Standard treatment of psoriasis in a day hospital. What are the treatment regimens for psoriasis? NSP program, standards, various techniques
Psoriasis is a disease that is not viral or fungal in nature, so it is not transmitted through the air, household objects, or through personal contact with a patient. The prerequisites for the occurrence of the disease are hereditary, psychological, and physiological factors.
Therapy for this dermatological disease involves the use of complex methods and approaches. There is a special treatment regimen for psoriasis, the use of which helps to effectively eliminate obvious and hidden symptoms of the disease. It is based on the following principles:
- Initially, the external manifestations of lichen planus are suppressed. For this, a number of local preparations are used in the form of sprays, ointments, balms, creams, lotions. With their help, the main symptoms of the disease are eliminated - itching and inflammation. The products also help improve the condition of the skin and make it elastic. Along with topical medications, a number of procedures are prescribed - physiotherapy, ultrasound, herbal medicine, electrosleep, PUVA method, light therapy, laser therapy, cryotherapy.
- Use of hormonal drugs. They are used only in extreme cases, they can quickly eliminate the symptoms of psoriasis, but have a significant disadvantage - a negative effect on other human organs.
- Biologics (monoclonal antibodies, GIPs) help the body's immune system cope with the manifestations of the disease.
- An important role is played by the prescription of vitamin complexes with the obligatory inclusion of vitamin D.
In addition to generally accepted therapy, there are other standards for the treatment of psoriasis: the Hungarian scheme, the Duma technique, the nsp program, the protocol for the treatment of psoriasis.
Hungarian psoriasis treatment regimen
There are several effective regimens that are widely used by doctors to maximize the period of remission of psoriasis. The Hungarian scheme is one of these. It was introduced into widespread medical practice in 2005.
This method of therapy is based on the idea of protecting the human body from endotoxins. According to the hypothesis, they penetrate the intestinal wall, influencing the pathogenesis of the disease. This effect is achieved through the use of bile acid. It is used in the form of capsules or powder. This treatment helps to protect the body from the appearance of cytotoxins that provoke the development of skin diseases.
The Hungarian treatment regimen for psoriasis involves several stages:
- Focusing. This period, which is 24 days, is needed to carry out a number of diagnostic measures with a detailed study of the patient’s tests. The purpose of this stage is to detect infections, fungi, and pathogenic microorganisms in the body.
- Drug therapy. It lasts up to 2 months. During this time, the patient should take 1 capsule of dehydrocholic acid with meals in the morning and evening. If a person does not have breakfast in the morning, then it is allowed to take the drug at lunch.
- Additional activities. With an advanced stage, the doctor may prescribe several injections (gluconate or calcium chloride).
- A strict diet with the use of vitamins D, B12.
The Hungarian method was created and researched by Hungarian dermatologists, which is why it received the same name.
How is the Duma technique used for psoriasis?
This method of treating a disease involves consuming food, medications, various herbs and vitamins at a certain time, according to a schedule.
The Duma technique for psoriasis should provide the patient with the desired result only if all its principles are observed. This is the main difficulty of this type of therapy. The daily regimen begins at 8 am with the use of a herbal decoction (St. John's wort, chamomile and phytohepatol No. 3), and ends at 22:45 with a soothing herbal tea. The day is strictly divided into morning, lunch, evening and night.
In the morning there is a mandatory shower using tar soap. During breakfast, you should take milk thistle oil, Essentiale (2 capsules), vitamins A and E, and a zinc-based product. After 40 min. after breakfast you should take one of the probiotics (Bifikol, Kipacid, Linex, Probifor). The morning ends with a light fruit lunch.
The medications should be repeated for lunch and dinner. At night, take a herbal bath made from a decoction of chamomile and calendula. At approximately 10 pm, it is necessary to lubricate the skin affected by the disease with salicylic ointment.
What is the NSP psoriasis treatment program?
NSP is a manufacturer of drugs for psoriasis. Accordingly, from their products, the company’s specialists created their own method for getting rid of the skin disease, which was called the NSP Psoriasis Treatment Program.
Patients use Chlorophylli Liquid. Take it up to 2 times a day for one and a half to two months. The main property of the drug is to strengthen cell membranes and prevent the formation of pathological processes in the body's gene pool. Next, the drug Burdock is introduced into the regimen, which is taken 2 times a day, 2 capsules for 1 month.
After 3 weeks, patients are given Calcium Magnesium Chelate, Eight, Omega-3 if necessary. A course of therapy with these drugs allows one to achieve excellent results in the patient’s condition.
Dead Sea psoriasis treatment protocol
Some doctors recommend using the influence of the Dead Sea as one of the effective methods of treating psoriasis. There is a certain procedure that regulates the therapy of this dermatological disease - this is the protocol for the treatment of psoriasis. It should be prescribed individually to each patient by an experienced dermatologist.
It should be noted that therapy at the Dead Sea is not suitable for all patients, and for some it is simply contraindicated.
Before prescribing treatment for psoriasis with medications, the dermatologist must collect a complete medical history of the patient, as well as prescribe all the necessary tests and become familiar with the list of medications the patient is already taking. Any treatment regimen for psoriasis involves eliminating the maximum number of risk factors. This is especially important if you plan to treat psoriasis with medication, because excessive exposure to chemical elements on the body can lead to very serious immune diseases and even cancer instead of a skin disease.
Standards for the treatment of psoriasis: mandatory studies before prescribing therapy
The US National Department of Health has issued a directive requiring that every patient undergo appropriate monitoring before starting drug therapy. The Hungarian treatment regimen for psoriasis also involves performing a minimum set of tests on the patient before starting systemic therapy. Despite the fact that European and American directives are not in force in post-Soviet countries, domestic clinics also conduct mandatory tests to check liver function, a complete blood count (including determining the number of platelets, identifying the hepatitis virus and immunodeficiency). The psoriasis treatment protocol also requires that patients be periodically screened for infections and malignancies while taking medications.
Who is the nsp psoriasis treatment program suitable for?
If patients are found to have serious infections that require antibiotic therapy, then therapy with natural drugs, a large range of which is offered by NSP, is prescribed. Since the Hungarian regimen and other official treatment programs are aimed at correcting the immune system when psoriasis is diagnosed, it is important to use all approaches to prevent the development of severe complications. Some treatment protocols also recommend the use of vaccines in patients suffering from postriatic plaques and receiving medications. After all, standard vaccinations, including against pneumococci, hepatitis A and B, influenza, tetanus, and diphtheria, can aggravate the patient’s condition. That is why it is preferable to complete the full course of vaccination before starting therapy. Administration of other vaccines should also be avoided under all circumstances.
26 Sep 2016, 23:57
Treatment of psoriasis with mumiyoAn effective treatment for psoriasis is still unknown to medicine, which is explained by the lack of knowledge about the true causes of the development of dermatosis. That is why treatment of pathology involves a comprehensive...
