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 with working age: from 15 to 35 years.Men and women are equally affected.Despite the widespread prevalence of the disease, not all patients understand what psoriasis is, what are the reasons for its occurrence and how to treat it.Let's solve all the questions in order.
The main thing is to be brief
Psoriasis is a chronic inflammatory disease of an autoimmune nature characterized by the formation of special "plaques" on the skin.The autoimmune mechanism is associated with the production of protective antibodies against the body's own cells, which are perceived as foreign.Scientists have known for a long time the connection between the disease and the activation of the immune system, but what causes a failure in the recognition of one's own cells has not yet been reliably clarified.
A genetic predisposition to psoriasis has been proven: if both parents are sick, the child has a 50% chance of having psoriasis.Even some genes responsible for its development have been identified.In addition, the effect of hormonal disorders, nervous tension, metabolic diseases and viral infection on the manifestation of psoriatic lesions of the body was established.
In many cases, psoriasis is combined with 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.
- Psoriasis vulgaris: Characteristic rashes appear on the skin that are raised above the surface (so-called papules) and look like the top with superficial peeling.This is why white scales appear, hence the second name of psoriasis - Scaly Lichen.If you break such an area, you can see the "Stearin Stain Phenomenon" - the number of flakes that look like a drop of frozen stearin will increase.After the complete removal of the scales, a shiny, wet terminal plate is exposed, along with which more itching, individual small drops will appear.Such papules are usually located on the scalp, on the wide surfaces of the joints.
- ExoDative Psoriasis: An inflammatory fluid is secreted in the inflamed area that forms scales, making it difficult to remove them.
- Seborrheic Psoriasis is typical for skin areas with a large number of sebaceous glands: nasolabial folds, scalp, between the shoulder blades and between the chest.In this variant, severe itchy plaques with yellowish scales are formed.
- The lacrimal form usually occurs in children and appears as multiple small red papules with slight peeling.
- Pustular psoriasis is a superficial pustule usually located on the palms and soles.
- Generalized forms: tsumbuzch psoriasis, accompanied by a wide mixed focus covering 90% of the body surface and the possibility of a wide focus.With common forms of the disease, it also suffers from a general state of well-being: weakness, malaise appears, and the body temperature rises.
- Psoriatic arthritis is manifested by redness and swelling of the skin in the joints, pain, their deformation, deformation and stiffness of the bed.
- Psoriatic Onychodystrophy is a lesion of the nails.Characteristic, "oil stain symptom" (yellowish-brown spots under the nail plate) and "timble symptom" (damage to the nail).
How is psoriasis treated?
Psoriasis treatment methods are constantly improved and added, 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 complications;
- relief of disease symptoms;
- improving the quality of life;
- Reducing the likelihood of complications and complaints.
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 (in particular, erythroderma and pustular psoriasis);
- the presence of complications and positive pathologies that aggravate the patient's condition;
- The need to use drugs that require regular monitoring of clinical and laboratory parameters.
Both local and systemic agents are used in the treatment of psoriasis.
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 combination of lesions.These drugs are very effective as proven by many studies.They can be used separately (for local forms) or together with other tools.
This group includes Flucinar, hydrocortisone, elokisone, prednisolone, Advanan, Acriderm.Topical glucocorticosteroids are available as creams, ointments, and lotions.
The disadvantage of such drugs is the long-term use of systemic (general) effects and the risk of developing effects with widespread areas.Rules for using these drugs:
- Only use courses where possible.
- When an infection occurs, glucocorticoids combined with an antibiotic or antifungal agent should be preferred.
- 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.Long-term use, adverse reactions may occur:
- burning, redness and itching;
- the appearance of acne;
- local infection;
- thin, dry skin;
- reduction of pigmentation;
- Striae.
The skin of the face and groin area suffers from complications the most.
Salicylic acid
It is used in combination with local glucocorticosteroids for significant peeling of the skin.Salatilates (Diproferic, Acriderm SK, ELOKOM S) effectively remove plaques and help restore the skin.
Vitamin therapy
Vitamin D is an effective treatment for topical forms of psoriasis because it reduces inflammation and excessive division of skin cells.Creams or ointments containing vitamin D3 (calcipotriol, Daivonex, calcitriole) are applied to plaques 1-2 times a day for about 2 months.It is not recommended to treat large areas of the skin with them.It can be used together with glucocorticoid hormones.
