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 simultaneous chronic diseases.According to literature, the prevalence of world psoriasis is 4-7%.
According to K. Reich, the mild 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 state, only require local treatment.The psoriasis of the moderate and severe course is a systemic and inflammatory process, which leads to the development of concomitant or worsening pathologies, and they themselves have a great impact on the health and quality of life of the patient.
The problem of treating psoriasis does not lose its relevance and, despite the appearance of new modern treatment methods, it remains a difficult task that requires a personified approach.
For the treatment of psoriasis, there is a wide selection of local and systemic medicines, most of which model the immune system.When choosing personified therapy, the prevalence and severity of psoriasis, the stage of the process, its clinical form, as well as the attitude towards patient's disease, they take into account.Then, with the location of rashes in the open areas of the skin: the face, the hairy part of the head and brush, the disease has a significant effect on the quality of life and causes severe psychomocional experiences.According to G. Krueger et al.(2001), 40% of patients with psoriasis were disappointed with the ineffectiveness of the resulting treatment and 32% considered insufficient treatment.
Psoriasis system therapy
Systemic tablet glucocorticoids are extremely rare in relation to numerous side effects.However, as the "ambulance" of the medicine 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, metretrexate is used.The mechanism of its action is associated with the inhibition of dihydrofolateredustase, which converts acidic acidichidropolic into tetrahydropholic and is a donor of simple carbon groups in the synthesis of purines and timidilate nucleotides necessary for DNA synthesis.In this sense, the simultaneous purpose of folic acid helps avoid metabolic anemia.
Cyclosporine, cyclic polypeptide, isolated from the tolepocladium infatum gams fungus, has an immunosuppressive effect by suppressing the activity of T cells and reducing its antigenic sensitivity due to the immune system.The medicine has a high effectiveness in the treatment of a common psoriasis that flows slowly, psoriatic erythrodermia.
Since 1997, the second generation aromatic retinoids have been used to treat refractory forms of psoriasis, whose chemical formula is aciteine.The drug inhibits the proliferation of the epidermis cells, normalizes the keratinization process, has an immunomodulatory effect.Product effectiveness depends on the dose: the highest doses lead to a faster resolution of psoriatic eruptions.
Recently, a new group of drugs appeared: biological drugs, which include recombinant protein substances, synthesized by biotechnological by living cells of animals, plants and microorganisms.The indications for the prescription of biological medications are serious forms of psoriasis resistant to other system medications.
The treatment of moderate and serious forms of psoriasis (more than 10% of the surface of the body) is carried out taking into account the conditions in which the patient has several chronic diseases, such as metabolic syndrome, cardiovascular diseases, diabetes mellitus, non -alcoholic liver liver and lipid metabolic disorders.According to statistical studies, such conditions for psoriasis are observed more frequently than in a general population.Therefore, in the treatment of psoriasis, it is necessary to take into account the risk of the side effects of ongoing systemic therapy, respectively, the conditions in which the patient has several chronic diseases that are detected individually in each patient.In fact, some pharmacological medications can negatively affect cardiovascular and metabolic concomitant diseases.The connection between psoriasis and metabolic heart 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 must be prescribed with caution in obesity, diabetes mellitus, not alcoholic fatty liver disease due to an increase in the risk of liver fibrosis.Cyclosporine, or can cause appearance or aggravate the course of arterial hypertension, improve insulin resistance and affect the metabolism of fatty acids, has a toxic effect.
Acitrotine also promotes hypertriglyceridemia and/or hypercholesterolemia.Therefore, when performing patients with psoriasis, it is necessary to take into account all data.
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 the immunity T cell.According to literature, the following areas of phototherapy action are distinguished: anti -inflammatory artificial inhibition of immunity and anti -acaulifier.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 deeper layers of the skin and have an effect on dermal fibroblasts, dendritic cells and immune system cells.The positive effect of ultraviolet radiation is due to the apoptosis of T cells, a decrease in the number of Langerganes cells, a change in cytokines, growth factors (EGF, vegf), adhesion and neuropeptide molecules.The purpose of phototherapy is advisable for a common skin process.
