All about psoriasis - how to treat, causes and symptoms, types

Treatment program Doctors Prices Reviews For more than two thousand years, humanity has been trying to unravel all the mysteries of this severe dermatosis, but still much remains unknown. According to statistics, this disease affects 4 to 7% of the population; women and men are equally susceptible to it. The first signs of psoriasis usually appear during puberty and accompany a person throughout the rest of his life, sometimes subsiding and disappearing completely, sometimes intensifying.

Is it possible to cure psoriasis?

? Modern medicine has achieved a lot in the treatment of this chronic dermatosis and is able to provide the patient with a decent level of quality of life.

• How dangerous is psoriasis and does it need to be treated?
• Treatment methods for psoriasis Nutrition for psoriasis Pegano diet

Causes of psoriasis

Psoriasis is a chronic skin inflammatory process, which modern medicine classifies as autoimmune (associated with allergies to one’s own tissues). There are many causes of psoriasis and factors predisposing to the development of this dermatosis, and therefore a number of theories of its origin have been put forward.

Autoimmune

This is the main theory, since it is well established that the immune system actively reacts to certain types of skin exposure.
The skin of people suffering from psoriasis is very sensitive to mechanical, physical, and chemical influences. Not only epithelial cells, but also the entire immune system react to such influences. Cellular immunity is disrupted: the relationship between individual subtypes of lymphocytes responsible for the formation of a normal immune response. Thus, with psoriasis, the number of helper T-lymphocytes - assistants that regulate immunity - increases, while at the same time the number of suppressor T-lymphocytes, which suppress an overly strong immune reaction, decreases. Lymphocytes and some other cells produce cytokines - active substances that stimulate the immune response. Humoral immunity also suffers, an imbalance of antibodies (immunoglobulins) develops in the blood serum, and antibodies to the patient’s body tissues appear.

Inflammation begins against the background of activation of T-lymphocytes, but why they are activated has not been established. Research is also underway on how to suppress the autoimmune reaction without harming the patient.

Exchange

Imbalance in metabolism has a significant impact on the skin and immunity. Patients with psoriasis experience an acceleration of metabolism, the appearance of a large number of toxic free radicals and other toxins that support the inflammatory response. Metabolism is disrupted:

• protein
  – the CDSN predisposition gene stimulates the synthesis of the protein corneodesmosin, which sensitizes (allergenic) the body; The content of albumin proteins in the blood decreases and the content of globulins increases; this condition is called dysproteinemia and further enhances sensitization;
• fatty
  – the content of lipids and cholesterol in the blood increases; eating predominantly plant foods and a general reduction in daily caloric intake can reduce the activity of psoriatic inflammation;
• carbohydrate
  – almost always violated;
• exchange of vitamins and minerals
  – the content of vitamin C in the skin increases, the content of vitamins C, A, B6, B12, iron, copper and zinc in the blood decreases.

Infectious

This theory was relevant at the beginning and in the middle of the last century. The causative agents of psoriasis were considered to be certain bacteria (streptococci), fungi and viruses. These theories were not confirmed. But dermatologists note that any acute infectious process or the presence of a permanent source of infection can provoke relapses. The viral theory occupies a special place. Recent studies have revealed the influence of retroviruses (RNA-containing viruses - HIV, etc.) on the genetic apparatus with the formation of genes for psoriatic predisposition.

Genetic

Predisposition to autoimmune reactions is inherited. If someone close to you suffers from psoriasis, then the likelihood of developing this disease increases many times over. There are predisposition genes for psoriasis (local complexes PSORS1 - PSORS9, PSORS1 is especially active, it contains the genes HLA-C, HLA-Cw6, CCHCR1 and CDSN, which are responsible for the development of the disease). Genes influence metabolism, immunity and the development of autoimmune processes. But the presence of such genes does not at all guarantee the development of the disease. The influence of provoking factors is of great importance.

Neurogenic

Prolonged stress, high neuropsychic stress, disorders of the autonomic nervous system (innervating the walls of blood vessels and internal organs) can cause the development of psoriasis, causing an imbalance in the endocrine system, disruption of metabolic and immunological processes.

Endocrine

Endocrine disorders in psoriasis are common and mainly play the role of a provoking factor. A clear connection between them has not been proven. Dermatologists note that patients often exhibit dysfunction of the thyroid gland, adrenal glands, and pituitary gland. There are disturbances of the menstrual cycle in women and sexual function in men.

Etiology and pathogenesis

Among the causes of psoriasis are the following:

• Genetics - the disease is associated with certain human leukocyte antigen (HLA) alleles, the most “strong” of which is HLA-Cw6. Other associated alleles are HLA-B27, HLA-B13, HLA-B17 and HLA-DR7.
• Immunology - The immunological concept of psoriasis is supported by high levels of cutaneous and circulating tumor necrosis factor alpha (TNF-α), as well as the fact that treatment with TNF-α inhibitors often puts patients into remission. In addition, it was noted that after certain immunological events, guttate psoriasis can occur - for example, after streptococcal pharyngitis, cessation of corticosteroid therapy, etc.
• Obesity is an incompletely studied factor. Whether excess weight alone, a genetic predisposition to obesity, or a combination of these factors influences the development of psoriatic plaques is not known. However, it has been noted that with an increase in body weight, the condition of psoriasis worsens, as well as vice versa, with a decrease in weight, the course of the disease improves.
• Stress and the environment - psychological experiences can both provoke the development of psoriasis and aggravate it. Exacerbations of the disease are also caused by injuries, infections (streptococcus, staphylococcus, human immunodeficiency virus), alcohol, and medications (aspirin, beta-blockers). One study documented an increase in the incidence of psoriasis flare-ups in patients with chronic gingivitis. Treatment of gingivitis allowed us to go into remission, but did not affect the disease in the long term, which once again emphasizes the complexity and multifactorial nature of psoriasis treatment methods.

Interestingly, 2.5% of people with HIV develop progressive psoriasis due to decreased CD4 T cell counts. This does not fit into modern understanding of the disease ( Fig. 1 ), since the leading hypothesis states that T cells are hyperactive in psoriasis , and treatment aimed at reducing their number usually reduces the severity of psoriasis. It is possible that a decrease in the number of CD4 T cells in patients with HIV leads to an increase in the activity of CD8 T cells, which causes the progression of psoriasis.

Rice. 1. General understanding of the etiology and pathogenesis of psoriasis, as well as the development of associated conditions (World Health Organization, WHO)

1. The first sector (internal, shaded) is genetics, environmental triggers.
2. The second sector is microinflammation, insulin resistance, obesity.

Two internal sectors include the basic predisposing factors and pathogenetic components of psoriasis. The main clinical sign is inflammation ( Inflammation ).

1. The third sector is myocardial infarction, atherosclerosis, stroke, metabolic syndrome.
2. The fourth sector is depression, anxiety disorders.

The two middle sectors reflect the transition to systemic lesions - from cutaneous psoriasis to psoriatic arthritis ( Psoriasis - Arthritis ) and related problems. Main clinical signs: cardiovascular pathologies ( CVD ), psychiatric complications ( Psychiatry ).

1. The fifth sector is patient stigmatization, increased cost and duration of treatment, and lack of satisfaction with therapy.
2. The sixth sector (outer, with an arrow) - smoking, alcohol abuse, possible secondary obesity, addiction, compliance (level of adherence to treatment)

The two external sectors reflect the consequences of the disease ( Consequences ) and the patient's quality of life ( Qol ), as well as the burden of psoriasis ( BoD ), i.e. deterioration in a person’s quality of life due to illness.

https://apps.who.int

Symptoms of psoriasis

The main symptoms of psoriasis are skin rashes. But there are other signs as well. The very first manifestations usually appear in adolescence or childhood against the background of hormonal disorders, vegetative-vascular dystonia and prolonged stress.

The disease begins with a feeling of constant fatigue and mood disturbances. Characteristic are small, pinkish formations (papules) rising above the surface, powdered with whitish peeling on top. They are surrounded by a brighter, raised rim.

Elements of the rash grow and unite into large plaques of bizarre shapes. The base of the papule is an inflammatory infiltrate. Based on the nature of the rash, psoriasis is divided into:

• point
  – elements no more than 1 mm in diameter;
• teardrop-shaped
  – papules-droplets up to 2 mm in size;
• coin-shaped
  – round papules-coins up to 5 mm in size.

Ulcerative rash

Guttate rash

Coin rash

Characteristic features of the rash:

• stearic stain
  - if scraped, the surface of the papule;
• terminal film
  - having thoroughly cleaned the surface of the papule from scales, we will see a transparent film;
• bloody dew (Auspitz phenomenon)
  - after scraping the film and violating its integrity, we will see small bloody droplets protruding on the surface.

