Leczany łuszczycy miejscowe / 2 / - preparations for the skin
PREPARATIONS USED IN LOCAL TREATMENT
Types of preparations:
keratol preparations - inhibiting excessive cell division of the epidermis - eg salicylic acid
dithranol
tar preparations
topical corticosteroids
greasing preparations
vitamin D3 derivatives
Salicylic acid
Preparations containing salicylic acid are particularly indicated at the beginning of treatment in the event of a significant degree of stratification of scales on the lesion surface. The presence of a thick stratum corneum prevents the penetration of drugs into the living layers of the epidermis. Usually salicylic acid in the form of an ointment or oil at a concentration of 3-5-10% is used.
dithranol
Preparations containing cygnoline are intended for the treatment of lesions of the normal psoriasis type with a stationary course. Do not use ointments containing cygnoline for sowing, irritated, erythrodermic or exudative changes as it may worsen. Cygnoline is used according to the so-called minute therapy method. Cymin ointment 0.1-0.5-1.0-2.0% is applied to skin lesions for a strictly defined time not exceeding usually 2 hours after which the skin surface should be thoroughly washed with soap and water. In Poland, ready-made preparations containing cygnoline are available, such as: Cignoderm 0.1-0.5-1-2%, Cignodermin 0.5% and Dithranol A 0.2-0.5-1 and 2%.
tar
The dough is a product of the distillation of various types of wood or hard coal. They belong to the oldest methods of psoriasis treatment. They are characterized by a dark color and unpleasant odor. Modern tar preparations are the result of selective distillation, which deprives them of those hydrocarbon fractions that are responsible for the unpleasant smell and dark color. The mechanism of action of this group of drugs is the inhibition of tissue respiration processes, which reduces the number of mitotic divisions in the basal layer of the epidermis. There are several ready-made preparations in Poland: 5% Psorisan, 10%, 20% contains prodermine, Delatar contains partially purified pine tar in 2% concentration. Shampoos with tar addition are recommended for the treatment of scalp psoriasis. The following preparations are available: Proderm, Freederm Tar, Ionil T, T-Gel, Denorex, Polytar et al. After washing your head, you can use a corticosteroid liquid or liquid tar such as Pinoderm or Pixoderm.
corticosteroids
Preparations containing corticosteroid hormones are the most commonly used in the treatment of psoriasis. Corticosteroids are usually used in the case of psoriatic lesions with a large inflammatory component, accompanied by pruritus and for treatment of long-term psoriasis. Currently, a wide range of preparations is available with different anti-inflammatory effects and skin penetration. However, corticosteroids of the newest generation should be used, characterized by strong local action and low penetration into the bloodstream and a long period of binding with the receptor in the skin. It gives you the possibility to apply 1 medicine once a day and in the maintenance treatment even once every few days. However, when corticosteroids are used, tachyphylaxis may occur, i.e., the sensitivity to the drug used is extinguished. You need to take into account the risk of relapse after treatment and the side effects of these medications such as post-marketing acne, telangiectasias, and skin atrophy. The children and the elderly are particularly exposed to the negative effects of local corticotherapy.
Derivatives of vitamin D 3
Preparations containing vitamin D analogues constitute a new group of drugs introduced for use in the treatment of plaque psoriasis. Their operation consists in normalizing the processes of epidermis keratosis and limiting inflammation.Drugs of this type are used normally 1-2 times a day for 6-8 weeks, although studies indicate the safety of treatment even if applied for a period of 12 months. In the absence of improvement, another form of therapy should be considered.
Retinoids for topical use
This is the latest form of local psoriasis therapy, introduced only in recent years. At present, one preparation containing Tazarotene is available. The drug available in two concentrations of 0.05% and 0.1% is characterized by good local tolerance and no side effects of corticosteroids. Due to the small absorbability through the skin (about 5% of the administered dose), the drug can be safely applied to the body surface area of 10 to 20% of the body.
Phototherapy of psoriasis
Radiotherapy - irradiation with specialist lamps is the oldest method of treatment used. The treatment of psoriasis is based on UVA and UVB irradiation emitted by an artificial light source. A relatively effective method is the so-called PUVA (photochemotherapy) involving the use of oral preparations intensifying the light rays (psolareny) and irradiation with UVA rays of a well-defined wavelength. This treatment can be associated with other methods, e.g. cygnoline, vitamin D 3 derivatives, tar oils and retinoids administered in general. But be warned - PUVA can cause side effects (liver damage, skin complications). In radiation therapy, other wavelengths can also be used (eg UVA + UVB in so-called selective phototherapy), without the use of oral preparations.
Contraindications of phototherapy:
- intensification of disease symptoms under the influence of sunlight
- a large number of pigmented pigments
- skin cancer risk.
- skin diseases provoked by sun rays, eg lupus erythematosus
- diseases of the circulatory system, kidneys, liver
- pregnancy, breast-feeding
ed.
Literature:
1. Practical dermatology; dermatologists: Małgorzata Opalińska, Katarzyna Prystupa, Wadim Stąpór, Wyd. Lek. PZWL 1997.
2. Practical tips for diagnosing and treating psoriasis Dr. Adam Borzęcki from the Department
Dermatological and Military Hospital in Lublin Head of the Department; Medycyna Rodzinna - 9 (1/2000)
3. Contemporary views on etiopathogenesis and psoriasis treatment - Aneta Szczerkowska Dobosz -adiunkt Dyrektor
and the Department of Dermatological and Venereal Diseases in Gdańsk - • http://www.sluzbazdrowia.com.pl
