Treatment methods for various 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 is detected in 125 million people worldwide.

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

Briefly about the essentials

Psoriasis is a chronic inflammatory disease of an autoimmune nature, characterized by the formation of specific “plaques” on the skin.The autoimmune mechanism is associated with the production of protective antibodies against cells of the body itself, which are mistakenly perceived as foreign.Scientists have long established the connection between the disease and the activation of the immune system, but the exact cause of a failure in recognizing one's own cells has not yet been reliably clarified.

A genetic predisposition to psoriasis has been proven: if both parents are sick, the child has a 50% chance of also being affected by psoriasis.Certain genes responsible for its development have even been identified.In addition, the influence of hormonal disorders, nervous tension, metabolic disorders and viral infections on the manifestation of psoriatic lesions of the body has been established.

Psoriasis in many cases is associated with diseases of other organs and systems:

• diabetes mellitus type 2;
• metabolic syndrome;
• liver and bile duct pathology;
• coronary heart disease;
• high blood pressure.

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 look like reddened areas raised above its surface (called papules) with superficial peeling.Thanks to this, white scales appear, hence the second name of psoriasis – scaly lichen.If you scratch such an area, you can observe the “stearin stain phenomenon”: the number of flakes will increase, which resembles a drop of frozen stearin.After the scales are completely removed, a shiny wet end plate is exposed, on which, upon further scratching, small individual droplets of blood will appear.These papules are generally located on the scalp, on the extensor surfaces of the joints.
2. Exudative psoriasis: an inflammatory fluid is secreted in the inflamed area, which wets the scales and turns them into scabs that are difficult to remove.
3. Seborrheic psoriasis is typical for areas of the skin with a large number of sebaceous glands: the nasolabial folds, the scalp, the area between the shoulder blades and on the chest.In this variant, very itchy plaques with yellowish scales form.
4. The teardrop shape is usually found in children and appears as multiple small red papules with slight scaling.
5. Pustular psoriasis is a superficial pustule, usually located on the palms and soles of the feet.
6. Generalized forms: psoriatic erythroderma, manifested by large confluent foci covering 90% of the body surface, and Tsumbusch psoriasis, accompanied by suppuration of extensive foci.In common forms of the disease, general well-being also suffers: weakness, discomfort appear and body temperature increases.
7. Psoriatic arthritis is manifested by redness and swelling of the skin in the joints, pain, limitation of joint movements, their deformation and stiffness of movements after sleep.
8. Psoriatic onychodystrophy is a lesion of the nails.The characteristics are the “oil stain symptom” (yellowish-brown spots under the nail plate) and the “thimble symptom” (point damage to the nail).

How is psoriasis treated?

Methods for treating psoriasis are constantly being improved and supplemented, but there is no drug that can defeat the disease forever.Therefore, the main treatment strategies for psoriasis aim to:

• reduction in the frequency of exacerbations;
• relief of disease symptoms;
• improve quality of life;
• reduce the risk of complications and concomitant diseases.

Treatment is generally carried out on an outpatient basis, but certain pathologies may require hospitalization:

• severe generalized variants of psoriasis, worsening the patient's general condition (notably erythroderma and pustular psoriasis);
• the presence of complications and concomitant pathologies worsening the patient's condition;
• the need to use drugs that require regular monitoring of clinical and laboratory parameters.

In the treatment of psoriasis, 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 numerous studies.They can be used either separately (for local forms) or in combination with other means.

This group includes flucinar, hydrocortisone, elocom, prednisolone, advantan, acriderm.Topical glucocorticosteroids are available in the form of creams, ointments and lotions.

The disadvantage of these drugs is the risk of developing systemic (general) effects with prolonged use and large areas of exposure.Here are the rules for using these medications:

• Use only in the shortest possible routes.
• When an infection occurs, glucocorticoids combined with an antibiotic or antifungal should be preferred.
• Children should not apply hormones to the face, neck, or skin folds.
• It is better to start treating children with weak or moderately active drugs (prednisolone, hydrocortisone).

