Treatment methods and characteristics of different forms of psoriasis

Psoriasis is one of the most common skin diseases.According to the International Federation of Psoriasis Associations (IFPA), it affects 125 million people worldwide.

In most cases, the disease develops in people of working age: 15-35 years.Men and women are affected equally often.Despite the widespread prevalence of the disease, not all patients understand what psoriasis is, the causes of its occurrence and how to treat it.Let's deal with all the questions in order.

Briefly to the point

Psoriasis is a chronic inflammatory disease of an autoimmune nature characterized by the formation of specific "plaques" on the skin.The autoimmune mechanism involves the production of protective antibodies against the body's cells, which it mistakenly perceives 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 of self-recognition.

The genetic predisposition to psoriasis has been proven: if both parents are sick, the child has a 50% chance of suffering from psoriasis.They even identified some genes that are responsible for its development.In addition, the impact of hormonal disorders, nervous tension, metabolic disorders and viral infections on the manifestation of psoriatic changes in the body has been established.

In many cases, psoriasis 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.

Psoriasis classification and symptoms

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 reddened areas (so-called papules) rising above the surface, in addition to superficial peeling.Because of this, white scales appear, hence the second name of psoriasis - scaly lichen.If you scrape such an area, you can see the "stearin spot phenomenon" - the number of flakes increases, which resembles a drop of frozen stearin.After the scales are completely removed, a shiny, wet terminal plate is exposed, on which, with further scraping, unique small drops of blood appear.Such papules are usually located on the scalp, on the extensor surfaces of the joints.
2. Exudative psoriasis: an inflammatory fluid is secreted in the inflamed area, which moistens the scales and turns them into a hard-to-remove crust.
3. Seborrheic psoriasis is characteristic of skin areas with a large number of sebaceous glands: nasolabial folds, scalp, the area between the shoulder blades, and the chest.In this version, very itchy plaques with yellowish scales form.
4. The teardrop form usually occurs in children and appears as several small red papules that are slightly scaly.
5. Pustular psoriasis is a superficial pustule usually located on the palms and soles.
6. Generalized forms: psoriatic erythroderma, which manifests as extensive confluent foci covering 90% of the body surface, and Tsumbusch psoriasis, which is accompanied by the proliferation of extensive foci.In common forms of the disease, general well-being also suffers: weakness, malaise, and body temperature rise.
7. Psoriasis of the arthritis manifests as redness and swelling of the joints, pain, limited movement of the joints, deformation and stiffness of movement after sleep.
8. Psoriatic onychodystrophy is a change in the nails.The "oil spot symptom" (yellowish-brown spots under the nail plate) and the "thimble symptom" (point nail damage) are typical.

How is psoriasis treated?

Psoriasis treatment methods are constantly being developed and supplemented, but there is no drug that can defeat the disease forever.Therefore, the main treatment strategies for psoriasis are aimed at:

• reducing the frequency of exacerbations;
• alleviating the symptoms of the disease;
• improving the quality of life;
• reducing the likelihood of complications and accompanying diseases.

Treatment is usually performed on an outpatient basis, but certain conditions may require hospitalization:

• severe generalized versions of psoriasis that worsen the general condition of the patient (especially 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 topical and systemic agents are used in the treatment of psoriasis.

Local therapy

This type of treatment is represented by ointments, gels, creams, which 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 lesions from coalescing.These drugs are very effective, as proven by many studies.They can be used separately (for local forms) or in combination with other tools.

This group includes flucinar, hydrocortisone, elocom, prednisolone, advantan, acriderm.Topical glucocorticosteroids are available as creams, ointments, and lotions.

The disadvantage of such drugs is the risk of systemic (general) effects in case of long-term use and large areas of exposure.Here are the rules for using medicines:

• Use only on the shortest possible courses.
• Glucocorticoids in combination with antibiotics or antifungals are preferred in case of infection.
• Children should not apply hormones to the face, neck or skin folds.
• It is advisable to start the treatment of children with weak or moderately active drugs (prednisolone, hydrocortisone).

Usually, hormonal agents are applied to psoriatic papules 1-2 times a day for up to 1 month.During their long-term use, side effects may occur:

• burning sensation, redness and itching;
• the appearance of acne;
• local infection;
• thinning and drying of the skin;
• reduction of pigmentation;
• striae.

Most often, the skin of the face and groin suffer from complications.

Salicylic acid

Combined with topical glucocorticosteroids for significant exfoliation of the skin.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 topical forms of psoriasis, as it reduces inflammation and excessive skin cell division.Creams or ointments containing vitamin D3 (calcipotriol, daivonex, calcitriene) should be applied to the plaques 1-2 times a day for about 2 months.It is not advisable to treat large skin areas with them.It can be used together with glucocorticoid hormones.

