To date, the pathogenesis and etiology of psoriasis are practically unknown, are held constant research on the disease, put forward many theories of its formation and development. Generally accepted, but not universally accepted, are a few theories - metabolic (exchange), neurogenic, genetic (hereditary) and viral. In this regard, each physician treats the disease in its own way, guided by the traditions of a particular theory of therapy. Most likely, the basis of psoriasis is multifactorial nature. Some importance in the pathogenesis of psoriasis is given enzymatic, immunological and other biochemical disorders of the body.
The main manifestation of pathology in psoriasis is epidermal hyperproliferation. Based on this, and try to determine its mechanisms, which will explore the pathogenesis of the disease and develop effective therapies that can help cure millions of people around the globe. T lymphocytes are the cellular elements of the dermal infiltrates, and B-lymphocytes are recorded in separate histological means in the form of single cells. Most T-lymphocytes that infiltrated the dermis, represent a T-helper cell. In this case, together with T-lymphocytes in the dermis (as it infiltrates) noted the presence of cells and Langernsa micro-failure monocytic cells.
The accumulated experience of therapy, different studies have revealed the presence of various functional disorders of the peripheral and central nervous system in people suffering from psoriasis. In addition, patients with psoriasis marked decrease in adrenal glucocorticoid function, disorders of the functionality of the pancreas, liver and other organs of the digestive disorders of lipid, protein, carbohydrate, water and salt, nitrogen, and other types of metabolism. In people with psoriasis and their relatives by blood fixed ultrastructural changes of the same type of pathological nature. Furthermore, these changes begin to appear much earlier than observed in clinical signs of disease. Predisposition of hereditary type, usually manifests itself under the influence of triggering factors trigger the body, for example, the focal infection foci, which promote autoimmunization. As you can see, we can say with certainty that psoriasis is a systemic multifactor disease pathogenesis which is largely dependent on immunological disorders, such as from dermatosis immuno dependent.
Psoriasis occurs over a long period of time in the chronic form of remission and exacerbation in general, to distinguish three stages of the disease - retrogressive, steady and progressive. As a rule, marked seasonality of the disease. Winter and autumn recorded recurrences of the disease in "winter" types of patients with improvement of the clinical picture in the summer. The "old" types of patients the disease involves deterioration in the summer. At the stage of progression of papular eruptions occur and are actively seeking to peripheral growth. Typically, at this stage, scales are covered only centers rash, but the peripheral zones are different so-called "halo of growth" - a free area of the flakes in the shape of the corolla red. The stationary phase, the corolla growth "is not marked, and new eruptions are not recorded.
Diagnosing psoriasis is based on the clinical picture. Differential diagnosis is carried out with a flat red lichen, syphiloderm papular. Certain problems arise in differentiating arthropathic psoriasis with arthritis rheumatoid. The clinical picture of symptoms is usually expressed in the formation of a monomorphic papular rash of rashes, which have a diameter of several millimeters to 1-2 centimeters. Localization of elements occurs in the hairy area of the head on the trunk, on the surfaces of straightening the arms and legs (most often - in the areas of knee and elbow joints). Rarely affected person, soles of the feet and the palms. Pinkish-red papules covered with scales white-silver, slightly above the skin surface are issued, have rounded contours scraping scales showing three diagnostic feature the first - a blood dew (there bleeding point type for scraping scales). The second - a terminal film (recorded a brilliant wet surface of reddish color under the scales, which are separated). The third criterion - stearic acid stains in this case, the scales fallen from papulnyh surfaces.
Papules psoriatic type had a significant tendency to increase the eccentric, causing the formation of plaques; their diameter is equal to several centimeters (3 to 100). Then there is a merger of plaques in the affected area of the continuous type, which are characterized by a palm-sized and irregular contour. Around papules on the progression of the disease is fixed ring of bright-red shade, which did not cover flakes. This proves the eccentricity growth papules. Are typical, and multiple new lesions, isomorphic to a positive reaction (a phenomenon Kebnera) manifests itself in a period from one week to ten days, and there is also a subjective itch? Plaque dissolved slowly in the devolution process, and the infiltration of the papules and the color intensity decreases. Plaques begin to dissolve either from the peripheral region, or from the central zone (in this case, the rash becomes ring-shaped). Papules around the rim is formed by Voronov (pseudo atrophy chesky) - depigmented white corolla. At places where there was resorption appears pseudo glee koderma - depigmentation of the time. At remission, in the areas of knee and elbow joints are marked individual (so-called "duty") plaque. A similar type of disease does not derail the disabled person, and recognized a small cosmetic flaw. In other cases, the disease more severe, there is no remission, there is a functional disorder of the kidneys (psoriatic erythroderma), an increase of peripheral lymph nodes in this case, the defeat spread over large skin areas.
