Psoriasis is an autoimmune disease with a negative combination of genesis factors with a recurrent course, a variety of phenotypes, clinical varieties and possible detection of various diseases at the same time undergoing chronic diseases.According to literature, the spread of psoriasis of the world is 4-7%.
According to K. Reich, the soft forms of the disease affecting less than 3-5% of the body area and do not give significant changes in the patient's immune status, require only local treatment.Psoriasis of moderate and severe course is a systemic, inflammatory process, leading to the development of concomitant pathologies or their deterioration, and they themselves have a major impact on the health and quality of life of the patient.
The problem of treating psoriasis does not lose its importance and, despite the emergence of new modern treatment methods, 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 predominance and severity of psoriasis, the stage of the process, its clinical form, and the attitude towards the patient's own disease are taken into account.So, with the localization of rashes in the open areas of the skin - face, scalp and brush part, the disease has a significant effect on the quality of life and causes severe psycho -unotational experiences.According to the study of G. Krueger et al.(2001), 40% of patients with psoriasis were disappointed by the ineffectiveness of the resulting treatment and 32% considered insufficient treatment.
Psoriasis system therapy
Systemic glucocorticoids in a form of tablets are extremely rare about multiple side effects.However, while the "ambulance" drug to stabilize the psoriatic process with a progressive phase, erythroderma is advised to use systemic glucocorticoid prolonged for intramuscular administration in the form of short courses.A therapy -like approach avoids adverse side effects.
Metotrexate is used for more than 40 years in the treatment of psoriasis.The mechanism of its action is associated with the inhibition of dihydrofolateredustase, which converts dihydrofolic acid into tetrahydrofolic and is a donor of simple carbon groups in the synthesis of purine and timidilat necessary for DNA synthesis.In this regard, the simultaneous purpose of folic acid helps to avoid metabolic anemia.
Cyclosporine, A-cyclic polypeptide, isolated from toolypocladium inflatum fungi, has an immunosuppressive effect by suppressing T cell activity and reducing their antigenic sensitivity due to the immune system.The drug has high effectiveness in the treatment of a slow flowing psoriasis, psoriatic erythroderma.
Since 1997, second -generation aromatic retinoids have been used to treat firm forms of psoriasis, the basis of the chemical formula of which is acythytetin.The drug impedes the spread of epidermis cells, normalizes the process of keratinization, has an immunomodulatory effect.The effectiveness of the product depends on the dose: higher doses lead to a faster solution of psoriatic rashes.
Relatively recently, a new group of drugs - biological drugs, which include recombinant protein, as synthesized by biotechnological cells, lives of animal cells, plants and microorganisms, has emerged.Indications for the recipe of biological drugs are severe forms of psoriasis resistant to other system medicines.
The treatment of moderate and severe forms of psoriasis (more than 10% of the body surface) is performed taking into account the conditions in which the patient has several chronic diseases such as metabolic syndrome, cardiovascular disease, mellitus diabetes, non-alcoholic fatty liver, and lipid metabolic disorders.According to statistical studies, such conditions for psoriasis are more often observed than in a general population.Thus, in the treatment of psoriasis, it is necessary to consider the risk of the side effects of the ongoing systemic therapy, namely, the conditions in which the patient has several chronic diseases that are individually detected in each patient.Indeed, some pharmacological drugs can adversely affect simultaneous cardiovascular and metabolic diseases.The link between psoriasis and cardiac-metabolic disorders has important clinical consequences.First, systemic therapy of psoriasis can adversely affect simultaneous metabolic diseases, especially in the case of continuous and prolonged treatment.In particular, metotoxate should be carefully described in overweight, diabetes mellitus, not alcoholic fatty liver disease due to an increased risk of liver fibrosis.Cyclosporine, or can cause the appearance or aggravate the course of arterial hypertension, improve insulin resistance and affect the metabolism of fatty acids, has a toxic effect.
