Treatment methods of different forms of psoriasis and their characteristics

Psoriasis is one of the most common skin diseases.According to the International Federation of Psoriasis Associations (IFPA), it is found in 125 million people worldwide.

In most cases, the disease develops in people of working age: from 15 to 35 years.Men and women get sick equally often.Despite the wide spread of the disease, not all patients understand what psoriasis is, what are the causes of its occurrence and how to treat it.Let's address each question in turn.

Briefly about the main thing

Psoriasis is a chronic inflammatory disease of an autoimmune nature, characterized by the formation of specific "plaques" on the skin.The autoimmune mechanism is associated with the production of protective antibodies against the body's own cells, which are mistakenly perceived as foreign.Scientists have long established the connection between disease and activation of the immune system, but it has not yet been reliably clarified what exactly causes the failure to recognize one's own cells.

A genetic predisposition to psoriasis has been proven: if both parents are sick, then the child also has a 50% chance of getting psoriasis.Even some genes responsible for its development have been identified.In addition, the impact of hormonal disorders, nervous tension, metabolic disorders and viral infection on the manifestation of psoriatic lesions of the body was determined.

In many cases, psoriasis is combined with diseases of other organs and systems:

• diabetes mellitus type 2;
• metabolic syndrome;
• liver and biliary tract pathology;
• coronary heart disease;
• arterial hypertension.

Classification and symptoms of psoriasis

The main clinical manifestations of the disease depend on its form and course.

1. Psoriasis vulgaris: characteristic rashes appear on the skin that look like redness raised above its surface (so-called papules) with superficial peeling.Because of it, white scales appear, hence the second name of psoriasis - scaly lichen.If you scrape such an area, you can see the "stearin stain phenomenon" - the number of scales will increase, resembling a drop of frozen stearin.After complete removal of the scales, a shiny, moist terminal plate is revealed, on which, on further scraping, individual small drops of blood will appear.Such papules are usually found on the scalp, on the extensor surfaces of the joints.
2. Exudative psoriasis: in the inflamed area, an inflammatory fluid is secreted that moistens the scales, turning them into crusts that are difficult to remove.
3. Seborrheic psoriasis is typical for areas of the skin with a large number of sebaceous glands: nasolabial folds, scalp, the area between the shoulder blades and on the chest.In this variant, very itchy plaques with yellowish scales are formed.
4. The droplet form is usually found in children and appears as multiple small red papules with slight peeling.
5. Pustular psoriasis is a superficial pustule usually found on the palms of the hands and soles of the feet.
6. Generalized forms: psoriatic erythroderma, which is manifested by extensive confluent foci covering 90% of the body surface, and Tsumbusch psoriasis, accompanied by suppuration of extensive foci.In common forms of the disease, the general well-being also suffers: weakness, lassitude appears, body temperature increases.
7. Psoriatic arthritis is manifested by redness and swelling of the skin over the joints, pain, limited movement in the joints, their deformation and stiffness of movement after sleep.
8. Psoriatic onychodystrophy is a lesion of the nails.The "oil stain symptom" (yellowish-brown spots under the nail plate) and the "thimble symptom" (point damage to the nail) are characteristic.

How is psoriasis treated?

Psoriasis treatment methods are constantly improved and supplemented, but there is no medicine that can defeat the disease forever.Therefore, the main treatment strategies for psoriasis are aimed at:

• reducing the frequency of exacerbations;
• alleviation of disease symptoms;
• improving the quality of life;
• reducing the likelihood of complications and accompanying diseases.

Treatment is usually performed on an outpatient basis, but some conditions may require hospitalization:

• severe generalized variants of psoriasis, worsening of the patient's general condition (especially erythroderma and pustular psoriasis);
• the presence of complications and accompanying pathologies that worsen the patient's condition;
• the need to use drugs that require regular monitoring of clinical and laboratory parameters.

In the treatment of psoriasis, both local and systemic drugs are used.

Local therapy

This type of treatment is represented by ointments, gels, creams that are applied directly to the affected areas.

Topical glucocorticoids

These are hormonal drugs that have an anti-inflammatory effect on the skin.In addition, hormones reduce itching, inhibit the immune response, reduce the spread of the inflammatory process and prevent the fusion of lesions.These drugs are very effective, as proven by many studies.They can be used either separately (for local forms) or in combination with other means.

This group includes flucinar, hydrocortisone, elocom, prednisolone, advantan, acriderm.Topical glucocorticosteroids are available as creams, ointments, and lotions.

