Psoriasis is an autoimmune disease with an unfavorable combination of genesis factors with a current course, various phenotypes, clinical varieties and possible detection of different diseases.According to the literature, the prevalence of the psoriasis of the world is 4-7%.
According to K. Reich, mild forms of diseases that affect less than 3-5% of body bodies and do not give significant changes in the patient's immune status, only local treatment require.The psoriasis of a moderate and difficult course is a systemic, inflammatory process, which leads to the development of simultaneous pathologies or exacerbate them, and themselves have a huge impact on the health and quality of life of the patient.
The problem of treating psoriasis does not lose relevance and, despite the appearance of new modern treatment methods, remains a difficult task that requires a personified approach.
For the treatment of psoriasis, there is a wide selection of local and systemic drugs, most modeling the immune system.When choosing personified therapy, prevalence and severity of psoriasis, process phase, its clinical form, as well as the attitude towards the patient's disease are only taken into account.So, with the localization of rashes in open skin surfaces - face, hairy part of the head and brush, the disease has a significant impact on the quality of life and causes severe psycho -emotional experiences.According to Mr. Krueger et al.(2001), 40% of patients with psoriasis were disappointed inefficiently caused by treatment, and 32% were considered to be insufficient.
Psoriasis system therapy
System glucocorticoids in the form of tablets are extremely rare in connection with the numerous side effects.However, as well as the drug "ambulance" to stabilize the psoracy process with a progressive phase, erythroderma is recommended to use extended system glucocorticoids for intramuscular application in the form of short courses.A similar approach to therapy avoids harmful side effects.
More than 40 years in the treatment of psoriasis, methotrexate is used.The mechanism of his action is associated with the inhibition of dihydrofolaterasse, which converts acid dihydrofolić in Tetrahydrofolic and the donor is simple carbon groups in the empty nucleotide and timidery required for DNA synthesis.In this regard, simultaneous purposes of folic acid helps avoid metabolic anemia.
Ciklonis, cyclic polypeptide, isolated from the Tolpocladium inflatum gams, has an immunosuppressive effect by suppressing T cell activities and reduces their antigen sensitivity due to the immune system.The medicine has high efficiency in the treatment of commonly slowly liquid psoriasis, psorian erythroderma.
Since 1997. year, the aromatic retinoids of the second generation were used to treat refractory forms of psoriasis, and the basis of the chemical formula is acitiretin.The drug inhibits the expansion of epidermis cells, normalizes the process of keratization, has an immunomodulating effect.The efficiency of the product depends on the dose: higher dose lead to faster psoriotic rash resolution.
Relatively recently recently emerged a new group of drugs - biological medicines, which include recombinant protein substances, synthesized by biotechnological live cells, plants and microorganisms.Indications for the prescribing of biological medicines are serious forms of psoriasis resistant to other system medicines.
Persorative and heavy forms of psoriasis (more than 10% of the body area) takes into account taking into account the patient has several chronic diseases such as metabolic syndrome, cardiovascular diseases and lipids.According to statistical studies, such conditions for psoriasis was observed more often than in the general population.Thus, in the treatment of psoriasis, it is necessary to take into account the risk of the side effects of current system therapies, ie the conditions in which the patient has several chronic diseases that are individually discovered in each patient.Indeed, some pharmacological medications can negatively affect cardiovascular and metabolic simultaneous diseases.The link between psoriasis and heart metabolism disorders has important clinical consequences.First, the system therapy of psoriasis can negatively affect metabolic simultaneous diseases, especially in the event of a continuous and extended treatment.In particular, methotrexate should be able to be caution in obesity, diabetes mellitus, not alcoholic fatty liver disease due to increasing the risk of liver fibrosis.Cyclosporin 'or may cause the appearance or worsen course of arterial hypertension, improve insulin resistance and influence fatty acid metabolism, has toxic effect.
Acitrotin also promotes hypertriglyceridemia and / or hyperholesterolemia.Thus, when carrying out patients with psoriasis, all data should be taken into account.
