Psoriasis is an autoimmune disease with a bad combination of genesis factors with recurrent courses, various phenotypes, clinical types and possible detection of various chronic diseases.According to literature, the prevalence of world psoriasis is 4-7%.
According to K. Reich, the mild forms of the disease affect less than 3-5% of the body area and do not provide significant changes in the patient's immune status, requiring only local treatment.Moderate and severe course psoriasis are systemic, inflammation, which leads to the development of pathological or aggravating them, and they have a significant impact on the health and quality of life of the patient.
The problem of treating psoriasis does not lose its relevance and, despite the emergence of new modern methods of treatment, remains a difficult task that requires a personalized approach.
For the treatment of psoriasis, there are a wide selection of local and systemic drugs, which are mostly immune system models.When choosing a personalized therapy, the prevalence and severity of psoriasis, the process of the process, its clinical form, and the attitude of the patient's own disease are taken into account.Therefore, with the localization of rash in the open area of the skin - the face, the hair and brushes, the disease has a significant effect on the quality of life and causes severe psychological experiences.According to a study G. Krueger et al.(2001), 40% of patients with psoriasis are disappointed with the resulting treatment and 32% considered inadequate treatment.
Psoriasis system therapy
Systemic glucocorticoids in tablet form are extremely rare related to many side effects.However, as a "ambulance" of drugs to stabilize the psoriatic process with progressive levels, erythroderma is advised to use prolonged systemic glucocorticoids for intramuscular administration in the form of short courses.The same approach to therapy avoids adverse side effects.
More than 40 years in the treatment of psoriasis, methotrexate is used.Its mechanism is associated with dihydrofolateredustase barrier, which makes dihydrofolic acidum a tetrahydrofolic and is a simple carbon group donor in the synthesis of purine nucleotides and thymidylate required for DNA synthesis.In this case, the simultaneous purpose of folic acid helps prevent metabolic anemia.
Cyclosporin, A-click polypeptides, isolated from inflatum tolypocladium fungal, have immunosuppressive effects by suppressing T cell activity and reducing their antigen sensitivity due to the immune system.This drug has a high efficacy in the treatment of slow flowing psoriasis, psoriatic erythroderma.
Since 1997, second -generation aromatic retinoids have been used to treat the form of refractory psoriasis, the basis of acitiretin chemical formulas.This drug prevents the proliferation of epidermal cells, normalizes the process of keratinization, has immunomodulation effects.The effectiveness of the product depends on the dose: higher doses lead to faster psoriatic rash resolution.
Recently -recently, a new group of drugs -biological drugs, which include recombinant protein, synthesized by biotechnology by animal -living cells, growths and microorganisms.Indications for prescription biological drugs are severe forms of psoriasis against other systems.
Treatment of moderate and severe psoriasis forms (more than 10% of the body's surface) is performed taking into account the conditions in which the patient has several chronic diseases such as metabolic syndrome, cardiovascular disease, diabetes mellitus, non -alcoholic liver, and lipid metabolic disorders.According to statistical studies, conditions such as psoriasis are observed more often than the general population.Therefore, in the treatment of psoriasis, it should take into account the risk of persistent side effects of systemic therapy, respectively, a condition in which the patient has several chronic diseases that are detected individually in each patient.Indeed, some pharmacological drugs can affect cardiovascular and metabolic disease.The connection between psoriasis and heart-metabolic disorders has an important clinical effect.First, systemic therapy of psoriasis can affect metabolic disease, especially in terms of persistent and prolonged treatment.In particular, methotrexate should be prescribed carefully in obesity, diabetes mellitus, not alcohol fatty disease due to increased risk of liver fibrosis.Cyclosporine, or may cause appearance or exacerbate arterial hypertension, increase insulin resistance and affect fatty acid metabolism, has toxic effects.
Acitrotin also promotes hypertriglyceridemia and/or hypercholesterolemia.Therefore, when performing patients with psoriasis, it should take into account all the data.
