Treatment methods for various 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 is detected in 125 million people worldwide.

In most cases, the disease develops in people of working age: from 15 to 35 years old.Men and women get sick with the same frequency.Despite the widespread prevalence of the disease, not all patients understand what psoriasis is, what are the causes of its occurrence and how to treat it.Let's deal with all the issues in order.

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 by it as foreign.Scientists have long established the link between the disease and activation of the immune system, 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, the child has a 50% chance of also having psoriasis.Even some genes responsible for its development have been identified.In addition, the influence of hormonal disorders, nervous tension, metabolic disorders and viral infections on the manifestation of psoriatic lesions on the body has been established.

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

• type 2 diabetes mellitus;
• metabolic syndrome;
• pathology of the liver and bile ducts;
• 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 reddish areas raised above its surface (so-called papules) with superficial scaling.Due to this, white scales appear, hence the second name of psoriasis – scaly lichen.If you scrape this area, you can see the “stearin stain phenomenon” - the number of flakes will increase, which resembles a drop of frozen stearin.After complete removal of the scales, a shiny, moist endplate is exposed, on which, with subsequent scraping, small individual drops of blood will appear.These papules are usually located on the scalp, on the extensor surfaces of the joints.
2. Exudative psoriasis: an inflammatory liquid is secreted in the inflamed area that wets the scales, transforming 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 the chest.In this variant, intensely itchy plaques and yellowish scales form.
4. The teardrop shape is usually found in children and appears as multiple small red papules with slight scaling.
5. Pustular psoriasis is a superficial pustule, usually located 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 Tsumbusch psoriasis, accompanied by suppuration of extensive foci.In common forms of the disease, general well-being is also impaired: weakness, malaise and an increase in body temperature appear.
7. Psoriatic arthritis is manifested by redness and swelling of the skin over the joints, pain, limited movement in the joints, deformation and stiffness of movement after sleeping.
8. Psoriatic onychodystrophy is a lesion of the nails.Characteristic are the “oil stain symptom” (yellowish-brown spots under the nail plate) and the “thimble symptom” (point damage to the nail).

How is psoriasis treated?

Methods for treating psoriasis are constantly being improved and supplemented, but there is no medicine that can defeat the disease forever.Therefore, the main psoriasis treatment strategies aim to:

• reduction in the frequency of exacerbations;
• relief of disease symptoms;
• improving quality of life;
• reducing the likelihood of complications and concomitant diseases.

Treatment is usually carried out 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 concomitant 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.

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 medications are very effective, as proven by many studies.They can be used separately (for local forms) or in combination with other media.

This group includes flucinar, hydrocortisone, elocom, prednisolone, advantan, acriderm.Local 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 medicines:

• Use only in the shortest courses possible.
• 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 medications (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, adverse reactions may occur:

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

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

Salicylic acid

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 local forms of psoriasis as 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 approximately 2 months.It is not advisable to treat large areas of the skin with them.Can be used in conjunction with glucocorticoid hormones.

Adverse reactions with local application of vitamin D3 are rare and are mainly represented by burning, redness and itching of the skin.In this case, I stop the treatment or use the ointment less frequently.In case of an overdose, systemic manifestations of hypervitaminosis D are possible: decreased bone density and the formation of kidney stones.

Medicines in this group are not prescribed before the start of UV therapy.

You cannot simultaneously use drugs based on salicylic acid and vitamin D analogues 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 relapses.The mechanism of action is antibacterial, antifungal activity and slowing cell division.Medications can cause allergies, dryness and skin irritation with repeated use.Therefore, the course of treatment should last no more than 1.5 months.

Systemic therapy

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

Methotrexate

A drug from the cytostatic group 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.

Doses of methotrexate are selected individually, taken once or several times a week.After the exacerbation subsides, the medicine continues to be taken at the minimum effective dose.The drug often causes side effects, so this treatment requires constant medical supervision.Possible adverse reactions:

• 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;
• headaches, drowsiness, convulsions;
• visual disturbances;
• kidney dysfunction;
• suppression of germ cell formation processes;
• decreased libido;
• joint and muscle pain;
• non-infectious pneumonia;
• allergic reactions.

The drug is discontinued if severe shortness of breath, coughing, development of serious infectious diseases, anemia, or a significant increase in blood markers of renal or hepatic failure occur.

Cyclosporine

A medicine that suppresses immune system function.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 cyclosporine with minimal dosages, which are then increased until you get the desired result.