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Expert advice
RSE at the RVC "Republican Center"
healthcare development"
Ministry of Health
and social development
Republic of Kazakhstan
from November 30, 2015
Protocol No. 18
Psoriasis- a chronic systemic disease with a genetic predisposition, provoked by a number of endo and exogenous factors, characterized by hyperproliferation and impaired differentiation of epidermal cells.
Protocol name: Psoriasis.
ICD X code(s):
L40 Psoriasis:
L40.0 Psoriasis vulgaris;
L40.1 Generalized pustular psoriasis;
L40.2 Persistent acrodermatitis (allopo);
L40.3 Palmar and plantar pustulosis;
L40.4 Guttate psoriasis;
L40.5 Arthropathic psoriasis;
L40.8 Other psoriasis;
L40.9 Psoriasis, unspecified
Date of development of the protocol: year 2013.
Protocol revision date: 2015
Abbreviations used in the protocol:
ALT - alanine aminotransferase
AST - aspartate aminotransferase
BR-Reiter's disease
DBST-diffuse connective tissue diseases
Mg - milligram
Ml - milliliter
INN - international nonproprietary name
CBC - complete blood count
OAM - general urine analysis
PUVA - therapy - a combination of long-wave ultraviolet (320-400 nm) irradiation and oral administration of photosensitizers
ESR - erythrocyte sedimentation rate
SFT - selective phototherapy
UFT - narrowband phototherapy
Protocol user: Dermatovenereologist at the skin and veins dispensary.
Clinical classification:
Psoriasis is divided into the following main forms:
vulgar (ordinary);
· exudative;
· psoriatic erythroderma;
· arthropathic;
· psoriasis of the palms and soles;
· pustular psoriasis.
There are 3 stages of the disease:
progressive;
· stationary;
· regressing.
Depending on prevalence:
· limited;
· widespread;
· generalized.
Depending on the season of the year, types:
· winter (exacerbation in the cold season);
· summer (exacerbation in the summer);
· uncertain (exacerbation of the disease is not associated with seasonality).
Diagnostic criteria:
Complaints and anamnesis
Complaints: skin rashes, itching of varying intensity, peeling, pain, swelling in the joints, limitation of movement.
History of the disease: onset of the first clinical manifestations, time of year, duration of the disease, frequency of exacerbations, seasonality of the disease, genetic predisposition, effectiveness of previous therapy, concomitant diseases.
Physical examination
Pathognomonic symptoms:
· psoriatic triad during scraping (“stearic spot”, “terminal film”, “blood dew”);
· Koebner's symptom (isomorphic reaction);
· presence of a growth zone;
· dimensions of elements;
· characteristics of the location of scales;
· psoriatic lesions of the nail plates;
· joint condition.
List of diagnostic measures
Basic diagnostic measures (mandatory, 100% probability):
general blood test in the dynamics of treatment
· general urine analysis in the dynamics of treatment
Additional diagnostic measures (probability less than 100%):
Determination of glucose
Determination of total protein
· Cholesterol determination
Determination of bilirubin
· Definition of ALaT
· Definition of ASaT
Determination of creatinine
Determination of urea
· Level I and II immunogram
Histological examination of skin biopsy (in unclear cases)
· Consultation with a therapist
· Consultation with a physiotherapist
Examinations that need to be carried out before planned hospitalization (minimum list):
· general blood analysis;
· general urine analysis;
· biochemical blood tests: AST, ALT, glucose, total. bilirubin.;
microreaction of precipitation;
· examination of stool for helminths and protozoa (children under 14 years of age).
Instrumental studies: not specific
Indications for consultation with specialists(in the presence of concomitant pathology):
· therapist;
· neurologist;
· rheumatologist.
Laboratory research
Leukocytosis, increased ESR
Histological examination of a skin biopsy: pronounced acanthosis, parakeratosis, hyperkeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements of “Munro microabcesses” (without vesiculation). In the dermis: cellular exudate; exocytosis of polynuclear leukocytes.
Differential diagnosis:
| Seborrheic dermatitis | Lichen planus | Parapsoriasis | Pink lichen of Zhiber | Papular (psoriasiform) syphilide |
| Erythematous lesions in seborrheic areas of the skin, with greasy dirty yellowish scales on the surface. | The mucous and flexor surfaces of the extremities are affected. Papules are polygonal in shape, bluish-red in color, with a central umbilical depression, and a waxy sheen. Wickham grid when wetting the surfaces of plaques with oil. | The papules are lenticular, round, pink-red in color, flat with pronounced polygonal fields of skin pattern. The scales are round, large, and removed like a “wafer.” | On the skin of the neck and body there are pinkish spots with peripheral growth, the larger ones resemble “medallions”. The largest "maternal plaque". | On the lateral surfaces of the body there are pink miliary papules with slight peeling. Positive complex of serological reactions. |
Treatment goals:
· stop the severity of the process;
· reduce or stabilize the pathological process (absence of fresh rashes) on the skin;
· remove subjective sensations;
· maintain ability to work;
· improve the quality of life of patients.
Treatment tactics.
Non-drug treatment:
Mode 2.
Table No. 15 (limit: intake of spicy foods, spices, alcoholic beverages, animal fats).
Drug treatment.
Treatment should be comprehensive, taking into account the basic aspects of pathogenesis (elimination of inflammation, suppression of keratinocyte proliferation, normalization of their differentiation), clinical picture, severity, complications.
Other drugs from these groups and new generation drugs can be used.
Main therapeutic approaches:
1. Local therapy: used for all forms of psoriasis. Monotherapy is possible.
2. Phototherapy: used for all forms of psoriasis.
3. Systemic therapy: used exclusively for moderate and severe forms of psoriasis.
Note: The following grades of recommendation and levels of evidence are used in this protocol
A - convincing evidence of the benefits of the recommendation (80-100%);
B - satisfactory evidence of the benefits of the recommendations (60-80%);
C - weak evidence of the benefits of recommendations (about 50%);
D - satisfactory evidence of the benefits of recommendations (20-30%);
E - convincing evidence of the uselessness of recommendations (< 10%).
