New hope for patients with psoriasis from planar shock wave treatment
An estimated 25 million people around the world are affected by psoriasis. In Germany alone,
between two and three million people (2-3% of the population) suffer from this unpleasant skin
Fig. 2: The Duolith SD1 planar applicator
There are various therapeutic approaches for alleviating symptoms, including topical treatments with salicylic acid, urea, polidocanol, tar, dithranol, cortisone and Vitamin D and A derivatives. Systemic treatments include methotrexate, corticosteroids, immunosuppressants, fumarates and biologicals. In addition to various alternative medical treatments, such as acupuncture and homeopathy, bath, light and climate therapies also represent promising treatment approaches. In addition, the precise application of a special laser light to the affected areas is now considered a standard treatment.
The first attempt to use planar shock waves to treat a patient who had been suffering from psoriasis vulgaris for many years was undertaken in October 2006.
Shock waves are rapid sound waves which trigger a biological response in treated tissue and can thus give rise to a range of effects. Details of the mode
Fig. 1: The Duolith SD1 shock wave source from
of action of shock waves on different cell types
have not yet been fully elucidated. What is considered certain is that growth factor formation and an increase in perfusion occurs, leading in the
Treatment of psoriasis is, however, considered
difficult. Because the disease is triggered by a
development of new, healthy tissue in the area
genetic defect, no causal treatment is possible.
Focused shock waves have been used with great
problematic, as they did not respond to either
success in the treatment of orthopaedic problems
such as tendinosis calcarea, lateral and medial humeral
We used planar shock waves generated using the
pseudoarthrosis for around 15 years. Extracorporeal
Duolith SD1 device manufactured by the Swiss
shock wave therapy (ESWT) was originally
company Storz Medical AG (Fig. 1). The high
developed for use in urology, where it has been
energy sound waves were applied to the margins of
used to destroy kidney stones non-invasively for
the psoriatic plaques using a mobile applicator (Fig.
2). Sterile ultrasound gel was first applied to the psoriatic plaques on the lower leg, which were then
Recently, extracorporeal (usually planar) shock
covered with a sterile film, to which a generous
waves have also begun to be used in dermatology.
amount of additional ultrasound gel was then
Poorly healing wounds, such as leg ulcers, burns or
applied. The margins of the psoriatic plaques were
diabetic leg ulcers, are being treated today with
then treated with a dosage of 0.22 mJ/mm and
200 pulses per cm² at a shock frequency of 4 Hz.
As a result of these insights, a first-ever attempt to
The patient was treated using this therapy regime a
use planar shock waves for treating psoriasis was
total of four times. The interval between treatment
sessions was 2 weeks. No topical or systemic treatment was administered in tandem with this
The treatment was performed on a 55-year-old
female patient who had been suffering from psoriasis for 30 years. She did not suffer from psoriatic arthritis. The skin plaques on the lower legs
Fig. 5: 2 weeks after the 4th treatment Narrowing of the margins, less intensive reddening
To evaluate treatment outcome, photos of the psoriatic plaques were made prior to the first treatment session and after the final (5th) treatment session.
Evaluation of the photographs shows visible improvement to the psoriasis after just 4 treatments, i.e. within 8 weeks. Scale formation, the core growth phenomenon, is significantly less pronounced and the margins of the lesions are no longer so sharply delineated. Signs of healing are clearly visible.
Fig. 6: Psoriasis also present on the other leg.
The patient failed to present, as arranged, for
Treatment with extracorporeal shock wave therapy
follow-up after completion of the treatment. In
(ESWT) clearly offers new hope for patients with
June 2008, 1.5 years after the final ESWT
treatment, the patient returned to the practice because of an orthopaedic problem. She stated
is that the shock waves can be applied directly to
that the lesions had healed completely 3 months
the affected area. In general, the treatment enjoys
after the final treatment and that no new plaques
good patient acceptance, as, when used correctly
had appeared on the treated lower leg since the
(sterile cover, energy not greater than 0.22
treatment, a period of more than a year. No new
mJ/mm²), no side effects should occur and the use
episode had occurred. After 1.5 years, the plaques
of planar shock waves of up to 0.22 mJ/mm² is
have healed completely, with no visible reddening
almost painless. The success of the treatment is
or scale formation. Skin quality appears normal.
visible after just a few (3-6) sessions. ESWT
The psoriatic plaque on the other, untreated lower
treatment can be repeated after a treatment-free
leg (Fig. 6) is still present. This plaque was very
period of 3 months. The very good long-term
small and the patient was not bothered by it, but
results after 1.5 years give patients with psoriasis
nonetheless the psoriasis was still clearly visible.
hope for an alternative to topical treatments and for a treatment to supplement systemic treatment methods.
For Further details, please contact:
A further observational study with more patients is planned to confirm this result.
Orthopädische PraxisR. RädelHaupt Str. 30944649 HerneGermany Tel: +49 (0)2325 988236Fax: +49 (0)2325 988237
Translation of: „Neue Hoffnung für Patienten mit Psoriasis durch die Behandlung mit planaren Stosswellen“R. Rädel
Published in Ästhetische Dermatologie 4, 2008
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