Forms of psoriasis
Psoriasis is made to subdivide into several forms, which depend on the clinical features of the process.
1. Patients with diabetes often formed exudative form of the disease. It is characterized by bright and swollen with psoriatic papules on the surface of which formed a yellowish crust, like scales (since they are soaked with exudate a major form of expression of small-sized cavity exudate with a sterile form. This form is called pustular psoriasis, and it is considered to be the severe type of disease.
2. Palmar-plantar type psoriasis lesions seen the soles and palms. Their skin covered with scales and cracks, grubeyut and blush. Psoriatic plaques, particularly evident to the edges of soles and palms. Palmar-plantar type of psoriasis observed in 10 percent of people with psoriasis.
3. Seborrheic form of psoriasis strikes, usually hairy areas on his head.
In addition, it isolated warty and eczematous form of the disease. Sometimes seeing defeat nail plates, in this case, the lesion is the twofold form. Usually, the plate having dobney copolymerization of yam point depressions, and nail plate resembles a thimble. This phenomenon is called the syndrome of a thimble. In some cases, it formed hyponychial hyperkeratosis, which is characterized by a dirty-yellow nail plate. In this case, the nail thickens considerably (oni hogrifoz) or crumbling (psoriatic nail dystrophy).
To date, treatment of psoriasis is a fairly simple process. In some situations, therapy can be very successful, as there are many variants of therapeutic effects, but there is merely a temporary effect of the therapy. Only in rare cases there is the improvement in quality of life of patients who record the duration of remission. It is worth noting that the significant role played by motivation of the patient, his social and family circumstances. Some of the patients satisfied with even minor improvements in the papule common type, and part want to achieve full and rapid recovery of the smallest manifestations of the disease. Strategy for treatment of people with psoriasis is compiled with the orientation of the multiple indicators. In this case, be sure to consider and adopt the following postulates:
• Therapy aims to achieve lasting remission.
• To maintain the confidence of the patient to the treatment process must be achieved as quickly as possible the first results of therapy.
• A local external therapy should be based on the conventional elements of a case, whose beneficial effects documented in vivo.
Methods and regimen are very diverse, as mentioned earlier in this article, and usually include a drug treatment, PUVA-therapy and phototherapy, exterior treatment, climatotherapy and various alternative methods. It makes sense to elaborate on the methods of treatment, as each of them can lead to many complications. And the manifestations of these complications are quite diverse, there may be a simple and itching or vomiting, and severe skin cancer lesions or functional disorders of the kidneys. The main drawback of the same therapy for psoriasis is the inability to complete cure a person from the disease. In this case, as such, the goal of completely cure psoriasis modern medicine and not posed. Success is the reduction of psoriasis to the smallest manifestations of the disease.
To start to dwell on the medicinal treatment of psoriasis. Overall treatment technology is not there; in each case, your doctor selects the regimen individually. It is very important is the fact that patients are not having any idea about the nature of the disease can literally "get stuck" on the disease, which leads to frustration and disappointment in therapy. And this although very often from the attending physician is required to use different combinations of drugs that are matched precisely the experimental method. In general, the treatment of psoriasis should be based on such factors as the patient's medical history, severity or extent of disease, type "suitability" of a person to therapy, and his lifestyle, sex and age of the patient-specific characteristics (for example, the type of skin on my knees would have required a different treatment, rather than on the face) the first stages of trying to prescribe the least "hard" drugs that have pronounced side effects. If therapy does not bring tangible results, are appointed by more sophisticated treatments are available. Already have certain side effects?