In the treatment of psoriasis, photochemotherapy (bulleting) is used, the combined use of long wave ultraviolet (UFA) (320–400 nm) and photosensitizer (8-methoxipsoren).Pumorapia is one of the most effective methods to treat psoriasis, its prescription is advisable with a common vulgar and exudative psoriasis, the stubborn course of the disease, severe infiltration.The treatment is carried out according to the irradiation methodology of 3 or 4 rack per week, on average, the course is 20-30 procedures.
Currently, selective phototherapy, a combination of wave radiation (280-320 NM) have lost their position and is less and less prescribed for the treatment of psoriasis.The indication of its purpose is psoriasis, characterized by formations with a low content of inflamed cells.
The narrow lane UFB therapy with the emission peak at a 311 Nm wavelength in high therapeutic efficiency is comparable to bullet therapy, but unlike the use of a photosensitizer.It is carried out according to the 3-5 Rack irradiation methodology per week with a course of 20-30 procedures.
For the treatment of limited vulgar psoriasis in a stationary stage, a highly effective therapeutic technique is an exidal laser, which allows the high -intensity monochromatic light of the wavelength of 308 nm to only the affected area of the skin.
Local therapy
A fairly large selection of local products for the treatment of psoriasis includes, in particular, traditional ointments that contain tar, naphtalan acid, ichtyol and salicylic.
When choosing topical therapy, an individual approach is important, in which the fulfillment of the patient with psoriasis will depend.So, due to the cosmetic impossibility of treatment, 40% of patients do not meet destiny.
The effectiveness of topical medications of corticosteroids in the treatment of psoriasis is based on its pronounced effects on the modulation of immunity and a decrease in tissue inflammation.The action is associated with the mechanism of the hormone and receptor complex, which penetrates the core of the target cell and increases the expression of genes that encode the synthesis of peptides that inhibit phospholipase activity.This mechanism leads to a decrease in the formation of inflammation mediators of phospholipids.The ointments and creams of corticosteroids combined with salicylic acid are 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 the atrophy of the skin, hypertrosis, the telangiectasis, the acne with steroids and the oppression of the adrenal function.
The synthetic anologists of vitamin D3 have been well established as highly effective means against psoriasis.The most famous of this group are calcipotriol.The principle of action of the drug is based on the effect of the softening of the keratinized skin with vitamin D3: inhibits the proliferation of keratinocytes and models the differentiation of the skin, and also has an immunomodulatory effect, in particular reducing the expression of IL-2 and information.Calcipotriol has a cumulative effect and, therefore, the therapeutic effect is observed after 1-2 weeks.From the beginning of treatment.
Unlike topical steroids, long -term use of this drug group is possible.To achieve maximum therapeutic effect, the combined purpose of calcipotriol and topical steroids is possible.
The action of local calcineurin inhibitors (Takrolimus and Pimecrolimus) is associated with the blocking of signals from the T lymphocytes when inhibiting calcineurin.It is more advisable to prescribe this group of medicines in case of location of eruptions in the face, because they have no topical side effects.
The value of the use of mitigating agents, in the treatment of psoriasis, is not in doubt: they soften the skin, reduce peeling and dryness, improve their hydration, especially after ultraviolet exposure;Contribute to a decrease in itching.The biggest effect is achieved when applied to wet skin after contact with water (bathroom, shower).The use of mitigating agents in the complex psoriasis therapy reduces the total cost of treatment as a result of achieving the stabilization of the disease and the beginning of the remission in shorter periods, which helps reduce the stay of patients in the hospital.
Therefore, the problem of treating psoriasis retains its relevance and remains an integral task, mainly aimed at a personified therapy approach, in which the patient's fulfillment with psoriasis and prospective conductive patients will depend, taking into account coordinity.