Typically, hormonal agents are applied to psoriatic papules 1-2 times a day for no more than 1 month.With their long-term use, undesirable effects may occur:

• burning, redness, and itching;
• the appearance of acne;
• local infection;
• thinning, dryness of the skin;
• reduction of pigmentation;
• streaks.

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

Salicylic acid

Used in combination with local glucocorticoids for significant desquamation 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 local 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 it.May be used in conjunction with glucocorticoid hormones.

Adverse effects linked to local application of vitamin D3 are rare and mainly result in burning, redness and itching of the skin.In this case, I either interrupt the treatment or use the ointment less often.In case of overdose, systemic manifestations of hypervitaminosis D are possible: decrease in bone density and formation of kidney stones.

Medicines in 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 treatment.

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 its relapses.The mechanism of action is antibacterial, antifungal activity and slowing of cell division.Medications can cause allergies, dryness and irritation of the skin with repeated use.Therefore, treatment should not last more than 1.5 months.

Systemic therapy

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

Methotrexate

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

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

• reduction in the number of all blood cells;
• suppression of appetite, 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;
• kidney dysfunction;
• suppression of germ cell formation processes;
• decreased libido;
• pain in joints and muscles;
• non-infectious pneumonia;
• allergic reactions.

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

Cyclosporin

A medicine that suppresses the function of the immune system.Given the autoimmune nature of psoriasis, such treatment is justified, but 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 taking cyclosporine with minimal doses, which are then increased until the desired result is achieved.

Side effects of 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 examinations.

Retinoids

Retinoids (acitretin, isotretinoin) are vitamin A derivatives that have a normalizing effect on the processes of division and keratinization of skin cells.The duration of treatment with such drugs is on average 2 months, the dose is selected individually.When using retinoids, there is also a certain risk of adverse reactions:

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

Despite the possible side effects, these medications are safer than previous options, especially since all of these complications are reversible and disappear some time after stopping the medication.Retinoids are not prescribed concomitantly 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 medications are administered subcutaneously or intravenously no more than once a week.Their negative impact on the body is mainly associated with the suppression of the immune response:

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

The use of drugs from 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, hormonal treatment should not be long due to the risk of aggravation of the process and the development of pustular forms.

Complementary drug treatment

This group includes drugs necessary for the correction of concomitant conditions that aggravate the course of psoriasis and for the treatment of 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 anxiolytics - tranquilizers (diazepam, phenazepam, buspirone) are prescribed.Antidepressants are generally prescribed for prolonged depression and stress and are taken in extended courses.Tranquilizers can be taken only once, on demand, depending on external circumstances.This group of drugs removes anxiety, agitation, susceptibility to stress factors 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 treatment of psoriasis.
2. Nonsteroidal anti-inflammatory drugs are used in the complex treatment of psoriatic arthritis to reduce the inflammatory reaction, swelling and pain.These products are produced in the form of tablets, solutions for injection, gels and ointments for external use.Due to their negative effect on the gastrointestinal tract (ulcer formation), these drugs are prescribed for the shortest possible duration.
3. Antihistamines are used occasionally to reduce itchy skin.Prescribed medications of first (Tavegil, Suprastin), second (Fenistil, Claritin) or third (Zyrtec, Erius) generation.The effectiveness of these drugs is largely comparable, however, third generation drugs do not have such a common side effect as antihistamines, such as increased drowsiness.

Physiotherapy for psoriasis

Ultraviolet irradiation (UVR) involves exposure to radiation with a wavelength of 311-313 nm to the entire body or individual parts of it.This technique is not applicable to severe generalized forms of psoriasis and its summer variant, as it can only aggravate the process.

Selective phototherapy (PUVA therapy) is a type of ultraviolet radiation, but the wavelength used in this case is 310 to 340 nm.This physiotherapy option, when used regularly, helps achieve long-term remission.A session can last up to 2 hours and the total recommended number is 35. After the procedure, dry skin may appear, which will require the use of a moisturizer.PUVA therapy has a number of contraindications, such as renal failure, diabetes mellitus, and skin tumors.