Stages of psoriasis

There are three stages of the disease:

1. progressive
   - the first elements of the rash appear, their number increases, and more and more new areas are captured; rashes also appear when scratching itchy skin or exposing it to some external irritating factors (Koebner phenomenon); in the initial stage of psoriasis, papules begin to merge into large plaques;
2. stationary
   - there are no new elements, and those that appeared earlier do not regress;
3. regressing
   - the rash turns pale and its base becomes less dense; the rash gradually regresses, the process often begins from the central part, so the plaques may have the appearance of rings; if plaques in psoriasis resolve from the periphery to the center, then they simply gradually decrease in size and a white ring forms around them - Voronov’s pseudoatrophic rim; where the rash was, white areas devoid of pigment remain - psoriatic leukoderma.

Occasionally, papules at all three stages of development are present on the skin at the same time. There are also summer and winter forms with a predominance of exacerbations in summer or winter.

Manifestations of psoriasis

At the first stage, the disease manifests itself in the form of a single pink papule. It changes, increases in size, grows above the skin, and becomes covered with white scales. More often, psoriasis plaques appear in places of friction and increased pressure on the skin: buttocks, elbows and knees. As the disease progresses, they can be found absolutely anywhere on the skin, including the scalp.

Main clinically diagnosed external signs:

• Stearic stains, i.e. easy separation of flakes by scraping.
• The terminal film remaining after the scale is removed. It looks like a smooth, shiny, even pink surface.
• Pinpoint bleeding, which can be caused by removing the scale.

Psoriasis develops quite slowly; an increase in the number of plaques and their growth can be observed over several months or years. In a small percentage of patients, the disease may manifest itself more intensely. As a rule, this is preceded by severe mental stress or a serious illness requiring massive drug treatment. In this case, the papules are not pale pink, but bright red, with obvious signs of inflammation, swollen, causing itching.

The second stage of psoriasis is characterized by more extensive lesions. At the site of scratching, new papules appear, forming new plaques. As a result of peripheral growth, new growths merge with existing ones. Plaques affect symmetrical limbs and form similar patterns and lines.

At the third stage, growth slows down, changes concern mainly the structure of the rash. The boundaries between healthy and affected skin become clearer. The plaques acquire a bluish tint and begin to actively peel off. In the absence of therapy, they thicken and sometimes form papillomatous nevi (brown) and warty growths (flesh-colored).

There is another stage - regression of the disease, at which time the symptoms fade away. Peeling goes away, the clarity of the border disappears, the skin normalizes and returns to its original state.

Is psoriasis contagious?

Numerous studies have confirmed that this is not a contagious disease. If infectious pathogens take part in its development, then only through a general effect on metabolism, immunity and the genetic apparatus.

Patients often ask:

• How is psoriasis transmitted?
  Psoriasis is not transmitted from person to person.
• Is psoriasis inherited?
  The answer is again negative, but there is a hereditary predisposition in the form of metabolic characteristics and the functioning of the immune system, which is passed on to close relatives.

Why are neurodermatitis and psoriasis the same thing?

Both diseases are not contagious and there is no danger to people in contact. The severity of both diseases always depends on the psychological situation. Stress, resentment, feelings of loneliness and unfulfillment in life serve as an impetus for exacerbation and progression of the disease, and slow down recovery. Another common feature is that climatic therapy with the sun and sea, physiotherapy, acupuncture, and psychotherapy help very well.

For both pathologies: when a person undergoes treatment under the guidance of an experienced dermatologist and takes the treatment prescribed in the clinic, it is possible to cope with the disease without the use of hormones.
There are proprietary non-hormonal methods that can be completed at the Moscow PsorMak Dermatological Center. Sign up for a consultation by phone or online and start moving towards health. October 25, 2020
Author of the article: dermatologist Mak Vladimir Fedorovich

Types of psoriasis

The nature of the rashes, their location, damage to other organs and systems in this chronic dermatosis can be different. Based on these symptoms, several types of the disease are distinguished.

Simple (vulgar, plaque)

The most common. Its symptoms are papules of a characteristic bright pink color, covered with white scales. Plaque psoriasis is divided into the following forms:

• mild
  – if the lesion covers no more than 3% of the skin; in the progressive phase, the papules increase, but then quickly undergo reverse development;
• moderate severity
  - the rash occupies from 3 to 10%; papules are large, merge into plaques;
• severe
  – the lesion affects more than 10%; The rashes are numerous, merging, forming a wide variety of shapes.

Mild form of psoriasis

Moderate psoriasis

Severe form of psoriasis

Vulgar psoriasis occurs in the form of relapses followed by remissions, but there is also a continuous course.

Elbow psoriasis

This is one of the manifestations of a mild form of plaque inflammation. A distinctive feature of psoriasis on the elbows is the constant presence of one or more “duty” plaques on the extensor side of the elbow joints. If these elements are injured, an exacerbation begins.

Elbow psoriasis

Guttate psoriasis

In the development of guttate psoriasis, bacterial (most often streptococcal) and viral infections are of great importance. Occurs in childhood. Inflammation begins after an infection. Streptococci secrete toxins (antigens - substances foreign to the human body) that bind to tissue proteins. Antibodies are produced to them and autoimmune inflammation develops.

The beginning is acute. Small red tear papules with a flaky surface appear on the skin of the extremities (less commonly the body and face). When injured, small erosions and ulcers form in the area of ​​the rash, increasing the risk of infection.

Onset of development of guttate psoriasis in childhood

Psoriasis quickly takes a subacute and chronic course. Relapses are replaced by remissions, spontaneous recovery or transition to the adult form of the disease is possible.

Palmoplantar psoriasis

It develops in those who do physical labor, is accompanied by severe itching and almost always causes complications on the nails. There are subspecies:

• plaque-fan-shaped
  - with large elements on the palmar and plantar surfaces, covered with white scales merging into fan-shaped plaques; This type of psoriasis is more common on the hands;
• circular
  - ring-shaped flaky elements on the palmar and plantar surfaces;
• callous
  - characterized by the proliferation of rough epithelium with the formation of calluses;

A separate subtype is pustular psoriasis on the palms and soles of Barber. The areas under the thumbs of the extremities become covered with blisters and pustules (with purulent contents), and severe itching appears. The ulcers merge, then dry out, forming crusts. In other places on the body, characteristic psoriatic elements develop. The disease often spreads to the nails.

Psoriasis on the legs is maintained and aggravated by varicose veins, in which case the rash will be mainly in the area of ​​the legs.

Nail psoriasis

Nail damage can be either independent or a complication. Characteristic symptoms:

• small dimples of varying depths appear on the nail plate; similar nail lesions occur with other dermatitis, but with psoriatic lesions they are deeper and slightly painful when pressed;
• spontaneous slow painless separation of the nail (onycholysis);
• subungual hemorrhages on the toenails, especially if the patient wears tight shoes;
• trachyonychia - clouding and irregularities on the nail plate; a depression forms in the middle of the nail and the nail becomes spoon-like (koilonychia).

Acute form of complication of the disease on the nails

Sometimes the periungual fold is affected, with inflammation spreading to other tissues (psoriatic paronychia).

Psoriasis of the scalp

Here the disease occurs independently or as part of a general pathological process. Characterized by weeping and the formation of crusts on part or the entire surface of the head. Hair growth is not affected: psoriasis on the scalp does not impair the function of the hair roots. But wetting creates a threat of infection with subsequent damage to the hair follicles.

Skin lesions on the scalp with psoriasis

It proceeds in waves, then subsiding with the disappearance of the crusts, then exacerbating again and is accompanied by severe itching, often leading patients to neurosis.

Seborrheic psoriasis

Seborrhea is a condition caused by a malfunction of the skin glands that produce sebum. Viscous sebum is produced, which irritates the skin and contributes to the development of inflammation - dermatitis.

Seborrheic psoriasis quickly spreads to the entire head, covering it in the form of a cap and accompanied by severe itching. In the areas behind the ears, weeping sometimes develops and infection occurs. Covered with dandruff and continuous crusts, the head sometimes looks like a psoriatic crown.

Psoriasis on the face

Typically, psoriasis on the face is localized in the area of ​​the nasolabial triangle, eyelids, above the eyebrows, and in the areas behind the ears. The merged elements of the rash form large areas of redness and swelling. If there is a malfunction of the sebaceous glands, the process is often accompanied by weeping, the formation of crusts, and an increased risk of infection.

