Psoriasis is an autoimmune disease with an adverse combination of genesis elements with a recurrence process, a range of phenotypes, clinical similarities and can detect different diseases at the same time through chronic diseases.According to literature, the world's incidence of psoriasis is 4 matches 7%.
According to K. Reich, mild diseases affect less than 3-5% of the body area and do not make significant changes in the patient's immunity, just need to be treated on the spot.The psoriasis of a moderate and serious course is a systemic process, causing inflammation, leading to the development of simultaneous diseases or making them worse, and they themselves have a great impact on the health and quality of the patient's life.
The treatment of psoriasis is not related and although the appearance of new modern treatments is still a difficult task that requires an approach to personality.
To treat psoriasis, there are many options for local and whole body, most of which model the immune system.When selecting personalization therapy, the incidence of psoriasis, the stage of the process, its clinical form, as well as the attitude towards patients with patients with the disease are taken into account.Therefore, with the positioning of the rashes in the open areas of the skin - the face, the hair of the head and the brush, this disease has a significant effect on the quality of life and causes serious psychological experiences.According to research by G. Krueger et al.(2001), 40% of patients with psoriasis were disappointed with the ineffective treatment of results and 32% considered not enough treatment.
Psoriasis system therapy
Glucocorticoids in the form of tablet are extremely rare related to many side effects.However, when an ambulance medicine, to stabilize the psoriasis process with the progressive phase, Erythroderma is encouraged to use glucocorticoids for prolonged body to use intramuscularly in the form of short courses.A similar approach to treat adverse side effects.
More than 40 years in the treatment of psoriasis, methotrexate is used.Its mechanism of action is associated with inhibition of dihydrofolateredustuStase, turning dihydrofolic acid into tetrahydrofolic and is a sponsor of simple carbon groups in the synthesis of nucleotide purine and thymidylate necessary to synthesize DNA.In this regard, the simultaneous purpose of folic acid helps avoid metabolic anemia.
Cyclosporin, A-Cyclic polypeptide, isolated from grams of tolypocladium inflatum, has a immunosuppressive effect by preventing T cell activity and reducing the immune system sensitivity due to the immune system.The drug is highly effective in the treatment of psoriasis slowly slowly, erythroderma psoriasis.
Since 1997, the aromatic retinoids of the second generation have been used to treat the type of fire -resistant material of psoriasis, the base of the chemical formula is acitiretin.The drug inhibits the proliferation of epidermal cells, normating the keratinization process, which has immune treatment.The effectiveness of the product depends on the dose: higher dose leads to faster resolution of the psoriasis rash.
Relatively recently, a new group of drugs appeared - biological drugs, including recombinant proteins, synthesized by biotechnology by living cells of animals, plants and microorganisms.The indication of the prescription of biological drugs is a serious form of psoriasis against other systems.
Treatment of moderate and serious psoriasis (more than 10% of the body surface) is performed to take into account the conditions in which patients suffer from a number of chronic diseases such as metabolic syndrome, cardiovascular disease, diabetes, non -alcoholic liver and lipid metabolic disorders.According to statistical studies, such conditions for psoriasis are more often observed in a general population.Therefore, in the treatment of psoriasis, it is necessary to take into account the risk of side effects of system therapy, corresponding, the patient's condition has some chronic diseases detected individually in each patient.Indeed, some pharmacological drugs can negatively affect diseases simultaneously cardiovascular and metabolism.The relationship between psoriasis and heart metabolism disorders with important clinical consequences.First, psoriasis system therapy can negatively affect diseases and metabolism, especially in the case of continuous and prolonged treatment.Specifically, methotrexate should be prescribed carefully in obesity, diabetes, not fatty liver disease due to alcohol due to increased risk of cirrhosis.Cyclosporine, or can cause the appearance or worsen artery hypertension, enhance insulin resistance and affect the metabolism of fatty acids, which have toxic effects.
Acitrotin also promotes increased triglyceridemia and/or hypercholesterol.Therefore, when conducting patients with psoriasis, it is necessary to take into account all data.
