The remedy for psoriasis can be either taken orally or applied to the rash. When choosing a drug individually for a patient, the doctor must take into account the form of the pathology, the severity of symptoms, and the general state of his health. To treat stage 1 or 2 disease, mainly external agents are used - ointments, creams, balms, gels. But with severe psoriasis, you cannot do without a course of taking pills. A high-quality drug should quickly cope with pain, redness and irritation of the skin, eliminate itching and burning.
Hormonal ointments
The development of any inflammatory process, including that accompanying the course of psoriasis, leads to the production of hormones by the kidneys. After they are released into the blood, a person’s well-being improves. Inflammation subsides, swelling decreases, pain and itching subside. All these properties are also characteristic of synthetic analogues of native hormones contained in ointments. The most popular external agents in the treatment of psoriasis are:
- Flucinar gel and ointment. Both dosage forms have antiexudative, antipruritic, antiallergic and anti-inflammatory effects. Flucinar copes with psoriasis of any localization, including those affecting the scalp. Gel or ointment is applied 2-4 times a day for no longer than 10 days;
- Hydrocortisone ointment. The drug was synthesized several decades ago, but is still in great demand in the treatment of psoriasis. It quickly relieves inflammation, stimulates the resorption of swelling, and reduces the severity of itching and burning. Hydrocortisone ointment is used up to 3 times a day. The duration of therapy varies from 1 to 3 weeks;
- Belosalik. The ointment contains salicylic acid, which gently exfoliates keratinized scales from psoriatic plaques. The second active ingredient, betamethasone, improves skin condition by blocking the synthesis of pain and inflammation mediators. A single application of Belosalik during the day for 3 weeks is sufficient.
Many hormonal ointments are intended for the treatment of psoriasis. These are Akriderm SK, Triderm, Lorinden A and C, Celestoderm, Mesoderm. The inexpensive domestic drug Sinaflan copes well with psoriatic plaques.
Features of treatment
Taking into account the large number of provoking factors, as well as the various manifestations of psoriasis, many treatment approaches have been developed. The most effective is considered to be a combination of drug therapy and non-drug measures. Also, many doctors emphasize the importance of diet and skin care. Patients are advised to reduce their consumption of fatty foods, give up alcohol, as well as confectionery and flour products. The diet should be dominated by proteins, which can be obtained from lean meat and fish, vegetables and dairy products. [7]
In the drug treatment of psoriasis, topical agents are used. They are aimed at reducing inflammation and peeling. The most effective are creams and ointments containing salicylic acid, as well as external glucocorticosteroids. [8]
Non-hormonal ointments
Medicines without hormones are much safer. They have a gentle, gentle effect on the body and rarely show side effects. These drugs are used to eliminate mild or moderate symptoms of psoriasis. They cannot cope with acute inflammation. Here is a list of the most popular non-hormonal ointments:
- Balsamic liniment according to Vishnevsky. A time-tested product with birch tar and xeroform soothes irritated skin within an hour. And thanks to castor oil, it retains the moisture necessary for tissue regeneration. Liniment is applied under breathable dressings up to 3 times a day until the skin is completely restored;
- Naftaderm. The chemical composition of the ointment with naftalan oil is saturated with mineral oils, trace elements, and aromatic hydrocarbons. It is characterized by powerful anti-inflammatory and anti-exudative properties. The ointment is applied to the rash 2 times a day. The course of treatment is individual, but does not exceed 1 month;
- Daivonex. Pharmacological novelty with calcipotriol, a synthetic metabolite of vitamin D₃. Prevents the immune system from producing T-lymphocytes, reliably stopping inflammation. Daivonex is distributed in a thin layer on the affected areas of the skin 2 times a day. The duration of treatment is from 3 weeks to 2 months.
In the treatment of psoriasis, drugs with antihistamine action are actively used, for example, Gistan, Fenistil, Psilo-balm. Salicylic ointment exfoliates well the keratinized scales of the epidermis. And Emolium, Locobase and Elobaze nourish and moisturize the skin, reducing the risk of painful relapses.
Types of disease
There are a large number of classifications of psoriasis, which are based on the severity of the condition, the nature of the rash, the location of the lesion, etc. The most common types of disease are:
- Plaque psoriasis (vulgar) makes up the majority of all types of psoriasis. It is characterized by the appearance of traditional plaques covered with white-gray scales.
