Treatment of psoriasis .Modern medicine - Causes, Symptoms and Treatment .MF .
Psoriasis Treatment should be aimed at the elimination of inflammation, inhibition of proliferation of epithelial cells, normalization of their differentiation.
To date, developed many different medications and methods of treatment of psoriasis.Given the limited scope of the article, it provides the most effective ones.
the appointment of treatment, patients with psoriasis should take into account the prevalence of skin lesions, stage of disease, age, sex, comorbidities and contraindications to a particular method of treatment or medication.
Psoriasis Treatment should be comprehensive and combine the use of both drugs for the local (outdoor), and systemic therapy.
External treatment for psoriasis
application of topical preparations in the form of lotions, creams and ointments reduces inflammation of the skin, its peeling and infiltration.Such drugs include ointments and creams containing salicylic acid (2%), sulfur (2.10%), urea (10%), dithranol (0.25-3%), and the glucocorticoid creams, ointments
In acute diseases are usually administered salicylic ointment or anti-inflammatory hormone ointment .Start with the easiest - hydrocortisone, prednisolone.In repeated exacerbations, severe inflammation is necessary to use more powerful drugs - fluorinated products (tselestoderm, Sinalar, vipsogal, belosalik and others).For example, when applying the ointment "Belosalik" comprising metazona b-dipropionate and salicylic acid, 60-70% of patients showed complete regression of lesions within 14 days.In the appointment of a lotion for 21-28 days, there is a pronounced clinical benefit in more than 80% of patients.
in recent years have been used non-halogenated glucocorticoid ointment (advantan, Elokim).Unlike their predecessors, they do not kompanentov containing fluorine and chlorine, which significantly reduces the risk of local and systemic adverse reactions.Such ointments and creams may be used even in the elderly and early childhood.
Expressed protivopsoriatichesky effect provide external preparations containing dithranol (psoraks, tsignolin, tsignoderm).Dithranol has antiproliferative and anti-inflammatory properties.The drug is prescribed in increasing concentrations by different techniques: short-term (causing rashes on for 20-30 minutes) or long (drawing 1 per day).Duration common forms of the disease is between 2 and 8 weeks.Significant improvement and clinical improvement with treatment dithranol noted in 70% of cases.Side effects of the drug - the possibility of the development of local edema, pruritus, erythema.
Recently, a vehicle, the action of which is based on the direct effect on the pathogenetic links psoriasis - ointment Psorkutan .The basis of its chemical structure is calcipotriol - a synthetic analogue of the most active metabolite of vitamin D3.By interacting with the receptors of keratinocytes, it inhibits their excessive division, normalizes the processes of morphological differentiation, has anti-inflammatory and an immunomodulating properties.Such properties Psorkutan determine the good results of the treatment of psoriasis.To date, it has already accumulated quite extensive clinical experience in the use of Psorkutan.According to the Center for the fight against psoriasis, which were treated psorkutanom more than 200 patients, the effect is usually observed already on the 7-10 th day of therapy: fading peeling, rashes fade, smoothed and flattened.By the end of the 8th week there is a complete disappearance of lesions or significant improvement in skin condition in majority of patients.What is important, is not Psorkutan unlike glucocorticoids atrophy of the skin and gives a lasting effect after application.Remission of the disease is sometimes more than a year.
Good psorkutanom combine treatment with ultraviolet radiation (PUVA or SFT).Expressed clinical effect in a regression of lesions in monotherapy psorkutanom is 43%, when combined with selective phototherapy - 86% and PUVA - 91%.
With long-term course of the disease, with frequent and recurring exacerbations of psoriasis makes sense to periodically change ointment or alternate them, as the skin gets used to the medication and apply ointment for a long time has less effect.
therapy Aromatic retinoids , has been used for about 20 years in the treatment of dermatological practice a number of skin diseases, took a leading role in the treatment of patients with psoriasis.The mechanism of action of aromatic retinoids in psoriasis is in the inhibition of proliferation (proliferation) of epithelial cells, normalization of keratinization and stabilization of cell membrane structures, including liposomes.
developments of recent years have led to the introduction of a new aromatic synthetic analogue of retinoic acid - atsetritina.
Unlike its predecessor - etretinate it has some significant advantages: not cumulated in the body and its half-life period of 50 hours (versus 100 days).This allows you to avoid or quickly eliminate a number of side effects that occur in the treatment of aromatic retinoids.Atsetritin is the active ingredient of the drug, which is called neotigazon.
neotigazon used at a dosage of 20-25 mg per day.If necessary, the dosage may be increased up to 50-75 mg per day.The course of treatment lasts 6-8 weeks.
neotigazon treatment has a pronounced therapeutic effect in the treatment of psoriasis of the scalp, psoriatic arthritis and psoriatic lesions of the nail plate.
Years of experience in the use of aromatic retinoids in the center of the struggle with psoriasis more than 3000 patients showed that the most effective is the combined use of retinoids to ultraviolet radiation (PUVA or SFT) and local protivopsoriaticheskimi drugs acting on the proliferative processes in the skin.
For comparison, the following figures.Monotherapy aromatic retinoids leads to clinical cure in 12% of patients, a significant improvement - 41% and the improvement - in 47% of patients.Combination therapy of 84% gives a clinical cure, 12% - a significant improvement in 4% - improvement.In those cases where there are contraindications for the use of ultraviolet radiation, expressed clinical effect (67%) gives psorkutanom combination with retinoids.
