Psoriasis is an autoimmune disease that is a harmful combination of genesis factors, recurrent course, various phenotypes, clinical varieties and possible detection of various chronic diseases.According to literature, world psoriasis prevalence is 4-7%.
According to K. Reich, mild forms of the disease, which affect less than 3-5% of the body area and do not give a significant change in the patient's immune system, require only local treatment.Moderate and severe path psoriasis is a systemic, inflammatory process that leads to or deterioration of simultaneous pathological pathologies and have a huge impact on the patient's health and quality of life.
The problem of treatment for psoriasis does not lose relevance, and despite the emergence of new modern treatment methods, it remains a difficult task that requires an impersonal approach.
There is a wide range of local and systemic drugs for the treatment of psoriasis, most of which model the immune system.When selecting personalized therapy, the prevalence and severity of psoriasis, the stage of the process, the clinical form, and the attitude towards the patient's illness are taken into account.So, by localizing rashes, the skin has a significant impact on the quality of life in the open areas of the skin - the face, the head and brush and cause severe psycho -emotional experience.G. Krueger et al.(2001), 40% of patients with psoriasis were disappointed with the ineffectiveness of the treatment and 32% considered the treatment to be insufficient.
System therapy of psoriasis
Systemic glucocorticoids in tablets are extremely rare for many side effects.However, since the drug is a "ambulance" to stabilize the psychic process with progressive stage, Erythroderma is advisable to use prolonged systemic glucocorticoids for intramuscular administration in the form of short courses.A similar approach to therapy avoids harmful side effects.
More than 40 years of treating psoriasis are used with methotrexate.The mechanism of the effect is associated with inhibition of dihydrofolateledustase, which converts the acidum -dihydrofoline into tetrahydrofolic and the donor of simple carbon groups in the synthesis of purin nucleotides and dNA synthesis synthesis.In this regard, the simultaneous purpose of folic acid helps to avoid metabolic anemia.
Cyclosporin, a-cycle polypeptide, isolated from the tolipocladium mushroom suffering, has an immunosuppressive effect by suppressing T cell activity and reducing their antigenic sensitivity to the immune system.The drug is highly effective in treating a generally slow -flowing psoriasis, psoriasis erythroderma.
Since 1997, the aromatic retinoids of the second generation have been used to treat fireproof forms of psoriasis, which is based on acitireetin.The drug inhibits the proliferation of epidermis cells, normalizes the keratinization process, and has an immunomodulatory effect.The effectiveness of the product depends on the dose: higher doses lead to faster breakdown of psoriasis rashes.
Relatively recently, a new group of drugs - biological drugs that contain recombinant protein substances, which are biotechnological synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthetic synthesis.Indications for prescription biological drugs are severe forms of psoriasis that resist the drugs of other systems.
Treatment of moderate and severe forms of psoriasis (more than 10% of the body surface) is taken into account in terms of conditions in which the patient has many chronic diseases such as metabolic syndrome, cardiovascular disease, diabetes, and non-alcoholic oily liver and lipid metabolic disorders.According to statistical studies, such conditions for psoriasis are observed more often than in the general population.Thus, treatment of psoriasis should be taken into account the risk of side effects of ongoing systemic treatment, the circumstances in which the patient has many chronic diseases that are detected separately in each patient.In fact, some pharmacological drugs can negatively affect cardiovascular and metabolic simultaneous diseases.The relationship between psoriasis and heart-metabolic disorders has important clinical consequences.First of all, systemic therapy for psoriasis can negatively affect metabolic diseases, especially in continuous and extended treatment.In particular, methotrexate should be prescribed in obesity, diabetes mellitus, not in alcoholic oily liver disease, as the risk of liver fibrosis has increased.Cyclosporin can either cause appearance or exacerbate the course of arterial hypertension, enhance insulin resistance and affect the metabolism of fatty acids, and may have a toxic effect.
Acitrotine also promotes hypertriglyceridemia and/or hypercolesterinemia.Thus, all data should be taken into account when performing patients with psoriasis.