Adverse reactions with local application of DOW 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 less ointment.In overdose, systemic manifestations of hypervitaminosis are possible: decreased bone density and the formation of kidney stones.
Drugs in this group are not prescribed before starting UV therapy.
Externally, you cannot use drugs based on salicylic acid and vitamin d analogs at the same time - this will lead to the inactivity of the latter and significantly reduce the effectiveness of the 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 its relapse.The mechanism of action is antibacterial, antifungal activity and slows down cell division.Medicines can cause allergies, dryness and irritation of the skin with repeated use.Therefore, the course of treatment should not exceed 1.5 months.
Systemic therapy
This treatment option includes the use of drugs in the form of tablets or injections;They affect not only integral tissues, but also internal organs.Systemic treatment is used for moderately severe psoriasis.
Methotrexate
A drug from the cytostatic group that stops cell division.If it does not respond to other types of therapy, it is prescribed for psoriatic arthritis, erythroderma, pustular and vulgar personal psoriasis.
Methotrexate doses are selected individually, taken once or several times a week.After the reduction of ecranbation, 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 adverse reactions:
- a decrease in the number of whole blood cells;
- Loss of appetite, nausea, vomiting;
- 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;
- suppressing the processes of the formation of microbial cells;
- decreased libido;
- pain in joints and muscles;
- Non-infectious pneumonia;
- Allergic reactions.
The drug is stopped if there is a significant increase in blood markers of shortness of breath, cough, severe infectious diseases, anemia or 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, but 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 minimally increasing doses until the desired result is achieved.
Adverse reactions to cyclosporine:
- kidney function, swelling, increased blood pressure;
- has a toxic effect on the liver and pancreas, nausea, empty stool;
- formation of malignant tumors and lymphomas;
- decrease in the number of blood cells;
- muscle pain, cramps;
- headache;
- allergies.
The use of Cikosporin requires constant medical supervision, regular blood tests and other necessary examinations.
Retinoids
Retinoids (acitretin, isotretinoin) are derivatives that have a normalizing effect on the division processes 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 adverse reactions:
- drying of mucous membranes;
- peeling of the skin;
- 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 these complications are all reversible and disappear for a while after stopping the drug.Retinoids are not prescribed incomparably with methotrexate, because it 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 either subcutaneously or intravenously no more than once a week.Their negative effects on the body are mainly associated with the suppression of the immune response:
- addition of an infection of any localization;
- WHOLE AND THEORETICAL NEOPLASMS;
- allergic manifestations;
- headache, dizziness;
- depression;
- Nausea, vomiting;
- joint and muscle pain.
The use of drugs in this category is possible together with methotrexate.
Systemic glucocorticoids
Systemic glucocorticoids (prednisolone, dexamethasone) are used only in the treatment of psoriatic arthritis and acute generalized forms of the disease in injections and drops.However, even in these cases, the course of hormonal therapy should not be long due to the risk of development of pustular forms.
Additional drug treatment
This group includes drugs that aggravate the course of psoriasis and are necessary for the correction of consecutive conditions for the treatment of articular forms of the disease.
- Psychotropic drugs are used due to the high frequency of high frequencies of psoriasis against the background of an unstable nervous state.In particular, antidepressants (Amitriptyline, fluoxetine, venlafaxine) and anti-anxiety drugs - tranquilizers (diazepam, phenazepam, buspirone) are prescribed.Antidepressants are usually prescribed for long-term depression and stress and are taken in long courses.Depending on external circumstances, tranquilizers may be required once.This group of drugs normalizes anxiety, agitation, sensitivity to stress factors, and sleep.However, these drugs also have contraindications for use and adverse reactions, which do not always allow taking them simultaneously with the main therapy for psoriasis.
- Non-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, injection solutions, gels and ointments for external use.Due to the negative effect on the gastrointestinal tract (ulcer formation), these drugs are prescribed for the shortest period of time.
- Antihistamines are sometimes used for itchy skin.Prescribed drugs of the first (tavegil, suprastin), second (Fenistil, Claritin) or third (Zyrtec, Erius) generation.The effectiveness of these drugs is basically comparable, but third-generation drugs do not have so many common side effects as antihistamines.
Physiotherapy for psoriasis
Ultraviolet radiation (UVR) involves exposure to radiation with a wavelength of 311-313 nm to the whole body or its individual parts.This method is not applicable for severe generalized forms of psoriasis and summer varieties, as it can only aggravate the process.
