Psoriasis is an autoimmune disease with an adverse combination of genesis factors with a recurring course, a variety of phenotypes, clinical varieties and the possible detection of various chronic diseases simultaneously.According to the literature, the prevalence of psoriasis in the world is 4 to 7%.
According to K. Reich, light forms of the disease that affect less than 3-5% of the body area and do not give significant changes in the patient's immune status, only require local treatment.Psoriasis of the moderate and severe course is an inflammatory and systemic process, leading to the development of concomitant pathologies or worsening them, and they themselves have a huge impact on the patient's health and life of life.
The problem of psoriasis treatment does not lose its relevance and, despite the emergence of new modern treatment methods, remains a difficult task requiring a personified approach.
For the treatment of psoriasis, there is a wide selection of local and systemic medications, most of which model the immune system.By choosing personified therapy, the prevalence and severity of psoriasis, the stage of the process, its clinical form and the attitude towards the patient's disease are taken into consideration.Thus, with the location of rashes in the open areas of the skin - the face, the hairy part of the head and the brush, the disease has a significant effect on the quality of life and causes severe psycho -emotional experiences.According to the study by G. Krueger et al.(2001), 40% of patients with psoriasis were disappointed with the ineffectiveness of resulting treatment and 32% considered treatment insufficient.
Systematic Therapy of Psoriasis
Systemic glucocorticoids in a tablet form are extremely rare in connection with numerous side effects.However, as the drug "ambulance" to stabilize the psoriatic process with a progressive stage, Erythroderma is advisable to use prolonged systemic glucocorticoids for intramuscular administration in the form of short courses.An approach similar to therapy avoids adverse side effects.
More than 40 years in the treatment of psoriasis, methotrexate is used.The mechanism of its action is associated with the inhibition of di -hydrofolateredustase, which transforms acid -hydropholic acid -hydropholic and is donor of simple carbon groups in purine and shydhydhylate synthesis necessary for DNA synthesis.In this sense, the simultaneous objective of folic acid helps prevent metabolic anemia.
Cyclosporine, a-cyclical polypeptide, isolated from the fungus toolrypocladium inflammum gams, has an immunosuppressive effect, suppressing T cell activity and reducing its antigenic sensitivity due to the immune system.The drug is high in the treatment of common slow psoriasis, psoriatic erythroderm.
Since 1997, second generation aromatic retinoids have been used to treat refractory forms of psoriasis, the basis of the chemical formula of which acithiretin is.The drug inhibits the proliferation of epidermis cells, normalizing the process of keratinization, has an immunomodulatory effect.The effectiveness of the product depends on the dose: higher doses lead to faster resolution of psoriatic rashes.
Relatively recently, a new group of medicines appeared - biological medicines, including recombinant protein substances, synthesized by biotechnological by living cells of animals, plants and microorganisms.Indications for the prescription of biological drugs are severe forms of psoriasis resistant to other medicines in the system.
The treatment of moderate and severe forms of psoriasis (more than 10% of the body surface) is performed taking into account the conditions under which the patient has various chronic diseases, such as metabolic syndrome, cardiovascular disease, diabetes mellitus, non -alcoholic fat liver and lipid metabolic disorders.According to statistical studies, these conditions for psoriasis are observed more often than in a general population.Thus, in the treatment of psoriasis, it is necessary to take into account the risk of side effects of systemic therapy in progress, respectively, the conditions under which the patient has several chronic diseases that are detected individually in each patient.In fact, some pharmacological drugs may negatively affect cardiovascular and metabolic concomitant diseases.The connection between psoriasis and cardiac-metabolic disorders has important clinical consequences.First, systemic psoriasis therapy can negatively affect metabolic concomitant diseases, especially in the case of continuous and prolonged treatment.In particular, methotrexate should be prescribed with caution in obesity, diabetes mellitus, not alcoholic greasy liver disease due to an increased risk of liver fibrosis.Cyclosporine, or may cause appearance or aggravate the course of hypertension, increasing insulin resistance and affecting fatty acid metabolism, has a toxic effect.
Acitrotin also promotes hypertriglyceridemia and/or hypercholesterolemia.Thus, by conducting patients with psoriasis, all data must be taken into account.
