Psoriasis vulgaris is the most common clinical form of psoriasis, which refers to chronic relapsing diseases of the skin, manifests itself rashes on the body. It is also called normal or plaque psoriasis. According to recent statistics, approximately 2% of the world population suffers from this disease.
Etiology
In scientific circles there are many theories that attempt to explain the cause of psoriasis. However, none of them is dominant. Many leading experts are inclined to a genetic predisposition, which is observed in patients who suffer from psoriasis. If you have a family history for this skin disease pathology makes its debut at an early age. In the absence of a burdened heredity psoriasis vulgaris begins to manifest itself at a more Mature age.
In addition, special attention is paid to failures in the normal functioning of the immune system. Also in the role of precipitating factors consider:
- Infectious diseases.
- Regular emotional stress.
- Drugs (blockers, anti-malaria treatment, oral contraception, etc.).
- A reduced level of calcium in the blood.
- The abuse of alcoholic beverages.
- The adverse climatic conditions.
- Injury.
The clinical picture
For the disease characterized by periods of exacerbations and remissions. Most often infection and severe emotional stress cause the development of skin disease exacerbations. It is noticed that in the winter time many patients significantly worsens the condition. Clinical symptoms of psoriasis:
- On the skin are formed flat papules that are sharply demarcated from the healthy surface.
- Psoriatic papules are pink-red. On top they found the loose scales with a white-silver hue.
- Observed symptom of "stearin spot". Scratched papules, increases peeling. The surface is similar to a drop of stearin.
- Manifested a symptom of the "terminal film". Removing scales from the psoriatic cells in the skin, stays moist shiny surface.
- Is determined by the symptom of "blood dew". Continuing to scratch the surface elements, there are small droplets of blood.
- Any area of the body can be affected by plaques.
- Knees, elbows, scalp are a favorite localization of the vulgar forms of the disease.
What is plaque psoriasis? It is nothing but a conglomeration of scaly psoriatic papules, covered with a pale grey crust, and which have a tendency to peripheral growth. They come in various sizes and shapes. Occur as isolated or large patches, which occupy extensive areas of the body.
Features of the course
Psoriasis vulgaris has three phase currents, each of which is characterized by the features:
- Progressive. There are small nodules with a bright pink tinge, prone to peripheral growth. Formed typical psoriatic plaques. Appear new rash on the site of the former rash in the area of damage or irritation of the skin (abrasions, scratches, scratches, etc.).
- Stationary. The appearance of new lesions were observed. Pathological elements become more pale. Missing the growth of plaques at the periphery.
- Retrogressive. Plaque flattened, reduced inflammation and cellular infiltration. Elements to resolve the skin, forming lesions with Hypo - and hyperpigmentation.
Treatment
How to treat plaque psoriasis vulgaris? Today continue the development of new methods of treatment of this serious skin disease. The fact is that no existing method can not give a guaranteed effect. Now to achieve a definitive treatment impossible. The most that you can expect from a modern therapy is to minimize symptoms of skin disease.
In the selection of course take into account the form and stage of the disease, the prevalence of pathological lesions, the patient's condition. In General, the treatment of psoriasis vulgaris is complex, which involves a combination of drugs for topical and systemic use.
Topical therapy
In the most prevalent priority for psoriasis pay adequate external therapy. If you experience mild forms of the disease, limited to the use of local medicines. At the stage of progression of a therapeutic agent administered with extreme caution, so as not to provoke a worsening of skin symptoms. The more inflammation, the lower the concentration of drugs for external use. As a rule, use tools hydrate, salicylic drugs and herbal baths.
If there is stationary or retrogressive stage of the disease, using different types of ointments (for example, Naftalan, ASP, salicylic) and other therapies. Do not forget that the duration of the therapeutic course and the choice of drugs determines exclusively the attending physician.
According to standard clinical Protocol psoriasis vulgaris treated the following types of drugs:
- Hydrate media.
- Salicylic acid.
- Products based on tar.
- Naftalan ointment.
- Local retinoids.
- The pyrithione zinc.
- Derivatives of vitamin D3.
- Corticosteroids.
Hydrate means
One of the basic components of treatment of psoriasis vulgaris are moisturizing drug for topical application. Hydrate products provide:
- Easing flaky surface of psoriatic lesions.
- The decrease in the tightening of the skin.
- Improving its elasticity.
Mostly moisturizer are presented lanolin creams which contain vitamins and mineral supplements. Given the results of international clinical studies, after the application of hydrating drugs in one third of patients have a pronounced positive effect in the form of reducing itching, reducing redness and flaking.
Salicylic drugs
Typically, the concentration of salicylic acid in ointments used for the treatment of psoriasis vulgaris varies from 0.5 to 5%. Can be combined with medications of tar and corticosteroids. Main pharmacological properties of salicylic acid:
- Antiseptic.
- Anti-inflammatory.
- Keratoplasties (restores the stratum corneum of epidermis).
- Keratolytic.
