Psoriasis is an autoimmune disease with adverse factors and adverse combinations of recurrence, multiple phenotypes, clinical varieties, and various possible detections that may simultaneously suffer from chronic diseases.According to the literature, the prevalence of psoriasis in the world is 4-7%.
According to Reich (K. Psoriasis with moderate and severe courses is a systematic, inflammatory process that leads to or worsens the pathological development and themselves have a huge impact on the patient's health and quality of life.
Treating psoriasis problems does not lose their relevance, and despite new modern treatments, it is a difficult task that requires a personalized approach.
To treat psoriasis, there are a variety of topical and systemic drug options, most of which model the immune system.When choosing personalized treatment, the prevalence and severity of psoriasis, the stage of the process, its clinical form, and attitude towards the patient's disease.Therefore, as the rash is positioned in open areas of the skin – the furry part of the face, head and brush, the disease has a significant impact on the quality of life and causes a serious psychological and emotional experience.According to the study of G. Krueger et al.(2001), 40% of patients with psoriasis were disappointed with the ineffectiveness of the treatment, while 32% believed that the treatment was insufficient.
Systematic treatment of psoriasis
Systemic glucocorticoids in tablet form are extremely rare in many side effects.However, since the drug “ambulance” stabilizes the psoriasis process at a gradual stage, it is recommended to use prolonged systemic glucocorticoids in the form of short courses for intramuscular administration.Similar treatments avoid adverse side effects.
For more than 40 years of treatment of psoriasis, methotrexate was used.The mechanism of its action is related to inhibiting the inhibition of dihydroproteinase, which converts acidic dihydrolipids into tetrahydrolipids and is a donor of simple carbon groups, a methyl acid group necessary for the synthesis of DNA necessary for the synthesis of purine nucleotides and thymic pyridyls.In this regard, folic acid is meanwhile aimed at helping to avoid metabolic anemia.
Cyclosporin is an A-circulating polypeptide isolated from fungal methylmalonyl magnetic GAMS, which has immunosuppressive effects by inhibiting the activity of T cells and reducing their antigen sensitivity due to the immune system.This drug is highly effective in treating common flow psoriasis and psoriatic red skin.
Since 1997, the second generation of aromatic retinotypes has been used to treat the refractory form of psoriasis, which is based on cinitiretin.This drug inhibits the proliferation of epidermal cells, normalizes the keratinization process, and has an immune regulation effect.The effectiveness of the product depends on the dose: higher doses lead to faster resolution of psoriasis rashes.
Compared with recent, a new set of drugs - biopharmaceuticals, which include recombinant protein substances, are synthesized by living cell biotechnology of animals, plants and microorganisms.The indication for biopharmaceutical prescription is a serious form of psoriasis that is resistant to other systemic drugs.
Moderate and severe forms of psoriasis (more than 10% of the body surface) are treated, given that the patient suffers from a variety of chronic diseases such as metabolic syndrome, cardiovascular disease, diabetes, diabetes, non-alcoholic fatty liver liver and lipid metabolism.According to statistical studies, this condition of psoriasis is observed more frequently than the general population.Therefore, it is necessary to take into account the risk of side effects of ongoing systemic therapy, respectively, of patients suffering from a variety of chronic diseases that are detected individually in each patient.In fact, certain medications can negatively affect cardiovascular and metabolic accompanying disease.The link between psoriasis and cardiac metabolic disease has important clinical consequences.First, systemic therapy of psoriasis can have a negative impact on metabolic concomitant disease, especially in the case of continuous and prolonged treatment.In particular, methotrexate should be prescribed with caution in the case of obesity, diabetes, and not alcohol fatty liver disease, which is due to an increased risk of liver fibrosis.Cyclosporin, which may cause or aggravate arterial hypertension, enhances insulin resistance and affects the metabolism of fatty acids, has a toxic effect.
Anti-nucleic acids can also promote hypertriglyceridemia and/or hypercholesterolemia.Therefore, it is necessary to consider all data when performing psoriasis patients.
