Psoriasis is an autoimmune disease with a adverse combination of genesis factors with a recurrent course, a variety of phenotypes, clinical varieties and the possible detection of different simultaneous chronic diseases.According to literature, the prevalence of the world's psoriasis is 4–7%.
According to K. Reich, the mild forms of the disease, which affect less than 3-5% of the body area and have no significant changes in the patient's immune status, only have local treatment.Psoriasis of the moderate and severe course is a systemic, inflammatory process that leads to the development of simultaneous pathologies or worsens them, and they themselves have an enormous influence on the patient's health and quality of life.
The problem of the treatment of psoriasis does not lose its relevance and, despite the development of new modern treatment methods, remains a difficult task of requiring a personified approach.
For the treatment of psoriasis there is a large selection of local and systemic medicines, most of which model the immune system.When choosing a personified therapy, the prevalence and severity of psoriasis, the stage of the process, its clinical form and the attitude of the patient itself are taken into account.With the localization 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 influence 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 the resulting treatment and looked at 32% inadequate the treatment.
System therapy of psoriasis
Systemic glucocorticoids in tablet form are extremely rare in connection with numerous side effects.However, since the drug "ambulance" is advisable to stabilize psoriasis with a progressive stage to use longer systemic glucocorticoids for intramuscular administration in the form of short courses.A similar approach to therapy avoids adverse side effects.
Method trexate is used for more than 40 years in the treatment of psoriasis.The mechanism of its effect is connected to the inhibition of dihydro fulfillatustasis, the acidum dihydropholic transforms into tetrahydrophological and a donor is simple carbon groups in the synthesis of purin -nucleotides and thymidylate that is necessary for the DNA synthesis.In this regard, the simultaneous purpose of folic acid helps to avoid metabolic anemia.
Cyclosporin, A-Cyclic polypeptide, isolated from the mushroom tolypocladium inflatum gam, has an immunosuppressive effect by suppressing the activity of T cells and reducing its antigen sensitivity due to the immune system.The drug has a high level of effectiveness in the treatment of a common, slowly flowing psoriasis, psoriasis erythroderma.
Since 1997, second generation's aromatic retinoids have been used to treat refractory forms of psoriasis, the basis of the chemical formula is acitimetin.The medicine inhibits the proliferation of epidermis cells, normalizing the keratization process, has an immune -modulating effect.The efficacy of the product depends on the dose: higher doses lead to a faster resolution of psoriasis cute rashes.
In a relatively short time, a new group of medication occurred - biological medication, which includes recombinant protein substances that were synthesized by living cells, plants and microorganisms through biotechnological synthesis.Indications for the prescription of biological medicines are serious forms of psoriasis that are resistant to other system medication.
The treatment of moderate and severe forms of psoriasis (more than 10% of the body surface) is carried out taking into account conditions in which the patient has several chronic diseases such as metabolic syndrome, cardiovascular diseases, diabetes mellitus, non -alcoholic fatty liver and lipid metabolic diseases.According to statistical studies, such conditions for psoriasis are observed more often than in a general population.When treating psoriasis, it is therefore necessary to take into account the risk of side effects of ongoing systemic therapy, the conditions under which the patient has several chronic diseases that are recognized individually for each patient.In fact, some pharmacological drugs can negatively influence the cardiovascular and metabolic simultaneous diseases.The connection between psoriasis and cardiac disorders has important clinical consequences.First, the systemic therapy of psoriasis can negatively influence that metabolic diseases are associated with continuous and longer treatment.In particular, methotrexate should be prescribed with caution in obesity, diabetes mellitus, non -alcoholic fatty liver disease due to an increase in liver fibrosis risk.Cyclosporin or the appearance or the course of arterial hypertension, reinforce insulin resistance and influence the metabolism of fatty acids, has a toxic effect.
Acitrotine also promotes hypertriglyceridemia and/or hypercholesterolemia.All data must therefore be taken into account when carrying out patients with psoriasis.