Radiotherapy involves treating the skin with gentle X-rays, which effectively combat itching and the formation of new plaques.

Ultrasound treatment involves exposing the skin to ultrasound waves, which have anti-inflammatory, antibacterial, analgesic and antipruritic 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 progression of psoriasis, thus 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.A session can last up to 1 hour, it is recommended to perform at least 10 interventions.

Psychotherapy

The role of an unstable mental state in the development of psoriasis has been proven by numerous studies.Various stresses, anxiety, fears and experiences often provoke the appearance or exacerbation of psoriasis in people with a genetic predisposition.Therefore, psychotherapy is important to prevent exacerbations and generally reduce the frequency of relapses.

During the session, the specialist chats with the patient, asks leading questions and tries to establish the cause of psychological problems.Other sessions aim 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 toward yourself and the world around you.

Therapeutic nutrition for psoriasis

It is recommended for patients with psoriasis:

• Drink more fluids: 7 to 10 glasses of plain 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 on the body of ultra-low temperatures, which can be local and general.The mechanism for improving the condition of psoriasis is the body's short-term stress response to cold.Against this background, rapid narrowing and subsequent expansion of blood vessels occurs, which leads to increased blood flow and decreased inflammation.In addition, low temperatures significantly slow down the speed of nerve impulses and prevent the formation of new lesions.General cryotherapy is carried out using a special cryogenic chamber in which a person can stay no more than 3 minutes.The temperature is set between -110 and -130°C.The entire course should not exceed 30 procedures.Local cryotherapy is carried out by exposing areas of skin with psoriatic plaques to liquid nitrogen vapors (temperature -140 – -160°C).During the research, it was found that after a course of procedures, psoriatic papules turn pale, decrease in size, peeling and itching disappear.
2. Hydrotherapy is widely used in sanatoriums with thermal waters.The Garra rufa fish that live in these waters eat the rough particles and scales from the surface of the skin, leaving healthy areas intact.
3. Plasmapheresis is a rather complex process that involves taking blood from the patient's body, purifying it from toxins, immune complexes and microorganisms and returning it to the general blood circulation.A special centrifuge is used to purify the blood.The positive effect of plasmapheresis in psoriasis is associated with the elimination from the blood circulation of immune complexes that support the autoimmune reaction, breakdown products formed as a result of chronic inflammation, as well as microorganisms and their toxins in case of secondary infection.
4. Mud therapy is an effective way to improve the health of patients with psoriasis.Due to the significant content of mineral salts, therapeutic mud suppresses the inflammatory process, 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 application to the skin, the mud is heated to 39°C, then spread in a thin layer on the areas covered with plaques and left to sit for 30 minutes.At the end of the procedure, the dirt is washed off with warm water and the skin is lubricated with a softening cream.

Traditional medicine recipes 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:

• Celandine tincture.The herb of this plant can be found in pharmacies.2 tbsp.L.dried grass is poured with 500 ml of alcohol or vodka and left to infuse for 10-14 days.Then 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 boil for about a quarter of an hour.Then filter, let cool and drink 1 tbsp.L.3 times a day for 1 month.
• Dill seeds.2 tbsp.L.seeds, pour 1 glass of boiling water, let it brew for about three hours, filter, drink ½ glass 2 times a day.
• Flax seeds.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 to the papules and leave for half an hour, then rinse with lukewarm water.
• Linseed oil.Apply to affected area up to 6 times daily.
• Egg ointment.Beat 2 chicken eggs, add 1 tbsp.L.sea buckthorn or sesame oil and 40 g of vinegar.Lubricate the plates 3 times a day.
• Propolis and tar ointment.30 g of propolis and 50 g of tar are heated in a water bath and stirred.Apply to psoriatic rashes up to 4 times daily.

It should be borne in mind that whatever alternative methods and traditional methods you use in the treatment of psoriasis, they should not replace the main traditional therapy.All medications 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 medication at will.