Phototherapy was obtained in a special location in psoriasis treatment.The positive effect of ultraviolet radiation on the skin is related to the selective inhibition of immune T cells.According to the literature, the following areas of phototherapy effects were identified: anti-inflammatory, artificial inhibition of immunity and anti-proteinase.The effect of ultraviolet rays on immunity is related to the depth of penetration.UFB rays affect epidermal keratinocytes and Langergan cells, and UFA rays penetrate deep layers of the skin and have an effect on skin fibroblasts, dendritic cells and cells of the immune system.The positive effects of UV radiation are due to apoptosis of T cells, a decrease in the number of Lange gene cells, changes in cytokines, growth factors (EGF, VEGF), adhesion and changes in neuropeptide molecules.For common skin processes, the purpose of phototherapy is recommended.
In the treatment of psoriasis, photochemotherapy (bullet therapy) - long-wave ultraviolet (UFA) (320-400 nm) and photosensitizer (8-methoxy molarone).Puva-therapy is one of the most effective ways to treat psoriasis, and its prescription recommends the use of common vulgar and exudate psoriasis, a stubborn process of the disease, severe infiltration.Treatment is performed according to an average weekly 3 or 4 radiation method, and the course is 20-30 procedures.
Currently, the combination of selective phototherapy, wave radiation (280-320 nm) has lost its position and is being prescribed less and less in the treatment of psoriasis.The indication of its purpose is psoriasis, characterized by the formation of inflammatory cells with a lower content.
The narrow lane UFB treatment has a peak emission at a wavelength of 311 nm with high treatment efficiency, but unlike the need for photosensitizers.It is conducted according to the weekly 3-5 irradiation method, with a course of 20-30 programs.
To treat limited fixed-stage vulgar psoriasis, the efficient treatment technique is an external laser that allows only 308 nm of high intensity monochromatic light to be transmitted to affected skin.
Local therapy
A considerable choice of topical products used to treat psoriasis includes traditional ointments containing tar, naphthalene, icylos and salicylic acid.
When choosing a topical therapy, a separate approach is important and the patient's adherence to psoriasis will depend on.Therefore, 40% of patients do not meet the destination due to cosmetics that cannot be treated.
The effectiveness of topical corticosteroid drugs in psoriasis treatment is based on their significant effects on immune regulation and reduced tissue inflammation.This action is related to the mechanism of hormone and receptor complexes that penetrate the core of the target cell and increase the expression of genes encoding peptide synthesis that inhibits phospholipase activity.This mechanism leads to a decrease in the formation of phospholipid inflammatory mediators.Especially preferred corticosteroid ointments and creams with salicylic acid are preferred.Preparations of topical corticosteroids do not show prolonged continuous treatment and suggest combination and rotational regimens, as prolonged use can lead to the development of side effects such as skin atrophy, hypertrophy, thymus hormones, steroids, steroids, and compression of adrenal function.
Synthetic analogs of vitamin D3 have established efficient means of psoriasis.The most famous of this group is calcitriol.The principle of action of this drug is based on the keratinized skin softening effect of vitamin D3: it inhibits the proliferation of keratinocytes and model skin differentiation, and also has an immune regulatory effect, especially reducing the expression of IL-2 and information.Calcitriol has an accumulation effect, so a therapeutic effect was observed after 1-2 weeks.Start with treatment.
Unlike topical steroids, this group of drugs can be used for a long time.In order to achieve the maximum therapeutic effect, the comprehensive purpose of calcitriol and topical steroids can be achieved.
The role of local calmodulin inhibitors (takrolimus and pimecrolimus) is associated with signal transduction of T-lymphocytes by inhibiting calmodulin signal transduction.It is recommended to prescribe this group of medications in the case of facial rash localization because they do not have side effects such as topical steroids.
The value of using relieving agents in psoriasis treatment is undoubtedly: they soften the skin, reduce peeling and drying, enhance their hydration, especially after UV exposure; help reduce itching.After contact with water, when applied to wet skin, the maximum effect can be achieved (bathtub, shower).The use of remission agents in complex therapies for psoriasis can reduce the total cost of treatment due to disease stability and reduce remission in a shorter time, which helps reduce patient stays in the hospital.
Therefore, the problem of treating psoriasis retains its relevance and remains a comprehensive task, primarily targeting personalized treatments, while taking into account coordinates, patients will rely on psoriasis and prospective guidance patients’ adherence to psoriasis.