The first symptoms of psoriasis on the face

Psoriasis on the genitals

This is not an isolated process. Along with damage to the genital organs, there are characteristic psoriatic rashes throughout the body, so identifying the disease is not difficult.

Psoriasis on the penis in men and the labia majora in women, as well as on the adjacent skin areas, manifests itself in the form of oval, pink, scaly papules slightly raised above the skin. There is practically no itching. Sometimes the process spreads to the mucous membranes and takes the form of vulvovaginitis in women and balanoposthitis in men.

Atypical psoriatic rashes can be observed in obese people in the folds located next to the genitals (inguinal, intergluteal). Here, areas of intense red color with a mirror-like surface are formed without signs of peeling due to constant wetting.

Clinical manifestations

The most common cutaneous manifestations of psoriasis are erythematous patches, papules, plaques, and scaling. Usually the spots appear first, then they transform into papules, then into well-circumscribed silvery plaques covering the erythematous surface of the affected skin.

Patients with psoriasis typically:

• The sudden appearance of small areas of red, scaly skin.
• Family history of a similar condition in the anamnesis.
• Recent streptococcal throat infection, viral infection, antimalarial drug use, trauma, stress.
• Gradual deterioration of the condition of erythematous areas, their enlargement and merging with each other.
• Soreness - with erythrodermic psoriasis.
• Itching - with eruptive or guttate psoriasis.
• Febrile condition - with pustular or erythrodermic psoriasis.
• Dystrophy of the nail plates is possible.
• Joint pain, including without obvious skin manifestations.
• Ophthalmic lesions - occur in 10% of patients, most often these are redness and lacrimation due to conjunctivitis or blepharitis.

Clinical forms of psoriasis (Fig. 3):

1. Plaque psoriasis - manifests itself as itchy red patches on the skin, with excess scaling and flaking. Lesions typically occur on the extensor (outer) side of the joints and scalp ( Figure 3A ). Most patients are embarrassed by these plaques, wear covered clothing and avoid exposing the affected areas. 38–76% of patients experience a Koebner reaction—the appearance of new plaques at the site of injury after 7–14 days. In some cases, the Koebner reaction is reversible, i.e. the lesions disappear as the injured area heals. 10–20% of patients experience psoriatic arthritis with joint pain, stiffness and deformity.
2. Guttate psoriasis is characterized by the sudden appearance on the body and proximal extremities of pinkish guttate papules with a diameter of 1–10 mm ( Fig. 3B ). They usually do not progress while at the same stage of development, but may be accompanied by itching.
3. Inverse psoriasis - irregularly shaped redness occurs on the flexor (inner) surfaces of the joints, in the groin, and armpits ( Fig. 3C ). It may be mistaken for a fungal infection.
4. Pustular psoriasis is characterized by typical pustules against a background of erythematous skin that appear on the body, less often on the face, elbow bends, and in the anogenital area ( Fig. 3 D ). There is also an increase in body temperature up to fever (febrile condition), tachycardia, redness of the oropharyngeal mucosa, “geographical” tongue, onychodystrophy (thinning and brittleness of nails).
5. Erythrodermic psoriasis - manifests itself as severe redness and peeling over large areas of the body ( Fig. 3 E ). The skin exfoliates not in small scales, as usual, but in large layers. Patients experience moderate to severe itching and pain. Body temperature may rise and fall sharply, especially on very hot or cold days, and tachycardia may occur.

Rice. 3. Clinical forms of psoriasis: A - plaque, B - guttate, C - inverse, D - pustular, E - erythrodermic (Danish national service on dermato-venereology)

On the website you need to put down the letters A-BCDE: plaques A, dots B, redness in the anus C, heel D, crossed arms E

How dangerous is psoriasis and does it need to be treated?

Advanced stage

The danger is that psoriasis can take a widespread, severe form, with rashes occupying more than 10% of the skin. This stage of the disease is severe, recurs, the elements of the rash become injured and become wet, and infection often occurs. Only timely treatment for psoriasis can stop the process of its spread.

Sometimes the disease is complicated by inflammation in the joints with the formation of psoriatic polyarthritis, against which the function of the joints can be significantly impaired.

Against the background of a systemic autoimmune process, which has a significant impact on the patient’s condition, other autoimmune diseases often develop (rheumatoid arthritis, some types of arthrosis, Crohn’s disease, etc.), as well as severe cardiovascular pathology, diseases of the digestive system, and neurological reactions.

If treatment for psoriasis is not started on time, the patient’s condition will become more complicated and lead to disability.

There is also a complication such as psoriatic erythroderma, which develops with improper or insufficient treatment of psoriasis, as well as with exposure to various irritating factors on the inflamed skin. The skin acquires a bright pink color with a clear demarcation of the affected areas from healthy ones, small and large lamellar peeling. This patient requires emergency medical care.

Is there a cure for psoriasis?

Yes, and quite successfully, but complete recovery cannot be guaranteed.

Find out how to get rid of psoriasis in a course of therapy of 10 sessions

Pathogenesis of psoriasis

The pathogenesis of the disease is not fully understood. It has been noted that a large number of activated T cells penetrate the epidermis, which trigger the proliferation of keratinocytes . The rate of their renewal changes from the usual 23 days to 3–5 days, which leads to the appearance of pathologically altered cells and peeling of the skin. Keratinocytes, which normally lose nuclei in the granular layer of the epidermis, retain them in psoriasis, which results in a disruption of the keratinization process - parakeratosis .

Against this background, uncontrolled inflammation with excessive production of cytokines: tumor necrosis factor alpha (TNF-α), interferon gamma, interleukin-12. It has been noted that a surge in TNF-α levels corresponds to exacerbations of psoriasis.

In the affected skin there is increased vascularization and dilation of superficial vessels. The main triggers of angiogenesis in psoriasis come from the epidermis - in particular, keratinocytes secrete vascular endothelial growth factor A (VEGF-A). Sources of angiogenic factors are also macrophages and fibroblasts, and additional participants are hypoxia-inducible factor (HIF), tumor necrosis factor α (TNF-α), interleukins (IL)-1, -6, -8, etc. ( Fig. 2 ) But the most important component is VEGF-A - it activates blood and lymphatic vessels, directly influencing the attraction of inflammatory cells to the psoriatic lesion. Serum VEGF-A levels correlate positively with disease severity and negatively with the success of standard therapy, indicating a critical role for VEGF-A in disease progression.

Rice. 2. The role of the vascular component of the skin and angiogenesis in the pathogenesis of psoriasis (Heidenreich R., et al. Angiogenesis drives psoriasis pathogenesis. Int J Exp Pathol 2009; 90(3): 232–248)

With the participation of vascular endothelial growth factor ( VEGF ), the proliferation of keratinocytes and vascular endothelial cells is triggered, which promotes angiogenesis. T helper cells ( Th ) produce interleukin-17 ( IL -17 ), which triggers the production of pro-angiogenic factors - this further enhances angiogenesis. Against this background, dendritic cells ( DC ) of the epidermis act on the population of T helper cells ( Th ), which begins to synthesize interferon gamma ( IFN -γ ), which suppresses angiogenesis. But this doesn’t help for long, because... other proangiogenic factors are activated: VEGF , bFGF , IL -8 , triggering further growth of small vessels and “unwinding” the pathogenesis of psoriasis.

• VEGF - vascular endothelial growth factor
• IL - interleukin
• IFN - interferon
• TNF - tumor necrosis factor
• TGF - tumor growth factor
• MMP—matrix metalloproteinases
• bFGF - basic fibroblast growth factor
• ECs - endothelial cells
• DC - dendritic cells
• Th - T-helpers
• N - neutrophils

Treatment methods

Autoimmune inflammation requires individually selected complex therapy, lifestyle changes, nutrition, and elimination of all bad habits. Modern medicine has proposed three basic principles for the successful treatment of psoriasis:

• strict adherence to the prescribed therapy algorithms;
• regular monitoring of the effectiveness of therapy;
• timely correction of prescribed therapy if it is insufficiently effective.

Nutrition for psoriasis

There is no special diet for psoriasis, but nutrition is of great importance. Therefore, when prescribing complex treatment, nutritional recommendations must be given:

• identify increased sensitivity of the body to certain products and exclude them from the diet;
• give preference to fresh vegetables, non-acidic fruits and berries, boiled and baked lean meat, drink more;
• what not to eat if you have psoriasis
  :
  products containing essential oils - onions, garlic, radishes;
• drinks containing caffeine (concentrated tea, coffee), alcohol;
• everything is saltier, sour and sweet, rich;
• products that promote sensitization (allergization) of the body - orange fruits, honey, nuts, cocoa, eggs;
• do not consume fatty animal products.