List of essential medicines (mandatory, 100% probability) - drugs of choice.
| Pharmacological group | INN of the drug | Release form | Dosage | Frequency of application | Note |
| Immunosuppressive drugs (Cytostatics), including anticytokine drugs | Methotrexate | ampoules, syringe Pills |
10, 15, 25, 30 mg 2.5 mg |
Once a week for 3-5 weeks Doses and prescription regimen are selected individually. |
Methotrexate was approved for the treatment of psoriasis without any of the double-blind, placebo-controlled studies that are currently required. Clinical guidelines were developed by a group of dermatologists in 1972, defining the main criteria for prescribing methotrexate for psoriasis. |
| Cyclosporine (level of evidence B-C) |
Concentrate for the preparation of solution for infusion, capsules |
(1 ml ampoules containing 50 mg); capsules containing 25, 50 or 100 mg of cyclosporine. | Cyclosporine concentrate for intravenous administration is diluted with isotonic sodium chloride solution or 5% glucose solution in a ratio of 1:20-1:100 immediately before use. The diluted solution can be stored for no more than 48 hours. Cyclosporine is administered intravenously slowly (drip) in an isotonic sodium chloride solution or 5% glucose solution. The initial dose is usually 3-5 mg/kg per day when administered into a vein, and 10-15 mg/kg per day when administered orally. Next, doses are selected based on the concentration of cyclosporine in the blood. Determination of concentration must be done daily. The radioimmunological method using special kits is used for the study. The use of cyclosporine should only be performed by physicians who have sufficient experience in the treatment of immunosuppressants. |
||
| Infliximab (level of evidence - B) | powder d/p solution | 100 mg | 5 mg/kg according to the schedule | ||
| Ustekinumab (level of evidence - A-B) | Bottle, syringe | 45 mg/0.5 ml and 90 mg/1.0 ml | 45 - 90 mg according to the schedule | It is used for moderate to severe forms of psoriasis, with the area and severity of skin lesions exceeding 10-15%. Selective inhibitor of pro-inflammatory cytokines (IL-12, IL - 23) | |
| Еtanercept* (level of evidence - B) |
Solution for subcutaneous administration | 25 mg - 0.5 ml, 50 mg - 1.0 ml. | Etanercept is prescribed at 25 mg twice a week, or 50 mg twice a week for 12 weeks, then 25 mg twice a week for 24 weeks. | It is used mainly for arthropathic psoriasis. Selective tumor factor inhibitor - alpha | |
| External therapy | |||||
| Vitamin D-3 derivatives | Calcipotriol (level of evidence - A-B) | ointment, cream, solution | 0.05 mg/g; 0.005% | 1-2 times a day | The use of calcipotriol more often than TGCS leads to skin irritation. Combination with TGCS may reduce the incidence of this effect. Dose-dependent side effects include hypercalcemia and hypercalciuria. |
| Glucocorticosteroid ointments (level of evidence B - C) Very strong (IV) |
Clobetasol propionate |
ointment, cream | 0,05% | Continuous therapy: 2 times a day, for 2 weeks, then switch to a weaker TGCS Intermittent therapy: 3 times a day on days 1, 4, 7 and 13, then switch to a weaker TGCS |
Intermittent therapy allows you to reduce the steroid load and minimize the risk of adverse events. The effectiveness of treatment will increase with complex therapy with corneoprotectors |
| Strong (III) | Betamethasone | ointment, cream | 0,1% | 1-2 times a day | Local use of THCS can cause stretch marks and skin atrophy, and these side effects are more pronounced with the use of highly active drugs and occlusive dressings. |
| Methylprednisolone aceponate | ointment, cream, emulsion | 0,05% | 1-2 times a day | ||
| Mometasone furoate | cream, ointment | 0,1% |
1-2 times a day |
||
| Fluocinolone acetonide | Ointment, gel | 0,025% | 1-2 times a day | ||
| Moderately strong (II) | Triamcinolone | ointment | 0,1% | 1-2 times a day | |
| Weak (I) | Dexamethasone | ointment | 0,025% | 1-2 times a day | |
| Hydrocortisone | cream, ointment | 1,0%-0,1% | 1-2 times a day | ||
| Calcineurin inhibitors | Tacrolimus (level of evidence: C) | ointment | 100 g of ointment contains 0.03 g or 0.1 g of tacrolimus | 1-2 times a day | There are several RCTs confirming the effectiveness of psoriasis therapy |
| Zinc preparations | Pyrithione zinc activated (level of evidence - C) | cream | 0,2% | 1-2 times a day | There are several comparative, randomized, multicenter, double-blind (with an additional open-label) placebo-controlled studies of the effectiveness of topical application of activated zinc pyrithione for mild to moderate papulous plaque psoriasis. |
List of additional medicines (probability less than 100%)
| Pharmacological group | INN of the drug | Release form | Dosage | Frequency of application | Note |
| Antihistamines* | Cetirizine | pills | 10 mg | Once a day No. 10-14 | To provide pronounced antiallergic, antipruritic, anti-inflammatory and antiexudative effects. |
| Chloropyramine | pills | 25 mg | Once a day No. 10-14 | ||
| Diphenhydramine | ampoule | 1% | 1-2 times a day No. 10-14 | ||
| Loratadine | pills | 10mg | Once a day No. 10-14 | ||
| Clemastine | pills | 10 mg | 1-2 times a day No. 10-14 | ||
| Sedatives* | Valerian extract | pills | 2 mg | 3 times a day10 days | If the pathological process on the skin is accompanied by an anxious state of mind and body associated with anxiety, tension and nervousness |
| Guaifenesin. Dry extract (obtained from rhizomes with roots of valerian officinalis, lemon balm herb, St. John's wort herb, leaves and flowers of hawthorn or prickly hawthorn, passionflower herb (passionflower), common hop fruits, black elderberry flowers) |
bottle | 100 ml | 5 ml 2 times a day | ||
| Peony evasive rhizomes and roots | bottle | 20-40 drops | 2 times a day for a course of therapy | ||
| Sorbents* | Activated carbon | tablet | 0.25 gr. | Once a day for 7-10 days | |
| Desensitizing drugs* | Sodium thiosulfate | ampoules | 30% - 10.0 ml | Once a day for 10 days | |
| Calcium gluconate | ampoules | 10% - 10.0 ml | Once a day for 10 days | ||
