Psoriasis treatment. Effective pills for psoriasis. Comparative analysis of the effectiveness of psoriasis treatment methods


A common chronic dermatosis that is characterized by scaly plaques and papules is called psoriasis. A new drug for the treatment of this elusive, multifaceted disease is patented annually in the register of pharmacological agents.

But despite the many new products, modern treatment psoriasis never found a universal remedy.

News in psoriasis treatment: internal modern remedies

Cytostatics (Methotrexate) and corticosteroids (Dexamethasone, Prednisalone) - drugs with an extensive list of adverse reactions - have been replaced by glucocorticoid combined drugs. New items for psoriasis:

  • Betamethasone,
  • Betazone,
  • Diprosan

and other new-generation drugs effectively relieve acute conditions.

The funds are injected intramuscularly several times a week in a short treatment course. Short-term - new in the treatment of psoriasis, allows you to reduce adverse reactions to a minimum.

The latest in the treatment of psoriasis: pathogenetic and etiotropic agents

Drugs that break down proteins that can damage skin cells are an effective novelty in genetic engineering.

Intravenous medications:

  • Etanercept,
  • Remicade,
  • Stelara,

belonging to the group of drugs with monoclonal antibodies - the latest in the treatment of psoriasis.

The newest drugs, injected with a dropper into the patient's bloodstream once every several weeks, neutralize the destructive effect of a protein that damages epidermal cells. At the same time, specific antibody proteins are synthesized in the patient's body, which coincide with human immunoglobulin. Clinical practice has confirmed the high efficiency of a new method of treating psoriasis

But in addition to this, dermatologists who use modern novelties in their practice have noted the following side reactions:

the appearance of hematomas on the skin.

  • Depression accompanied by apathy and drowsiness;
  • Rash, itching;
  • Arrhythmia, instability of blood pressure;
  • Change in blood composition;
  • Conjunctivitis, pneumonia with the development of pulmonary edema;
  • Thrombophlebitis, nosebleeds due to bleeding disorders,

Psoriasis news: local remedies

1 . Psorkutan is a modern effective drug.

Calcipotril (active substance) is an analogue of D3-vitamin, which is an active metabolite. The preparation applied to the skin, interacting with the cells of the epidermis,

  • suppresses pathological cell division,
  • stops the process of inflammation,
  • has an immunocorrective effect.

Psorkutan does not cause:

  • skin atrophy,
  • relapse after canceling the drug,
  • goes well with PUVA therapy, which cannot be said about glucocorticoid drugs of the earlier generation.

2 . Elokom and Advantan - non-halogenated ointment preparations belonging to the fourth group of glucocorticoid agents. Available in the form of a cream, emulsion, ointment. Applying novelties in treatment, patients manage to avoid a number of adverse reactions that are often observed when using other glucocorticoids.

The absence of such components as chlorine and fluorine in the composition of the funds allows prescribing Ekolom and Advant in the form of an ointment, emulsion, cream for elderly patients and children.

3 ... Active substance Dithranol has a pronounced antidermatous effect. Suppresses inflammation and the multiplication of histio and hematogenous cells in it.

  • Psorax,
  • Tsignoderm,
  • Zignolin,

Novelties for psoriasis containing Dithranol.

The course of treatment is from two weeks to two months. Improvement is noted in 70% of patients. The duration of therapy and the technique (long-term or short-term) are selected by the attending dermatologist.

Itching, swelling and redness (erythema) at the site of application are side reactions that may occur.

New treatments for psoriasisare developed every year. Among those that are just appearing in Russia: ultraviolet treatment (laser and UV rays 311 nm), the Goekerman method, blood correction, Brodalumab and Cosentix monoclones. Let's consider their advantages and prospects.

Ultraviolet treatment (phototherapy)

The method has been widely used in Europe since the 60s of the last century. In Russia, phototherapy is just emerging and gaining popularity. Its main advantage is no side effects and safety... Ultraviolet treatment is approved by the Ministry of Health and is included in the state standard of therapy for patients with psoriasis. However, it is not yet very common. Let's consider two new types of phototherapy for Russian medicine.

Narrowband UVB therapy

Ultraviolet Psoriasis Treatment Device

Long-range UVB narrowband therapy acts at the cellular level. When this method is used, it is this peak of activity that acts most favorably for skin diseases.

