms, the most frequent of which are erythematous, hyperkeratotic, exfoliative and dyshidrotic psoriasis










 HYPERKERATOTIC FORM                           EXFOLIATIIVE FORM                        DYSHIDROTIC FORM













When psoriasis affects the hands and feet


When psoriasis affects the palms and soles, it creates new management problems because one of the characteristics of even the mildest forms of palmo-plantar psoriasis is the presence of cracks or rhagades. This is due to the fact that a poorly organised stratum corneum can never have the necessary elasticity to cope with the movements of the hands and feet.  The cracking may be clearly visible or not, as in the case of the microfissures or microrhagades in the examples below.




















When cortisone treatment is prescribed

Cortisone is still the most widely used drug for the treatment of localised (particularly palma-plantar) psoriasis. Unfortunately, cortisone is the least suitable drug for treating a chronic dermatitis such as psoriasis because of its known unwanted effects of tachyphylaxis and rebound.

Tachyphylaxis is a form of desensitisation over time that means an increasing amount of drug has to be administered in order to obtain the same therapeutic result.

In the case of psoriasis, this means starting to control the disorder by applying cortisone once a week, but then having to apply it everyday or more than once a day, and sometimes still being unable to control it.

Rebound is the term used to describe the fact that, when cortisone is stopped, the dermatitis markedly worsens. In the case of palmo-plantar psoriasis, stopping cortisone leads to swelling, burning, the opening of the cracks, and the appearance of blisters or blebs.







Controlling rebound after the discontinuation of cortisone  is particularly difficult, and often exposes the patient to considerable suffering. For this reason, before stopping the drug, it is necessary to justify the need to do so.



Psoriasis is an inflammatory state of the skin, and worsens in the presence of other stimuli of cutaneous inflammation. In other words, it must be soothed and not stimulated. When it affects the hands and feet, it is particularly difficult not to cause further stress on the skin: it is enough to think of walking and the everyday handling of common objects. The philosophy of “placating” palmo-plantar psoriasis therefore involves eliminating as many pro-inflammatory stimuli as possible. The most important of these is contact with water and detergents. Water is itself an irritant of the psoriatic state: it can penetrate between the scales and in the cracks, making them damp and thus favouring microbial growth and the consequent irritation. The tensioactive ingredients in detergents are further pro-inflammatory stimuli that psoriatic skin needs protecting against. Even dust causes irritation and needs to be kept away from the skin.

Wash without getting your hands and feet wet. The idea is to prevent water and detergents from coming into contact with psoriatic skin. In the case of the hands, the recommendation is to wear vinyl gloves [7], which are impermeable to water and do not irritate the skin themselves.

However, they do not adhere to the wrists, and so it necessary to take care that water does not enter the gloves while you are washing. The same vinyl gloves should be worn every time you are likely to get your hands dirty (so that you do not have to wash then afterwards), or to protect them from dust. When it is necessary to wash your hands, such as before eating or after having used the toilet, it is necessary to use a “dry” disinfectant. One possibility is an acqueous solution of benzalconium chloride [8], which has a simultaneously cleansing and disinfecting action: soak some cotton wool with the disinfectant, squeeze it to eliminate the excess liquid, and then rub it on the hands

As far as the feet are concerned, put a stool in the shower so that you can sit on it when washing the rest of your body while keeping your feet out of contact with the water. You can then wash your feet in the same way as your hands

Using natural reducing agents on palms and soles. It is advisable to treat palmo-plantar psoriasis with the same natural reducing agents as those described in the previous chapter. The agent should be applied in the evening taking particular care to massage it in well because the thickness of the stratum corneum on the palms and soles limits the absorption of topical products to a minimum. If you use coal tar, you should wear light cotton gloves or socks when sleeping in order to avoid staining the sheets, but this is not necessary if you use one of the other agents.

Protect your hands during the day.

