Methods of treatment of different forms of psoriasis and their features

Psoriasis is one of the most common skin diseases.According to the International Federation of Psoriasis Associations (IFPA), it has been detected 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 tackle all the questions in turn.

Briefly to 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 by it as foreign.Scientists established the link between the disease and the activation of the immune system long ago, but what exactly causes a failure to recognize one's own cells has not yet been reliably clarified.

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

Psoriasis in many cases is combined with diseases of other organs and systems:

• type 2 diabetes mellitus;
• 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, which look like red areas raised on its surface (so-called papules) with superficial skin.Because of it, white scales appear, hence the second name of psoriasis - scaly lichen.If you scratch such an area, you can see the "stearin spot phenomenon" - the number of flakes will increase, which resembles a frozen drop of stearin.After complete removal of the scales, a shiny and wet terminal plate is exposed, in which, with further scratching, small individual drops of blood will appear.Such papules are usually located on the scalp, on the extensor surfaces of the joints.
2. Exudative psoriasis: an inflammatory fluid is secreted in the inflamed area, which moistens the scales, turning them into crusts that are difficult to remove.
3. Seborrheic psoriasis is typical for skin areas with a large number of sebaceous glands: nasolabial folds, scalp, the area between the shoulder blades and on the chest.In this variant, severely itchy plaques with yellow scales form.
4. The lacrimal form is usually found in children and appears as multiple small red papules with light skin.
5. Pustular psoriasis is a superficial pustule, usually located on the palms and soles.
6. Generalized forms: psoriatic erythroderma, manifested by wide confluent foci covering 90% of the body surface and Tsumbusch psoriasis, accompanied by suppuration of wide foci.With common forms of the disease, general well-being also suffers: weakness appears, maltreatment and body temperature rises.
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.Characteristic are the "oil stain symptom" (yellow-brown spots under the nail plate) and the "finger symptom" (damage to the nail with dots).

How is psoriasis treated?

Methods for the treatment of psoriasis are constantly being improved and supplemented, but there is no drug that can defeat the disease forever.Therefore, the main treatment strategies for psoriasis are aimed at:

• decrease in the frequency of irritations;
• relief of disease symptoms;
• improving the quality of life;
• reducing the possibility of complications and associated diseases.

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

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

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

Local therapy

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

Local 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 tools.

This group includes flucinar, hydrocortisone, elocom, prednisolone, advantan, acriderm.Topical glucocorticosteroids are available in the form of creams, ointments, and lotions.

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

• Use only in the shortest possible courses.
• When an infection occurs, preference should be given to glucocorticoids combined with an antibiotic or antifungal agent.
• Children should not apply hormones to the 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, adverse reactions may occur:

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

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

Salicylic acid

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

Vitamin therapy

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

Side reactions with the local application of vitamin D3 are rare and are mainly represented by burning, redness and itching of the skin.In this case, I either stop the course of treatment or use the oil less often.In case of overdose, systemic manifestations of hypervitaminosis D are possible: decrease in bone density and formation of kidney stones.

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

You cannot simultaneously use medicines based on salicylic acid and analogues of vitamin D externally - this will lead to the inactivation of the latter and will significantly reduce the effectiveness of the 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 to prevent its relapses.The mechanism of action is antibacterial, antifungal activity and the slowing down of cell division.Medicines can cause allergies, dryness and irritation of the skin with repeated use.Therefore, the course of treatment should not last more than 1.5 months.

Systemic therapy

This treatment option includes the use of drugs in tablet or injection form;they affect not only the integrative 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 selected individually, taken once or several times a week.After the irritation subsides, the drug continues to be taken at the minimum effective dose.The drug often causes side effects, so this treatment requires constant medical supervision.Possible negative reactions:

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

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

Cyclosporine

A drug that suppresses the function of the immune system.Considering 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;
• the formation of malignant tumors and lymphomas;
• decrease in the number of blood cells;
• muscle pain, cramps;
• headache;
• allergies.

The use of cyclosporine 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 an average of 2 months, the dose is selected individually.When using retinoids, there is also a certain risk of adverse reactions:

• drying of mucous membranes;
• skin peeling;
• fungal vulvovaginitis;
• hair loss, thinning, brittle nails;
• muscle and joint pain;
• liver inflammation, 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 the liver structures.

Monoclonal antibodies

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

• the addition of an infection of any location;
• benign and malignant neoplasms;
• allergic manifestations;
• headache, dizziness;
• depression;
• nausea, vomiting;
• joint and muscle pain.