Recommended foods for psoriasis

Pegano diet for psoriasis

This diet was developed by the American physician John Pegano, but has not found official recognition in medicine. The principle of constructing the Pegano diet for psoriasis is associated with alkalization of the body by selecting the right diet. According to this principle, all products are divided into:

• alkali-forming (two-thirds of the daily diet) - non-acidic fruit and berry mixtures and juices, vegetables (exclude those that cause increased gas formation);
• acid-forming (one-third of the diet) - meat, fish, dairy products, beans, peas, potatoes, cereals, sweets and baked goods.

Patients are recommended to drink still mineral water, drinking water up to 1.5 liters per day, plus other liquids to drink (compotes, juices, etc.)

Drug therapy

Treatment of mild forms of psoriasis is carried out using external medications. Severe and rapidly progressing forms of the disease are treated primarily in a hospital setting with the prescription of general (systemic) drugs.

External treatment of psoriasis

The medicine is selected by a dermatologist. For vulgar psoriasis with dry constricting plaques, ointments are suitable; if weeping develops (with seborrheic psoriasis), then creams and medicinal solutions are used. In order to avoid resistance (resistance) of the body to a certain drug, it is changed over time.

In the acute (progressive) stage, the following external therapy is performed:

• agents that have a softening effect - boric petroleum jelly, 2% salicylic ointment;
• non-hormonal ointments for psoriasis containing activated zinc pyrithione (Skin-cap, Zinocap) are effective; they suppress infection and have a cytostatic (suppress tissue proliferation) effect;
• external agents containing glucocorticosteroid (GCS) hormones;
• Daivobet ointment is a combination product with calcipotriol (an analogue of vitamin D3) and GCS betamethasone; perfectly suppresses the inflammatory process;

External treatment of psoriasis in the stationary stage:

• ointments that dissolve scales (keratolytic) and have an anti-inflammatory effect - 5% naphthalan, boron-naphthalan, tar-naphthalan;
• corticosteroid drugs.

External treatment of psoriasis in the resolving stage:

• the same keratolytic ointments, but in a higher concentration: 10% tar-naphthalan ointments;
• ointments based on vitamin D3 analogues (Calcipotriol, Psorkutan) - for 6 - 8 weeks; suppresses the inflammatory process and peeling of the rash.

To treat nail psoriasis, special varnishes (Belvedere) are used, which suppress the development of the pathological process. It is recommended to treat the periungual phalanges with moisturizing gels.

Systemic treatment of psoriasis

• agents that relieve inflammation and intoxication - calcium chloride, sodium thiosulfate, unithiol in the form of injections;
• tablets for psoriasis, suppressing the processes of proliferation (reproduction of epithelial cells) - cytostatics (Methotrexate), suppressing the activity of the immune system (Cyclosporin A), vitamin A analogues (Acitretin), corticosteroid hormones;
• biological agents (ustekinumab - Stelara), containing human monoclonal antibodies of the IgG class, affecting certain parts of inflammation by suppressing the synthesis of cytokines; this is a very effective modern drug that is administered by injection;
• vitamins for psoriasis help restore metabolism and keratinization of epithelial cells; Doctors prescribe vitamins A, E (Aevit), D3, group B.

Folk remedies for psoriasis

Any treatment for psoriasis, including using folk remedies, can only be prescribed by a doctor. Self-treatment can lead to the opposite effect: the spread of the disease.

The following methods can be used as part of complex therapy:

• grease
  – a product of processing of technical oils; to prepare the ointment, you need to buy medical solidol at the pharmacy; recipe: in 0.5 kg of solid oil, add 50 g of honey and half a package of baby cream; procedures are carried out daily; At the pharmacy you can purchase ready-made preparations based on solid oil Magnipsor, Ungvetol, etc.
• baking soda
  is a folk remedy for psoriasis, helps cleanse crusts, relieves itching; recipe for soda applications: take 60 g of soda, dissolve in 0.5 liters of water, soak a gauze cloth in the solution, fold it in several layers and apply to the lesion for 20 minutes; After the procedure, blot the skin and apply any softening ointment to it; treatment of psoriasis with soda is carried out once a day;
• Shilajit
  – has a pronounced anti-inflammatory effect, relieves itching well; can be taken orally once a day, 0.2 g for two weeks; external therapy is carried out with mumiyo solution; it is applied to dry itchy plaques twice a day; Treatment of psoriasis on the head is carried out by rinsing the scalp with a mummy solution after washing;
• sea ​​salt
  – relieves inflammation and itching well; baths with sea salt: take 1 kg of salt, dilute in two liters of water and add to the bath; take a bath for 15 minutes, then rinse off the solution under a warm shower, pat the body dry with a towel and apply a softening ointment; treat psoriasis with baths no more than twice a week;
• clay
  – has a pronounced cleansing effect, adsorbing on its surface toxins formed as a result of inflammation and improper metabolism; promotes drying, eliminating crusts and itching; You can take any clay, but it is better to buy blue clay at the pharmacy; pieces of clay need to be thoroughly dried, broken with a hammer, diluted with water and allowed to stand for several hours; Place the resulting plate-shaped clay on a napkin (up to 3 cm thick) and apply to the areas of inflammation for three hours; Treat psoriasis with clay every other day.

Important: treatment of psoriasis at home with folk remedies should be carried out with caution and strictly as prescribed by the doctor. For one patient, such treatment will help, but for another it may cause an exacerbation and rapid spread of inflammation. Therefore, if the patient’s condition worsens during therapy, you should immediately stop it and consult a doctor.

Home treatment for psoriasis

When treating psoriasis at home, it is important to follow nutritional recommendations, lead a healthy lifestyle, eliminate bad habits and strictly follow all the dermatologist’s instructions.

How to cure psoriasis at home? Some patients try to cleanse themselves of toxins and waste using all sorts of unconventional methods (enemas, etc.). This can give the exact opposite result: the functioning of the digestive tract will be disrupted and an exacerbation will begin. Modern medicine recognizes cleansing the body in the form of proper nutrition and getting rid of bad habits.

It is important to follow all doctor’s orders and pay attention to how the prescribed therapy works. If it is not effective enough, the doctor will replace the treatment, achieving maximum therapeutic effect.

Phototherapy

Phototherapy for psoriasis

Treatment of psoriasis with light has been used for a long time and successfully. For this purpose, two types of ultraviolet (UV) radiation are used:

• mid-wave UV radiation B
  – irradiation is carried out using the method of selective phototherapy, in which the affected areas of the skin are irradiated; 20 procedures at intervals every other day are sufficient for a course of treatment;
• long-wave UV A radiation
  is photochemotherapy or PUVA therapy; the patient’s body is first exposed to a photosensitizer (it can be taken orally or used externally, in the form of a solution), which increases the skin’s sensitivity to UV rays; After 90 minutes, the skin is irradiated with long-wave UV rays.

Surgical method

Photo: Martynov V.L.

The surgical method for treating psoriasis was developed by Dr. Martynov. It consists of strengthening the bauhinium valve - the pylorus, located on the border of the small and large intestines.

Normally, the pylorus allows food to pass in only one direction: from the small intestine to the large intestine. But sometimes the valve does not work and the contents of the large intestine are thrown into the small intestine. And since many microorganisms, food breakdown products, toxic gases, etc. accumulate in the large intestine, the body suffers from intoxication. Toxic substances provoke the development of skin disorders.

After surgical treatment of psoriasis, many patients experience stable remission. However, it should be understood that, as with any abdominal surgery, there is a risk of developing severe complications: infection, bleeding, complications from general anesthesia, etc.

Therefore, before deciding on surgical intervention, it is worth discussing with a dermatologist how this treatment method is right for you.

Psoriasis and modern methods of its treatment

Psoriasis (scaly lichen) is a chronic, very common skin disease, known for a long time. Its prevalence in different countries ranges from 0.1 to 3%. However, these figures reflect only the proportion of psoriasis in patients with other dermatoses or the frequency of its occurrence in patients with internal diseases. Since the disease is often localized and inactive, patients usually do not seek help from medical institutions and, therefore, are not registered anywhere.

The cause of the disease remains unclear. Despite the huge number of proposed hypotheses, none is generally accepted. Only the role of genetic factors has been clearly established - the family rate of patients is several times higher than the population one. There are indications of a connection between psoriasis and HLA system antigens - B13, B15, B16, B17, B27, B39, Dw11, DRW6, DR7, A1. There is evidence of the possible pathogenetic significance of the genetic markers Lewis, MN, Ss, Duffy, Hp.