During the course of the day, your hands come into contact with various objects or substances that could aggravate the psoriasis, and this has given rise to the idea of using something to protect the hands. Although protective creams acts as stress factors on psoriatic skin and cannot be applied, what have proved useful are ointments containing polyethylene glycol (PEG) [9]. These ointments have the advantage that they form a barrier between the skin and the external environment, but still allow the skin to breathe. The suggested PEG ointment [8] also contains allantoin, a substance that favours the cicatrisation of the fissuring, and can be applied a number of times during the day.

When palmo-plantar psoriasis is in remission. Once the remission of palmo-plantar psoriasis has been obtained, care needs to be taken when handling potentially irritating substances in order to avoid “re-awakening” the condition. The best suggestion is to continue wearing vinyl gloves as necessary [7] and usiing lauryl sulphate-free cleansing cream [3] instead of normal soap and shampoos.


Psoriasis in the summer

In the summer, psoriasis tends to improve or completely regress, mainly due to the effect of sunlight. However, it must be borne in mind that not all forms of psoriasis improve with the sun, and that some actually worsen. Nevertheless, it can be estimated that the sun is beneficial in 80% of cases

The sun acts as an anti-psoriatic agent in various ways: it increases the synthesis of vitamin D, which has an anti-psoriatic action; decreases the rate of growth of the cells damaging DNA; and reduces inflammation by distancing lymphocytes. It is probable that it also acts against psoriasis by releasing some brain neurotransmitters – the same ones that make us more good humoured.

The sun can therefore be considerd another natural reducing agent. However the same ultraviolet (UV) rays that are responsible for a large part of the sun’s anti-psoriatic action are also the cause of skin cancers, and so it is necessary to keep a balance between costs and benefits. Finally, it is worth remembering that sunburn (i.e. excessive exposure to the sun before beginning to acquire a tan) can “re-awaken” psoriasis – and the same goes for exposure to a UV lamp. It is therefore necessary not to get carried away by the urge for a sun cure, but to take care when sunbathing – not  least because sun protection creams and lotions must be avoided.


Practical advice
• Start sunbathing early in the season. UV rays are effective as early as April, and it is more comfortable to stay in the sun because the air is cooler
• Do not use sun protection creams or lotions, but take care not to get burnt
• If you are at the sea, take advantage of the action of bathing in sea water
• If necessary, use a natural reducing agent in the evening as a complement
• Remeber not to use coal tar because it is a photosensitiser
• If your skin becomes dry, use a self-hydrating ointment [3] after showering
• Emollient Ointment – Extreme - [4] can also be used before going out into the sun as it facilitates the penetration of UV rays
• Do not allow yourself to be conditioned by psoriasis, but also go sunbathing in the presence of others.


Psoriasis in a spa environment


Many spas, particularly those in Italy, have springs of sulphurous thermal water in which the sulphur may be free or combined with other substances. Various hydrological schools have classified sulphurous waters in different ways. The Italian school identifies sulphurous waters as those containing at least 1 mg of free H2S (1 hydrogen sulphide degree 0.001 g, equal to 0.658 ml di H2S), and distinguishes:
• weak sulphurous waters: 1 - 10 mg/l of free H2S at 760 Torr;
• medium sulphurous waters: 11 - 100 mg/l of free H2S at 760 Torr;
• strong sulphurous waters: more than 100 mg/l of free H2S at 760 Torr.
The action of sulphur on the skin is thought to be due to its interaction with the cysteine and its catabolites contained in keratinocytes. After this reaction, the sulphur changes to hydrogen sulphide (H2S) thus promoting keratinisation. At high concentrations, sulphur has a keratolytic effect by setting under way the proteolysis of keratins via the same hydrogen sulphide.
Sulphurous water baths have been used since ancient times as a remedy for the various types of psoriasis. Spas terme normally foresee a 10-minute sulphurous thermal water bath in the morning, and freedom of sunshine or ultraviolet lamp therapy as indicated by the on-site dermatologist. Positive results have been reported in the majority of patients; however, it emerges from the various clinical reports that the results of spa treatment appear from the fifteenth day onwards. As the Italian National Health Service grants psoriatic patients 12 thermal baths and people generally now have less time to spend at spas, it can be concluded that such treatment has been reduced to little more than a complement.