The disadvantage of such drugs is the risk of developing systemic (general) effects with long-term use and large areas of exposure.Here are the rules for using these drugs:

• Use only in the shortest possible courses.
• When infection occurs, preference should be given to glucocorticoids in combination with an antibiotic or antifungal agent.
• Children should not apply hormones to their face, neck or skin folds.
• It is better to start treating children with weak or moderately active drugs (prednisolone, hydrocortisone).

As a rule, hormonal agents are applied to psoriatic papules 1-2 times a day for up to 1 month.With their long-term use, unwanted reactions may occur:

• burning, redness and itching;
• appearance of acne;
• local infection;
• thinning, drying of the skin;
• reduction of pigmentation;
• stretch marks.

The skin of the face and groin most often suffer from complications.

Salicylic acid

It is used in combination with topical glucocorticosteroids for significant peeling of the skin.Preparations containing salicylates (diprosalic, acriderm SK, elokom S) effectively remove exfoliated plaques and help renew the skin.

Vitamin therapy

Vitamin D is an effective treatment for local forms of psoriasis, as it reduces inflammation and excessive skin cell division.Creams or ointments containing vitamin D3 (calcipotriol, daivonex, calcitrien) are applied to the plaques 1-2 times a day for approximately 2 months.It is not recommended to treat large areas of the skin with them.It can be used in combination with glucocorticoid hormones.

Adverse reactions to topical application of vitamin D3 are rare and are mostly manifested by burning, redness and itching of the skin.In that case, I either stop the course of treatment or use the ointment less often.In case of overdose, systemic manifestations of hypervitaminosis D are possible: decrease in bone density and formation of kidney stones.

Medicines of this group are not prescribed before starting UV therapy.

You cannot simultaneously use drugs based on salicylic acid and analogues of vitamin D externally - this will lead to inactivation of the latter and significantly reduce the effectiveness of therapy.

Zinc pyrithione

Preparations of this category (skin-cap, zinocap) are produced in the form of creams, aerosols and shampoos.They are used not only to treat psoriasis, but also to prevent its recurrence.The mechanism of action is antibacterial, antifungal action and slowing down cell division.Medicines can cause allergies, dryness and irritation of the skin with repeated use.Therefore, the course of treatment should not last longer than 1.5 months.

Systemic therapy

This treatment option involves the use of medication in the form of tablets or injections;they affect not only the covering tissues, but also the internal organs.Systemic treatment is used for moderate to severe psoriasis.

Methotrexate

A drug from the group of cytostatics that stops cell division.It is prescribed for psoriatic arthritis, erythroderma, pustular and vulgar psoriasis, if it does not respond to other types of therapy.

Methotrexate doses are chosen individually, taken once or several times a week.After the aggravation subsides, the drug continues to be taken in the minimum effective dose.The drug often causes side effects, so this treatment requires constant medical supervision.Possible side effects:

• decrease in the number of all blood cells;
• appetite suppression, nausea, vomiting;
• formation of ulcers and erosions in any part of the digestive system;
• liver and pancreas damage;
• headaches, drowsiness, convulsions;
• visual disturbances;
• kidney dysfunction;
• suppression of the process of formation of germ cells;
• decreased libido;
• joint and muscle pain;
• non-infectious pneumonia;
• allergic reactions.

The drug is discontinued if there is severe shortness of breath, cough, development of severe infectious diseases, anemia or a significant increase in blood markers of kidney or liver failure.

Cyclosporine

A drug that suppresses the function of the immune system.Given the autoimmune nature of psoriasis, such therapy is justified, however, a general decrease in immunity often leads to infectious and oncological complications.Therefore, the drug is rarely used as maintenance therapy, but is prescribed only during exacerbations.Start taking ciclosporin with minimal doses, which are then increased until the desired result is achieved.

Adverse reactions to cyclosporine:

• impaired kidney function, swelling, increased blood pressure;
• toxic effect on the liver and pancreas, nausea, loose stools;
• formation of malignant tumors and lymphomas;
• decrease in the number of blood cells;
• muscle pain, cramps;
• headache;
• allergies.

The use of ciclosporin requires constant medical supervision, regular blood tests and other necessary examinations.

Retinoids

Retinoids (acitretin, isotretinoin) are derivatives of vitamin A that have a normalizing effect on the processes of division and keratinization of skin cells.The course of treatment with such drugs is on average 2 months, the dose is selected individually.When using retinoids, there is also a certain risk of unwanted reactions:

• drying of the mucous membrane;
• peeling skin;
• fungal vulvovaginitis;
• hair loss, thinning, brittle nails;
• pain in muscles and joints;
• inflammation of the liver, jaundice;
• nausea, stool disorders.