Acitotin also promotes hypertriglyceridemia and/or hypercholesterolemia.Thus, when directing patients with psoriasis, it is necessary to consider all the data.
A special place in the treatment of psoriasis is given phototherapy.The positive effect of ultraviolet radiation on the skin is associated with selective inhibition of the T cell of immunity.According to the literature, the following fields of phototherapy are distinguished: anti -inflammatory artificial inhibition, immune artificial and anti -kallifiers.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 T cell apoptosis, a decrease in the number of langergan cells, a change in cytokines, growth factors (EGF, ENGF), adhesive molecules and neuropeptides.The purpose of phototherapy is advised for a common skin process.
In the treatment of psoriasis, photochemotherapy (bulletin-therapy) is used-Combined use of long-wave ultraviolet rays (UFA) (320-400 Nm) and photosensitizers (8-methoxynsorale).PUVA therapy is one of the most effective methods for treating psoriasis, its recipe is advised with a common vulgar and exudative psoriasis, stubborn course of disease, severe infiltration.Treatment is performed according to the radiation methodology 3- or 4-faft per week, on average, the course is 20-30 procedures.
Currently, selective phototherapy, a combination of wave radiation (280–320 NM) have lost its position and has been described less and less for the treatment of psoriasis.The story of its purpose is psoriasis, characterized by formations with a low content of inflamed cells.
UFB therapy with narrow lane with the peak of emissions at a wavelength of 311 nm in high therapeutic efficiency is comparable to bullet therapy, but unlike the use of a photosensitator.It is performed according to the 3-5-rack methodology per week with a course of 20-30 procedures.
For the treatment of vulgar psoriasis restricted to a stationary stage, a very effective therapeutic technique is an external laser, which allows to give high -intensity monochromatic light of 308 nm only in the affected area of the skin.
Local therapy
A large selection of local products for the treatment of psoriasis includes, in particular, traditional ointments containing pitch, naphthalan, ichthyol and salicylic acid.
When choosing topical therapy, an individual approach is important, on which the patient's compliance with psoriasis will depend.So, due to the cosmetic inability of treatment, 40% of patients do not match the destination.
The effectiveness of current corticosteroid drugs in the treatment of psoriasis is based on their pronounced effects on immune modulation and a decrease in tissue inflammation.The action is associated with the mechanism of the hormone and receptors complex, which penetrates the essence 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 by phospholipids.Ointments and combined corticosteroid creams with salicylic acid are particularly preferred.Local corticosteroid preparations are not indicated for constant prolonged treatment and suggest combination and rotating schemes because prolonged use can lead to the development of side effects, such as skin atrophy, hypertricosis, telangiectasis, steroid acne and suppressing adrenal function.
Synthetic analogs of vitamin D3 have set themselves and very effective tools against psoriasis.The most famous of this group are calpotriol.The principle of the action of the drug is based on the effect of softening keratinized skin with vitamin D3: it inhibits the spread of keratinocytes and patterns differentiation of the skin, and also has an immunomodulatory effect, in particular reduces 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 current steroids, long -term use of this group of medicines is possible.To achieve the maximum therapeutic effect, the combined purpose of calcipotriol and topical steroids is possible.
The action of local calcinurin inhibitors (takrolimus and pimecrolimus) is associated with blocking T-lymphocyte T signal by inhibiting calcinurin.It is more advisable to prescribe this set of drugs in the event of localization of the rash on the face because they have no such side effects as topical steroids.
The value of the use of mitigating agents, in the treatment of psoriasis, is not in doubt: they soften the skin, reduce the peel 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 therapy of psoriasis reduces the total cost of treatment as a result of achieving stabilization of the disease and the onset of remission in shorter periods, which helps reduce the stay of patients in the hospital.
Thus, the problem of treating psoriasis maintains its importance and remains a comprehensive task, which aims primarily a personified approach to therapy, from which the patient's compliance with psoriasis and patients with future performance will depend on coordination.