To date, very popular ointment for the treatment of psoriasis based on the calcipotriol group, for example, Dayvoneks and Psorkutan. They show the best efficiency in the treatment, ensuring in many cases, excellent treatment results. Dayvoneks used worldwide to treat psoriasis for over twenty years and more than 95 percent of patients have recovery of the clinical nature. Dayvoneks recommended for appointment as patients who have pockets of psoriasis does not exceed forty percent of the skin surface. When using calcipotriol creatine in the blood serum and the calcium content is not increased. Let's consider more in detail these drugs, given that, in principle, they are identical therapeutic agents, which are marketed under different names by distinctive manufacturers.
Dayvonex can initiate morphological differentiation of keratinocytes and stop their proliferation. Manufactured product as a colorless solution, which has low viscosity, a cream or ointment is used to treat psoriasis. One milliliter of the solution includes 50 micrograms calcipotriol, and it contains isopropanol, levomentol, sodium citrate and hydroxypropyl cellulose.
From the standpoint of pharmacology, Dayvoneks (the active ingredient calcipotriol) - a synthetic analogue of the metabolite of vitamin D. Calcipotriol - is a powerful repressor of T-lymphocytes, which is caused by interleukin, I. Dayvoneks indicated for use among the psoriasis vulgar, including for the treatment of his chronic forms on the scalp. Metering mode depending on what form Dayvoneks apply. For example, a day when using the ointment can be applied not more than 15 grams of the drug, while its total amount in seven days - no more than 100 g ointment applied thinly twice a day on the affected skin. The effect of using fixed usually at 7-14 days after starting therapy. The total course of treatment may be a half or two months. For pediatric patients (6-12 years), the maximum dose of ointment Dayvoneks is 50 g per week; children in the age of 12 can apply up to 75 grams of the drug for a week. A similar therapeutic scheme is used and when using the cream Dayvoneks.
Dayvoneks in the form of a solution is applied at the beginning and end of the day on the scalp, a maximum rate of 60 ml of the drug for a week.
When using Dayvoneks can see some dermatological side effects (local skin irritation, skin erythema and itching, sometimes there may be a worsening of the disease, dermatitis, including perioral its shape). And in applying the solution is likely to develop dermatitis of facial skin. From a metabolism may occur hypercalcemia and hypercalciuria. Furthermore, sometimes there are allergic reactions such as angioneurotic facial edema in rare case of a fixed-pigmentation, photosensitivity.
Contraindications to therapy Dayvoneks are diseases in which basis is abnormal calcium metabolism in the body and increased susceptibility to the components that comprise Dayvoneks. Separately, we note that the drug should be very carefully applied in hypercalciuria, hypervitaminosis D, nephrolithiasis. For children under six years of clinical data on the use of Dayvoneks as there are none, so it makes sense to be very careful to prescribe it in this category of patients. In addition, caution should be used for drug and elderly patients aged over 65 years to avoid serious side effects. Since the evidence is allocated or not Dayvoneks with breast milk available, it is undesirable to appoint him and lactating mothers during pregnancy.
When treating Dayvoneks should adhere to some basic principles. The drug is not recommended for use on skin. After treatment, arms should be washed with soap and water to eliminate the risk of getting Dayvoneks to your face. It is advisable to adhere strictly to the recommended dosage regimes, since their excess may cause hypercalcemia, which is to remove the drug. It is very important to know that when sharing solution Dayvoneks with ointment or cream, the total amount of calcipotriol per week should not be more than five milligrams. Calcipotriol in the number of five milligrams - a 40 ml solution 60 mg of a cream or ointment or 60 mL of 40 mg of ointment or cream. Dayvonek's course of therapy can be performed simultaneously with PUVA-therapy, which we describe below.
Signs of overdose Dayvoneks is to increase the calcium in the blood. In these cases, it is best to stop taking the money. Not recommended for use Dayvoneks with drugs, which have in their composition of salicylic acid.
Of great interest is the study that was conducted on patients of childhood (10-15 years), who gave a lot of useful information on the impact Dayvoneks for this age group of patients. All under the supervision of doctors in the study were 60 children, of whom identified a core group, consisting of 13 girls and 17 boys. Limitation of the disease they have ranged from 2-3 months to three years. 22 people have been diagnosed - psoriasis vulgaris in a common form (the area of the affected body surface does not exceed forty per cent), the eight - the stationary phase of limited psoriasis. The control group included 10 girls and 22 boys (4 with a diagnosis - the stationary phase of limited psoriasis and 26 - common psoriasis vulgaris). All patients in the control and study group were prescribed sedative antihistamine's vitamins B-group. Study group used Dayvoneks twice a day (children over 12 years - from 75 grams of the drug per week, up to 12 years - 50 g). In the control, group was used topically twice a day Porinden A + cream Unna. After 14 days of treatment 80% of patients (24 persons) of the main group was recorded an improvement (the size of foci decreased, the elements of pale and uplostilis), 20% of patients (six men) clinical effect in the severe form was not observed. No side effects were observed. Blood level of calcium was within normal limits. On day 14 of therapy in 93% of study group (28 persons) and 97% (29 people) of the control group was observed regression of lesions. One person from the control group and in two of the main effects of treatment were noted.