- Guttate psoriasis manifests itself as numerous and fairly small rashes with scales over the entire surface of the body after a cold or sore throat.
- The pustular variant is characterized by the formation of plaques with purulent inflammation.
- Seborrheic – it is characterized by the presence of oily scales in the area of hair growth, nasolabial folds, chest and back. It differs from seborrhea in the clearer boundaries of the plaques.
- In palmoplantar psoriasis, the elements are located in the corresponding areas of the skin.
- The exudative version differs in that the scales are saturated with a yellowish liquid - exudate. Due to this, they look stuck together and change color. Often observed in obesity.
- Psoriatic erythroderma is a severe form of the disease, since almost the entire surface of the skin is affected and systemic reactions occur (fever, weakness, malaise, enlarged lymph nodes, impaired liver and kidney function).
- The arthropathic type causes damage to the joints, is observed in 3-5% of all patients with psoriasis, and often leads to disability.
According to the stages of the pathological process, scaly lichen is divided into progressive, stationary and regressive stages.
Systemic drug therapy
Therapy is selected individually for each patient. The treatment regimen may include:
- Immunomodulators
(Poludan, Timolin). They increase immunity, reduce the severity of the inflammatory reaction, and normalize metabolic processes. - Immunosuppressants
. They suppress natural defenses, resulting in a decrease in the intensity of the main manifestations of the disease - itching, hyperemia and swelling of the skin. Immunosuppressants (Methotrexate, Cyclosporine) are used only for severe forms of psoriasis with frequent and prolonged exacerbations. - Enterosorbents
(Activated carbon, Polysorb). They cleanse the body of waste and toxins, which speeds up the restoration of the skin. - Antihistamines
(Claritin, Suprastin, Erius). Reduce itching and swelling. - Hepatoprotectors
(Karsil, Heptral). Supports liver function and promotes its recovery. - Sedatives
(Deprim, Persen). They have a calming effect, somewhat reduce itching, and improve night sleep.
New developments for psoriasis are drugs containing monoclonal antibodies. Biological products reduce the activity of cells responsible for tissue proliferation and normalize cell division. Experimental use of monoclonal antibodies has proven their effectiveness in 90% of cases.
Biological drugs are prescribed strictly according to indications. Their most significant drawback is their high cost, so only a few can afford such treatment.
What factors provoke psoriasis?
The trigger is many reasons: autoimmune diseases, recurrent chronic diseases that affect decreased immunity. But no one can name the exact reasons.
Medicine identifies the following factors:
- hereditary predisposition. They assume it's a matter of genes. If the mother had the disease, there is a high probability of it occurring in the child;
- presence of chronic diseases. These include stomach and intestinal problems, as well as endocrine pathology;
- psychosomatics: experienced stressful situations and a nervous breakdown can trigger the appearance of psoriasis.
Prevention: how to reduce the risk of relapse
Unfortunately, medicine currently does not know how to completely cure psoriasis. Therapy removes external manifestations and discomfort. But the risk of relapse is high. The situation is similar to oncology. Hereditary predisposition influences. But some people develop psoriasis, and some don’t. To reduce the frequency of manifestations, try to lead a healthy lifestyle: eat well, get enough sleep, and take care of your health. It would not be a bad idea to visit a dentist, endocrinologist, gastroenterologist or ENT specialist if there are problems with them. Carious cavities, inflammation of the tonsils and a large stomach can become provoking factors for a relapse. The longer the period spent in remission, the more effectively the body recovers and the lower the load on the immune system.
Basic approaches to the treatment of psoriasis
Treatment of a disease such as psoriasis should begin with identifying the causes of exacerbation of the disease. If you systematically eliminate the factors that contribute to the exacerbation of this pathology, you will be able to keep the course of the disease under control. Treatment methods for psoriasis are selected taking into account several aspects:
- complexity of the disease;
- presence of concomitant pathology;
- localization and size of psoriatic plaques;
- the patient's ability to comply with medical recommendations.
In this regard, when choosing methods of treating psoriasis, doctors focus on solving the following problems:
- maximum possible cleansing of the skin from lesions;
- obtaining results in the shortest possible time;
- relief of the main symptoms of the disease;
- reducing the likelihood of relapse or worsening the course of the disease.