In an attempt to strengthen spa therapy for psoriasis we has recently proposed the following combined treatment:
• a 10-minute sulphurous water bath in the morning
• complete drying of the skin
• the application with massagge of vaseline-free evanescent sulphur salicylic cream [1] on the psoriatic areas
• a skin wash in the evening using a lauryl sulphate-free cleansing cream [3] 
• the post-washing application of an Emollient Ointment –Extreme [4] with pickling activity.

The next day, the same treatment is repeated

In a study recentelly carried out, this treatment regimen led to significantly better results after two weeks than treatment based solely on the baths.

We also recommend this type of treatment for people who have the opportunity to visit a spa. In the summer, this treatment can be complemented by heliotherapy, but we personally do not recommend the use of UV lamps.

Despite some positive reports, the application of muds, algae and hay does not seem to lead to substantial benefits in the treatment of psoriasis.



Psoriasis stress and society        








How to feel at ease, and how to disguise psoriasis

Many people sustain that psoriasis is purely psychosomatic; we think it is more correct to say that it is a disease that is aggravated by stress but has different bases.

In any case, in the everyday experience of both physicians and patients, there is a clear relationship between psoriasis and stress. What should be considered is how much psoriasis induces stress in patients, regardless of how much stress has influenced the onset of psoriasis. If psoriasis generates stress, in addition to treating the skin, dermatologists must try to attenuate the stress or the treatment will have no effect.

Stress Psoriasis Stress Psoriasis...

Unfortunately, everyday practice makes it all too plain how difficult it is to attenuate the stress generated by psoriasis, and that even recourse to anxiolytics or hypnogens often has no effect (as well as being generally poorly accepted by patients).

The stress generated by society, work, the family, etc. is even more unmanageable and, from this point of view, the picture is as disappointing as it is worrying.

Luckily, given that any worsening is easily perceptible, psoriatic patients are themselves well aware of the role of direct or reflected stress in the genesis of their psoriasis.

Dermatologists must therefore remember and repeat these concepts, and help their patients to reflect upon the need to seek all possible and sustainable means of escaping stress.


How not to be stressed by psoriasis

The rules are:
• Consider that psoriasis is not contagious
• Consider that psoriasis does not involve health
• Consider that psoriasis is very well known and does not shock people
• Consider that people look a lot but see very little
• Consider that psoriasis can regress at any time.

How to disguise psoriasis

When visible, psoriasis becomes an aesthetically displeasing sight that patients may not be able to tolerate. The most common case is psoriasis of the nails, although it can be treated/disguised in many ways. The nail plate can be filed to eliminate the distorsions and (partially) the stains; it can be covered with coloured or opaque nail varnish; it can be hidden by a false resin nail.If the psoriasis affects the face, topical therapies can be applied in the evening and, in the morning, make-up can be used to eliminate the the erythematous nuance that makes it noticeable.

In the case of scalp psoriasis, it can be suggested to keep your hair short, or long but tied back, and to wear light-coloured clothing and not black or navy blue.







Recommended products according to clinical experience

1) MOST Cream 2 S  (MOST Technical Cosmetics, Milan.

2) MOST Dermictiol Shampoo  (MOST Technical Cosmetics, Milan.

3) MOST Cleansing Cream  (MOST Technical Cosmetics, Milan.

4) MOST Emollient Ointment – Extreme   (MOST Technical Cosmetics, Milan.

5) MOST Dermictiol Cream  (MOST Technical Cosmetics, Milan.

6) Magistral preparation of 4% coal tar in evanescent cream made up by a pharmacist upon the prescription of a dermatologist*

7) Disposable vinyl gloves available in boxes of 100 in S, M, L sizes

8) Disintyl 240 ml (Zeta Farmaceutici, Vicenza.

9) MOST PEG Ointment (MOST Technical Cosmetics. Milan.

* Pharmacists may have difficulty in obtaining coal tar, and so it is sometimes necessary to apply to a hospital pharmacy