The main pathogenetic link that causes the appearance of skin rashes is increased mitotic activity and accelerated proliferation of epidermal cells, leading to the fact that the cells of the lower layers “push out” the overlying cells, preventing them from becoming keratinized. This process is called parakeratosis and is accompanied by abundant peeling. Of great importance in the development of psoriatic lesions in the skin are local immunopathological processes associated with the interaction of various cytokines - tumor necrosis factor, interferons, interleukins, as well as lymphocytes of various subpopulations.

The trigger point for the onset of the disease is often severe stress - this factor is present in the anamnesis of most patients. Other trigger factors include skin trauma, medication use, alcohol abuse, and infections.

Numerous disorders in the epidermis, dermis and all body systems are closely related and cannot separately explain the mechanism of disease development.

There is no generally accepted classification of psoriasis. Traditionally, along with ordinary (vulgar) psoriasis, erythrodermic, arthropathic, pustular, exudative, guttate, palmoplantar forms are distinguished.

Normal psoriasis is clinically manifested by the formation of flat papules, clearly demarcated from healthy skin. The papules are pinkish-red in color and covered with loose silvery-white scales. From a diagnostic point of view, an interesting group of signs occurs when papules are scraped and is called the psoriatic triad. First, the “stearin spot” phenomenon appears, characterized by increased peeling when scraped, which makes the surface of the papules resemble a drop of stearin. After removing the scales, the phenomenon of “terminal film” is observed, which manifests itself in the form of a wet shiny surface of the elements. Following this, with further scraping, the phenomenon of “blood dew” is observed - in the form of pinpoint, non-merging droplets of blood.

The rash can be located on any part of the skin, but is mainly localized on the skin of the knee and elbow joints and the scalp, where the disease very often begins. Psoriatic papules are characterized by a tendency to grow peripherally and merge into plaques of various sizes and shapes. Plaques can be isolated, small or large, occupying large areas of the skin.

With exudative psoriasis, the nature of peeling changes - the scales become yellowish-grayish, stick together to form crusts that fit tightly to the skin. The rashes themselves are brighter and more swollen than with regular psoriasis.

Psoriasis of the palms and soles can be observed as an isolated lesion or combined with lesions in other locations. It manifests itself in the form of typical papulo-plaque elements, as well as hyperkeratotic, callus-like lesions with painful cracks or pustular rashes.

Psoriasis almost always affects the nail plates. The most pathognomonic is the appearance of pinpoint impressions on the nail plates, giving the nail plate a resemblance to a thimble. Loosening of the nails, brittle edges, discoloration, transverse and longitudinal grooves, deformations, thickening, and subungual hyperkeratosis may also be observed.

Psoriatic erythroderma is one of the most severe forms of psoriasis. It can develop due to the gradual progression of the psoriatic process and the fusion of plaques, but more often it occurs under the influence of irrational treatment. With erythroderma, the entire skin acquires a bright red color, becomes swollen, infiltrated, and there is abundant peeling. Patients are bothered by severe itching and their general condition worsens.

Radiologically, various changes in the osteoarticular apparatus are observed in most patients without clinical signs of joint damage. Such changes include periarticular osteoporosis, narrowing of joint spaces, osteophytes, and cystic clearing of bone tissue. The range of clinical manifestations can vary from minor arthralgia to the development of disabling ankylosing arthrosis. Clinically, swelling of the joints, redness of the skin in the area of ​​the affected joints, pain, limited mobility, joint deformities, ankylosis, and mutilation are detected.

Pustular psoriasis manifests itself in the form of generalized or limited rashes, localized mainly on the skin of the palms and soles. Although the leading symptom of this form of psoriasis is the appearance of pustules on the skin, which in dermatology are considered a manifestation of a pustular infection, the contents of these blisters are usually sterile.

Guttate psoriasis most often develops in children and is accompanied by a sudden rash of small papular elements scattered throughout the skin.

Psoriasis occurs with approximately equal frequency in men and women. In most patients, the disease begins to develop before age 30. In many patients, there is a connection between exacerbations and the time of year: more often the disease worsens in the cold season (winter form), much less often in the summer (summer form). In the future, this dependence may change.

During psoriasis, there are 3 stages: progressive, stationary and regressive. The progressive stage is characterized by growth along the periphery and the appearance of new lesions, especially at the sites of previous lesions (isomorphic Koebner reaction). In the regressing stage, there is a decrease or disappearance of infiltration around the circumference or in the center of the plaques.

Vulgar psoriasis is differentiated from parapsoriasis, secondary syphilis, lichen planus, discoid lupus erythematosus, and seborrheic eczema. Difficulties arise in the differential diagnosis of palmoplantar and arthropathic psoriasis.

With vulgar psoriasis, the prognosis for life is favorable. With erythroderma, arthropathic and generalized pustular psoriasis, disability and even death are possible due to exhaustion and the development of severe infections.

The prognosis remains uncertain regarding the duration of the disease, duration of remission and exacerbations. Rashes can exist for a long time, for many years, but more often exacerbations alternate with periods of improvement and clinical recovery. In a significant proportion of patients, especially those not subjected to intensive systemic treatment, long-term, spontaneous periods of clinical recovery are possible.

Irrational treatment, self-medication, and turning to “healers” worsen the course of the disease and lead to exacerbation and spread of skin rashes. That is why the main purpose of this article is to give a brief description of modern methods of treating this disease.

Today, there are a huge number of methods for treating psoriasis; thousands of different drugs are used in the treatment of this disease. But this only means that none of the methods gives a guaranteed effect and does not cure the disease completely. Moreover, the question of cure is not raised - modern therapy is only able to minimize skin manifestations, without affecting many currently unknown pathogenetic factors.

Treatment of psoriasis is carried out taking into account the form, stage, degree of prevalence of the rash, and the general condition of the body. As a rule, treatment is complex, involving a combination of external and systemic drugs.

The patient’s motivation, family circumstances, social status, lifestyle, and alcohol abuse are of great importance in treatment.

Treatment methods can be divided into the following areas: external therapy, systemic therapy, physiotherapy, climatotherapy, alternative and folk methods.

External therapy

Therapy with external drugs is of utmost importance for psoriasis. In mild cases, treatment begins with local measures and is limited to them. As a rule, drugs for topical use are less likely to have any side effects, but are inferior in effectiveness to systemic therapy.

In the advanced stage, external treatment is carried out with great care so as not to cause deterioration of the skin condition. The more intense the inflammation, the lower the concentration of ointments should be. Usually at this stage, the treatment of psoriasis is limited to Unna cream, 0.5–2% salicylic ointment, and herbal baths.

At the stationary and regressing stage, more active drugs are indicated - 5-10% naphthalan ointment, 2-10% ASD ointment, 2-5% salicylic ointment, 2-5% sulfur-tar ointment, as well as many other methods of therapy.

In modern conditions, when choosing a method of therapy or a specific drug, the doctor must be guided by official protocols and formularies developed by the governing health authorities. The Federal Guide to the Use of Medicines (Issue IV) suggests steroid medications, salicylic ointment, tar preparations, and calcipotriol for topical treatment of patients with psoriasis.

Based on the “Guidelines for the diagnosis and treatment of the most common sexually transmitted infections and skin diseases” developed by the Central Scientific Research Institute of Medical Sciences in 2001, 1–2% salicylic ointment, ointments containing 5–10% tar, are used as external therapy. naphthalan 5–10%, vitamin D3, as well as corticosteroid ointments (betamethasone with salicylic acid, mometasone) and zinc pyrithioneate aerosol. The “Patient Management Protocols” developed by TsNIKVI scientists in 2003 recommend the same drugs.

We will focus mainly on the drugs indicated in the manuals.

Hydrating agents. Soften the flaky surface of psoriatic elements, reduce skin tightness, improve elasticity. They use creams based on lanolin with vitamins, Unna cream. According to the literature, even after such mild exposure, clinical effects (reduction of itching, erythema and peeling) are achieved in a third of patients.

Salicylic acid preparations . Typically, ointments with a concentration of 0.5 to 5% salicylic acid are used. It has antiseptic, anti-inflammatory, keratoplastic and keratolytic effects and can be used in combination with tar and corticosteroids. Salicylic ointment softens the flaky layers of psoriatic elements, and also enhances the effect of local steroids by enhancing their absorption, therefore it is often used in combination with them. Salicylic acid itself easily penetrates the skin and then into the blood. Therefore, it is not used on large surfaces and in concentrations greater than 2%, and in children even 2% ointment is applied only to limited areas of the skin. Intolerance is rare, but salicylic acid may cause increased skin inflammation as a side effect.