| Magnesium sulfate solution | ampoules | 25% - 10.0 ml | Once a day for 10 days | ||
| Drugs that correct microcirculation disorders* | Dextran | bottles | 400,0 | Once a day No. 5 | |
| Vitamins* | Retinol | capsules | 300-600 thousand IU (adults) 5-10 thousand IU per 1 kg (children) |
1-2 months daily | Compound: |
| Alpha tocopheryl acetate, retinol palmitate | capsules | 100-400 IU | 1-2 times a day 1.5 months | ||
| Thiamine | ampoules | 5%-1.0 ml | Once a day for 10-15 days | ||
| Pyridoxine | ampoules | 5%-1.0 ml | Once a day for 10-15 days | ||
| Tocopherol | capsules | 100mg, 200mg, 400mg | 3 times a day 10-15 days | ||
| Cyanocobolamine | ampoules | 200µg/ml, 500µg/ml | 1 time per day every other day No. 10 | ||
| Folic acid | pills | 1mg, 5mg | 3 times a day 10-15 days | ||
| Ascorbic acid | ampoules | 5%-2.0 ml | 2 times a day for 10 days | ||
| Glucocorticosteroids* | Betamethasone | Suspension for injection | 1.0 ml | Once every 7-10 days | |
| Hydrocortisone | Suspension for injection | 2,5% | dose and frequency are determined individually | according to indications, depending on severity | |
| Dexamethasone | pills ampoules |
0.5 mg; 1.5 mg 0.4% - 1.0 ml |
dose and frequency are determined individually | according to indications, depending on severity | |
| Prednisolone | pills ampoules |
5 mg 30 mg/ml |
dose and frequency are determined individually | according to indications, depending on severity | |
| Methylprednisolone | Pills, Lyophilisate for the preparation of solution for injection |
4 mg; 16 mg 250, 500, 1000 mg |
dose and frequency are determined individually | according to indications, depending on severity | |
| Drugs that improve peripheral circulation* | Pentoxifylline | ampoules | 2% - 5.0 ml | Once a day for 7-10 days | |
| Means that help restore intestinal microbiological balance* | 1. Germless aqueous substrate of metabolic products of Escherichia coli DSM 4087 24.9481 g 2. germ-free aqueous substrate of metabolic products Streptococcus faecalis DSM 4086 12.4741 g 3. germless aqueous substrate of metabolic products Lactobacillus acidophilus DSM 4149 12.4741 g 4. germless aqueous substrate of metabolic products of Lactobacillus helveticus DSM 4183 49.8960 g. |
bottle | 100.0 ml | 20-40 drops 3 times a day for 10-15 days | |
| Lebenin powder | capsules | 3 times a day 21 days | |||
| Lyophilized bacteria | bottle capsules |
3 and 5 doses |
3 times a day for the entire course of treatment | ||
| Hepatoprotectors* | Fumigata extract, milk thistle | capsules | 250 mg | According to indications, mainly if there is concomitant liver pathology. | |
| Ursodeoxycholic acid | capsules | 250 mg | 1 capsule 3 times a day for the entire course of treatment | ||
| Immunomodulators* | Levamisole | pills | 50 - 150mg | Once a day in courses of 3 days with a 4-day break | Mainly in case of identified disorders of the immune status. In order to normalize immunity. |
| Liquid extract (1:1) from the grass of tussock pike and ground reed grass) | dropper container | 25ml, 30 ml, 50 ml. | according to the scheme: 1 week - 10 drops x 3 times a day Week 2 - 8 drops x 3 times a day Week 3 - 5 drops x 3 times a day Week 4 - 10 drops x 3 times a day |
||
| Sodium oxodihydroacridinyl acetate | pills ampoules |
125 mg 1.0/250 mg |
2 tablets 5 times a day No. 5 1 ampoule 4 times a day No. 5 |
||
| Biogenic stimulants* | Phibs | ampoules | 1.0 ml | s/c once a day for a course of 10 injections | |
| External therapy* | CycloPyroxolAmin | shampoo | 1,5% |
Rub onto damp scalp until foam forms. Leave the foam for 3-5 minutes, rinse. Repeat the procedure 2nd time | During the period of relapse every other day. In stationary and regression stage 1 time per week |
| Ketoconazole | shampoo | 2% | 1-2 times a day | Mainly in stationary and regression stages | |
| Corneoprotectors | Preparations of Palmitoyl Ethanol Amine based on Derma-Membrane-Structure (DMS) | Cream, Lotion | 17% 31% |
Adjuvant therapy during remission: apply to the skin of the entire body 10 minutes before TGCS applications, daily, 2 times a day. Prevention of exacerbations in the stationary and regression stages: daily, 2 times a day for the whole body. |
To restore the integrity of the stratum corneum, it has a local antipruritic, anti-inflammatory and antioxidant effect. Reduces skin sensitivity, reduces the frequency of TGCS use, and helps prolong remission. |
Other types of treatment.
Physiotherapy:
· phototherapy (level of evidence from A to D. There are many therapeutic combinations where the effectiveness of phototherapy methods in complex treatment has been proven at a high level): PUVA therapy, PUVA - baths, SFT + UFT.
· phonophoresis, laser magnetic therapy, balneotherapy, heliotherapy.
Surgical intervention - no reason
Indicators of treatment effectiveness and safety of diagnostic and treatment methods:
· significant improvement - regression of 75% of rashes or more;
· improvement - regression from 50% to 75% of rashes.
Indications for hospitalization indicating the type of hospitalization:
· progression of a disease resistant to therapy (planned).
· acute joint damage, erythroderma (planned).
· severity and severity of the course (planned).
· torpid course of the disease (planned).
Preventive actions:
Diet low in carbohydrates and fats, enriched with fish and vegetables
· elimination of risk factors
· treatment of concomitant pathology
· courses of vitamin therapy, herbal medicine, adaptogens, lipotropic agents
hydrotherapy
· Spa treatment.
· corneoprotectors (to restore the integrity of the stratum corneum, help prolong remission).
· emollients (mainly during the inter-relapse period - to restore the hydrolipid layer)
Further management:
Dispensary registration at the place of residence with a dermatologist, preventive anti-relapse treatment, sanatorium-resort treatment.
Patients are subject to referral to VTEK to determine disability (in severe clinical forms - employment with restriction of work in warm rooms).