When a patient has mild and mild psoriasis, treatment usually involves the use of external agents that help eliminate the external signs of the disease. The specialist’s task is to select a drug that will help obtain the effect, suit the patient and can be used for a long time. Complex, severe forms of psoriasis are treated systemically, selecting a whole range of drugs. Here it is important to start taking measures as early as possible, then it will be possible to stop the disease before it has a serious impact on the patient’s quality of life.
Hygiene rules for psoriasis
You can't do without regular cleansing. Water treatments help get rid of external impurities and excess sebum. On the other hand, prolonged contact with water during the acute phase can worsen the skin condition. The plaques become soft, grow, and their area increases[3].
To avoid worsening, you should refrain from taking a bath and spend no more than 5-10 minutes in the shower. The water temperature should be average - no higher than 37-38 degrees. Hard sponges cannot be used. Mechanical impact can injure the skin, which leads to the appearance of new lesions.
Particular attention is paid to the choice of detergents. Key criteria:
- neutral pH level;
- no fragrance;
- homogeneous texture without abrasive particles;
- minimal amount (or complete absence)
Do not rub your skin after a shower. Such tactics will only increase irritation. It is better to gently blot areas with plaques with a soft towel.
With psoriasis, it is extremely important to keep your hands clean to protect yourself from introducing pathogenic bacteria to the affected skin. To avoid scratching, it is better to cut your nails short. If the plate itself is damaged, you should stop polishing or applying varnish.
Characteristic signs of psoriasis
Most often, with psoriasis, pink-red plaques appear on the surface of the skin, covered with grayish or white scales (psoriatic plaques). It is with this symptom that another name for the disease is associated - scaly lichen.
The size of the rashes may vary. The primary elements are small papules (nodules) from pink to bright red or burgundy. Over time, their size increases significantly, and they also tend to merge.
In 90% of cases, signs of psoriasis include the formation of standard plaques, which are characterized by a triad of symptoms. This triad is identified by a doctor with a special diagnostic test - plaque scraping:
- Stearic stain - characterized by peeling when the plaque is scraped and the separation of gray-white scales, reminiscent in appearance of candle shavings.
- If you continue to scrape the surface of the plaque, then after removing all the scales, a thin shiny film will appear, called terminal.
- The symptom of blood dew can be detected by removing the terminal film. At the same time, tiny droplets of blood appear on the surface.
Rashes can be found on a variety of areas of the skin, but most often they are located:
- on the extensor surfaces of the limbs (elbows, knees);
- along the hairline (the so-called “psoriatic crown”);
- in the area of the sacrum.
Often psoriatic plaques are located symmetrically. Rashes exist on the skin for a long time, but can decrease and even disappear during periods of temporary recovery (remission) and reappear during periods of exacerbation.
Also, psoriasis symptoms can wax and wane depending on the season. For example, in the autumn-winter period in most patients the disease enters the acute phase, while in the summer its symptoms decrease. Scientists explain this phenomenon by increased exposure to ultraviolet radiation, which heals the skin. But the opposite effect is also possible, when sunlight acts as an irritant for the skin. Then the manifestations of the disease intensify in the summer, and in the winter the symptoms disappear.
Causes
The exact cause of psoriasis is unknown. Genetic predisposition plays a significant role in its development: approximately 40% of patients with psoriasis or psoriatic arthritis have a family history of the disease (the presence of psoriasis in close blood relatives).
The development and course of the disease are also influenced by lifestyle, environmental factors and habits: smoking, excess weight, taking certain medications (beta blockers, lithium, antimalarial drugs), infections, alcohol, stress.
Skin care cosmetics
- Moisturizing. Such products protect the skin from excessive dryness, fight flaking and a feeling of tightness, and restore comfort. For psoriasis, you can use emollients - special pharmaceutical products with a complex effect. They deliver water to the deep layers of the skin, restore the lipid barrier and promote damage healing.
- Exfoliating (keratolytics). These products soften plaques and promote healthy skin. The composition may include urea, lactic acid, salicylic acid.
For psoriasis, it is useful to use skincare products containing vitamin D3[4]. This substance helps suppress inflammation and strengthen the skin barrier. Another form, vitamin D2, is synthesized inside the body under the influence of UV rays. The compound also accelerates healing, so experts recommend taking short (no more than 15-20 minutes) sunbathing for psoriasis. Despite the benefits of tanning, you should not ignore products with an SPF filter. They protect sensitive skin from burns, which in psoriasis are no less dangerous than mechanical damage.