A special place in the treatment of psoriasis is given phototherapy.The positive effect of ultraviolet radiation on the skin is associated with the selective immunity T-cell inhibition.According to the literature, the following areas of phototherapy were emphasized: anti-inflammatory, artificial inhibition of immunity and anti -Unification.The effect of ultraviolet air on immunity is associated with the depth of the penetration.UFB Rays affect epidermine keratinocytes and Langergan cells, UFA rays penetrate deeper layers of skin and have an impact on dermal fibroblasts, dendritite cells and cell immune systems.The positive effect of ultraviolet radiation is due to apoptosis T cell, reducing the number of Langergenis cells, changes in cytokines, growth factors (egf, vegf), adhesion and neuropeptide molecules.The purpose of phototherapy is recommended for a common skin process.
In the treatment of psoriasis, photochemotherapy is used (bullet-therapy) - the combined use of long wave ultraviolet airs (UFA) (320-400 Nm) and photosenses (8-methoxysralen).Puva-Therapija is one of the most efficient methods for treatment of psoriasis, its prescription is recommended with the usual vulgar and ex-folding psoriasis, stubborn course of illness, severe infiltration.The treatment is performed according to the methodology of 3 or 4 stands on average, on average is the course 20-30 proceedings.
Currently, selective phototherapy, a combination of wave radiation (280-320 nm) lost its position and prescribed less and less to treat psoriasis.The indication for its purpose is psoriasis, characterized by formations with low stations inflammatory content.
The narrow strip of UFB therapy with the high-therapeutic efficiency emissions in a wavelength of 311 NM in high therapy efficiency is compared with the bullet therapy, but unlike it does not require the use of the photo.It is carried out according to the methodology from radiation 3-5 racks per week with a course 20-30 procedures.
For the treatment of limited vulgar psoriasis in the stationary phase, highly efficient therapeutic technique is an eximmar laser, which allows a high-intensity of high-intensity wavelength of 308 Nm only on the affected skin surface.
Local therapy
A fairly large selection of local products for the treatment of psoriasis includes, especially traditional fat containing tar, naphthalan, ichthyol and salicylic acid.
When choosing the Theme Therapy, an individual approach is an important approach on which it will depend on the harmonization of the patient with psoriasis.Thus, due to the cosmetic impossibility of treatment, 40% of patients are not in accordance with the destination.
The efficiency of current corticosteroid medicines in the treatment of psoriasis is based on their expressed effects on the modulation of immunity and reduce tissue inflammation.The action is associated with the mechanism of the hormone and receptor complex, which penetrates the core of the target cell and increases the expression of the gene encodes the peptide synthesis that are inhibiting phospholipase activity.This mechanism leads to a reduction in the formation of inflammatory mediators from phospholipids.Fat and molticosteroid fats and creams with salicylic acid are especially preferred.Local corticosteroid preparations are not presented for extended continuous treatment and suggest combinations and rotational schemes, as extended use can lead to the development of side effects, such as skin atrophy, telagiectasis, steroid acne and anti-adrenal functions.
Synthetic vitamin D3 analogues have established a good as a highly efficient agent against psoriasis.The most famous of this group are Kaccipotriol.The principle of drug action is based on the effect of softening keratinized skin with vitamin D3: it inhibits the spread of keratinocytes and models skin differentiation, and also has immunomodulating effect, especially by reducing the expressions of IL-2 and the information.Calcipotriol has a cumulative effect, and thus the therapeutic effect is noticed after 1-2 weeks.From the beginning of the treatment.
Unlike local steroids, the long-term use of this group of medicines is possible.In order to achieve maximum therapeutic effect, a combined purpose of calcipotrioli and local steroids is possible.
The action of local Kalnikhin inhibitors (takrolimus and pimecrolimus) is associated with blocking the transduction of the signal of T-lymphocytes inhibit Kalnicaurin.The most obvious is prescribed by this group of drugs in the event of a localization of the rash on the face, because they do not have such side effects as current steroids.
The value of use of mitigation, in the treatment of psoriasis, is not alleviated: they soften the skin, reduce peeling and dryness, improve its hydration, especially after ultraviolet exposure;contribute to reducing itching.The biggest effect is achieved when registering on damp skin after contact with water (bath, shower).The use of facilitating agents in complex therapy of psoriasis reduces the overall treatment costs as a result of the stabilization of diseases and the beginning of remission in shorter periods, which helps to reduce patient's stay in the hospital.
Therefore, the problem of psoriasis is retaining its relevance and remains a comprehensive task, whose vaccine, whose personified approach to therapy, will depend on the harmonization of psoriasis and perspective conductive patients, taking into account coordination.