- Minutes of meetings of the Expert Council of the RCHR of the Ministry of Health of the Republic of Kazakhstan, 2015< >List of used literature: 1. “Skin and venereal diseases.” Guide for doctors. Edited by YK Skripkin. Moscow. - 1999 2. “Treatment of skin and venereal diseases.” Guide for doctors. THEM. Romanenko, V.V. Kaluga, SL Afonin. Moscow. - 2006. 3. “Differential diagnosis of skin diseases.” Edited by A.A. Studnitsina. Moscow 1983 4. Rational pharmacotherapy of skin diseases and sexually transmitted infections. Guide for practicing physicians. // Edited by A.A. Kubanova, V.I. Kisina. Moscow, 2005 5. “European Guide to the Treatment of Dermatological Diseases” Ed. HELL. Katsambasa, T.M. Lottie. // Moscow Medpress inform 2008.-727 p. 6. “Therapeutic reference book on dermatology and allergology.” P. Altmaier Ed. house GEOTAR-Med Moscow.-2003.-1246 p. 7. A 52-week trial comparing briakinumab with methotrexate in patients with psoriasis. Reich K, Langley RG, Papp KA, Ortonne JP, Unnebrink K, Kaul M, Valdes JM. // Source Dermatologikum Hamburg, Hamburg, Germany. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/22029980. 8. Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled clinical trial. Radmanesh M, Rafiei B, Moosavi ZB, Sina N. // Source Department of Dermatology, Jondishapour University of Medical Sciences, Ahvaz, Iran. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/21950300 9. Weber J, Keam SJ. Ustekinumab // BioDrugs. 2009;23(1):53-61. doi: 10.2165/00063030-200923010-00006. 10. Farhi D. Ustekinumab for the treatment of psoriasis: review of three multicenter clinical trials // Drugs Today (Barc). 2010.-Apr; 46(4):259-64. 11. Krulig E, Gordon KB. Ustekinumab: an evidence-based review of its effectiveness in the treatment of psoriasis // Core Evid. 2010 Jul 27; 5:-22. 12. Kubanova A.A. Activated zinc pyrithione (Skin-cap) in the treatment of mild and moderate papulous plaque psoriasis. Results of the randomized, placebo-controlled trial ANTHRACITE. Vestn. dermatol. Venerol., 2008;1:59 - 65. 13. Safety and efficacy of a fixed-dose cyclosporinmicroemulsion (100 mg) for the treatment of psoriasis. Shintani Y, Kaneko N, Furuhashi T, Saito C, Morita A. // Source Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/21545506. 14. Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation. Grozdev IS, Van Voorhees AS, Gottlieb AB, Hsu S, Lebwohl MG, Bebo BF Jr, Korman NJ; National Psoriasis Foundation.// Source. Department of Dermatology and Murdough Family Center for Psoriasis, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. J Am Acad Dermatol. 2011 Sep;65(3):537-45. Epub 2011 Apr 15. http://www.ncbi.nlm.nih.gov/pubmed/21496950 15. The risk of infection and malignancy with tumor necrosis factor antagonists in adults with psoriatic disease: a systematic review and meta-analysis of randomized controlled trials. Dommasch ED, Abuabara K, Shin DB, Nguyen J, Troxel AB, Gelfand JM. // Source Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. http://www.ncbi.nlm.nih.gov/pubmed/21315483 16. Infliximab monotherapy in Japanese patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. A randomized, double-blind, placebo-controlled multicenter trial. Torii H, Nakagawa H; Japanese Infliximab Study investigators. http://www.ncbi.nlm.nih.gov/pubmed/20547039. 17. Efficacy of systemic treatments for moderate to severe plaque psoriasis: systematic review and meta-analysis. Bansback N, Sizto S, Sun H, Feldman S, Willian MK, Anis A. // Source Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada. http://www.ncbi.nlm.nih.gov/pubmed/19657180. 18. Long-term efficacy and safety of adalimumab in patients with moderate to severe psoriasis treated continuously over 3 years: results from an open-label extension study for patients from REVEAL. Gordon K, Papp K, Poulin Y, Gu Y, Rozzo S, Sasso EH. http://www.ncbi.nlm.nih.gov/pubmed/21752491 19. Efficacy and safety of adalimumab in patients with psoriasis previously treated with anti-tumour necrosis factor agents: subanalysis of BELIEVE Ortonne JP, Chimenti S, Reich K, Gniadecki R, Sprøgel P, Unnebrink K, Kupper H, Goldblum O, Thaçi D. // Source. Department of Dermatology, University of Nice, Nice, France. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/21214631 20. Integrated safety analysis: short- and long-term safety profiles of etanercept in patients with psoriasis. Pariser DM, Leonardi CL, Gordon K, Gottlieb AB, Tyring S, Papp KA, Li J, Baumgartner SW. // Source. Eastern Virginia Medical School and Virginia Clinical Research Inc, Norfolk, Virginia, USA. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/22015149. 21. Development, evaluation and clinical studies of Acitretin loaded nanostructured lipid carriers for topical treatment of psoriasis. Agrawal Y, Petkar KC, Sawant KK. // Source. Center for PG Studies and Research, TIFAC CORE in NDDS, Department of Pharmacy, The M.S. University of Baroda, Vadodara 390002, Gujarat, India. http://www.ncbi.nlm.nih.gov/pubmed/20858539. 22. Quality of life in patients with scalp psoriasis treated with calcipotriol/betamethasone dipropionate scalp formulation: a randomized controlled trial. Ortonne JP, Ganslandt C, Tan J, Nordin P, Kragballe K, Segaert S. // Source. Service de Dermatologie, Hôpital L'Archet2, Nice, France. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/19453810 23. A calcipotriene/betamethasone dipropionate two-compound scalp formulation in the treatment of scalp psoriasis in Hispanic/Latino and Black/African American patients: results of the randomized , 8-week, double-blind phase of a clinical trial. Tyring S, Mendoza N, Appell M, Bibby A, Foster R, Hamilton T, Lee M. // Source. Center for Clinical Studies, Department of Dermatology, University of Texas Health Science Center, Houston, TX, USA. http://www.ncbi.nlm.nih.gov/pubmed/20964660. 24. Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation. Grozdev IS, Van Voorhees AS, Gottlieb AB, Hsu S, Lebwohl MG, Bebo BF Jr, Korman NJ; National Psoriasis Foundation. Source. // Department of Dermatology and Murdough Family Center for Psoriasis, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. http://www.ncbi.nlm.nih.gov/pubmed/21496950. 25. Topical treatments for chronic plaque psoriasis. Mason AR, Mason J, Cork M, Dooley G, Edwards G. // Source. Center for Health Economics, University of York, Alcuin A Block, Heslington, York, UK, YO10 5DD. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/19370616. 26. European S3-Guidelines on the systemic treatment of psoriasis vulgaris. D Pathirana, AD Ormerod, P Saiag, C Smith, PI Spuls, A Nast, J Barker, JD Bos, G-R Burmester, S Chimenti, L Dubertret, B Eberlein, R Erdmann, J Ferguson, G Girolomoni, P Gisondi, A Giunta , C Griffiths, H Honigsmann, M Hussain, R Jobling, S-L Karvonen, L Kemeny, I Kopp, C Leonardi, M Maccarone, A Menter, U Mrowietz, L Naldi, T Nijsten, J-P Ortonne, H-D Orzechowski, T Rantanen, K Reich, N Reytan, H Richards, HB Thio, P van de Kerkhof, B Rzany. October 2009, volume 23, supplement 2. EAVD. 27. Evaluation of methylprednisolone aceponate, tacrolimus and combination thereof in the psoriasis plaque test using sum score, 20-MHz-ultrasonography and optical coherence tomography. Buder K, Knuschke P, Wozel G. // Source. Department of Dermatology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. http://www.ncbi.nlm.nih.gov/pubmed/21084037. 28. Efficacy and safety of the Betamethasone valerate 0.1% plaster in mild-to-moderate chronic plaque psoriasis: a randomized, parallel-group, active-controlled, phase III study. Naldi L, Yawalkar N, Kaszuba A, Ortonne JP, Morelli P, Rovati S, Mautone G. // Source. ClinicaDermatologica, OspedaliRiuniti, Centro Studi GISED, Bergamo, Italy. http://www.ncbi.nlm.nih.gov/pubmed/21284407. 29. Evaluation of methylprednisolone aceponate, tacrolimus and combination thereof in the psoriasis plaque test using sum score, 20-MHz-ultrasonography and optical coherence tomography. Buder K, Knuschke P, Wozel G. // Source. Department of Dermatology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. http://www.ncbi.nlm.nih.gov/pubmed/21084037. 30. Bioavailability, antipsoriatic efficacy and tolerability of a new light cream with mometasonefuroate 0.1%. Korting HC, Schöllmann C, Willers C, Wigger-Alberti W. // Source Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/22353786. 31. Mometasonefuroate 0.1% and salicylic acid 5% vs. mometasonefuroate 0.1% as sequential local therapy in psoriasis vulgaris. Tiplica GS, Salavastru CM. // Source. Colentina Clinical Hospital, Bucharest, Romania. [email protected]. http://www.ncbi.nlm.nih.gov/pubmed/19470062. 32. Kligman A.M., Review Article Corneobiology and Corneotherapy - a final chapter. // International Journal of Cosmetic Science, 2011, - 33, - 197 33 Zhai H, Maibach H.I. Barrier creams - skin protectants: can you protect skin? // Journal of Cosmetic Dermatology 2002, 1, (1), - 20-23. 34. V.V. Mordovtseva “Corneotherapy for psoriasis” // Journal Corneoprotectors in Dermatology, 2012, pp. 25 - 28 (56).