A special place for treating psoriasis gets phototherapy.The positive effect of ultraviolet radiation on the skin results in selective inhibition of Immunity T-cells.According to literature, phototherapy is distinguished by the following areas: anti -inflammatory, artificial inhibition of immunity and anti -kaulificator.The effect of ultraviolet rays on immunity is caused by the depth of penetration.UFB rays affect epidermal keratinocytes and langergan cells, UFA rays penetrate deeper layers of the skin and affect dermal fibroblasts, dendritic cells and immune cells.The positive effect of ultraviolet radiation is due to changes in Apoptosis of T -cells, decrease in the number of langergan cells, cytokines, growth factors (EGF, VEGF), adhesion and neuropeptides molecules.The purpose of phototherapy is advisable for a common skin process.
In the treatment of psoriasis, photochemotherapy (ball therapy) is used together with long-wave ultraviolet rays (UFA) (320-400 nm) and photosensitizing (8-metoxy).Puva therapy is one of the most effective methods for treating psoriasis, a recipe for common vulgar and exudative psoriasis, stubbornly, with severe infiltration.Treatment is carried out according to the weekly radiation methodology, the course is 20-30.
Currently, the combination of selective phototherapy, wave radiation (280-320 nm) has lost its position and is less and less prescribed for the treatment of psoriasis.Its purpose is to indicate psoriasis, which is characterized by the formations of low inflamed cells.
Narrow-band UFB treatment, with the peak of emissions, at 311 nm wavelength, high therapeutic efficiency, comparable to ball therapy, but unlike no photosensitizer.This is performed according to the 3-5 weekly radiation methodology by 20-30.
To treat limited vulgar psoriasis at a locally -bound stage, an extremely effective therapeutic technique is an eximmary laser that allows the monochrome light of the 308 nm wavelength, only to the affected area of the skin.
Local therapy
A fairly large selection of local products for treating psoriasis includes traditional ointments, which contain tar, naphthalene, ichthyol and salicylic acid.
When choosing local therapy, the individual approach is important, which depends on compliance with a patient with psoriasis.So, due to the cosmetic impossibility of treatment, 40% of patients do not meet the destination.
The effectiveness of topical corticosteroid drugs in the treatment of psoriasis is based on its outstanding effects on modulation of immunity and reduction of tissue inflammation.The effect is related to the mechanism of the hormones and receptors complex, which penetrates the core of the target cell and increases the expression of genes encoding the synthesis of peptides, and inhibits phospholipase activity.This mechanism leads to a reduction in the development of inflammatory mediators from phospholipids.Combined corticosteroid ointments and creams with salicylic acid are particularly beneficial.Local corticosteroid formulations are not shown for longer continuous treatment and no suggestions for combination and rotation schemes are shown, as long -term use can lead to side effects, such as skin atrophy, hypertrichosis, telangiectasia, steroid acne and adventure.
Synthetic analogues of vitamin D3 have created extremely effective tools against psoriasis.The most famous of this group is calcipotriol.The effect of the drug is based on the softening of keratinized skin with vitamin D3: it inhibits proliferation of keratinocytes and models by differentiation of the skin and has an immunomodulatory effect, with particular reference to the expression of IL-2 and information.The calcipotriol has a cumulative effect, so the therapeutic effect is observed after 1-2 weeks.From the beginning of treatment.
Unlike local steroids, long -term use of the drug group is possible.The combined purpose of calcipotriol and local steroids is possible to achieve the maximum therapeutic effect.
The effect of local calcineurin inhibitors (tacrolimus and pimecrolimus) involves blocking the signal transaction of T-lymphocytes by inhibition of calcineurin.It is most advisable to prescribe this group of drugs on the face of localization as they do not have side effects such as local steroids.
The value of the use of mitigating agents in the treatment of psoriasis is not doubtful: soften the skin, reduce peeling and dryness, and improve its hydration, especially after ultraviolet exposure;contributes to a decrease in itching.The biggest effect is when applied to wet skin after contact with water (bath, shower).The use of mitigating agents in the complex therapy of psoriasis reduces the total cost of treatment as a result of stabilization of the disease and the onset of remission, which promotes patients to reduce hospitalization.
Thus, the problem of treating psoriasis retains its relevance and remains a comprehensive task, primarily aimed at the personalized approach to therapy, in which psoriasis and patients with prospective patients take into account coordination.