Despite the possible side effects, these drugs are safer than the previous options, especially considering that all these complications are reversible and disappear some time after stopping the drug.Retinoids are not prescribed simultaneously with methotrexate, as this increases the risk of damage to liver structures.

Monoclonal antibodies

Monoclonal antibodies (infliximab, adalimumab, efalizumab) are biological products of genetic engineering that are antibodies.They have the ability to suppress autoimmune processes and reduce inflammation.These drugs are given subcutaneously or intravenously no more than once a week.Their negative impact on the body is mainly related to the suppression of the immune response:

• addition of infection of any localization;
• benign and malignant neoplasms;
• allergic manifestations;
• headaches, dizziness;
• depression;
• nausea, vomiting;
• joint and muscle pain.

The use of drugs of this category is possible in combination with methotrexate.

Systemic glucocorticoids

Systemic glucocorticoids (prednisolone, dexamethasone) are used exclusively in the treatment of psoriatic arthritis and acute generalized forms of the disease in injections and droppers.But even in those cases, the course of hormonal therapy should not be long due to the risk of worsening the process and the development of pustular forms.

Additional drug treatment

This group includes medicines necessary for the correction of accompanying conditions that complicate the course of psoriasis, and for the treatment of joint forms of the disease.

1. Psychotropic drugs are used due to the high frequency of psoriasis exacerbations against the background of an unstable nervous state.Antidepressants (amitriptyline, fluoxetine, venlafaxine) and anti-anxiety drugs - tranquilizers (diazepam, phenazepam, buspirone) are especially prescribed.Antidepressants are usually prescribed for long-term depression and stress and are taken in long courses.Tranquilizers can be taken once, on demand, depending on external circumstances.This group of drugs suppresses anxiety, agitation, sensitivity to stress factors and normalizes sleep.However, it should be remembered that the drugs have their own contraindications for use and side effects, which do not always allow them to be taken simultaneously with the main therapy of psoriasis.
2. Non-steroidal anti-inflammatory drugs are used in the complex therapy of psoriatic arthritis to reduce the inflammatory reaction, swelling and pain.These products are produced in the form of tablets, solutions for injections, gels and ointments for external use.Due to the negative effect on the gastrointestinal tract (ulcer formation), these drugs are prescribed in the shortest possible course.
3. Antihistamines are occasionally used to reduce itchy skin.Prescribed drugs of the first (Tavegil, Suprastin), second (Fenistil, Claritin) or third (Zyrtec, Erius) generation.The effectiveness of these drugs is generally comparable, however, third-generation drugs do not have such a common side effect of antihistamines as increased drowsiness.

Physiotherapy for psoriasis

Ultraviolet radiation (UVR) implies exposure to radiation with a wavelength of 311-313 nm to the whole body or to individual parts.This technique is not applicable for severe generalized forms of psoriasis and its summer types, as it can only worsen the process.

Selective phototherapy (PUVA therapy) is a type of ultraviolet radiation, but the wavelength used in this case is 310-340 nm.This physiotherapy option, when used regularly, makes it possible to achieve long-term remission.One session can last up to 2 hours, and the total recommended number is 35. Dry skin may appear after the procedure, which requires the use of a moisturizing cream.PUVA therapy has a number of contraindications, such as kidney failure, diabetes mellitus and skin tumors.

X-ray therapy involves treating the skin with soft X-rays, which help effectively combat itching and the formation of new plaques.

Ultrasound treatment involves exposing the skin to ultrasound waves that have anti-inflammatory, antibacterial, analgesic and antipruritic effects.One procedure lasts 15 minutes, does not cause discomfort and is well tolerated.A total course of 14 procedures is recommended.

Elektrosan affects the course of psoriasis indirectly, improving the psychological state of the patient.This manipulation has a calming effect, improves sleep, increases resistance to stress and reduces excessive excitability of the nervous system.The session can last up to 1 hour, it is recommended to carry out at least 10 procedures.

Psychotherapy

The role of an unstable mental state in the development of psoriasis has been proven by numerous studies.Various stresses, anxiety, fears and experiences often cause psoriasis to appear or worsen in people with a genetic predisposition.Therefore, psychotherapy is important to prevent exacerbations and generally reduce the frequency of relapses.

During the session, the specialist talks to the patient, asks suggestive questions and tries to determine the cause of psychological problems.Further sessions aim to stabilize the patient's emotional state.A psychotherapist can teach you to deal with stress at work and at home, find an outlet for negative energy and develop a positive attitude towards yourself and the world around you.