Excimer laser treatment

Excimer laser

The excimer laser has a wavelength of 308 nm and acts narrowly... The irradiation area is only 3x3 cm. Well suited for patients with limited forms of psoriasis, with single spots of small size.

The method is not yet widespread in Russia, especially in the regions, due to the high cost of equipment. To treat with an excimer laser, a doctor must have special qualifications and a high level of professional skills.

There are positive reviews on the application of the method on the forum:

Review of laser treatment by user manaraska

Goeckermann's method

The principle of this method is similar to the principle. First, the patient is smeared with coal tar, which increases the susceptibility to ultraviolet light. Then irradiated with a UV-B spectrum lamp (311 nm).

Since the method is relatively new, do not use it yourself, as you need to accurately calculate the doses of ultraviolet radiation and tar. It can be used only in a hospital under the supervision of a physician.

New generation monoclonal antibodies

Monoclonal antibodies are biologics used to treat psoriasis and psoriatic arthritis. The essence of the method is to isolate substances that the body lacks in psoriasis, artificially synthesize and administer to the patient. These drugs do not suppress the immune system, act only on diseased cells, have a high efficiency (80-90% according to various sources).

Consider a new generation of drugs.

Brodalumab

The drug trials began about 4-5 years ago around the world, including Russia. In Russia, tests were closed in June 2015 for unknown reasons (officially - the appearance of suicidal thoughts in patients). However, the effectiveness of the drug is high.

Review of a Russian patient with psoriasiswho participated in the tests:

Feedback on laser treatment from user JuliaK

Therefore, the expert council of the United States Food and Drug Administration (FDA) has advocated registration of the drug. How the story will continue is not yet known. The decision on registration of the drug will be made in November 2016.

Cosentix (secukinamab)

In January 2015, the FDA (US Food and Drug Administration) approved the use of Cosentix, a next generation monoclonal antibody drug. The product was tested on 2403 patients with moderate to severe psoriasis.

Research is still underway in Russia, therefore there are no significant reviews on performance yet.

Diet and vitamin D

Western scientists conducted a study of the newest method, which involved 9 patients with psoriasis.

For six months, patients received vitamin D3 (dose: 35,000 IU) once a day, followed a diet low in calcium (avoided dairy products, rice, oat, soy milk). As a result everyone got rid of the stainsand the performance has improved.

Scientists associate this positive experience with the fact that the synthesis of vitamin D3, as well as the balance of calcium, are disrupted in the body of patients with psoriasis. If they are restored, the skin will return to a healthy state. Read the detailed study results in the publication: "Pilot study of the effect of high daily doses of vitamin D3 on the clinical course of psoriasis and vitiligo" (in English).

Surgical treatments for psoriasis

Surgical methods are used for severe forms of psoriasis, since it strong interference with the body... The essence of these methods is the effect on blood, blood and plasma purification.

Hemocorrection of blood

The essence of the method is to remove unnecessary cells from the bloodstream, which affect the disease. There are several types of hemocorrection:

  • monocytapheresis and granulocytapheresis (GMA) - gives a positive result and does not have serious side effects when,;
  • lymphocytapheresis (LfA) gives a result in psoriasis, studied in 5 patients;
  • extracorporeal photopheresis (EKF) - PUVA blood therapy, in which the blood is directly irradiated with ultraviolet light. In this case, a photosensitizer (a substance that increases susceptibility to UV rays) is injected into the blood or taken as a medicine.

Hemocorrection methods promising, however, are not widely used due to their high cost and technical complexity.

Conclusions on new treatments for psoriasis

Modern medicine knows about 700 ways to treat psoriasis... However, none of them helps absolutely everyone 100% of the time. Therefore, scientists invent more modern methods, come up with new drugs.

From new treatments for psoriasis and psoriatic arthritis effective the following:

  1. excimer laser treatment;
  2. goeckerman's method - a combination of 311 nm UV rays and tar;
  3. Brodalumab and Cosentix - new generation biological products;
  4. a combination of a diet low in calcium and vitamin D3 in high concentration;
  5. hemocorrection of blood.

Scientists and patients alike rely on the discovery of the perfect medicine, a pill that will save you from psoriasis. However, the success of the treatment lies only in complex action to the disease - from the inside and outside. To heal from the inside, use. To influence from the outside, many effective means have already been invented: ointment, shampoos. Otherwise, the remission of psoriasis will be short-lived.

