Treatment methods for different 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 affects 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 widespread prevalence of the disease, not all patients understand what psoriasis is, what are its causes and how to treat it.Let's deal with 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 related to the production of protective antibodies against the cells of the organism itself, which are mistakenly perceived by it as foreign.Scientists have long established the link between the disease and the activation of the immune system, but what exactly causes a failure to recognize one's own cells is still not reliably understood.

A genetic predisposition to psoriasis has been proven: if both parents are sick, then 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 infection 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:

• diabetes mellitus type 2;
• 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 appear as reddened areas raised above its surface (so-called papules) with superficial scaling.Because of it, 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 will increase, which looks like a drop of frozen stearin.After complete removal of the scales, a shiny, moist end plate is revealed, on which, upon 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 released in the inflamed area, which moistens the scales, turning them into hard-to-remove crusts.
3. Seborrheic psoriasis is typical for areas of the skin with a large number of sebaceous glands: nasolabial folds, scalp, area between the shoulder blades and chest.In this variant, very itchy plaques with yellowish scales are formed.
4. The droplet form usually occurs in children and appears as multiple small red papules with slight peeling.
5. Pustular psoriasis is a superficial pustule, usually localized on the palms and soles.
6. Generalized forms: psoriatic erythroderma, manifested by extensive confluent foci that cover 90% of the body surface, and Tsumbusch psoriasis, accompanied by suppuration of extensive foci.In general forms of the disease, the general well-being also suffers: weakness, malaise appear, and the body temperature rises.
7. Psoriatic arthritis is manifested by redness and swelling of the skin over the joints, pain, limited movement in the joints, their deformation and stiffness of movements after sleep.
8. Psoriatic onychodystrophy is a lesion of the nails.The symptom "greasy spot" (yellowish-brown spots under the nail plate) and the "thimble symptom" (point damage to the nail) are characteristic.

How is psoriasis treated?

Psoriasis treatment methods 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:

• reducing the frequency of exacerbations;
• alleviation of the symptoms of the disease;
• improving the 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 worsening the general condition of the patient (especially erythroderma and pustular psoriasis);
• the presence of complications and concomitant pathologies that worsen the patient's condition;
• the need to use drugs that require regular monitoring of clinical and laboratory indicators.

In the treatment of psoriasis, both 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 drugs are very effective, as proven by many studies.They can be used both separately (for local forms) and in combination with other means.

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 developing systemic (general) effects with long-term use and large areas of exposure.Here are the rules for using these drugs:

• Use only in the shortest possible courses.
• If infection occurs, preference should be given to glucocorticoids combined with an antibiotic or antifungal agent.
• Children should not have hormones applied 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 1 month.With prolonged use, side effects may occur:

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

The skin of the face and groin most often suffer from complications.

Salicylic acid

It is used in combination with topical glucocorticosteroids for significant peeling 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 because it reduces inflammation and excessive skin cell division.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 skin with them.It can be used together with glucocorticoid hormones.

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

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

You cannot simultaneously use drugs based on salicylic acid and vitamin D analogues externally - this will lead to the inactivation of the latter and significantly reduce the effectiveness of the 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 relapses.The mechanism of action is antibacterial, antifungal activity and delay of cell division.Medicines can cause allergies, dryness and irritation of the skin with repeated use.Therefore, the course of treatment should not last more than 1.5 months.

Systemic therapy

This treatment option includes the use of drugs in the form of tablets or injections;they affect not only the covering tissues, but also the internal organs.Systemic treatment is used in moderate to severe psoriasis.

Methotrexate

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

Methotrexate doses are selected individually, taken once or several times a week.After the exacerbation subsides, the drug continues to be taken in the minimum effective dose.The drug often causes side effects, so this treatment requires constant medical supervision.Possible side effects:

• decrease 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 germ cell formation processes;
• decreased libido;
• joint and muscle pain;
• non-infectious pneumonia;
• allergic reactions.

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

Cyclosporine

A drug that suppresses the function of the immune system.Considering the autoimmune nature of psoriasis, such therapy is justified, but the 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 doses, which are then increased until the desired result is achieved.

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 supervision, regular blood tests and other necessary tests.

Retinoids

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

• drying of 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 the previous options, especially considering that all these complications are reversible and disappear some time 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 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 related to suppressing the immune response:

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

The use of drugs of 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 deterioration of the process and development of pustular forms.