Tar preparations . They have been used for a long time in the form of 5–15% ointments and pastes, often in combination with other local drugs. In Russia, ointments with wood tar (usually birch) are used, in some foreign countries - with coal tar. The latter is more active, but, according to our scientists, it has carcinogenic properties, although numerous publications and foreign experience do not confirm this. Tar is superior to salicylic acid in activity and has anti-inflammatory, keratoplastic and anti-exfoliative properties. Its use in psoriasis is also due to its effect on cell proliferation. The use of tar preparations is limited due to the unpleasant odor; they cannot be applied to the face. Combinations of tar with zinc or salicylic acid do not have significant advantages over monocomponent tar preparations. Tar's ability to increase photosensitivity is used for combination therapy in combination with ultraviolet irradiation. Tar preparations should not be used for a long time and in high concentrations, as this can lead to absorption and systemic effects (kidney damage, general intoxication, paralysis). When prescribing tar preparations, one should take into account its photosensitizing effect and the risk of deterioration of kidney function in people with nephrological diseases.

To wash your hair, use shampoos with tar (Friderm-tar, T/gel).

Naftalan oil . A mixture of hydrocarbons and resins, contains sulfur, phenol, magnesium and many other substances. Naftalan oil preparations have anti-inflammatory, absorbable, antipruritic, antiseptic, exfoliating and reparative properties. To treat psoriasis, 10–30% naphthalan ointments and pastes are used. Naftalan oil is often used in combination with sulfur, ichthyol, boric acid, and zinc paste.

Local retinoid therapy . The first effective topical retinoid approved for use in the treatment of psoriasis is tazarotene. This drug has not yet been registered in Russia. It is a water-based jelly and is available in concentrations of 0.05 and 0.1%. In terms of effectiveness, it is comparable to potent corticosteroids. Side effects include itching and skin irritation. One of the advantages of this drug is its longer remission compared to GCS. Thus, according to J. Koo, 3 months after treatment, relapse was observed only in 185 patients (after fluocinonide - in 55%). The work of A. Marchetti shows the pharmacoeconomic advantages of tazarotene in the form of a 0.1% gel in comparison with fluocinonide ointment (local corticosteroids) and calcipotriene (a type of vitamin D3 for topical use).

Hydrantrons . In the first half of the 20th century. ointments were used with a mixture of natural anthracene derivatives - chrysarobin, which was obtained from the trunks of the Brazilian tree Vonacopua araroba of the legume family.

Currently, synthetic hydroxyanthrones are used in Europe and the USA - dithranol, anthralin, cignolin, anthrarobine.

Dithranol is an analogue of natural chrysarobin, has a cytotoxic and cytostatic effect, leads to a decrease in the activity of oxidative and glycolytic processes in the epidermis. As a result, the number of mitoses in the epidermis, as well as hyperkeratosis and parakeratosis, decreases. Unfortunately, dithranol has a pronounced local irritant effect, and if it comes into contact with healthy skin, burns can occur. On the other hand, dithranol is very effective and does not cause systemic side effects. Several years ago, drugs appeared in Europe that release dithranol only at human skin temperature (micanol). As a result, the coloration of the skin is weakened. Today, dithranol is used in fairly high concentrations (>1%), applied for 5–30 minutes. This method is not inferior in effectiveness to using the drug in low concentrations at night. According to the literature, the average remission during treatment with dithranol is 4–6 months.

Russian specialists rarely use drugs from this group; they are not produced in Russia and are not purchased abroad. Previously, several drugs in this group were offered - cygnoderm, ditrastik, psorax. They come in the form of a stick, like lipstick. The addition of paraffin allows drugs to be applied precisely to the affected area, which is especially convenient when treating limited, old lesions.

Drugs in this group include anthralin, which is used in European and American treatment centers. The drug inhibits the synthesis of nuclear and mitochondrial DNA, inhibits metabolism in tissues, which leads to a decrease in proliferation. When used, it strongly stains contacted surfaces and can cause irritation and burns.

Derivatives of mustard gas.

These include psoriasin and antipsoriaticum. They contain blister agents - mustard gas and trichlorethylamine. Treatment with these drugs is carried out with great caution, first using ointments with a small concentration on small lesions once a day. Then, if well tolerated, the concentration, area and frequency of use are increased. Treatment is carried out under close medical supervision, with weekly blood and urine tests. Now these drugs are practically not used, but they are very effective in the stationary stage of the disease.

Zinc pyrithioneate . An active substance produced in the form of aerosols, creams and shampoos under the trade name “Skin-cap”. It has antimicrobial, antifungal, and antiproliferative effects - it suppresses the pathological growth of epidermal cells in a state of hyperproliferation. The latter property determines the effectiveness of the drug for psoriasis. The drug relieves inflammation, reduces infiltration and peeling of psoriatic elements. Treatment is carried out on average for a month. For the treatment of patients with lesions of the scalp, aerosol and shampoo are used, for skin lesions - aerosol and cream. The drug is applied 2 times a day, shampoo is used 3 times a week. In Russia, since 1995, the clinical effectiveness and tolerability of all dosage forms of zinc pyrithioneate have been studied. According to the conclusion of the leading dermatological centers - TsNIKVI, RGMU, MMA, VMA - the effectiveness of the drug in the treatment of patients with psoriasis reaches 85–90%. Based on data published in periodicals by leading specialists from these and other centers, clinical cure can be achieved by the end of 3–4 weeks of treatment. The effect develops gradually, but it is very important that the results of treatment are obvious by the end of the first week from the moment of starting to use the drug - itching is sharply reduced, peeling is eliminated, and erythema turns pale. Such a rapid achievement of clinical effect leads, accordingly, to a rapid improvement in the quality of life of patients. The drug is well tolerated. Approved for use from 3 years of age.

Ointments with vitamin D3 . Since 1987, a synthetic preparation of vitamin D3, calcipotriol, has been used for local treatment. Numerous experimental studies have shown that calcipotriol inhibits the proliferation of keratinocytes, accelerates their morphological differentiation, affects the factors of the skin immune system that regulate cell proliferation, and has anti-inflammatory properties. There are 3 drugs of this group from different manufacturers on the Russian market. The drugs are applied to the affected areas of the skin 1-2 times a day. The effectiveness of ointments with D3 approximately corresponds to the effect of corticosteroid ointments of classes I, II, and according to J. Koo - even class III. When using these ointments, a pronounced clinical effect occurs in the majority of patients (up to 95%). However, to achieve a good effect it may take quite a long time (from 1 month to 1 year), and the affected area should not exceed 40%. I. V. Khamaganova reports positive experience with the use of calcipotriol in children. The drug was applied 2 times a day, a pronounced effect was observed by the end of the fourth week of treatment. No side effects were identified. V. A. Samsonov reports the same treatment results when using calcipotriol in adults.

Sometimes when using calcipotriol, skin irritation, dermatitis, photosensitivity, exacerbation of the psoriatic process, and hypercalcemia may occur. However, calcipotriol does not cause side effects characteristic of steroids, and sometimes provides a more lasting effect than ointments with corticosteroids. Although, according to the same J. Koo, relapses occur in more than 50% of patients, while the average duration of remission does not exceed 1.5 months.

More pronounced effects are achieved with the combined use of calcipotriol with any form of phototherapy, as well as with systemic therapy.

Corticosteroid drugs . They have been used in medical practice as external agents since 1952, when Sulzberger first demonstrated the effectiveness of external use of steroids. To date, about 50 glucocorticosteroid agents for external use are registered on the Russian pharmaceutical market. This undoubtedly makes it difficult to choose a doctor, who must have information about all drugs. A special survey conducted by N. G. Kochergin among dermatologists showed that when choosing products for external therapy, doctors proceed from the following data: the activity of the skin process, the localization of rashes, the age of the patient, the effectiveness of advertising and the cost of the drug in the pharmacy. The most commonly prescribed corticosteroids for psoriasis, according to the same survey, include combination drugs (flumethasone pivalate with salicylic acid), mometasone furoate or betamethasone dipropionate.

The therapeutic effect of external corticosteroids is due to a number of potentially beneficial effects:

• anti-inflammatory effect (vasoconstriction, resolution of inflammatory infiltrate);
• epidermostatic (antihyperplastic effect on epidermal cells);
• antiallergic;
• local analgesic effect (elimination of itching, burning, soreness, feeling of tightness).