It is known that salicylic ointment enhances effect of external corticosteroids, so they are quite often combined. It is characterized by a fast penetration into the skin and bloodstream. Because of this, it is not extensive lubricate the affected surface, when the concentration of the drug more than 2%. Severe allergic reaction to salicylic acid is very rare. It may, however, amplify the inflammatory process on the skin.
Tar tools
Typically, coal tar preparations are used in the form of ointments or pastes of concentrations from 5 to 15%. Normally combined with other medications for external use. In the post-Soviet countries applying ointment based on wood tar. In Europe prefer carbo tar. It is noted that the activity he much higher than that of salicylic acid. Highlight the main effects of drugs with tar:
- Anti-inflammatory.
- Keratoplasties.
- Intextricably.
However, a very unpleasant smell limits its application. In addition, they should not obscure the face. It is established that the tar enhances photosensitivity, so it is often combined with ultraviolet radiation. At the same time they are not used for a long time and in high concentrations, as may systemic effect on the body with the development of renal damage, General intoxication, paralysis etc. For treatment of the scalp applied dermatological shampoo with tar.
Zinc pyrithione
Exhibits the following pharmacological action:
- Antimicrobial.
- Antifungal.
- Antiproliferative. Involved in the suppression of pathologic cell growth of the epidermis.
Besides helping to reduce inflammation, reduce infiltration, and peeling rashes. The use of the spray and cream is recommended for skin lesions. When distributing the pathological process on the scalp, employ a aerosol or shampoo. Domestic clinical studies have shown that zinc pyrithione is effective in the treatment of psoriasis in 85% of cases. To remove the skin symptoms of the disease can after 20-25 days of therapy.
Is characterized by a gradual development of therapeutic effect (reduction of sensation of itching, eliminate peeling, reduce redness). There is a rapid improvement in the quality of life of people who suffer with psoriasis. Most patients is relatively good tolerability of the drug. Approved for use in children starting from three years.
Derivatives of vitamin D3
A long time ago as a topical therapy applies the drug, which refers to a synthetic analogue of vitamin D3. It is recommended to apply on the affected area two times a day. It is confirmed that the level of effectiveness of gluco-corticosteroid ointments first and second classes are almost identical.
The appearance of pronounced clinical effect of the use of external tools based on the vitamin D3 it is noted in 95% of cases. However, to achieve a stable effect, you must undergo a very long course of therapy, which usually lasts from several months to a year. In some patients, these creams can cause the development of irritation of the skin, dermatitis, photosensitive, increasing the level of calcium in the blood and exacerbation of the underlying disease. Enhance positive actions observed in appointing the combination of derivatives of vitamin D3 and phototherapy.
Corticosteroids
The use of corticosteroids for the treatment of psoriasis was widespread in dermatological practice. Currently, the domestic pharmaceutical market is full of different kinds of steroid ointments, gels and creams. Basic therapeutic effects:
- Anti-inflammatory.
- Antihyperglycemic (suppression of abnormal growth of epidermal cells).
- Anti.
- Local analgesic.
Most experts recommend to start treatment with milder steroid medications. In the case of exacerbations and the absence of therapeutic effect can go for stronger. At the same time, American dermatology use very different tactics. First uses strong medication to achieve fast result. And then move to maintenance therapy, applying a weaker glucocorticosteroid.
The most frequent side effects to topical steroids:
- Atrophic changes in the skin.
- Excessive hair growth in the external use.
- The expansion of small capillaries of the skin (spider veins).
- The development of pustular skin lesions.
Each form of the glucocorticosteroid drug has its own particular use and benefits:
- Medication in the form of ointment does not spread and creates a good film in the coating that facilitates the efficient resorption of the pathological focus.
- Preparations in the form of a cream better able to cope with acute inflammation, well moistened and cooled the skin.
- Without fat the lotion is very convenient for treatment of the scalp. Does not stick together hair and disruption of their structure.
Systemic therapy
With the development of severe forms of psoriasis involves systemic therapy, which includes the appointment of:
- Aromatic retinoids.
- Methotrexate.
- Immunodepressant drugs.
- Corticosteroids.
The therapeutic course usually lasts up to two months. Quite effective for the treatment of severe and complicated forms of the disease. Dosage and duration of therapy with immunosuppressive agents is determined individually based on the severity of psoriasis.
Physical therapy
In this psoriasis widely used in various physiotherapy treatments. We list the most commonly prescribed methods of physiotherapy treatment:
- Photochemotherapy (PUVA).
- Combined PUVA therapy.
- Selective phototherapy.
Photochemotherapy is a simultaneous use of ultraviolet radiation with a photo-sensitizing drug that is ingested over approximately 120 minutes before the procedure. Usually photochemotherapy is up to four times a week. The total course includes approximately 20 procedures. Can combine the PUVA therapy local retinoid. Contraindication it is considered to be the acute infectious diseases, exacerbation of chronic diseases, serious problems with the cardiovascular system, cancer, diabetes, severe violations of the kidneys and liver.
In some cases, resorted to selective phototherapy, which is ultraviolet radiation without photo-sensitising drugs. If there is no dense psoriatic plaques or there are contraindications to photochemotherapy, then assign selective phototherapy.