Additional drug treatment

This group includes drugs necessary to correct concomitant conditions that worsen the course of psoriasis and to treat 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 anti-anxiety drugs - tranquilizers (diazepam, phenazepam, buspirone) are prescribed.Antidepressants are usually prescribed for long-term depression and stress and are taken for long courses.Tranquilizers can be taken once, on demand, depending on the external circumstances.This group of drugs suppresses anxiety, agitation, sensitivity to stressors and normalizes sleep.However, it should be borne in mind that drugs also have their contraindications for use and side effects, which do not always allow them to be taken simultaneously with the main therapy for 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 (formation of ulcers), these drugs are prescribed for the shortest possible course.
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, but third-generation drugs do not have such a common side effect of antihistamines as increased drowsiness.

Physiotherapy for psoriasis

Ultraviolet radiation (UVR) is exposure to radiation with a wavelength of 311-313 nm on the whole body or on individual parts of it.This technique is not applicable for severe generalized forms of psoriasis and its summer varieties, as it can only worsen 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 total recommended 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 kidney failure, diabetes mellitus, and skin tumors.

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

Ultrasound treatment involves exposure of the skin to ultrasound waves, which have anti-inflammatory, antibacterial, analgesic and anti-itching 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.One 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 types of stress, anxiety, 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 relapse rates.

During the session, the specialist talks to the patient, asks guiding questions and tries to find out the cause of the psychological problems.Further sessions are aimed at stabilizing 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 in psoriasis

Psoriasis patients are recommended:

• Drink more fluids: 7-10 glasses of still water or freshly squeezed juices per day.
• Eat more fruits and vegetables: grapes, nectarines, cherries, pineapples;beets, carrots, cucumbers, cabbage, garlic, onions, fennel, 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 overdo it with citrus fruits, tomatoes, red peppers, strawberries, honey.
• Avoid chocolate and high-fat whole milk.
• Do not drink alcohol, caffeine, spicy, salty, smoked foods.

Alternative methods to fight 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 in psoriasis is the body's short-term stress reaction to cold.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.In addition, low temperatures sharply slow down the speed of nerve impulses and prevent the formation of new lesions.General cryotherapy is performed using a special cryochamber, in which a person can stay for no more than 3 minutes.The temperature in it is set in the range -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 vapors of liquid nitrogen (temperature -140 – -160°C).In the course of the research, it was found that after a course of procedures, psoriatic papules fade, decrease in size, peeling and itching disappear.
2. Hydrotherapy is widely used in sanatoriums with thermal waters.Garra rufa fish that live in such water eat coarse particles and scales from the surface of the skin, leaving healthy areas untouched.
3. Plasmapheresis is a rather 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, breakdown products formed as a result of chronic inflammation, as well as microorganisms and their toxins when secondary infection occurs.
4. Mud therapy is an effective means of improving the health of patients with psoriasis.Thanks to the significant content of mineral salts, the healing mud suppresses the inflammatory process, promotes tissue regeneration and softens rough areas of the skin.Mud treatment 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 a thin layer is applied to 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 smeared with a softening cream.

Recipes of traditional medicine 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:

• Tincture of celandine.The herb of this plant can be found in the pharmacy.2 tbsp.l dried herb is poured with 500 ml of alcohol or vodka and left to brew for 10-14 days.After that, the tincture is filtered and taken 20 g 3 times a day.
• Bay leaf decoction.Put 15 bay leaves in 1 liter of boiling water and let it boil for about a quarter of an hour.Then strain, cool and drink 1 tbsp.l. 3 times a day for 1 month.
• Fennel seeds.2 tbsp.l. seeds, pour 1 cup of boiling water, let it brew for about three hours, filter, drink ½ cup 2 times a day.
• Linseed.1 tbsp.l seeds, pour a glass of boiling water, stir, leave overnight, take in the morning, before breakfast.

External traditional medicine for the treatment of psoriasis:

• Fish oil.Apply a thin layer on 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.l sea buckthorn or sesame oil and 40 g of vinegar.Lubricate plaques 3 times a day.
• Propolis-tar ointment.30 g of propolis and 50 g of tar are heated in a water bath and mixed.Apply to psoriatic rashes up to 4 times a day.

It should be borne in mind that no matter what alternative methods and folk methods you use in the treatment of psoriasis, they should not replace the main, traditional therapy.All medicines 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 at will.