Thus, the study showed that under identical timing of therapy, a positive effect from the use of creams and ointments Porinden A Dayvoneks almost similar (97 and 93% respectively). However, it is the permanent or prolonged use of topical corticosteroids plan was unacceptable because they cause serious complications and adverse side effects. What does the preference of drugs based on calcipotriol.
Furthermore, used to treat psoriasis and drug Psorkutan in the form of 0, 005% ointment and a solution for recent use containing one gram of 50 micrograms calcipotriol. Psorcutan used as a topical therapeutic agent. The mechanism by which Psorkutan associated with the correction of the immune processes of the skin and the effect on calcium metabolism. In general, the drug almost no effect systemically, and a very small extent modifies the body calcium metabolism. Psorcutan in many cases is the best option for the treatment of psoriasis middle and mild severity.
Ointment should be applied twice a day with a thin layer on affected areas of the body, in some cases and less frequent use leads to a therapeutic effect. During the day, cannot be used for more than 15 grams of the drug, but a week - more than 100 g. The duration of therapy Psorkutan ranges from half to two, months. Ointment may appoint for a year, but remember that the system of clinical studies on this issue is not implemented. Solution of the drug rubbing light massaging movements in the skin of the head, per week, you can use up to 60 ml Psorkutan. It is worth noting that the duration of the therapeutic course depends on the complete clinical picture, and is determined individually for each patient. As well as in the case of Dayvoneks the week the total number of used calcipotriol should not exceed five milligrams (60 grams in an ointment + 30 milliliters of a solution, or 60 ml + 30 g of ointment) in the course of treatment, Psorkutan chances of adverse dermatological manifestations - papules, vesicles, pustules. Sometimes there may be a burning sensation, redness, itching, and other transient symptoms. If the product enters the skin of face the high risk of developing dermatitis, which has transmitted the character at the end of Psorkutan. It not recommended to use Psorkutan in complex disorder's functionality of the liver and kidneys, with increased sensitivity to the elements means, for pustular type of psoriasis, the progression of the disease and diseases associated with calcium metabolism. Due to lack of information on the application, Psorkutan during pregnancy and breastfeeding is not desirable to prescribe a drug of this category of patients.
Psorkutan used in combination with PUVA-therapy, as well as with other methods of therapy. Do not assign Psorkutan while taking salicylic acid. Furthermore, not recommended for use Psorkutan for patients younger than 18 years because of the lack of systematic information on treatment outcomes in this group of patients. Psorcutan drug released in the pharmacy network without a prescription, but the first makes sense to consult a physician for the possibility of its use for treatment of psoriasis.
As you can see, the drugs Dayvoneks Psorkutan and have a good performance with minimum adverse side effects, which causes their relevance in contemporary clinical practice, treatment of psoriasis.
Systematically used by the intramuscular or oral steroids are also used for treatment of psoriasis, but to say that this is a standard regimen of therapy is not feasible. Withdrawal of steroids is often associated with sudden exacerbation of the disease or with his sharp deterioration. Long-term administration of steroids can cause severe side effects. Steroid injections have no effect in lesions of multiple and can be applied only to areas of lesions, which are isolated.
Psoriasis, PUFA-therapy and rotational therapy.
As immunosuppressive agents can be assigned to methotrexate and cyclosporin. Immediately, it is worth noting that these drugs cause severe side effects. So, for example, methotrexate cause's damage to the kidneys, toxic hepatitis, thrombocytopenia, sores on the mucous membrane of the mouth, serious vomiting and nausea. In addition, the "cons" of methotrexate include the early formation of relapse after the marked improvement and torpid to other regimens subsequently. Use of methotrexate makes sense in cases where other treatment methods have failed. With widespread severe forms of psoriasis that are resistant to many types of treatment used cyclosporine. However, it is worth saying that it can be used for all patients.