Side effects from topical application of vitamin D3 are rare and are mainly burning, redness and itching of the skin.In such cases, I either interrupt the treatment or use the ointment less often.In case of overdose, systemic manifestations of hypervitaminosis D are possible: decreased bone density and kidney stone formation.

Medicines belonging to this group are not prescribed before starting UV therapy.

Medicines based on analogs of salicylic acid and vitamin D cannot be used externally at the same time - it leads to inactivation of the latter and significantly reduces the effectiveness of therapy.

Zinc pyrithione

Products belonging to this category (skin-cap, zinocap) are produced in the form of creams, aerosols and shampoos.It is used not only to treat psoriasis, but also to prevent relapse.The mechanism of action is the antibacterial and antifungal effect, as well as the slowing down of cell division.Medicines can cause allergies, dry skin and irritation with repeated use.Therefore, the duration 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 internal tissues, but also internal organs.Systemic treatment is used for moderate to severe psoriasis.

Methotrexate

A drug belonging to the group of cytostatics that stops cell division.It is prescribed for the treatment of psoriatic arthritis, erythroderma, pustular and vulgar psoriasis, if it does not respond to other types of therapy.

The dose of methotrexate is selected individually and should be taken once or more times a week.After the exacerbation subsides, the drug is continued at the minimum effective dose.The drug often causes side effects, so this treatment requires constant medical supervision.Possible side effects:

• a decrease in the number of total 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;
• suppression of germ cell formation processes;
• decreased libido;
• pain in the joints and muscles;
• non-infectious pneumonia;
• allergic reactions.

The drug should be discontinued if there is severe shortness of breath, cough, the development of serious infectious diseases, anemia or a significant increase in blood markers of kidney or liver failure.

Cyclosporine

A drug that suppresses the immune system.Given 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 cyclosporine with minimal doses, which are then increased until desired results are achieved.

Side effects of ciclosporin:

• impaired kidney function, swelling, increased blood pressure;
• toxic effects on the liver and pancreas, nausea, loose stools;
• development of malignant tumors and lymphomas;
• decrease in the number of blood cells;
• muscle pain, cramps;
• headache;
• allergies.

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

Retinoids

Retinoids (acitretin, isotretinoin) are vitamin A derivatives that normalize the processes of skin cell division and keratinization.Treatment with such drugs lasts an average of 2 months, the dose is selected individually.There is also a certain risk of unwanted reactions when using retinoids:

• drying of mucous membranes;
• peeling of the skin;
• fungal vulvovaginitis;
• hair loss, thinning, brittle nails;
• muscle and joint pain;
• hepatitis, jaundice;
• nausea, stool disorders.

Despite the possible side effects, these drugs are safer than previous options, especially considering that these complications are reversible and disappear after a while after stopping the drug.Retinoids are not prescribed simultaneously 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 are able to suppress autoimmune processes and reduce inflammation.These drugs are administered subcutaneously or intravenously up to once a week.Their negative effect on the body is primarily related to the suppression of the immune response:

• addition of infection of any localization;
• benign and malignant tumors;
• allergic manifestations;
• headache, dizziness;
• depression;
• nausea, vomiting;
• joint and muscle pain.

It is possible to use drugs belonging to this category in combination with methotrexate.

Systemic glucocorticoids

Systemic glucocorticoids (prednisolone, dexamethasone) are used exclusively for the treatment of psoriatic arthritis and acute generalized forms of the disease in injections and droppers.But even in these cases, hormone therapy should not be long due to the risk of aggravating the process and the development of pustular forms.

Additional medication

This group includes medicines necessary for the correction of simultaneous conditions that aggravate the course of psoriasis, as well as for the treatment of joint forms of the disease.

1. Psychotropic drugs are used due to the high frequency of psoriasis exacerbations against the background of an unstable nervous state.In particular, antidepressants (amitriptyline, fluoxetine, venlafaxine) and anti-anxiety drugs - sedatives (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 conditions.This group of drugs suppresses anxiety, agitation, tendency to stress factors and normalizes sleep.However, it should be borne in mind that the drugs also have their own contraindications and side effects, which do not always allow simultaneous use with the main therapy of psoriasis.
2. Non-steroidal 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, 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 possible time.
3. Antihistamines are sometimes used to reduce itchy skin.Prescribed drugs of the first (Tavegil, Suprastin), second (Fenistil, Claritin) or third (Zyrtec, Erius) generation.The effectiveness of these drugs is largely comparable, however, the third-generation drugs do not have the common side effects of antihistamines, such as increased drowsiness.