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Psoriasis (scaly lichen) is a fairly common chronic disease that affects 3% of all inhabitants of the earth. As a rule, every patient knows that it is impossible to completely get rid of this disease, however, now there are new methods of treating psoriasis that contribute to long-term remission.

These methods are aimed at preventing increased cell formation, which causes inflammatory process, however, it should be borne in mind that modern techniques in no way deny traditional therapy, but, on the contrary, demonstrate the most effective results when combined.

List of modern methods of therapy

It is not always possible to achieve the desired result with traditional therapy, and the improvement is short-term, therefore, more and more new ways of getting rid of this disease are being developed:

Ichthyotherapy. This technique is recommended for the treatment of the vulgar form of psoriasis. To get rid of psoriatic plaques, small fish Garra rufa are used, which eat the affected skin area without affecting healthy skin, as a rule, improvement is noted after 5-6 months after regular ichthyotherapy.

Treatment according to Goekerman. Treatment according to Goekerman is known to many as MONEY THERAPY. The tool is recommended to be applied to psoriatic areas of the skin, but this technique is more effective when combined with UFO, since tar increases the skin's susceptibility to ultraviolet rays.

The procedure itself is performed as follows:

  • therapeutic mud is heated to a certain temperature (39 ° C);
  • the ointment is applied for 30 minutes to the area of \u200b\u200bthe skin affected by psoriasis, after which it is washed off with warm water;
  • then the skin must be treated with a hypertonic (saline) solution and moisturized with a cream.

After the procedure, the patient stays at rest for several days, under the supervision of the attending physician. In addition, there is a special therapy regimen with tar and anthralin-salicylic acid, the mixture of which is left overnight.

UFO. This way of treatment considered one of the most effective in getting rid of psoriasis. Long and medium ultraviolet waves are used directly for the procedure. A special fluorescent erythema or quartz lamp with a maximum power of 60 watts is used for irradiation.

Before the start of the session, the patient is recommended to take special medications that can increase the skin's sensitivity to UV radiation. The maximum therapeutic course is 40 procedures with a break of one day. Before the session, the patient needs to take inside special medications that can increase the sensitivity of the skin to radiation. The optimal course of treatment is 20-40 procedures with a frequency every other day.

However, it should be borne in mind that UFO is contraindicated in diseases of the gastrointestinal tract, pregnancy, diabetes and tuberculosis, malignant neoplasms, cataracts and diseases of internal organs. In addition, there are certain age restrictions, for example, for patients over 55 years old and children, this procedure is contraindicated.

PUVA therapy. This tactic of treatment is most optimal for severe forms of psoriatic manifestations. Photochemotherapy is performed using a special photosensitizing drug (Psoralen) with simultaneous ultraviolet irradiation. Psoralen increases the sensitivity of the skin to ultraviolet rays.

Despite its effectiveness, this method of treatment has a number of negative manifestations in the form of severe itching, burning and increased dryness of the skin. The appearance of nausea, hyperpigmentation is possible, but the most dangerous consequence is the malignant development of skin neoplasms. Therefore, it is necessary to monitor the patient's condition by the attending physician.

UVB irradiation (narrow band) with Calcipotriol and Betamethasone. This method of treatment allows you to get rid of negative psoriatic symptoms as effectively as possible using ultraviolet radiation and a mixture of 2 ointments. In this case, ointments enhance the effect of ultraviolet radiation. In addition, Betamethasone has anti-inflammatory, anti-edema, anti-allergic and anti-proliferative effects. Calciferol, in turn, inhibits keratinocyte proliferation.

Innovative medicines. Instead of traditional drugs for the treatment of psoriasis, such as Methotrexate and Prednisolone, in 2016-2017 dermatologists often use Betazone and Diprosan, whose action is aimed at stopping the acute stages of psoriasis. These medicines are intended for intramuscular administration, and the course of treatment should not exceed 5-7 days. The short duration is the advantage of this treatment technique, which minimizes side effects.

