Treatment methods for various forms of psoriasis and their characteristics

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.Men and women get sick equally often.Despite the wide prevalence of the disease, not all patients understand what psoriasis is, what the causes of its occurrence are and how to treat it.Let's address all the questions 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 connection between the disease and the activation of the immune system, but it has not yet been reliably clarified what exactly causes the failure to recognize one's own cells.

A genetic predisposition to psoriasis has been demonstrated: if both parents are affected, the probability that the child will also have psoriasis is 50%.Some genes responsible for its development have also been identified.In addition, the influence of hormonal disorders, nervous tension, metabolic disorders and viral infections on the manifestation of psoriatic lesions of 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 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, which appear as red and raised areas above its surface (the so-called papules) with superficial desquamation.Due to this, white scales appear, hence the second name of psoriasis: scaly lichen.If you scrape such an area, you can see the "stearin stain phenomenon": the number of scales will increase, resembling a drop of frozen stearin.After complete removal of the scales, a shiny, moist end plate is exposed, on which, with further scraping, individual small droplets of blood will appear.Such papules are usually found 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, transforming 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, area between the shoulder blades and on the chest.In this variant, plaques with yellowish, very itchy scales form.
4. The teardrop shape is usually found in children and appears as multiple small red papules with light 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.With common forms of the disease, general well-being is also affected: weakness, malaise and increased body temperature appear.
7. Psoriatic arthritis is manifested by redness and swelling of the skin over the joints, pain, limited movement of the joints, their deformation and stiffness of movements after sleep.
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 treatment strategies for psoriasis are aimed at:

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

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

• severe generalized variants of psoriasis, which worsen the patient's general condition (in particular, erythroderma and pustular psoriasis);
• the presence of complications and concomitant 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 fusion of lesions.These drugs are very effective, as demonstrated by numerous studies.They can be used separately (for local forms) or in combination with other means.

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 drugs:

• 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 their 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;
• the appearance of acne;
• local infection;
• thinning, dryness of the skin;
• reduction of pigmentation;
• striae.

The skin of the face and groin very 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 about 2 months.It is not recommended to treat large areas of the skin with them.It can be used in combination with glucocorticoid hormones.

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

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

It is not possible to 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 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 to prevent its relapses.The mechanism of action is antibacterial, antifungal and slows cell division.Medicines may 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 therapeutic option involves the use of drugs in the form of tablets or injections;they affect not only the integumentary 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.

Doses of methotrexate are selected individually, taken one or more times a week.After the exacerbation has subsided, the medicine continues to be taken at the lowest 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;
• headache, drowsiness, convulsions;
• visual disturbances;
• renal dysfunction;
• suppression of the processes of germ cell formation;
• decreased libido;
• joint and muscle pain;
• non-infectious pneumonia;
• allergic reactions.

The drug is stopped if severe shortness of breath, cough, development of serious infectious diseases, anemia, or a significant increase in blood markers of renal or liver failure occurs.

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 flare-ups.Start taking ciclosporin with minimal doses, which will then be increased until the desired result is achieved.

Adverse reactions to ciclosporin:

• 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;
• heachache;
• allergies.

The use of cyclosporine requires constant medical supervision, regular blood tests and other necessary tests.

Retinoids

Retinoids (acitretin, isotretinoin) are derivatives of vitamin A which have a normalizing effect on the division and keratinization processes of skin cells.The course of treatment with such drugs lasts on average 2 months, the dose is selected individually.When using retinoids, there is also a certain risk of unwanted reactions:

• drying 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 the possible side effects, these drugs are safer than previous options, especially considering that all these complications are reversible and disappear some time after stopping the drug.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 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 associated with the suppression of the immune response:

• the addition of an 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 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 aggravating the process and the development of 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 joint forms of the disease.

1. Psychotropic drugs 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 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, susceptibility to stress factors and normalizes sleep.However, it should be kept in mind that drugs also have their contraindications for use and adverse reactions, which do not always allow them to be taken at the same time as the main therapy for psoriasis.
2. Nonsteroidal anti-inflammatory drugs are used in 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 (formation of ulcers), these drugs are prescribed for the shortest possible course.
3. Antihistamines are occasionally 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 irradiation (UVR) involves exposure to radiation with a wavelength between 311 and 313 nm on the whole body or on individual parts of it.This technique is not applicable to severe, generalized forms of psoriasis and its summer variety, since 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 physiotherapy 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. Dry skin may appear after the procedure, which will require the use of a moisturizer.PUVA therapy has a number of contraindications, such as renal failure, diabetes mellitus and skin tumors.

Radiotherapy involves treating the skin with soft X-rays, which helps 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 anti-itch effects.One procedure lasts 15 minutes, does not cause discomfort and is well tolerated.A total course of 14 procedures is recommended.

Electrosleep indirectly influences the course of psoriasis, 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 carry out at least 10 procedures.

Psychotherapy

The role of an unstable mental state in the development of psoriasis has been demonstrated by numerous studies.Various stresses, anxiety, fears and experiences often cause the appearance or exacerbation of psoriasis in people with genetic predisposition.Therefore, psychotherapy is important to prevent flare-ups and generally reduce the frequency of relapses.

During the session the specialist talks with the patient, asking important questions and trying to establish the cause of the 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 toward yourself and the world around you.

Therapeutic nutrition for psoriasis

Patients with psoriasis are recommended:

• Drink more fluids: 7-10 glasses of plain water or freshly squeezed juices per day.
• Eat more fruits and vegetables: grapes, nectarines, cherries, pineapple;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 stress response to cold.Against this background, rapid narrowing and subsequent expansion of blood vessels occurs, which leads to increased blood flow and decreased inflammation.Additionally, low temperatures dramatically slow the speed of nerve impulses and prevent new lesions from forming.General cryotherapy is carried out using a special cryochamber, in which a person can stay for no more than 3 minutes.The temperature is set in the range between -110 and -130°C.The entire course should not exceed 30 procedures.Local cryotherapy is carried out by exposing the skin areas with psoriatic plaques to liquid nitrogen vapors (temperature -140 – -160°C).In the course of research, it was found that after a course 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 living in such waters eat rough particles and flakes from the surface of the skin, leaving healthy areas intact.
3. Plasmapheresis is a rather complex process that involves the withdrawal of blood from the patient's body, its purification from toxins, immune complexes, microorganisms and its reintroduction into 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, decomposition 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 means of improving the health of patients suffering from psoriasis.Thanks 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 application to the skin, the mud is heated to 39°C, then a thin layer is spread on the areas covered with plaques and left to act for 30 minutes.At the end of the procedure, 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:

• Celandine tincture.The herb of this plant can be found in the pharmacy.2 tbsp.the.dried grass is poured with 500 ml of alcohol or vodka and left to ferment for 10-14 days.Then the tincture is filtered and taken 20 g 3 times a day.
• Decoction of bay leaves.Place 15 bay leaves in 1 liter of boiling water and boil for about a quarter of an hour.Then strain, cool and drink 1 tbsp.the.3 times a day for 1 month.
• Dill seeds.2 tbsp.the.seeds, pour 1 glass of boiling water, let it brew for about three hours, strain, drink ½ glass 2 times a day.
• Flax seeds.1 tbsp.the.seeds, pour a glass of boiling water, mix, 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 and leave for half an hour, then wash 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.the.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 popular methods are used 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.In no case should you self-medicate or change the dose and regimen of the drug as you like.