A special place in the treatment of psoriasis is given phototherapy.The positive effect of the ultraviolet radiation on the skin is associated with the selective inhibition of the T-cell of immunity.According to the literature, the following areas of phototherapy are differentiated: anti -inflammatory, artificial inhibition of immunity and anti -caulifier.The effect of ultraviolets rays on immunity is associated with a depth of penetration.UFB rays influence the epidermal keratinocytes and Langergan cells, Ufa radiation penetrates deeper layers of the skin and have an impact on skin fibroblasts, dendritic cells and cells of the immune system.The positive effect of the ultraviolet radiation is to be attributed to the apoptosis of T cells, a decrease in the number of long -energy cells, a change in the 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 (bullet therapy) is used by the combined use of long ultraviolet rays (UFA) (320–400 Nm) and photosensitis (8-method typSoral).Puva therapy is one of the most effective methods for the treatment of psoriasis.The recipe is advisable with frequent vulgar and exudative psoriasis, the persistent course of the disease, severe infiltration.The treatment takes place according to the 3 or 4-RAK radiation method per week per week, on average the course is 20-30 procedures.
Selective phototherapy has currently lost a combination of wave radiation (280–320 Nm) and is being prescribed less and less for the treatment of psoriasis.The display for its purpose is psoriasis, which is characterized by formations with a low content of inflamed cells.
The UFB therapy of the narrow gauge with the emission tip value with a wavelength of 311 Nm with high therapeutic efficiency is comparable to ball therapy, but in contrast to the use of a photosensitis, it is not necessary.According to the 3-5-RAK radiation method, it is carried out per week with a course of 20 to 30 procedures.
For the treatment of limited vulgar psoriasis in a inpatient stage, a highly effective therapeutic technology is an eximmary laser, which enables the monochromatic light of the high intensity of the wavelength of 308 Nm only deliver to the affected area of the skin.
Local therapy
A fairly large selection of local products for the treatment of psoriasis in particular includes traditional ointments that contain tar, naphthalan, ichthyol and salicylic acid.
When choosing topical therapy, an individual approach is important, which depends on the patient with psoriasis.Due to the cosmetic treatment of treatment, 40% of patients do not correspond to the goal.
The effectiveness of topical corticosteroid medication in the treatment of psoriasis is based on its pronounced effects on the modulation of immunity and a decrease in tissue inflammation.The effect is connected to the mechanism of the complex of hormones and receptors, which penetrates the core of the target cell and increases the expression of genes that encode the synthesis of peptides that inhibit the activity of the phospholipase.This mechanism leads to a decrease in the formation of inflammatory mediators from phospholipids.Combined corticosteroid ointments and creams with salicylic acid are particularly preferred.Local corticosteroid preparations are not shown for a longer continuous treatment and beating combination and rotary schemes, since a longer use to develop side effects such as skin atrophy, hypertrichosis, telangiectasia, steroid acne and oppression of adrenal function can lead.
Synthetic analogues of vitamin D3 have established themselves as a highly effective remedy for psoriasis.The best known from this group are calcipotriol.The principle of action of the drug is based on the effect of the softening of keratized skin with vitamin D3: it inhibits the proliferation of keratinocytes and modeled the skin differentiation and also has an immune-modulating effect, in particular 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.
In contrast to topical steroids, long -term use of this group of medicines is possible.In order to achieve the maximum therapeutic effect, the combined purpose of calcipotriol and topical steroids is possible.
The effect of local calcineurin inhibitors (takakolimus and pimecrolimus) is connected to the blocking of the signal transduction of T lymphocytes by inhibiting calcineurin.It is most advisable to prescribe this group of pharmaceuticals in the localization of rashes on the face, since they have no side effects such as topical steroids.
The value of the use of mitigating means in the treatment of psoriasis is not doubtful: they soften the skin, reduce the peeling and dryness and improve its fluid intake, especially according to ultraviolet exposure.contribute to a decline in the itching.The biggest effect is reached when applying wet skin after contact with water (bathtub, shower).The use of reductions in the complex therapy of psoriasis reduces the total costs for the treatment as a result of the achievement of the stabilization of the disease and the use of remission in shorter periods, which helps to reduce the stay of patients in the hospital.
The problem of treating psoriasis therefore keeps its relevance and remains a comprehensive task that mainly aims at a personified approach to therapy that will depend on compliance with the patient with psoriasis and prospective leading patients taking into account the coordinity.