A special place in the treatment of psoriasis is treated with opticalization.The positive effect of ultraviolet radiation on the skin is associated with the selective inhibition of T cells of immunity.According to documents, the following areas of the action of optical therapy are distinguished: anti -inflammatory, artificial inhibition of immunity and anti -bacterial.The effects of ultraviolet rays on immunity are associated with the depth of the lovely.UFB rays affect the epidermal keratinocytes and langergan cells, UFA rays penetrate deeper layers of the skin and affect the fibroids, the tail cells and the cells of the immune system.The positive effect of ultraviolet radiation is due to the apoptosis of T cells, reducing the number of langerganes cells, a change in cytokine, growth factors (EGF, VEGF), adhesion and neuropeptide molecules.The purpose of optical therapy is recommended for a common skin process.
In the treatment of psoriasis, photographic therapy (ammunition therapy) is used-Use combining long-wave rays (UFA) (320 iron) and photosynthesis (8-methoxypsoralen).Puva therapy is one of the most effective methods to treat psoriasis, its prescription drugs are recommended with vulgar and pettish psoriasis, the stubborn process of the disease, serious intrusion.Treatment is done by irradiation method 3 or 4 or 4 or average per week, the course is 20-30 procedures.
Currently, selective optical therapy, a combination of wave radiation (280 throwing 320nm) has lost its position and is increasingly regulated to treat psoriasis.The indication of its purpose is psoriasis, characterized by the formation of low inflammatory cells.
Narrow lane UFB therapy with emissions peaks at 311nm wavelength on high treatment effect can be compared to ammunition therapy, but unlike it requires the use of optical substances.It is carried out in a 3-5 irradiation method with a process of 20-30 procedures.
To treat vulgar psoriasis in the standing period, an effective treatment technique is an Eximmary laser, which allows the provision of the monochromatic light of the high intensity of the wavelength of 308Nm to the affected area of the skin.
Local therapy
A fairly large choice of local products to treat psoriasis includes, in particular, traditional ointments contain Tar, Naphthalan, Ichthyol and Salicylic acid.
When choosing local therapy, a very important personal approach, whereby the adherence of patients with psoriasis will depend on.Therefore, due to the untreated cosmetics, 40% of patients do not follow the destination.
The effectiveness of topical corticosteroid drugs in the treatment of psoriasis is based on their clear effect on the modulation of immunity and tissue inflammation.This action is associated with the mechanism of hormone complex and receptor, penetrating the core of the target cell and increasing the expression of genes encoding the synthesis of peptides inhibiting the activity of phospholipase.This mechanism leads to a reduction in the formation of inflammatory substances from phospholipids.Combining corticosteroid ointment and cream with salicylic acid is especially popular.Local corticosteroid preparations are not shown for long -term treatment and propose combined and rotating diagrams, because prolonged use can lead to the development of side effects, such as skin atrophy, hypertension, telangiectasia, steroid acne and oppress adrenal gland function.
The synthetic substances of Vitamin D3 have established itself as well as highly effective vehicles against psoriasis.The most famous from this group is Calcipotriol.The active principle of the drug is based on the effect of softening Keratin skin with vitamin D3: it inhibits the proliferation of keratinocytes and skin modeling, and also has the effect of immune treatment, especially reducing the manifestation of IL-2 and information.Calcipotriol has an accumulated effect, and thus the treatment effect is observed after 1-2 weeks.From the beginning of treatment.
Unlike local steroids, long -term use of this group is possible.To achieve maximum treatment effect, the combination purpose of calcable and local steroids are possible.
The actions of local calecineurin inhibitors (takrolimus and pimecrolimus) are associated with preventing the load of signals of T lymphocytes by inhibiting calcineurin.You should prescribe this group of drugs in the case of localization of the rash on the face, because they do not have side effects like local steroids.
The value of the use of minimum agents, in the treatment of psoriasis, no doubt: they soften the skin, reduce peeling and dryness, enhance its hydration, especially after exposure to ultraviolet rays;Contribute to reducing itching.The biggest effect is achieved when applied to wet skin after exposure to water (bathing, shower).The use of minimizing agents in the complicated treatment of psoriasis reduces the total treatment costs due to the stability of the disease and declasses in a shorter time, helping to reduce the stay in patients in the hospital.
Therefore, the treatment of psoriasis still maintains its involvement and is still a comprehensive task, mainly for the purpose of approaching personalization of therapy, in which the adherence to patients with psoriasis and the patient in the future will depend on coordination.