Treatment methods for 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), psoriasis is diagnosed in 125 million people worldwide.

In most cases, the disease develops in people of working age: between 15 and 35 years old.Men and women get sick at the same rate.Despite the widespread nature of the disease, not all patients understand what psoriasis is, what causes its occurrence and how to treat it.Let's deal with all the questions in turn.

Briefly about the main thing

Psoriasis is a chronic inflammatory autoimmune disease characterized by the formation of specific “plaques” on the skin.The autoimmune mechanism is associated with the production of protective antibodies against cells of the body itself that are mistakenly perceived by it as foreign.Scientists have long since established the connection between the disease and the activation of the immune system, but what exactly causes the recognition of one's own cells to fail has not yet been clarified with certainty.

A genetic predisposition to psoriasis has been proven: if both parents are sick, the probability that the child will also suffer from psoriasis is 50%.Some genes responsible for its development have even been identified.In addition, the influence of hormonal disorders, nervous tension, metabolic disorders and viral infections on the manifestation of psoriatic lesions in the body has been proven.

In many cases, psoriasis is accompanied by diseases of other organs and systems:

• diabetes mellitus type 2;
• metabolic syndrome;
• pathology of the liver and biliary tract;
• 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 reddened areas raised above the surface of the skin (so-called papules) with superficial peeling.This causes white scales to form, hence the second name of psoriasis – psoriasis.If you scrape such an area, you can observe the “stearin spot phenomenon” - the number of flakes increases, resembling a drop of frozen stearin.After the scales have been completely removed, a shiny, moist end plate is revealed, on which individual small drops of blood appear when further scraped off.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 wets the scales and turns them into crusts that are difficult to remove.
3. Seborrheic psoriasis is typical for areas of skin with a large number of sebaceous glands: nasolabial folds, scalp, area between the shoulder blades and on the chest.In this variant, very itchy plaques with yellowish scales form.
4. The teardrop-shaped form usually occurs in children and appears in the form of several small red papules with slight detachment.
5. Pustular psoriasis is a superficial pustule that is usually found on the palms of the hands and soles of the feet.
6. Generalized forms: psoriatic erythroderma, manifested by extensive confluent foci covering 90% of the body surface, and tsumbush psoriasis, accompanied by suppuration of extensive foci.In common forms of the disease, general well-being also suffers: weakness, malaise appear and the body temperature rises.
7. Psoriatic arthritis is manifested by redness and swelling of the skin over the joints, pain, limited mobility of the joints, their deformation and stiffness of movement after sleep.
8. Psoriatic onychodystrophy is a lesion of the nails.The “oil spot symptom” (yellowish-brown spots under the nail plate) and the “thimble symptom” (point damage to the nail) are characteristic.

How is psoriasis treated?

Methods for treating 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:

• reducing the frequency of exacerbations;
• relief of disease symptoms;
• improving quality of life;
• Reducing the likelihood of complications and comorbidities.

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

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

Both local and systemic active ingredients are used in the treatment of psoriasis.

Local therapy

This type of treatment consists of ointments, gels and creams that are applied directly to the affected areas.

Topical glucocorticoids

These are hormonal medications 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 many studies show.They can be used either individually (for local forms) or in combination with other means.

This group includes Flucinar, Hydrocortisone, Elocom, Prednisolone, Advantan and Acriderm.Topical glucocorticosteroids are available in the form of creams, ointments and lotions.

The disadvantage of such drugs is the risk of 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.
• In case of infection, glucocorticoids should be preferred in combination with an antibiotic or antifungal.
• Children should not apply hormones to their face, neck, or skin folds.
• It is better to start treatment of children with weak or moderately effective drugs (prednisolone, hydrocortisone).

As a rule, hormonal agents are applied to psoriatic papules 1-2 times a day for up to 1 month.With prolonged use, the following side effects may occur:

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

The skin on the face and groin most often suffers from complications.

Salicylic acid

Used in combination with local glucocorticosteroids for significant skin exfoliation.Preparations containing salicylate (Diprosalic, Acriderm SK, Elokom S) effectively remove exfoliated plates and help restore the skin.