List of developers:
Baev A.I. - Ph.D. senior researcher at the Research Institute of Dermatovenerology of the Ministry of Health of the Republic of Kazakhstan
Reviewers:
1. G.R. Batpenova - Doctor of Medical Sciences, chief freelance dermatovenerologist of the Ministry of Health of the Republic of Kazakhstan, head of the department of dermatovenereology of JSC "MUA"
2. Zh.A. Orazimbetova - Doctor of Medical Sciences, Head. course at the Kazakh-Russian Medical University
3. S.M. Nurusheva - Doctor of Medical Sciences, Head. Department of Kazakh National Medical University named after. S.D. Asfendiyarova
Indication of the conditions for reviewing the protocol: Protocols are updated as proposals are received from users of the protocol and new medicines are registered in the Republic of Kazakhstan.
Clinical protocols for diagnosis and treatment are the property of the Ministry of Health of the Republic of Kazakhstan
Psoriasis is a disease that is not viral or fungal in nature, so it is not transmitted through the air, household objects, or through personal contact with a patient. The prerequisites for the occurrence of the disease are hereditary, psychological, and physiological factors.
Therapy for this dermatological disease involves the use of complex methods and approaches. There is a special treatment regimen for psoriasis, the use of which helps to effectively eliminate obvious and hidden symptoms of the disease. It is based on the following principles:
- Initially, the external manifestations of lichen planus are suppressed. For this, a number of local preparations are used in the form of sprays, ointments, balms, creams, lotions. With their help, the main symptoms of the disease are eliminated - itching and inflammation. The products also help improve the condition of the skin and make it elastic. Along with topical medications, a number of procedures are prescribed - physiotherapy, ultrasound, herbal medicine, electrosleep, PUVA method, light therapy, laser therapy, cryotherapy.
- Use of hormonal drugs. They are used only in extreme cases, they can quickly eliminate the symptoms of psoriasis, but have a significant disadvantage - a negative effect on other human organs.
- Biologics (monoclonal antibodies, GIPs) help the body's immune system cope with the manifestations of the disease.
- An important role is played by the prescription of vitamin complexes with the obligatory inclusion of vitamin D.
- Diet food.
In addition to generally accepted therapy, there are other standards for the treatment of psoriasis: the Hungarian scheme, the Duma technique, the nsp program, the protocol for the treatment of psoriasis.
Hungarian psoriasis treatment regimen
There are several effective regimens that are widely used by doctors to maximize the period of remission of psoriasis. The Hungarian scheme is one of these. It was introduced into widespread medical practice in 2005.
This method of therapy is based on the idea of protecting the human body from endotoxins. According to the hypothesis, they penetrate the intestinal wall, influencing the pathogenesis of the disease. This effect is achieved through the use of bile acid. It is used in the form of capsules or powder. This treatment helps to protect the body from the appearance of cytotoxins that provoke the development of skin diseases.
“We have implemented a national Russian development that can get rid of the cause of psoriasis and destroy the disease itself in a few weeks. "
The Hungarian treatment regimen for psoriasis involves several stages:
- Focusing. This period, which is 24 days, is needed to carry out a number of diagnostic measures with a detailed study of the patient’s tests. The purpose of this stage is to detect infections, fungi, and pathogenic microorganisms in the body.
- Drug therapy. It lasts up to 2 months. During this time, the patient should take 1 capsule of dehydrocholic acid with meals in the morning and evening. If a person does not have breakfast in the morning, then it is allowed to take the drug at lunch.
- Additional activities. With an advanced stage, the doctor may prescribe several injections (gluconate or calcium chloride).
- A strict diet with the use of vitamins D, B12.
The Hungarian method was created and researched by Hungarian dermatologists, which is why it received the same name.
How is the Duma technique used for psoriasis?
This method of treating a disease involves consuming food, medications, various herbs and vitamins at a certain time, according to a schedule.
The Duma technique for psoriasis should provide the patient with the desired result only if all its principles are observed. This is the main difficulty of this type of therapy. The daily regimen begins at 8 am with the use of a herbal decoction (St. John's wort, chamomile and phytohepatol No. 3), and ends at 22:45 with a soothing herbal tea. The day is strictly divided into morning, lunch, evening and night.
In the morning there is a mandatory shower using tar soap. During breakfast, you should take milk thistle oil, Essentiale (2 capsules), vitamins A and E, and a zinc-based product. After 40 min. after breakfast you should take one of the probiotics (Bifikol, Kipacid, Linex, Probifor). The morning ends with a light fruit lunch.
The medications should be repeated for lunch and dinner. At night, take a herbal bath made from a decoction of chamomile and calendula. At approximately 10 pm, it is necessary to lubricate the skin affected by the disease with salicylic ointment.
What is the NSP psoriasis treatment program?
NSP is a manufacturer of drugs for psoriasis. Accordingly, from their products, the company’s specialists created their own method for getting rid of the skin disease, which was called the NSP Psoriasis Treatment Program.
Patients use Chlorophylli Liquid. Take it up to 2 times a day for one and a half to two months. The main property of the drug is to strengthen cell membranes and prevent the formation of pathological processes in the body's gene pool. Next, the drug Burdock is introduced into the regimen, which is taken 2 times a day, 2 capsules for 1 month.