And now let's focus on the treatment of psoriasis by PUFA therapy and phototherapy. On local and vast areas of damaged skin may be used UVB radiation in those situations when therapy medication does not work. Furthermore, phototherapy can be assigned in conjunction with other treatments for psoriasis. Short-term risk of the use of UVB therapy is very small, long-term - is comparable with the manifestations of solar radiation (skin aging, cancer). Nonetheless, phototherapy is recognized by many doctors one of the most effective ways to treat severe psoriasis and medium-low risk, when other methods did not reveal any effect. In recent years, many patients are trying to be treated with UVB-plants at home. It should be understood that such self-treatment is fraught with all sorts of evils, it is recommended that in any case, always consult a doctor, who will determine the intensity of the impact of UVB radiation.
PUFA-therapy is used to relieve psoriatic forms intractable to other treatments, as well as for self-treatment of strong and medium forms of psoriasis. PUFA - a drug psoralen and ultraviolet radiation, most often, this method is part of the treatment. PUFA are generally prescribed to patients who have psoriasis struck more than a third of the body surface. Emotionally, or physically debilitated patients and elderly patients may apply PUFA therapy as initial treatment with a specific use. Short-term therapy can cause reddening of the skin; they itch, nausea, and with prolonged use, PUFA may develop cataracts, premature aging of skin or the appearance of freckles. Furthermore, do not forget about the risk of basal cell carcinoma and squamous metastasizing cancer with a continued use of therapy PUFA.
Considerable preventive and therapeutic significance spa and climatic factors in psoriasis proved beneficial effects of river and sea bathing, sun exposure. Climatotherapy based on the application of natural marine products a key factor in the climate plan - this solar UVR. The most persistent effect was observed in the treatment of climatotherapy at the Dead Sea. Its high content of water of various important minerals, such as the concentration of bromine, there are 50 times more than the world's oceans, which has a calming effect on the patient's central nervous system. Typically, treatment in sanatoriums in the Dead Sea is between two weeks to a month, which is very small. It is advisable to purchase several tickets. One should know that patients with increased intensity of the disease, treatment at the Dead Sea is unacceptable as long as the process is not completely stable.
Natural sunlight cannot only weaken the psoriasis, but also significantly improve his clinical picture. Prescribed short daily dose of light of the sun, but should take care not to get sunburn, which aggravate the disease. Sunbathing to increase the risk of the formation of cancer of skin diseases, and this must not be forgotten.
Separately, talk about a rotational therapy, which has a large negative side effect, manifested in a long time, which can be reduced through the use of various methods of short-lived. The composition of rotation therapy includes cyclosporine, etretinate, methotrexate, PUFA-treatment, the resin with UVB. Each of the methods used in the treatment of rotating from one to two years, after which the patient is transferred to another method of therapy. If manifestations of psoriasis eliminated, therapy is terminated prior to the inception of disease recurrence. At relapse apply the same cycle.
There are a number of alternative treatments for psoriasis, each of which is applied with some success in various hospitals. These include - hypnosis, a method of transcranial electrical stimulation, the method of influence on the disease with extremely low temperatures, ozoterapiya, the method of microwave resonance therapy. Similar methods are used in combination with conventional treatment regimens.
According to generally accepted idea's people with psoriasis should not adhere to any restrictions on food, then there is no special diet for them is not developed. General health recommendations are warning about the need to avoid overeating, reduce consumption of foods high in animal fats and alcohol. In general, the regimen must be undemanding and easy. Therapy should be directed to the fact that the habitual way of life is not disturbed, that is unacceptable are missing work, appointments and so on. Therapy should also have a clear focus on the emotional factors of illness, so the emotional component of disease in some situations is crucial. For example, British researchers have published data that suggest that psychotherapy can explain many of the persistent manifestations of eczema, psoriasis and some other diseases of the skin. Of the 64 people suffering from chronic skin diseases, 44 patients indicated that the death of a loved one, leave, divorce, etc. and the onset of disease occurred in about the same time. That is why it is so important to consider all the psychological aspects as causes of disease and treatment of psoriasis. However, most important it is, perhaps, sincere desire to improve patient's quality of life and all possible assistance to him from family and friends.
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