Vitamin therapy

Vitamin D is an effective treatment for local forms of psoriasis because it reduces inflammation and excessive division of skin cells.Creams or ointments containing vitamin D3 (calcipotriol, daivonex, calcitriene) are applied to the plaques 1-2 times a day for about 2 months.It is not advisable to treat large areas of skin with it.Can be used in conjunction with glucocorticoid hormones.

Side effects when using vitamin D3 locally are rare and are mainly expressed in burning, redness and itching of the skin.In this case I either interrupt the treatment or use the ointment less often.In case of overdose, systemic manifestations of hypervitaminosis D are possible: reduced bone density and formation of kidney stones.

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

You cannot use drugs based on salicylic acid and vitamin D analogues externally at the same time - this leads to their inactivation and significantly reduces the effectiveness of therapy.

Zinc pyrithione

Preparations in 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 relapses.The mechanism of action is an antibacterial, antifungal effect and a slowing of cell division.Medicines can cause allergies, dryness and irritation of the skin with repeated use.Therefore, the treatment period should not last longer than 1.5 months.

Systemic therapy

This treatment option uses medication in tablet or injection form;They affect not only the skin tissue, 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 when it does not respond to other types of therapy.

Methotrexate doses are selected individually and taken once or several times a week.After the exacerbation 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 side effects:

• reduction in the number of all blood cells;
• appetite suppression, nausea, vomiting;
• the formation of ulcers and erosions in any part of the digestive system;
• damage to the liver and pancreas;
• headache, drowsiness, cramps;
• visual disturbances;
• kidney dysfunction;
• Suppression of the processes of germ cell formation;
• decreased libido;
• pain in joints and muscles;
• non-infectious pneumonia;
• allergic reactions.

The drug is discontinued if severe shortness of breath, cough, the development of serious 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.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 only prescribed for exacerbations.Start taking ciclosporin with minimal dosages, which are then increased until the desired result is achieved.

Side effects of ciclosporin:

• impaired kidney function, swelling, increased blood pressure;
• toxic effect on 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 vitamin A derivatives that have a normalizing effect on the division and keratinization processes of skin cells.The duration of treatment with such drugs is on average 2 months, the dose is selected individually.There is also a certain risk of adverse reactions when using retinoids:

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

Despite possible side effects, these medications are safer than previous options, especially considering that all of these complications are reversible and disappear some time after discontinuing the medication.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 medications are administered either subcutaneously or intravenously no more than once a week.Their negative effects on the body are mainly associated with suppression of the immune response:

• the addition of infection of any localization;
• 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 for the treatment of psoriatic arthritis and acute generalized forms of the disease in injections and droppers.But even in these cases, hormone therapy should not last long, since there is a risk of aggravation of the process and the development of pustular forms.

Additional drug treatment

This group includes drugs that are necessary to correct concomitant diseases that aggravate the course of psoriasis and to treat articular forms of the disease.

1. Due to the high frequency of exacerbations of psoriasis against the background of an unstable nervous state, psychotropic drugs are used.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 over a longer period of time.Sedatives can be taken once as needed, depending on the external circumstances.This group of drugs suppresses anxiety, restlessness, susceptibility to stress factors and normalizes sleep.However, it should be borne in mind that medications also have contraindications and side effects that 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 injections, gels and ointments for external use.Due to the negative effect on the gastrointestinal tract (ulcer formation), these drugs are prescribed for the shortest possible duration.
3. Antihistamines are sometimes used to relieve itching of the skin.Prescribed drugs of the first (Tavegil, Suprastin), second (Fenistil, Claritin) or third (Zyrtec, Erius) generation.The effectiveness of these drugs is largely comparable, although third-generation drugs do not have such a common side effect of antihistamines as increased sleepiness.

Physiotherapy for psoriasis

Ultraviolet radiation (UVR) involves exposing the entire body or individual parts of the body to radiation with a wavelength of 311-313 nm.This technique is not applicable for severe generalized forms of psoriasis and its summer variant, as it can only aggravate the process.

Selective phototherapy (PUVA therapy) is a type of ultraviolet radiation, but the wavelength used here is 310-340 nm. This option of physiotherapy allows you to achieve long-term remission with regular use.One session can last up to 2 hours, the recommended total is 35. Dry skin may occur after the procedure, requiring the use of a moisturizer.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 effectively combats itching and the formation of new plaques.