The use of drugs in 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 drops.But even in these 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 drugs necessary for the correction of concomitant conditions that worsen the progress of psoriasis and for the treatment of articular 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.In particular, antidepressants (amitriptyline, fluoxetine, venlafaxine) and anti-anxiety drugs - sedatives (diazepam, phenazepam, buspirone) are prescribed.Antidepressants are usually prescribed for prolonged 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 borne in mind that medications also have their contraindications for use and adverse reactions, which do not always allow them to be taken simultaneously with the main therapy for psoriasis.
2. Nonsteroidal 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 injection, gels and ointments for external use.Due to the negative effect on the gastrointestinal tract (ulcer formation), these medications are prescribed for the shortest possible course.
3. Antihistamines are sometimes used to reduce itchy skin.Prescribed drugs of the first generation (Tavegil, Suprastin), second (Fenistil, Claritin) or third (Zyrtec, Erius).The effectiveness of these drugs is largely comparable, however, third-generation drugs do not have such a common side effect of antihistamines as increased drowsiness.

Physiotherapy for psoriasis

Ultraviolet radiation (UVR) involves exposure to radiation with a wavelength of 311-313 nm to the whole body or to specific parts of it.This technique is not applicable to severe generalized forms of psoriasis and its summer variety, 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, allows you to achieve long-term remission.A session can last up to 2 hours, and the total recommended number is 35. After the procedure, dry skin may appear, which will require the use of a moisturizing cream.PUVA therapy has a number of contraindications, such as renal failure, diabetes mellitus and skin tumors.

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

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

Electrosleep affects the course of psoriasis indirectly, improving the mental state of the patient.This manipulation causes a calming effect, improves sleep, increases resistance to stress and reduces excessive excitability of the nervous system.A session can last up to 1 hour, it is recommended to perform at least 10 procedures.

Psychotherapy

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

During the session, the specialist talks with the patient, asking key questions and trying to determine the cause of psychological problems.Further sessions are aimed at stabilizing 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 food for psoriasis

Psoriasis patients are recommended:

• Drink more fluids: 7-10 glasses of still water or freshly squeezed juices per day.
• Eat more fruits and vegetables: grapes, nectarines, cherries, pineapples;beets, carrots, cucumbers, cabbage, garlic, onions, fennel, 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 overdo it with citrus fruits, tomatoes, red bell peppers, strawberries, honey.
• Avoid chocolate and whole milk with high fat content.
• Do not drink alcohol, caffeine, spicy, salty, smoked foods.

Alternative methods to fight psoriasis

1. Cryotherapy is the effect on the body of ultra-low temperatures, which can be local and general.The mechanism for improving the condition of psoriasis is the body's short-term stress response to cold.Against this background, a rapid narrowing and subsequent expansion of blood vessels occurs, which leads to increased blood flow and a decrease in inflammation.In addition, low temperatures significantly slow down the speed of nerve impulses and prevent the formation of new lesions.General cryotherapy is performed using a special cryochemistry chamber, in which a person can stay for no more than 3 minutes.The temperature in it is set within the range of -110 – -130°C.The entire course should not exceed 30 procedures.Local cryotherapy is performed by exposing skin areas with psoriatic plaques to liquid nitrogen vapor (temperature -140 – -160°C).During the research, it was found that after a course of procedures, psoriatic papules fade, decrease in size, peeling and itching disappear.
2. Hydrotherapy is widely used in sanatoriums with thermal waters.Garra rufa fish that live in such water eat rough particles and scales from the surface of the skin, leaving the healthy areas intact.
3. Plasmapheresis is a rather complex process that involves taking blood from the patient's body, cleaning it from toxins, immune complexes, microorganisms and returning it to the general blood circulation.A special centrifuge is used to clean the blood.The positive effect of plasmapheresis in psoriasis is associated with the removal from the bloodstream of immune complexes that support the autoimmune reaction, breakdown products formed as a result of chronic inflammation, as well as microorganisms and their toxins when a secondary infection occurs.
4. Mud therapy is an effective tool for improving the health of patients with psoriasis.Due to the significant content of mineral salts, therapeutic mud suppresses the inflammatory process, promotes tissue regeneration and softens rough skin areas.Mud therapy allows you to achieve better results in the treatment of psoriatic arthritis.Before applying to the skin, the clay is heated to 39°C, then a thin layer is spread on the areas covered with tiles 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 an emollient cream.

Recipes of traditional medicine for psoriasis

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

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

Traditional external medicine for the treatment of psoriasis:

• Fish oil.Apply a thin layer to 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.
• Ointment with eggs.Beat 2 chicken eggs, add 1 tbsp.l.sea buckthorn or sesame oil and 40 g of vinegar.Lubricate the plates 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 psoriatic rashes up to 4 times a day.

It should be borne in mind that regardless of which alternative methods and folk methods you use in the treatment of psoriasis, they should not replace the main, traditional therapy.All medications used for psoriasis must be strictly prescribed by a doctor.Under no circumstances should you self-medicate or change the dosage and regimen of the drug at will.