Psoriasis physiotherapy

Ultraviolet radiation (UVR) means exposure to radiation with a wavelength of 311-313 nm on the whole body or some parts of it.This technique cannot be used for severe generalized forms and summer versions of psoriasis, as it can only aggravate the process.

Selective light therapy (PUVA therapy) is a type of ultraviolet radiation, but in this case the wavelength used is 310-340 nm.This option of physiotherapy, if used regularly, makes it possible 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, for which a moisturizing cream should be used.PUVA therapy has several contraindications, such as renal failure, diabetes mellitus, and skin tumors.

X-ray therapy involves treating the skin with soft X-rays, which effectively help to fight itching and the formation of new plaques.

During ultrasound treatment, the skin is exposed to ultrasound waves, which have anti-inflammatory, antibacterial, pain-relieving and anti-itching effects.One procedure lasts 15 minutes, does not cause discomfort and is well tolerated.A total of 14 procedures are recommended.

Electrosleep indirectly affects the course of psoriasis, improving the patient's mental state.This manipulation has 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 is proven by numerous studies.Various stress, anxiety, fears and experiences often cause psoriasis to appear or worsen in people with a genetic predisposition.Therefore, psychotherapy is important in preventing exacerbations and generally reducing the frequency of relapses.

During the session, the specialist talks to the patient, asks guiding questions and tries to uncover the cause of psychological problems.The purpose of further sessions is to stabilize the patient's emotional state.A psychotherapist can teach you how to cope 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 suffering from psoriasis are recommended to:

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

Alternative methods to combat psoriasis

1. Cryotherapy is the effect of ultra-low temperature on the body, which can be local or general.The mechanism for improving the condition of psoriasis is the body's short-term stress reaction to cold.The background of this is the rapid narrowing and then expansion of blood vessels, which leads to increased blood flow and reduced inflammation.In addition, low temperature sharply slows down the speed of nerve impulses and prevents the formation of new lesions.General cryotherapy is carried out using a special cryochamber, in which a person can stay for no more than 3 minutes.The temperature inside is set between -110 and -130°C.The entire course cannot exceed 30 procedures.Local cryotherapy is performed by exposing skin areas with plaques in psoriasis to liquid nitrogen vapor (temperature -140 to -160°C).During the research, it was found that after a procedure, the psoriatic papules become pale, their size decreases, and the peeling and itching disappear.
2. Hydrotherapy is widely used in thermal water sanatoriums.Garra rufa fish living in such water eat coarse particles and scales from the surface of the skin, leaving healthy areas intact.
3. Plasmapheresis is a rather complex process that involves removing blood from the patient's body, cleaning it of toxins, immune complexes, microorganisms, and returning it to the general bloodstream.A special centrifuge is used to clean the blood.The positive effect of plasmapheresis in psoriasis involves the removal of immune complexes supporting the autoimmune reaction, decomposition products resulting from chronic inflammation, and, in case of secondary infection, microorganisms and their toxins from the bloodstream.
4. Mud therapy is an effective tool for improving the health of patients with psoriasis.Due to its significant mineral salt content, the medicinal mud suppresses inflammatory processes, promotes tissue regeneration, and softens rough areas of the skin.Mud therapy allows you to achieve better results in the treatment of psoriatic arthritis.Before applying to the skin, the mud is heated to 39°C, then applied in a thin layer to the areas covered with plaques and left to stand for 30 minutes.At the end of the procedure, the dirt is washed off with warm water and the skin is smeared with an emollient cream.

Traditional medicinal recipes for psoriasis

Folk remedies for the treatment of psoriasis can be divided into two groups: oral preparations and external remedies.The first category includes:

• Tincture of celandine.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 boiled for 10-14 days.Then the tincture is filtered and 20 g should be taken three 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 add 1 tbsp.l.3 times a day for 1 month.
• Dill seeds.2 tbsp.l.pour seeds with 1 glass of boiling water, leave for approx.boil for three hours, filter, drink ½ glass twice a day.
• Linseed.1 tablespoon.l.seeds, pour a glass of boiling water, mix, leave overnight, take in the morning, before breakfast.

Traditional external medicine for the treatment of psoriasis:

• Fish oil.Apply a thin layer on the papules and leave it on for half an hour, then rinse 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 plaques three times a day.
• Propolis-tar ointment.Heat 30 g of propolis and 50 g of tar in a water bath and mix.Apply it up to 4 times a day on rashes caused by psoriasis.

It should be kept in mind that regardless of what alternative methods and folk methods are used in the treatment of psoriasis, they cannot replace the main, traditional therapy.All medicines used to treat psoriasis must be strictly prescribed by a doctor.Under no circumstances should you self-medicate or change the dose and regimen of the medicine at will.