During ultrasound treatment, the skin is exposed to ultrasound waves that have anti-inflammatory, antibacterial, analgesic and antipruritic effects.A procedure takes 15 minutes, does not cause any discomfort and is well tolerated.A total of 14 procedures is recommended.

Electrosleep indirectly affects the course of psoriasis and improves the patient's psychological state.This manipulation produces a calming effect, improves sleep, increases resistance to stress and reduces excessive excitability of the nervous system.One 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 many studies.In people with a genetic predisposition, various stresses, fears, anxieties and experiences often lead to the appearance or worsening of psoriasis.Psychotherapy is therefore important to prevent exacerbations and generally reduce the frequency of relapses.

During the session, the specialist talks to the patient, asks key questions and tries to find out the cause of the psychological problems.Further sessions are aimed at stabilizing the patient's emotional state.A psychotherapist can teach you how to deal with stress at work and at home, find an outlet for negative energy, and develop a positive attitude toward yourself and the world around you.

Therapeutic nutrition for psoriasis

Patients with psoriasis 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, 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 use too much citrus fruits, tomatoes, red peppers, strawberries and honey.
• Avoid chocolate and high-fat whole milk.
• Do not drink alcohol, caffeine, spicy, salty or smoked foods.

Alternative methods to combat psoriasis

1. Cryotherapy refers to the effect of extremely low temperatures on the body, which can occur locally and generally.The mechanism for improving the condition of psoriasis is the body's short-term stress response to cold.Against this background, there is a rapid narrowing and subsequent expansion of blood vessels, which leads to increased blood flow and a decrease in inflammation.In addition, low temperatures greatly slow down the speed of nerve impulses and prevent the formation of new lesions.General cryotherapy is carried out in a special cryochamber, in which a person is not allowed to stay for 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.In local cryotherapy, areas of skin with psoriasis plaques are exposed to liquid nitrogen vapor (temperature -140 - -160 ° C).In the course of research, it was found that after a series of procedures, psoriatic papules become pale, become smaller, peeling and itching disappear.
2. Hydrotherapy is often used in sanatoriums with thermal water.The Garra rufa fish that live in such waters eat coarse particles and scales from the surface of the skin, leaving healthy areas untouched.
3. Plasmapheresis is a fairly complex process in which blood is taken from the patient's body, purified from toxins, immune complexes and microorganisms and returned to the general bloodstream.A special centrifuge is used to clean the blood.The positive effect of plasmapheresis in psoriasis is associated with the removal of immune complexes that support the autoimmune reaction, degradation products arising as a result of chronic inflammation, as well as microorganisms and their toxins from the bloodstream when a secondary infection occurs.
4. Mud therapy is an effective way to improve the health of patients with psoriasis.Due to the high content of mineral salts, healing mud suppresses the inflammatory process, promotes tissue regeneration and softens rough areas of the skin.With mud therapy, you can achieve better results in treating 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 to act 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.

Traditional medicine recipes for psoriasis

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

• Tincture of celandine.The herb of this plant is available at the pharmacy.2 tbsp.l.Dried herb is poured with 500 ml of alcohol or vodka and left to infuse for 10-14 days.The tincture is then filtered and taken 20 g three times a day.
• Decoction of bay leaves.Add 15 bay leaves to 1 liter of boiling water and cook for about a quarter of an hour.Then filter, let cool and drink 1 tbsp.l.3 times daily 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 twice a day.
• Linseed.1 tbsp.l.Seeds, pour a glass of boiling water, stir, leave overnight, take in the morning before breakfast.

External traditional medicine for the treatment of psoriasis:

• Fish oil.Apply a thin layer to the papules, leave for half an hour, then wash off with warm water.
• linseed oil.Apply to the affected area up to 6 times daily.
• Egg ointment.Beat 2 chicken eggs, add 1 tbsp.l.Sea buckthorn or sesame oil and 40 g of vinegar.Lubricate the plaques three times a day.
• Propolis tar ointment.30 g of propolis and 50 g of tar are heated and stirred in a water bath.Apply to psoriasis rashes up to four times daily.

It should be borne in mind 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 medications used against psoriasis must be prescribed by a doctor.Under no circumstances should you self-medicate or change the dose and treatment regimen of the drug at will.