After 3 weeks, patients are given Calcium Magnesium Chelate, Eight, Omega-3 if necessary. A course of therapy with these drugs allows one to achieve excellent results in the patient’s condition.
Dead Sea psoriasis treatment protocol
Some doctors recommend using the influence of the Dead Sea as one of the effective methods of treating psoriasis. There is a certain procedure that regulates the therapy of this dermatological disease - this is the protocol for the treatment of psoriasis. It should be prescribed individually to each patient by an experienced dermatologist.
It should be noted that therapy at the Dead Sea is not suitable for all patients, and for some it is simply contraindicated.
The Dead Sea psoriasis treatment protocol includes:
- Diagnostics. During the examination of the patient, blood and urine tests are taken, radiography is performed and qualified consultation with specialists is held.
- Based on the diagnostic results, appropriate procedures are prescribed. The course of therapy is 28 days. The therapeutic effect lasts for almost half a year. Some patients forget about the disease for longer periods (up to 2-3 years).
Treatment of psoriasis according to the protocol is only part of the overall treatment of the disease. It will in no way replace traditional methods of achieving remission.
Elena Malysheva: “How did I manage to defeat psoriasis at home in 1 week, without leaving the couch?!”
Psoriasis. Clinical protocol, 2015
Psoriasis- a chronic systemic disease with a genetic predisposition, provoked by a number of endo and exogenous factors, characterized by hyperproliferation and impaired differentiation of epidermal cells.
Protocol name: Psoriasis.
ICD X code(s):
L40 Psoriasis:
L40.0 Psoriasis vulgaris;
L40.1 Generalized pustular psoriasis;
L40.2 Persistent acrodermatitis (allopo);
L40.3 Palmar and plantar pustulosis;
L40.4 Guttate psoriasis;
L40.5 Arthropathic psoriasis;
L40.8 Other psoriasis;
L40.9 Psoriasis, unspecified
Date of development of the protocol: year 2013.
Protocol revision date: 2015
Abbreviations used in the protocol:
ALT – alanine aminotransferase
AST – aspartate aminotransferase
BR-Reiter's disease
DBST-diffuse connective tissue diseases
mg – milligram
Ml – milliliter
INN – international nonproprietary name
CBC - complete blood count
OAM - general urine analysis
PUVA - therapy - a combination of long-wave ultraviolet (320-400 nm) irradiation and oral administration of photosensitizers
ESR – erythrocyte sedimentation rate
SPT – selective phototherapy
UFT – narrowband phototherapy
Protocol user: Dermatovenereologist at the skin and veins dispensary.
CLASSIFICATION
Clinical classification:
Psoriasis is divided into the following main forms:
vulgar (ordinary);
· exudative;
· psoriatic erythroderma;
· arthropathic;
· psoriasis of the palms and soles;
· pustular psoriasis.
There are 3 stages of the disease:
progressive;
· stationary;
· regressing.
Depending on prevalence:
· limited;
· widespread;
· generalized.
Depending on the season of the year, types:
· winter (exacerbation in the cold season);
· summer (exacerbation in the summer);
· uncertain (exacerbation of the disease is not associated with seasonality).
SYMPTOMS, COURSE
Diagnostic criteria:
Complaints and anamnesis
Complaints: skin rashes, itching of varying intensity, peeling, pain, swelling in the joints, limitation of movement.
History of the disease: onset of the first clinical manifestations, time of year, duration of the disease, frequency of exacerbations, seasonality of the disease, genetic predisposition, effectiveness of previous therapy, concomitant diseases.
Physical examination
Pathognomonic symptoms:
· psoriatic triad during scraping (“stearic spot”, “terminal film”, “blood dew”);
· Koebner's symptom (isomorphic reaction);
· presence of a growth zone;
· dimensions of elements;
· characteristics of the location of scales;
· psoriatic lesions of the nail plates;
· joint condition.
DIAGNOSTICS
List of diagnostic measures
Basic diagnostic measures (mandatory, 100% probability):
general blood test in the dynamics of treatment
· general urine analysis in the dynamics of treatment
Additional diagnostic measures (probability less than 100%):
Determination of glucose
Determination of total protein
· Cholesterol determination
Determination of bilirubin
· Definition of ALaT
· Definition of ASaT
Determination of creatinine
Determination of urea
· Level I and II immunogram
Histological examination of skin biopsy (in unclear cases)
· Consultation with a therapist
· Consultation with a physiotherapist
Examinations that need to be carried out before planned hospitalization (minimum list):
· general blood analysis;
· general urine analysis;
· biochemical blood tests: AST, ALT, glucose, total. bilirubin.;
microreaction of precipitation;
· examination of stool for helminths and protozoa (children under 14 years of age).
Instrumental studies: not specific
Indications for consultation with specialists(in the presence of concomitant pathology):
· therapist;
· neurologist;
· rheumatologist.
LABORATORY DIAGNOSTICS
DIFFERENTIAL DIAGNOSIS
TREATMENT
· stop the severity of the process;
· reduce or stabilize the pathological process (absence of fresh rashes) on the skin;
· remove subjective sensations;
· maintain ability to work;
· improve the quality of life of patients.
Treatment tactics.
Non-drug treatment:
Mode 2.
Table No. 15 (limit: intake of spicy foods, spices, alcoholic beverages, animal fats).
Drug treatment.
Treatment should be comprehensive, taking into account the basic aspects of pathogenesis (elimination of inflammation, suppression of keratinocyte proliferation, normalization of their differentiation), clinical picture, severity, complications.
Other drugs from these groups and new generation drugs can be used.
Main therapeutic approaches:
1. Local therapy: used for all forms of psoriasis. Monotherapy is possible.
2. Phototherapy: used for all forms of psoriasis.
3. Systemic therapy: used exclusively for moderate and severe forms of psoriasis.
INFORMATION
List of developers:
Baev A.I. - Ph.D. senior researcher at the Research Institute of Dermatovenerology of the Ministry of Health of the Republic of Kazakhstan
Reviewers:
1. G.R. Batpenova - Doctor of Medical Sciences, chief freelance dermatovenerologist of the Ministry of Health of the Republic of Kazakhstan, head of the department of dermatovenereology of JSC "MUA"
2. Zh.A. Orazimbetova - Doctor of Medical Sciences, Head. course at the Kazakh-Russian Medical University
3. S.M. Nurusheva - Doctor of Medical Sciences, Head. Department of Kazakh National Medical University named after. S.D. Asfendiyarova
Indication of the conditions for reviewing the protocol: Protocols are updated as proposals are received from users of the protocol and new medicines are registered in the Republic of Kazakhstan.
Basics of international standards for the treatment of psoriasis
Statistics show that psoriasis affects both men and women equally.