Therapeutic nutrition for psoriasis

Psoriasis patients are recommended to:

• Drink more fluids: 7-10 glasses of still water or freshly squeezed juices per day.
• Eat more fruits and vegetables: grapes, nectarines, cherries, pineapple;beets, carrots, cucumbers, cabbage, garlic, onions, dill, cumin.
• Do not forget about the protein component of the diet: chicken eggs, lean meat, nuts, legumes.
• There are only natural sweets: dried apricots, dates, raisins.
• Do not overuse citrus fruits, tomatoes, red peppers, strawberries, honey.
• Avoid chocolate and high-fat whole milk.
• Do not drink alcohol, caffeine, spicy, salty, smoked food.

Alternative methods in the fight against psoriasis

1. Cryotherapy is the effect on the body of ultra-low temperatures, which can be local or general.The mechanism for improving the condition of psoriasis is the body's short-term reaction to cold stress.Against this background, there is a rapid narrowing and subsequent expansion of blood vessels, which leads to increased blood flow and reduced inflammation.In addition, low temperatures sharply slow down the speed of nerve impulses and prevent the formation of new lesions.General cryotherapy is carried out using a special cryochamber, in which a person can stay for no more than 3 minutes.The temperature in it is set in the range of -110 – -130°C.The entire course should not exceed 30 procedures.Local cryotherapy is performed by exposing parts of the skin with psoriatic plaques to vapors of liquid nitrogen (temperature -140 – -160°C).During the research, it was established that after the procedure, psoriatic papules fade, decrease in size, peeling and itching disappear.
2. Hydrotherapy is widely used in sanatoriums with thermal waters.Garra rufa fish living in such water eat coarse particles and scales from the surface of the skin, leaving healthy areas untouched.
3. Plasmapheresis is a rather complex process that involves taking blood from the patient's body, purifying it of toxins, immune complexes, microorganisms and returning it to the general bloodstream.A special centrifuge is used to purify the blood.The positive effect of plasmapheresis in psoriasis is associated with the removal from the bloodstream of immune complexes that support an autoimmune reaction, degradation products that arise as a result of chronic inflammation, as well as microorganisms and their toxins when a secondary infection occurs.
4. Mud therapy is an effective means of improving the health of patients with psoriasis.Due to the significant content of mineral salts, the therapeutic mud suppresses the inflammatory process, promotes tissue regeneration and softens rough parts of the skin.Mud therapy allows achieving better results in the treatment of psoriatic arthritis.Before applying to the skin, the mud is heated to 39°C, then a thin layer is applied to the areas covered with plaques and left for 30 minutes.At the end of the procedure, the dirt is washed off with warm water, and the skin is lubricated with a softening cream.

Recipes of traditional medicine for psoriasis

Folk remedies for the treatment of psoriasis come in two groups: preparations for oral administration and external remedies.The first category includes:

• Tincture of celandine.You can find the plant of this plant in the pharmacy.2 tbsp.l.the dried plant is poured with 500 ml of alcohol or vodka and left to brew for 10-14 days.Then the tincture is filtered and taken 20 g 3 times a day.
• Bay leaf decoction.Put 15 bay leaves in 1 liter of boiling water and cook for about a quarter of an hour.Then strain, cool and drink 1 tablespoon.l.3 times a day for 1 month.
• Dill seeds.2 tbsp.l.seeds, pour 1 glass of boiling water, let it brew for about three hours, filter, drink ½ glass 2 times a day.
• Linseed.1 tbsp.l.seeds, pour a glass of boiling water, mix, leave overnight, take in the morning, before breakfast.

External traditional medicine for the treatment of psoriasis:

• Fish oil.Apply a thin layer on the papules and leave for half an hour, then rinse with warm water.
• Linseed oil.Apply to the affected area up to 6 times a day.
• Egg fat.Beat 2 chicken eggs, add 1 tbsp.l.sea buckthorn or sesame oil and 40 g of vinegar.Lubricate plaques 3 times a day.
• Propolis-tar ointment.30 g of propolis and 50 g of tar are heated in a water bath and mixed.Apply to the psoriatic rash up to 4 times a day.

It should be remembered that no matter what alternative methods and folk methods you use in the treatment of psoriasis, they should not replace the main, traditional therapy.All medicines used for psoriasis must be strictly prescribed by a doctor.Under no circumstances should you self-medicate or change the dose and regimen of medication at will.