A special place in the treatment of psoriasis is given phototherapy.The positive effects of ultraviolet radiation on the skin are associated with selective inhibition of immune cells.According to literature, the following fields of phototherapy are distinguished: anti -inflammation, artificial inhibition of immunity and antiulifier.The effect of ultraviolet radiation on immunity is associated with depth of penetration.UFB rays affect the epidermis and cells of langergan, ufa rays penetrate the deeper layers of the skin and have an effect on dermal fibroblasts, dendritic cells and immune system cells.The positive effects of ultraviolet radiation are due to apoptosis of T cells, decreased number of langerana cells, cytokine changes, growth factors (EGF, vegf), adhesion and neuropeptide molecules.The purpose of phototherapy is advised for the same skin process.
In the treatment of psoriasis, photochemotherapy (bullet therapy) is used-the use of long wave ultraviolet rays (UFA) (320-400 nm) and photosensitizer (8-methoxypsoralen).Puva -api is one of the most effective ways to treat psoriasis, its prescriptions are advised with coarse and exudative psoriasis, stubborn disease course, severe infiltration.Treatment is carried out according to the 3- or 4-raking irradiation methodology per week, on average, the course is 20-30 procedures.
Currently, selected phototherapy, a combination of waves (280-320 nm) has lost its position and is set less and less for the treatment of psoriasis.Indicators for its purpose are psoriasis, characterized by the formation of inflamed cell content.
Narrow UFB therapy with peaks of discharge at 311 Nm wavelengths in high therapeutic efficiency is comparable to ammunition therapy, but unlike it does not require the use of photosensitizer.It is carried out in accordance with 3-5-5-raking irradiation methodology with a course of 20-30 procedures.
For the treatment of vulgar psoriasis limited in stationary stages, a very effective therapeutic technique is Eximmary's laser, which allows for conveying monochromatic light high intensity of 308 nm wavelength only to the affected area of the skin.
Local therapy
The selection of large local products for the treatment of psoriasis includes, in particular, traditional ointments containing tar, naphthalan, ichthyol and salicylic acid.
When choosing topical therapy, individual approaches are important, where adherence to patients with psoriasis will depend.Therefore, due to the cosmetics of treatment, 40% of patients do not comply with the destination.
The effectiveness of topical corticosteroid drugs in the treatment of psoriasis is based on its obvious effects on immune modulation and decreased tissue inflammation.This action is associated with complex mechanisms of hormone and receptors, which penetrate the target cell core and increase the expression of gene that dodes peptide synthesis that inhibits phospholipase activity.This mechanism leads to a decrease in the formation of inflammatory mediators from phospholipids.Combined corticosteroid ointments and creams with salicylic acid are preferred.Local corticosteroid preparations are not shown for continuous treatment and suggest combination and rotation schemes, as prolonged use can lead to the development of side effects, such as skin atrophy, hypertrichosis, telangiectasia, steroid acne and adrenal suppression.
Vitamin D3's synthetic analogs have established themselves in a very effective way of psoriasis.The most famous of this group is Calcipotriol.The principle of drug action is based on the effects of softening keratinized skin with vitamin D3: it prevents the proliferation of keratinocytes and the differential skin of the model, and also has immunomodulation effects, in particular reducing IL-2 expressions and information.Calcipotriol has a cumulative effect, and therefore therapeutic effects are observed after 1-2 weeks.From the beginning of treatment.
Unlike topical steroids, the long use of this drug group is possible.To achieve maximum therapeutic effect, the purpose of the combination of calcipotriol and topical steroids is possible.
Local Calcineurin inhibitors (takrolimus and pimecrolimus) are associated with blocking T-lymphocyte signal transduction by preventing calcineurin.It is best to prescribe this group of drugs in the face of rash localization, as they have no side effects like topical steroids.
The value of the use of the reduction agent, in the treatment of psoriasis, does not doubt: they soften the skin, reduce its removal and dryness, increase its hydration, especially after ultraviolet exposure;Contributes to the decrease in itching.The biggest effect is achieved when applying wet skin after contact with water (bath, bath).The use of reduction agents in complex therapy psoriasis reduces the total cost of treatment as a result of achieving disease stabilization and the onset of remission in a shorter period of time, which helps reduce hospitalization.
Therefore, the problem of treating psoriasis maintains its relevance and remains a comprehensive task, aimed at primarily in a manifested approach to therapy, where compliance with patients with psoriasis and prospective that the patient will depend, taking into account coordination.