This skin disease is chronic and occurs under the influence of various factors:
- heredity;
- constant stress;
- significant abuse of alcohol and smoking;
- hormonal disorders;
- infectious diseases;
- unhealthy diet, etc.
About 4% of the world's population suffers from psoriasis. This disease most often occurs during adolescence (from 15 to 20 years), or at the age of 50 years.
Signs of psoriasis
Already at the initial stage of psoriasis, infiltrates (thickenings), a red, persistent rash, severe peeling and erythema (redness) appear on the skin. Individual areas of the skin react to the rash differently. Bleeding cracking may occur in the area of the feet. In some cases, areas of peeling become constantly wet. In other skin areas, as a rule, no painful sensations are observed. In rare cases, arthritis develops against the background of psoriasis.
Is there a miracle cure for psoriasis?
In this article we will look at the international standard of care. Among patients with psoriasis, many fail to comply with the prescribed treatment. Ignoring modern techniques, many doctors approach the treatment of psoriasis in a fundamentally wrong way. On the Internet you can often see advertisements for various “miraculous” ointments that are actively promoted by such doctors. At the same time, it is very difficult to find actually useful and informative information about the latest developments and studies conducted by European or American doctors.
Many patients already know that the problem of psoriasis can only be approached comprehensively and individually. There are no ointments and creams that would have a magical effect on skin affected by psoriatic rash.
Good doctor dermatologist
A professional dermatologist who actually cares about treating his patients will never offer you a discount on a very good product that he actively advertises. The second sign of a professional is attending international conferences, which will be evidenced by supporting certificates.
International treatment regimens
Today, psoriasis is classified according to several evaluation parameters: affected area (BSA), calculation of the disease severity index (PASI), psoriasis quality of life index (assessed by the patient himself), designation - DLQI. If the treatment is chosen correctly, the first index should decrease by at least 50%, the second by 10 points. If the DLQI decreased by only 5 points or less, the treatment must be changed.
World standards for the treatment of psoriasis
Diagnostics
Diagnosis of psoriasis involves a number of tests and examinations. Information about diseases that the patient has had previously or is currently suffering from is required. Only a complete clinical picture with biochemical and general blood tests, skin microscopy and a number of other examinations can provide diagnostic data to determine the picture of the disease and adequate treatment.
Treatment
Measures to combat psoriasis begin with local treatment. Some clinics use balneotherapy. The complex of local treatment should include phototherapy, immunobiological drugs and general medications.
People with psoriasis have extremely dry skin that is prone to severe cracking and increased moisture loss. The physicochemical properties of the skin change, and protective functions are disrupted. Topical treatment has several purposes. Firstly, it is active hydration and prevention of skin moisture loss due to decreased barrier functions. There are many creams and medicinal ointments that have a beneficial, soothing and anti-inflammatory effect on the skin. Using special creams you can gently exfoliate the skin.
Corticosteroids
These drugs are most often prescribed for local therapeutic effects on the feet, for which the most effective steroids of the highest class are used. The medicine is applied to the skin of the feet no more than twice a day. It is possible to increase the speed of action and effectiveness of steroids by combining them with antibacterial agents and keratolytics.
As a result of treating psoriasis with the use of steroids, itching and inflammation are reduced, the disease quickly goes into a stage of long-term remission, which can be maintained with additional methods.
Steroids have one drawback. Over time, their effectiveness decreases, the therapeutic effect may weaken or drop to a minimum. If you use drugs for too long in increased doses, thinning of the skin will occur, as well as absorption of the drug into the blood. You can use corticosteroids on a regular basis, but you need to take breaks during which you need to use other means.
Vitamin D3 (analogs)
Analogues of vitamin D3 in international medical practice in the treatment of psoriasis are the drugs calcipotriol and calcitriol. These medications prevent the rapid division of skin cells, slowing down and normalizing these processes. Available in the form of ointments, creams, lotions, which must be rubbed into the affected areas of the skin 2 times a day. The products are recommended to be used in combination with other medications and therapy. The drugs can be used only as prescribed by a doctor, without exceeding the maximum norm - no more than 100 grams per 7 days.
Phototherapy
This treatment technique is based on artificial ultraviolet radiation, which inhibits the processes of accelerated division of skin cells. The radiation occurs using special medical lamps. For each patient, the dose is determined individually. The rays used to treat psoriasis have equal wavelengths (UVB, UVA).
Photochemotherapy
This method involves irradiation with UVA rays in combination with the oral drug psoralen (a photosensitizer). Treatment is recommended when other methods do not bring the desired result to patients with extensive skin lesions. UVA rays themselves, without psoralen, do not produce a visible effect. A photosensitizer is not a completely safe drug. In case of long-term use, a number of complications may arise: the risk of cancer and intestinal disorders increases. When taking psoralen, its active substance is retained in the lenses of the eyes, causing the eyes to become especially sensitive to light. Today, the use of this treatment method is included in the international standard, but it is strictly limited.
Phototherapy - UVB rays
An independent method of treating psoriasis that does not require the use of a photosensitizer. It is considered a safe treatment for pregnant women and children. Sessions are carried out up to 5 times every 7 days.
UV-B is divided into 2 categories:
The first method of phototherapy is more effective; the skin regenerates faster and gets rid of lesions. Subsequently, the disease goes into remission, or its manifestations cease to bother the patient completely. Like other treatment methods, UV-B phototherapy is combined with medications.
Balneotherapy
This type of treatment involves contact of the patient with water. Water includes any natural sources, including sea water, mineral and thermal springs. An example is Dead Sea water, known for its healing properties for psoriasis.
You can create the effect of balneotherapy even at home. For this purpose, bath compositions are used, including foot baths. Sulfides and various salts are used as bath additives. As a result of treatment, blood circulation improves and the functions of the central nervous system are normalized.
Systemic drug therapy
Systemic treatment of psoriasis includes oral medications, subcutaneous, intravenous and intramuscular injections.
The following drugs are used:
- immunobiotics;
- cyclosporine (immunosuppressant);
- accitretin (retinoids);
- methotrexate (cytostatics).
The drugs are prescribed only by a doctor and used under his supervision.
Immunobiological drugs
The active substance is a protein that changes the body's immune response. Medicines affect elements of the immune system that are associated with the development of psoriasis. They have a selective effect, while other drugs have a broad effect on the immune system.
These drugs include ustekinumab, etanercept, inficlisima-b and others. Due to the high cost, these drugs have not been widely used.
Clothes and shoes for psoriasis
It is important that during an exacerbation the patient wears only soft and loose shoes and socks without seams, made from environmentally friendly materials. Standard – soft felt slippers with light soles. It is necessary to limit any stress on the legs during an exacerbation. Avoid physical activities such as swimming, squats, weight training, running, etc.