The drugs in this group include:

  • drugs with Dithranol (Psorax, Zignolin, etc.), which suppress the pathological process and prevent the multiplication of histio-and-hematogenous cells;
  • the newest effective drugthat directly affects cell division, stops inflammation and corrects the immune system is Psorkutan. The characteristic property of this tool is good combination with PUVA therapy, as well as the absence of atrophic changes in the skin at the end of treatment;

  • the newest drugs for external use (Advantan and Elokom) show good results. As a rule, these funds rarely cause side effects. In addition, the absence of chlorine and fluorine in them makes it possible to use them for debilitated patients and young children. The positive effect is observed in 95% of patients who were prescribed these drugs. The duration of treatment is determined only by a dermatologist;
  • another newest way to neutralize psoriatic symptoms is the injectable drug for subcutaneous administration, Enbrel, which belongs to the group of biological immunosuppressants. This remedy is prescribed for extremely severe psoriasis, in which they are powerless traditional ways therapy. Enbrel has a strong anti-inflammatory effect and suppresses the pathological process of T-cell division. It is effective for all forms of psoriatic manifestations. Medicine assigned to 25 mg 2 p. within 7 days or 50 mg. 1 p. in a week.

Therapeutic measures are performed until complete remission, but the total course of treatment should not exceed 6 months.

Positive dynamics in the neutralization of psoriasis is observed in the treatment of drugs that directly affect the protein.

These drugs include Remicade, Stelara and Etanercept, which are intended for intravenous administration once every 2-3 weeks. These agents prevent the destructive effect of a protein that inhibits epidermal cells, which is confirmed by clinical trials.

Nevertheless, the possibility of developing such side effects as:

  • the appearance of hematomas on the skin after drug administration;
  • the possible development of a depressive state, accompanied by apathy and drowsiness;
  • allergic manifestations in the form of redness skin, severe burning and itching;
  • violation of the heart rhythm;
  • inflammatory diseases of the pulmonary system;
  • thrombocytopenia and thrombophlebitis.

On clinical trial

It should be borne in mind that medicine does not stand still, and new drugs and ways to get rid of psoriasis are being developed. One of these drugs, which was actively developed in 2015-2016, but has not yet been used in human treatment, is considered Dual-F-Nalp. The action of this remedy lies in the deepest possible effect on the epidermis, which allows it to destroy directly the psoriasis genome. However, this drug is currently only undergoing clinical trials in rodents.

A new biological drug for the treatment of moderate and severe plaque psoriasis - C® (ustekinumab) has appeared in Russia, combining a unique safety profile comparable to placebo and ease of use: subcutaneous injections once every 12 weeks. The drug, which is 100% monoclonal human antibodies, opens a new class of drugs for the treatment of psoriasis.

Psoriasis is currently one of the most common chronic dermatoses, affecting about 125 million people worldwide. Scientists believe that a key role in the development of psoriasis is played by impaired immune response (the inflammatory psoriatic process is immune in nature with impaired T-cell function). Patients with psoriasis experience significant physical and psychological discomfort, they have great difficulties with social and professional adaptation.

According to a study by the European Association of Psoriasis Patients (EUROPSO) of about 18,000 psoriasis patients, 77% reported dissatisfaction with the available treatments, despite being generally satisfied with the work of their doctors. The most difficult aspects of treatment, patients consider its laboriousness (50%) (the need to take medications daily and use local therapy - ointments, creams), as well as ineffectiveness (32%).

Breakthroughs in psoriasis therapy are biological drugs that block the action of certain cells of the immune system that play a key role in the development of the disease. Biological therapy allows you to achieve the main therapeutic goal - long-term remission and complete cleansing of the skin from the manifestations of psoriasis.

The biological preparation STELARA® has a highly selective mechanism of action that affects the cytokines interleukin-12 (IL-12) and interleukin-23 (IL-23), proteins that play a key role in the development of psoriasis.

Thus, acting at an earlier stage in the development of inflammation, the drug provides a quick and lasting effect. Improvements become noticeable to the patient (by subjective sensations) already 2 weeks after the 1st injection. Effectiveness persists over a long period of time, with maintenance therapy every 12 weeks. Unlike other biological drugs, it has a unique molecular composition, which is 100% monoclonal human antibodies, which are perceived by the body as its own immunoglobulin.

This provides an optimal safety profile, comparable to placebo, and a low incidence of adverse events compared to other biological therapies for psoriasis. The efficacy, safety and tolerability of STELAR® in the treatment of moderate and severe forms of plaque psoriasis were studied in 1996 patients in 2 multicenter, randomized, placebo-controlled, double-blind, phase III clinical studies PHOENIX 1 and PHOENIX 2.

Research data indicate that the PASI index of 75 was achieved in patients receiving STELARA® (75% cleansing of the skin compared to the baseline) at 12 weeks (after 2 injections), which lasted for at least one year with maintenance therapy every 12 weeks.