Selective phototherapy (puva therapy) is a type of ultraviolet radiation, but the wavelength used in this case is 310-340 nm.This option of physiotherapy, when used regularly, allows you to achieve long-term remission.One session can last up to 2 hours and the recommended total number is 35.After the procedure, dry skin may appear, which will require the use of a moisturizer.PUVA Therapy has several contraindications, such as renal failure, diabetes mellitus, and skin tumors.
X-ray therapy also involves treating the skin with soft X-rays that help with itching and the formation of new plaques.
Ultrasound treatment involves exposure to ultrasound waves that have anti-inflammatory, antibacterial, analgesic, 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.
Electroskeep indirectly affects the course of psoriasis by improving the mental state of the patient.This manipulation has a calming effect, improves sleep, increases resistance to stress and reduces excessive excitement of the nervous system.One 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.Various stress, anxiety, fear and experience often cause the appearance or exacerbation of psoriasis 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 with the patient, asking leading questions and trying to determine the cause of psychological problems.Additional sessions are aimed at stabilizing the patient's emotional state.A psychotherapist teaches you how to cope with stress at work and at home, find an outlet for negative energy and develop a positive attitude to 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 a day.
- Eat more fruits and vegetables: grapes, nectarines, cherries, pineapples;beetroot, carrot, cucumber, cabbage, garlic, onion, dill, who.
- 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 bell peppers, strawberries, honey.
- Avoid high-fat chocolate and whole milk.
- Do not drink alcohol, caffeine, spicy, salty, smoked foods.
Alternative methods to fight psoriasis
- Cryotherapy is the effect of ultra-low temperature on the body, which can be local or general.The mechanism of psoriasis improvement is the body's short-term stress response to cold.Against this background, rapid narrowing and subsequent expansion of blood vessels occurs, which leads to increased blood flow and reduced inflammation.In addition, low temperature dramatically slows down the speed of nerve impulses and prevents the formation of new lesions.General cryotherapy is carried out using a special cryocamber, in which a person is no more than 3 minutes.The temperature inside is set in the range of -110 to -130 °C.The entire course should not exceed 30 procedures.Local cryotherapy is performed by exposing skin areas with pus-filled plaques to liquid nitrogen vapor (temperature -140 to -160 °C).During the study, after the course of procedures, psoriatic papules fade, decrease in size, peel and itch disappear.
- Hydrotherapy is widely used in sanatoriums with thermal waters.Garra Rufa fish living in such water, using healthy areas, eat coarse particles and scales from the surface of the skin.
- Plasmapheresis is a very complex process that involves taking blood from the patient's body, cleaning it of toxins, immune complexes, microorganisms and returning it to the general blood stream.A special centrifuge is used to clean the blood.The positive effect of plasmapheresis in psoriasis depends on the immune response, as well as sex inflammation, as well as microorganisms and their microorganisms and their toxins, as well as their toxins and their toxins and their toxins, toxins and their toxins.
- Mud therapy is an effective tool for improving the health of psoriasis patients.Due to the significant content of mineral salts, therapeutic mud suppresses the inflammatory process, promotes tissue regeneration and softens rough areas of the skin.Mud therapy allows for 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 spread on the areas covered with a plate 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.
Traditional medicine recipes for psoriasis
Folk remedies for the treatment of psoriasis fall into two groups: preparations for oral administration and external treatment.The first category includes:
- Cedandine tincture.The herb of this plant can be found in the pharmacy.2 tbsp.l.The dried herb is poured with 500 ml of alcohol or vodka and allowed 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 boil for about a quarter of an hour.Then filter, cool and drink 1 tbsp.l.3 times 3 times a day.
- Fennel seeds.2 tbsp.l.Seeds, pour 1 cup of boiling water, let it brew for about three hours, filter, bottle 2 times a day.
- Linseed.1 tbsp.l.Seeds, pour a glass of boiling water, mix, leave overnight, take in the morning before breakfast.
Foreign traditional medicine for the treatment of psoriasis:
- Fish oil.Apply a thin layer on the skin and leave it for half an hour, then wash it off with warm water.
- Linseed oil.Apply to the affected area up to 6 times a day.
- Egg ointment.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 layers are heated in a water bath and mixed.Apply to psoriatic rashes up to 4 times a day.
It should not be forgotten that regardless of alternative methods and folk methods 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 change or change the dosage or regimen of the medication.