Cyclosporin A is a cyclic polypeptide having an immunosuppressive effect.Action Cyclosporine due to suppression of secretion of interleukins and other lymphokines by activated T-lymphocytes, which leads to reduced activity of T-lymphocytes in the dermis and the epidermis of psoriasis patients and indirectly affects the state of vascular hyperproliferation of the epidermis and on inflammatory cells.Along with this, tacrolimus inhibits the growth of keratinocytes.This effect may be due to inhibition of keratinocyte growth factor mononuclear leukocytes in combination with a direct effect on the growth of keratinocytes.Tacrolimus is indicated for patients with severe psoriasis, when conventional therapy is not effective or are contraindicated to other therapies.
preparation is administered at the rate of 1.25 - 2.5 mg per 1 kg of body weight per day.If necessary, the dose may be increased up to 5 mg per 1 kg of body weight per day.The duration of treatment is 4-8 weeks.
Methotrexate. is an antagonist of folic acid, cytostatics.Due to the effect antifolievym drug inhibits DNA synthesis and cell proliferation, and to a lesser extent of RNA and protein synthesis.Most sensitive to the drug active proliferation of cells, particularly skin cells of the epithelium.Assign methotrexate in severe cases of refractory psoriasis (Arthropathic, pustular psoriasis, erythroderma).
Methods of treatment with methotrexate is different.Taking into account the data on the pharmacokinetics of the drug, cell proliferation in psoriasis is most expedient to his appointment in three steps inside of 2.5-5 mg at 12-hour intervals every week or once in doses of 7,5-25 mg orally or 7,5-30mg intravenously or intramuscularly 1 time per week.Treatment is recommended to start with a small dose (5-10 mg 1 time per week), gradually increasing it to an effective therapy with good endurance and normal values of laboratory tests.The course continued for about 4 weeks.
Nonsteroidal anti-inflammatory drugs.When artropaticheskom and to reduce the severity of inflammation in exudative and erythrodermic psoriasis prescribed NSAIDs: indomethacin, diclofenac (0.025-0.05 g for 3 times a day), naproxen (0.25-0.75 g 2times a day).Daily doses and length of treatment depend on the severity of inflammatory changes, the intensity of pain in the joints, tolerability.
duration of treatment is usually 4-6 weeks.
Photochemotherapy (PUVA). Combined use of long-wavelength ultraviolet (UV-A) with a wavelength of 360-365 nm, a photosensitizer (8-methoxypsoralen).When photochemotherapy counts are reacted activated photosensitizer long-wave ultraviolet rays to the DNA, to form a mono- or bifunctional linkages, leading to inhibition of cell proliferation by inhibiting the synthesis of nucleic acids and proteins.Action photochemotherapy may also be related to the immunomodulatory effect of the normalization of cellular immunity, the direct impact on the immune cells in the skin, the influence on the biosynthesis and metabolism of prostaglandins.Photochemotherapy is performed with an initial dose of UV-A, equal to 0.25-0.5 J / cm2 by the method of 4-week single irradiation with a gradual increase in the dose of UV-A to 0.25-0.5 J / cm2.The treatment typically consists of 20-30 treatments.
Selective phototherapy (SFT). Selective phototherapy used medium-wave ultraviolet rays (UV-B) at a wavelength of 315-320 nm.Treatment begins with the dosage of UV-B rays, equal 0.05-0.1 J / cm2 irradiation procedure 4-6 single weekly dose with gradual increase in UV-B at 0.1 J / cm2 on each subsequent procedure.The course of treatment typically includes 25-30 procedures.
Climatotherapy. good results climatotherapy (spa treatment) or on the Black Sea coast of the Dead Sea in Israel.Treatment Dead Sea factors include ultraviolet radiation, air temperature, humidity, atmospheric pressure and the composition of salts in the water of the Dead Sea.The Dead Sea is located at 395 m below the level of the oceans, and these additional layers of the atmosphere, as well as evaporation from the surface of the water is filtered and delayed harmful rays of the sun, creating an ideal balance of long-wave (UVA 315 - 390 nm) and medium wave (UVB 300 - 315 nm)UV rays.The average relative humidity is low and the air temperature is high, the number of sunny days a year reaches 330.
The Dead Sea region is marked the highest (800 mm Hg. Art.) In the world barometric pressure.The oxygen content in the air for 6-8% of the molecules of 1 m higher than the level of the Mediterranean Sea.Dead Sea water contains a large amount of minerals and salts.Concentration of salts is about 300 grams of salt in 1 liter of water, whereas in the Mediterranean - about 35 g of salt to 1 liter of water.
Treatment on the coast of the Dead Sea includes sunbathing, starting with 5 - 15 minutes, 2 times a day with the constant increase solar exposure for 10 minutes to a maximum of 6-8 hours daily, in combination with the sea baths ranging from 10 to 60 m 2 -3 times a day.Depending on the condition of the skin produce a time correction in the sun and in the sea water.
in natural oils (avocado, olive) indifferent creams and moisturizers, shampoos containing Dead Sea minerals used as a topical treatment, and tar.Sometimes, during the first days of treatment, ointments containing sulfur, salicylic acid, and tar.
The recommended length of stay at the Dead Sea - 28 days.
observations showed that at the end of treatment complete clearance of the skin was observed in 68% of patients, a significant improvement - in 22%, improvement - 10% of patients.None of the patients did not come worse.
Aerogeliotalassoterapiya on the Black Sea coast, showed the following results: after a 21-30-day course in 23.3% of patients had remission of the disease, at 40.2% - a significant improvement and 36.3% - an improvement.
The results and comparative data show the high efficiency of climatotherapy at the Dead Sea.
Summing up we can say that the treatment of psoriasis should be necessarily complex and take into account the stage of disease, and particularly of its course.In any case, need to consult a doctor for a full-time appointment of drugs and to identify contraindications to a particular method of treatment.