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 cyclosporine requires constant medical monitoring, regular blood tests and other necessary tests.

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 these drugs is an average of 2 months, the dose is selected individually.When using retinoids, there is also a certain risk of unwanted reactions:

• dryness of mucous membranes;
• skin peeling;
• fungal vulvovaginitis;
• hair loss, hair loss, brittle nails;
• muscle and joint pain;
• liver inflammation, jaundice;
• nausea, stool disorders.

Despite the possible side effects, these medications are safer than the previous options, especially considering that all of these complications are reversible and disappear some time after stopping the medication.Retinoids are not prescribed concomitantly 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 subcutaneously or intravenously, no more than once a week.Its negative impact on the body is mainly associated with the suppression of the immune response:

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

The use of drugs from 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 these cases, the course of hormone therapy should not be long due to the risk of worsening the process and developing pustular forms.

Additional drug treatment

This group includes drugs necessary for the correction of concomitant conditions that aggravate the course of psoriasis and for the treatment of articular forms of the disease.

1. Psychotropic medications are used due to the high frequency of exacerbations of psoriasis against the background of an unstable nervous state.In particular, antidepressants (amitriptyline, fluoxetine, venlafaxine) and anxiolytics - tranquilizers (diazepam, phenazepam, buspirone) are prescribed.Antidepressants are usually prescribed for long-term depression and stress and are taken in long courses.Tranquilizers can be taken once as needed depending on external circumstances.This group of drugs suppresses anxiety, agitation, susceptibility to stress factors and normalizes sleep.However, it should be borne in mind that medications also have 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, injectable 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 possible time.
3. Antihistamines are occasionally used to reduce itchy skin.Prescription medications of the first (Tavegil, Suprastin), second (Fenistil, Claritin) or third (Zyrtec, Erius) generation.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 irradiation (UVR) involves exposure to radiation with a wavelength of 311-313 nm to the entire body or individual parts of it.This technique is not applicable for severe generalized forms of psoriasis and its summer variety, 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 physical therapy option, 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 moisturizer.PUVA therapy has several contraindications, such as renal failure, diabetes mellitus and skin tumors.

X-ray therapy involves treating the skin with gentle x-rays, which help to effectively combat 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.One procedure lasts 15 minutes, does not cause discomfort and is well tolerated.A total course of 14 procedures is recommended.

Electrosleep indirectly affects the course of psoriasis by improving the patient's mental state.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.Various stresses, anxieties, fears and experiences often cause the onset 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 to the patient, asking important questions and trying to establish the cause of psychological problems.Other sessions aim to stabilize 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 towards yourself and the world around you.

Therapeutic nutrition for psoriasis

Patients with psoriasis are recommended:

• Drink more fluids: 7 to 10 glasses of still water or natural 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 abuse citrus fruits, tomatoes, red peppers, strawberries, honey.
• Avoid chocolate and high-fat whole milk.
• Do not drink alcohol, caffeine, spicy, salty and smoked foods.

Alternative methods to combat 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 cold stress response.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.Furthermore, low temperatures drastically reduce 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 cannot 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.Local cryotherapy is performed by exposing areas of the skin with psoriatic plaques 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, decrease in size, peeling and itching disappear.
2. Hydrotherapy is widely used in sanatoriums with thermal waters.Garra rufa fish that live in these waters eat rough particles and scales from the surface of the skin, leaving healthy areas untouched.
3. Plasmapheresis is a very 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 the autoimmune reaction, degradation 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 way to improve 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 you to obtain 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 plaque-covered areas 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 are divided into two groups: preparations for oral administration and external remedies.The first category includes:

• Celandine tincture.The herb of this plant can be found in the pharmacy.2 tbsp.I.dry herb is poured with 500 ml of alcohol or vodka and left to infuse 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 let it boil for about a quarter of an hour.Then filter, cool and drink 1 tablespoon.I.3 times a day for 1 month.
• Dill seeds.2 tbsp.I.seeds, pour 1 glass of boiling water, let it brew for about three hours, filter, drink ½ glass 2 times a day.
• Flax seeds.1 tbsp.I.seeds, pour a glass of boiling water, stir, 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 it for half an hour, then wash it off with warm water.
• Flaxseed oil.Apply to the affected area up to 6 times a day.
• Egg ointment.Beat 2 chicken eggs and add 1 tbsp.I.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 stirred.Apply to psoriatic rashes up to 4 times a day.

It should be borne in mind that no matter what alternative 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 dose and regimen of the medication at will.