Changes in the structure of GCS affected their properties and activity. This is how a fairly large group of drugs appeared, differing in their chemical structure and activity. Hydrocortisone acetate is practically not used today for psoriasis; it is used in clinical studies for comparison with newly produced drugs. For example, it is believed that if the activity of hydrocortisone is taken as one, then the activity of triamcinolone acetonide will be 21 units, and betamethasone - 24 units. Of the second class drugs for psoriasis, flumethasone pivalate in combination with salicylic acid is most often used, and the most modern are non-fluorinated corticosteroids. Due to the minimal risk of side effects, ointments and creams with aclomethasone are approved for use on sensitive areas (face, skin folds), treatment of children and the elderly, when applied to large areas of skin.

Among the drugs of the third class, one can distinguish a group of fluorinated corticosteroids - fluocinolone acetonide, triamcinolone acetonide, betamethasone valerate and dipropionate. A pharmacoeconomic analysis of the use of these drugs (though not for psoriasis), which consists of studying the price/safety/efficacy ratio, according to V. A. Akovbyan, revealed favorable indicators for betamethasone valerate - rapid development of the therapeutic effect, lower cost of treatment .

When treating psoriasis, you should start with milder drugs - hydrocortisone, prednisolone, aclomethasone, and in case of repeated exacerbations and ineffectiveness of the drugs used, give stronger ones. However, the following tactics are popular among American dermatologists: first, a strong GCS is used to achieve a quick effect, and then the patient is transferred to a moderate or weak drug for maintenance therapy. In any case, strong drugs are used in short courses and only on limited areas, since side effects are more likely to develop when they are prescribed.

In addition to this classification, drugs are divided into fluorinated, difluorinated and non-fluorinated drugs of different generations. Non-fluorinated first-generation corticosteroids (hydrocortisone acetate) compared to fluorinated ones are usually less effective, but safer in terms of adverse reactions. Now the problem of low effectiveness of non-fluorinated corticosteroids has already been solved - non-fluorinated drugs of the fourth generation have been created, comparable in strength to fluorinated ones, and in safety - to hydrocortisone acetate. These are, in particular, hydrocortisone butyrate, mometasone furoate, methylprednisolone aceponate. The problem of enhancing the effect of the drug is solved not by halogenation, but by esterification. In addition to enhancing the effect, this allows you to use esterified drugs once a day. For example, hydrocortisone butyrate has the following pharmacodynamic properties: inhibition of the migration of leukocytes and lymphocytes to the area of ​​inflammation, inhibition of the proteolytic activity of tissue kinins, inhibition of fibroblast growth, prevention of the development of connective tissue in the area of ​​inflammation. It is the fourth generation non-fluorinated corticosteroids that are currently preferred for topical use in psoriasis.

Standard side effects when using local steroids are the development of skin atrophy, hypertrichosis, telangiectasia, pustular infections, systemic action with an effect on the hypothalamic-pituitary-adrenal system. With the modern non-fluoridated medications mentioned above, these side effects are kept to a minimum.

Pharmaceutical companies are trying to diversify the range of dosage forms and produce GCS in the form of ointments, creams, and lotions. Fatty ointment, creating a film on the surface of the lesion, causes more effective resorption of infiltration than other dosage forms. The cream better relieves acute inflammation, moisturizes, and cools the skin. The fat-free base of the lotion ensures its easy distribution over the surface of the scalp without sticking the hair.

According to literature data, when using, for example, mometasone for 3 weeks, a positive therapeutic effect (reduction in the number of rashes by 60–80%) can be achieved in almost 80% of patients. According to V. Yu. Udzhukhu, the most favorable “efficacy/safety” ratio can be achieved when using hydrocortisone butyrate. The pronounced clinical effect when using this drug is combined with good tolerability - the authors did not observe any adverse reactions in any of the patients who underwent treatment, even when applied to the face. With long-term use of other corticosteroids, it was necessary to stop treatment due to the development of side effects. According to B. Bianchi and N. G. Kochergin, a comparison of the results of the clinical use of mometasone fuorate and methylprednisolone aceponate showed the same effectiveness of these drugs when used externally. A number of authors (E. R. Arabian, E. V. Sokolovsky) propose staged corticosteroid therapy for psoriasis. It is recommended to start external therapy with combination drugs containing corticosteroids (for example, betamethasone and salicylic acid). The average duration of such treatment is about 3 weeks. Subsequently, there is a transition to pure GCS, preferably of the third class (for example, hydrocortisone butyrate or mometasone furoate).

Patients are attracted by the ease of use of steroid drugs, the ability to quickly relieve the clinical symptoms of the disease, accessibility, and lack of odor. In addition, these medicines do not leave greasy stains on clothes. However, their use should be short-term to avoid worsening the course of the disease. With prolonged use of steroid ointments, addiction develops. Abrupt withdrawal of corticosteroids can cause an exacerbation of the skin process. The literature indicates different durations of remission after topical treatment with corticosteroids. Most studies indicate short-term remission - from 1 to 6 months. Research by R. Seville has established that GCS in combination with other methods (in particular, dithranol) increases the effectiveness of treatment, but reduces the duration of remission. Patients should be advised to avoid the use of corticosteroid ointments for as long as possible. In many foreign sources, ointments containing glucocorticosteroid hormones are recommended to be used preferably on limited open areas of the skin surface - face, hands. However, one should remember the danger of developing steroid perioral dermatitis or rosacea on the face, especially when using fluorinated corticosteroids.

For psoriasis, combinations of steroid hormones (most often betamethasone) with salicylic acid are most effective. Salicylic acid, due to its keratolytic and antimicrobial effects, complements the dermatotropic activity of steroids.

It is convenient to apply combination lotions with corticosteroids and salicylic acid to the scalp. According to domestic authors (G.I. Sukolin, V.A. Molochkov, N.S. Potekaev), the effectiveness of combined preparations reaches 80 - 100%, while skin cleansing occurs very quickly - within 3 weeks.

To summarize, it should be said that in practice, the doctor always needs to decide whether to use only external methods of treatment or prescribe them in combination with any systemic therapy in order to increase the effectiveness of treatment and prolong remission.

Yu. N. Perlamutrov , Doctor of Medical Sciences, Professor A. M. Solovyov , Candidate of Medical Sciences MGMSU, Moscow

Will hormones help with psoriasis?

Corticosteroid hormones are widely used in the treatment of psoriasis. They perfectly eliminate swelling, itching, and suppress tissue proliferation. But hormones quickly become addictive and have serious side effects.

. Therefore, dermatologists use them with great caution, in courses and in combination with other medications that enhance their effect.

One of the most effective combinations is the combination of the synthetic analogue of vitamin D3 calcipotriol and the corticosteroid betamethasone in the drug Daivobet. The two active ingredients mutually enhance each other's effects and reduce side effects by reducing dosages. The body's resistance to this drug practically does not develop when it is prescribed in short, repeated courses throughout the year. This technique combines well with systemic therapy.

Daivobet - a hormonal drug for psoriasis

The question often arises about how to treat psoriasis on the scalp. Daivobet ointment is perfect for these purposes. It is able to maintain long-term remission and prevent the onset of relapses. Daivobet is assessed by patients as a stabilizing drug that maintains remission and prevents the onset of exacerbations.

Medicines for psoriasis

You cannot get rid of the disease, but its course can be controlled. External medications[5] will help with this. Therapeutic creams and ointments relieve itching, trigger epidermal regeneration, and suppress inflammation. Experts recommend the use of complex-action drugs containing several active components at once [6].

A universal assistant for psoriasis - Akriderm SK. It contains two components: betamethasone and salicylic acid[7]. This composition provides a comprehensive effect. The product penetrates to the source of inflammation, promotes the healing of psoriatic plaques and eliminates the symptoms of psoriasis - itching, burning, redness, swelling. It helps fight pathogenic flora on the surface of the skin, which can help reduce the risk of relapse and secondary infection. This is how it differs from monocomponent analogues. In addition, the drug is well tolerated and causes virtually no side effects [8].

An exacerbation of psoriasis is accompanied by discomfort, but unpleasant symptoms can be avoided if you carefully care for your skin during periods of remission. It is important to avoid mechanical damage, protect yourself from sunburn, regularly use moisturizers, and in case of relapses, use topical medications prescribed by a specialist.

Eastern medicine methods for psoriasis

Eastern medicine views autoimmune inflammation as a disorder of neuroendocrine balance and immunity. Doctors at our clinic influence certain points on the patient’s body (acupuncture points - AT) to restore the disturbed balance.

Over many years of practice, we have developed unique methods for treating psoriasis, combining proven techniques of the East and innovative methods of Western medicine:

Su-Jok therapy

We work with certain areas of the skin (foot or palm), helping the body overcome the disease that has engulfed it. The method relieves pain and tension, improves general condition.