A special place in the treatment of psoriasis receives phototherapy.The positive effect of ultraviolet radiation on the skin is associated with the selective inhibition of immunity cell T.According to the literature, the following areas of phototherapy action are distinguished: anti -inflammatory and artificial inhibition of immunity and anti -decalifier.The effect of ultraviolet rays on immunity is associated with a depth of penetration.UFB rays affect epidermal keratinocytes and Langergan cells, UFA rays penetrate the deeper layers of the skin and affect dermal fibroblasts, dendritic cells and immune system cells.The positive effect of ultraviolet radiation is due to T cell apoptosis, a decrease in the number of langergain cells, a change in cytokines, growth factors (EGF, VEGF), adhesion and neuropeptide molecules.The goal of phototherapy is advisable for a common skin process.
In the treatment of psoriasis, photochemotherapy (bullet therapy) is used the combined use of long wave rays (UFA) (320-400 nm) and photosensitizers (8-metoxipsoralen).Puva therapy is one of the most effective methods for the treatment of psoriasis, its prescription is advisable with common psoriasis and common exudative psoriasis, the stubborn course of the disease, severe infiltration.The treatment is performed according to the irradiation methodology of 3 or 4 rack per week, on average, the course is 20 to 30 procedures.
Currently, selective phototherapy, a combination of wave radiation (280-320 nm), has lost its position and is prescribed less and less for psoriasis treatment.The indication for its purpose is psoriasis, characterized by formations with a low inflamed cell content.
UFB narrow -track therapy with emissions peak at a 311 nm wavelength in high therapeutic efficiency is comparable to bullet therapy, but unlike the use of a photosensitizer.It is performed according to the 3-5 rack irradiation methodology per week, with a course of 20 to 30 procedures.
For the treatment of limited vulgar psoriasis at a stationary stage, a highly effective therapeutic technique is a eximary laser, which allows to provide monochrome light of the high wavelength of 308 nm wavelength only in the affected area of the skin.
Local therapy
A very large selection of local psoriasis treatment in particular includes traditional ointments containing tar, naphthal, ichthiol and salicylic acid.
When choosing topical therapy, an individual approach is important, on which the patient's compliance with psoriasis will depend.Therefore, due to the cosmetic impossibility of treatment, 40% of patients do not comply with the destination.
The efficacy of corticosteroid drugs to the treatment of psoriasis is based on its pronounced effects on immunity modulation and a decrease in tissue inflammation.The action is associated with the mechanism of the hormone and receptor complex, which penetrates the target cell nucleus and increases gene expression that encodes peptide synthesis that inhibit phospholipase activity.This mechanism leads to a decrease in the formation of phospholipid inflammation mediators.Corticosteroid ointments and creams combined with salicylic acid are especially preferred.Local corticosteroid preparations are not shown for prolonged continuous treatment and suggest combined and rotational schemes, because prolonged use can lead to the development of side effects such as skin atrophy, hypertrichosis, tenngiectasia, steroid acne and oppression of adrenal function.
Vitamin D3 synthetic analogs have established themselves as highly effective means against psoriasis.The most famous of this group are Calcipotriol.The principle of the action of the drug is based on the effect of keratinized skin softening with vitamin D3: inhibits the proliferation of keratinocytes and skin differentiation models and also has an immunomodulator effect, in particular, reducing IL-2 expression and information.Calcipotriol has a cumulative effect and, therefore, the therapeutic effect is observed after 1-2 weeks.Since the beginning of treatment.
Unlike topical steroids, long -term use of this group of medicines is possible.To achieve the maximum therapeutic effect, the combined objective of Calcipotriol and topical steroids is possible.
The action of local calcineurin inhibitors (Takrololimus and PimecroLolimus) is associated with blocking of T lymphocyte signal transduction, inhibiting calcineurin.It is more advisable to prescribe this group of medicines in case of rash location on the face, because they have no side effects such as topical steroids.
The value of the use of mitigating agents, in the treatment of psoriasis, is no doubt: they soften the skin, reduce peeling and dryness, increase its hydration, especially after ultraviolet exposure;contribute to a decrease in itching.The biggest effect is achieved when applying to wet skin after contact with water (bath, shower).The use of mitigating agents in complex psoriasis therapy reduces the total cost of treatment as a result of obtaining stabilization of the disease and starting remission in shorter periods, which helps reduce patients' suspension in hospital.
Thus, the problem of psoriasis treatment maintains its relevance and remains a comprehensive task, mainly intended for a personified approach to therapy, of which patients with psoriasis and patients who conduct patients will depend, taking into account the coordination.