“Modern healthcare in Russia is actively pursuing organizational reforms aimed at improving the quality of life of the population, which is directly related to improving the quality and efficiency of medical care,” comments Academician A.A. Kubanova, Director of the State Research Center for Clinical Medicine, chief dermatovenerologist and cosmetologist of the Russian Federation, “Special attention is paid to the development of high-tech care with the use of biological drugs for the treatment of severe forms of psoriasis. This highly effective method allows for the first time to achieve long-term remission in the treatment of this complex autoimmune diseasewhich has a chronic recurrent and torpid character. " This innovative approach to the treatment of psoriasis opens up good prospects for its widespread implementation in medical practice. STELARA® is also currently undergoing research for the treatment of psoriatic arthritis, Crohn's disease and sarcoidosis.

Psoriasis is a chronic, non-infectious skin disease. According to statistics, 2-4% of people around the world are faced with this problem. Modern medicine has taken a colossal step forward in the fight against psoriasis. There are many new, alternative treatments available today.

Biologicals

Biologicals are proteins that perform therapeutic functions in the human body. Their main task is to suppress the actions of cells of the immune system that cause inflammation of the skin. Thanks to biotherapy, it was possible to completely get rid of the symptoms of the disease and achieve a long-term remission.

Biologicals include:

  1. 1. Stelara. Used to treat plaque psoriasis. A positive result is observed within three weeks. The dose is selected individually by the doctor, based on the patient's weight. Maintenance therapy is given every 4 months.
  2. 2. Remicade. It is used for psoriatic arthritis, severe psoriasis. Treatment is carried out under the strict supervision of a physician for 8 weeks.
  3. 3. Humira. The medicine is used for psoriatic arthritis. Injections are carried out once every 2 weeks.

Benefits of biologics:

  • affect the cause of the disease;
  • possible use in severe, advanced cases;
  • quick effect.

Disadvantages:

  • high price;
  • injection method of drug administration;
  • the risk of developing infections and chronic diseases increases.

During treatment, other systemic drugs that affect the immune system should be abandoned.

The use of biological products is possible only under the strict supervision of a physician. Biologicals are contraindicated in children, pregnant and lactating women. They are not used in the presence of infections (including tuberculosis), malignant neoplasms in the body.

It should be borne in mind that this therapy is still in the development stage. Doctors of all countries are observing positive dynamics in the fight against psoriasis, however side effects not fully understood.

Retinoids

Retinoids are Vitamin A derivatives created by chemical synthesis. All retinoids stimulate the regeneration of skin cells, regulate the processes of keratinization of the epidermis. It is taken orally in the form of capsules.

Spectrum of action:

  • anti-inflammatory effect;
  • regulating the growth and division of cells in the epidermis;
  • immunomodulatory effect.

Aromatic retinoids include:

  1. 1. Etretinat (Tigazon). It is used in the form of capsules, according to an individual scheme. The course is 6-8 weeks.
  2. 2. Neotigazone (Acitretin). Used for the treatment of psoratic erythroderma, pustular psoriasis for 6-8 weeks.

Retinoids are prescribed for severe diseases such as generalized pustular psoriasis, as well as erythroderma, pityriasis versicolor, and Darier's disease. Contraindications:

  • pregnancy, lactation period;
  • hepatic and renal failure;
  • taking tetracyclines, vitamin A;
  • simultaneous use with methotrexate;

The doctor must monitor throughout the treatment:

  1. 1. Liver condition, cholesterol concentration, especially in diabetes mellitus, lipid metabolism disorders or long-term therapy with these drugs.
  2. 2. Glucose level in patients with diabetes mellitus.
  3. 3. Children should be monitored for bone growth and development.

Studies have shown that retinoid therapy is most effective in combination with ultraviolet radiation and local non-hormonal ointments.

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External means

Ointments, lotions and aerosols are used for mild psoriasis as an independent remedy and as a complex therapy for complicated forms.

Vitamin D3 ointments

A synthetic derivative of vitamin D3 - calcipotriol - promotes skin regeneration, relieves inflammation and itching. It is indicated for vulgar, chronic psoriasis. Contraindicated in children and the elderly over 65.

Preparations:

  • Daivonex. Apply to the affected skin 2 times a day. If the skin condition improves, the dose can be reduced to 1 time per day. The course is 6-8 weeks.