Phytotherapy

Using individually selected medicinal herbs and preparations from them, the herbalist helps restore the body weakened by disease.

Tszyu therapy

Burning with heated wormwood cigars is a painless method that eliminates pain and improves metabolism and blood circulation.

Plasmolifting

The essence of plasmolifting is that platelet-rich plasma is injected into problem areas. Platelets acquire regenerative ability when their content in plasma becomes several times higher than normal.

Acupuncture

The acupuncturist inserts sterile needles to a shallow depth, individually selecting points associated with the internal systems of the patient’s body.

Moxibustion therapy

We warm up the locations of biologically active points using moxas, which are harmless to humans - aromatic cigars.

Pharmacopuncture

The method allows you to get by with minimal doses of drugs, introducing them into areas known to the specialist. The drug immediately begins to influence the area affected by the disease.

PRP therapy

PRP therapy is the newest way to stimulate recovery processes. It is used to restore the functions of various organs after diseases and injuries, including the treatment of wounds and restoration of the function of the musculoskeletal system.

All treatment methods

Points for the treatment of psoriasis are selected for each patient individually after the doctor has carried out a special diagnosis using Eastern methods.

If a specialist really understands Eastern methods of diagnosis and treatment, then the therapeutic effect will eliminate relapses for years. There are no side effects!

These techniques are widely used in our clinic by specialists who have all the necessary training in reflexology. After a course of treatment for psoriasis, exacerbations, as a rule, do not occur for a long time, and regular preventive courses of reflexology eliminate relapses for many years and significantly improve the quality of life.

Accurate diagnosis and verification of the severity of psoriasis

The severity of psoriasis depends on the area of ​​skin damage:

• Light - up to 2% of the body surface.
• Average - from 3 to 10%.
• Severe - more than 10% of the body surface.

It is not possible to determine the severity of psoriasis by eye; one can only guess it based on the experience of a specialist and the external signs of the disease in the patient. To accurately diagnose psoriasis, instrumental methods should be used - for example, FotoFinder PASIvision .

FotoFinder PASIvision is based on Automatic Total Body Mapping (ATBM) technology, which allows you to quickly obtain standard images of the patient's entire body. A special camera takes 16 digital photographs, including those using a polarizing filter.

Next, the program automatically analyzes the area of ​​skin lesions and the severity of psoriasis according to PASI - Psoriasis Area and Severity Index . PASI is the most important criterion not only for primary diagnosis, but also for determining the effectiveness of treatment, disease control and prognosis.

To identify the dynamics and choose a method of effective treatment of psoriasis, the doctor can open two images of the same area at once, taken at different times. After selecting the desired comparison method, the program automatically calculates the PASI of the specified areas - this is the most visual and reliable method of monitoring the effectiveness of the therapy.

The doctor has access to convenient sorting of images and patients, as well as a number of reports that can be printed or sent by email.

Sanatorium treatment of psoriasis at sea

Sea bathing, sunbathing and mud have a positive effect on patients with psoriasis. With this effect, the skin is cleansed, it becomes smooth and healthy. Staying a patient with psoriasis in a sanatorium for a month can prevent relapses of the disease for six months.

Important: Treatment at sea is contraindicated in the acute stage of psoriasis

There are sanatoriums for psoriasis patients on the Black and Azov Seas. Spa treatment at the Dead Sea is considered more effective. The method is suitable for patients in stationary and regressing stages. An acute inflammatory process (progressive stage) is a contraindication for such treatment, as progression may intensify. There are also patients for whom seaside resorts are contraindicated, as they contribute to the development of exacerbations.

Table of contents

1. Etiology and pathogenesis
2. Pathogenesis of psoriasis
3. Clinical manifestations
4. Accurate diagnosis and verification of the severity of psoriasis
5. Principles of treatment

Psoriasis is a complex chronic multifactorial inflammatory disease characterized by excessive proliferation of epidermal keratinocytes and an increase in their turnover rate. It can begin at any age, but more often at 20–30 or 50–60 years.

In our company you can purchase the following equipment for diagnosing psoriasis:

• FotoFinder (FotoFinder)

On average, 2–3% of people worldwide suffer from psoriasis, but the incidence varies greatly regionally. For example, in the USA the prevalence is about 2.2%, and among South American Indians it is 0%, i.e. Not a single case of psoriasis was identified in a survey of 26 thousand people. The disease is more often diagnosed in light-skinned people (2.5%) than in dark-skinned people (1.3%).

According to ICD-11, psoriasis is included in group 14 “Skin diseases”, subgroup “Papulosquamous diseases”, section EA90 “Psoriasis”.

Prevention of psoriasis

Prevention of exacerbations is:

• active lifestyle;
• dietary nutrition;
• getting rid of bad habits;
• proper skin care with the selection of individual hygiene products;
• prevention of skin injury;
• the habit of promptly treating all foci of infection;
• limiting contact with any skin irritants;
• combating prolonged stress and high emotional stress;
• taking any medications must be agreed with your doctor;
• wearing loose clothing made from natural fabrics;
• if possible, annual sanatorium-resort treatment of psoriasis at sea.

Will they be drafted into the army with psoriasis?

Do they take you into the army with psoriasis? This question interests many conscripts. Widespread, progressive and severe forms of this autoimmune disease are grounds for exemption from service, regardless of whether psoriasis is contagious or not to others. They can join the army if psoriasis first started and it was stopped. But more often, such conscripts are given a “Partially fit” conclusion and sent to the reserves. A Partially Unfit determination means that a person can only be called up for service if hostilities break out.

How to cure psoriasis forever?

Unfortunately, this is impossible; even after a long remission, another exacerbation may begin. You should always remember this and constantly carry out preventive procedures.

Psoriasis is a severe systemic disease with predominant damage to the skin and involvement of many other organs and systems in the process. In most cases, regular maintenance therapy prescribed by a competent specialist allows you to control the spread of the psoriatic process and significantly improve the patient’s quality of life.

Specialists at our clinic provide courses of treatment for psoriasis, both in the active phase and during remission. Our treatment is distinguished by an individual approach and a combination of the best techniques of Western and Eastern medicine. This approach allows patients to forget about disease relapses and side effects.

from treatment for many years.

Themes

Psoriasis, Skin diseases Date of publication: 05/18/2018 Date of update: 07/09/2021

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Principles of effective treatment of psoriasis

1. Local therapy:

• Vitamin D analogues
• Topical corticosteroids (hydrocortisone, betamethasone)
• Topical retinoids

1. Phototherapy or PUVA therapy
2. Systemic therapy:

• Methotrexate
• Cyclosporine
• Acitretin
• Biological agents

The simplest and most effective way to put skin lesions into remission is daily exposure to the open sun , local hydration and general relaxation to avoid stress.

You can find over-the-counter tar or tar-based medications in pharmacies that are suitable for treating psoriatic plaques. Local corticosteroids, anthralin, tazarotene, salicylic acid, calcipotriol (an analogue of vitamin D) are useful. In general, combination treatment is found to be more effective than monotherapy. A combination of calcipotriol or topical retinoids with topical corticosteroids works well.

PUVA therapy is based on the use of local or systemic psoralens and ultraviolet A (UVA, 320–400 nm). Its name comes from the English PUVA therapy, where the abbreviation stands for “ P soralen and U ltra V iolet A ”, i.e. “psoralen and ultraviolet A.” Photosensitizers enter into photo-oxidative reactions in pathologically altered skin cells, inhibiting their excessive mitotic activity. Currently, 8-methoxypsoralen (8-MOP), 5-methoxypsoralen (5-MOP) or 4,5′,8-trimethylpsoralen (TMP) are used. Long-term courses of PUVA therapy help achieve remission, but increase the risk of squamous cell skin cancer and malignant melanoma in fair-skinned Europeans.

Narrowband UVB therapy is less effective than PUVA, but is gentler on the skin.

In severe cases, systemic medications such as acitretin (a retinoid), methotrexate, cyclosporine, 6-thioguanine, azathioprine, etc. can be used to effectively treat psoriasis. Retinoids have been reported to cause dry eyes, blepharitis, corneal opacities, cataracts, and decreased night vision. Other adverse effects include gastrointestinal dysfunction and liver damage (acitretin, 6-thioguanine, azathioprine, methotrexate), bone marrow suppression (6-thioguanine, methotrexate, azathioprine, hydroxyurea), and kidney damage (cyclosporine).

If you have psoriatic arthritis or persistent (often worsening) psoriasis, you can use biological agents - ustekinumab, adalimumab or secukinumab.