Detailed treatment regimen at the Institute of Psoriasis. International protocols for the treatment of psoriasis Treatment regimen at the Institute of Psoriasis

Statistics show that psoriasis affects both men and women equally.

This skin disease has chronic form 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 on initial stage psoriasis, infiltrates (thickenings), red, persistent rash, severe peeling and erythema appear on the skin (redness). 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. None in other skin areas painful sensations, as a rule, is not 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 international standard treatment. Among patients with psoriasis, many fail to comply with the prescribed treatment. Ignoring modern techniques, many doctors approach the treatment of psoriasis completely incorrectly. 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 truly cares about treating his patients will never suggest that you buy a very good remedy at a discount, which 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: area affected (BSA), calculation of the disease severity index (PASI), quality of life index with psoriasis (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 sick in is required. this moment. 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. Physicochemical characteristics the skin changes, 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. You can increase the speed 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)

Vitamin D3 analogues in the international medical practice The drugs calcipotriol and calcitriol are used in the treatment of psoriasis. 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 according to individually. The rays used to treat psoriasis have equal wavelengths (UVB, UVA).

Photochemotherapy

This method consists of irradiation with UVA rays in combination with the oral drug psoralen (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. The photosensitizer is not completely safe drug. In case of long-term use, a number of complications may occur: the risk of oncological diseases, intestinal disorders. 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. Counts safe method treatment for pregnant women and children. Sessions are carried out up to 5 times every 7 days.

UV-B is divided into 2 categories:

narrowband;
broadband.

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 water of the Dead sea, 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. 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 administration drugs, 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 the elements immune system which are associated with the development of psoriasis. They have a selective effect, while other drugs have a broad effect on the immune system.

Psoriasis is a disease that is not viral or fungal in nature, so it is not transmitted through the air, household objects or personal contact with the patient. The prerequisites for the occurrence of the disease are hereditary, psychological, and physiological factors.

Therapy for this dermatological disease involves the use of integrated methods and approaches. There is a special treatment regimen for psoriasis, the use of which helps to effectively eliminate obvious and hidden symptoms diseases. 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 medications local action a number of procedures are prescribed - physiotherapy, ultrasound, herbal medicine, electrosleep, PUVA method, phototherapy, laser therapy, cryotherapy.
Usage hormonal drugs. They are used only in extreme cases, they can quickly eliminate the symptoms of psoriasis, but they have a significant disadvantage - Negative influence to 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 a few effective schemes, which 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 strengthening cell membranes and prevention of education pathological processes in the gene pool of the organism. 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 as one of effective methods Treatment of psoriasis using the influence of the Dead Sea. 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.

Psoriasis is a skin disease characterized by patches of red, thickened and scaly skin on various parts bodies. In diseased areas, new cells are formed faster than old ones are shed, so excess cells gradually accumulate, forming thick skin plaques.

There are four main forms of the disease, in each of which the affected skin has distinctive features. Some patients may suffer from several forms of psoriasis at once.

Common psoriasis

The most common form of the disease, it is a chronic and incurable condition. Can affect people at any age.

The following symptoms are characteristic:

plaques of thickened red skin with a scaly surface. They occur on the knees, elbows (a common site for psoriasis plaques), buttocks, lower back and scalp, behind the ears and along the hairline, and in some cases develop on old scars;
periodic itching of the affected skin;
discolored nails with small white spots appearing on them. In severe cases, the nails move away from the nail bed.

Guttate psoriasis

Most often affects children and adolescents and very often begins after bacterial infection throat.

Typical symptoms:

multiple small, round pink patches of scaly skin approximately 1 cm in diameter, mainly on the back or chest;
intermittent itching of the affected skin.

These symptoms usually resolve within 4 to 6 months and do not recur, but more than half of patients later develop another form of psoriasis.

Pustular psoriasis

A rare form of the disease that can be life-threatening. It affects mainly adults and can develop suddenly. Accompanied by the following symptoms:

small blisters filled with pus appear on the palms and soles of the feet;
thickening and peeling of the affected skin occurs.
areas of red, inflamed and very painful skin extend to large area. In its most severe form, pustular psoriasis affects the entire body.

Reversible psoriasis

Older people often develop this type of disease. Red, weeping, and thickened plaques appear in folds of the skin rather than spread over a large area. The rash usually affects the skin in the groin, under the breasts and in some cases in the armpits. Usually treatable, but may recur.

Risk factors

Depends on the form of psoriasis. The disease is often inherited. The gender of the patient does not matter. In some people, psoriasis may be triggered by taking certain medications, such as antihypertensive drugs, And . Stress is a trigger that causes exacerbation.

Complications

About 1 in 10 people with psoriasis develop some form of arthritis, which usually affects the fingers and knee joints. If left untreated, it can be life-threatening.

Mild psoriasis that does not cause big problems, you can leave it without treatment skin manifestations. In other cases, it is necessary to follow the doctor's advice and carry out the appropriate therapeutic course.

Modern methods of treating psoriasis
Standards of treatment for psoriasis
Psoriasis treatment protocols

Psoriasis vulgaris

Profile: therapeutic, specialty - dermatovenerologist.
Treatment stage: polyclinic (outpatient).
Purpose of the stage: regression skin rashes(significant reduction in infiltration, peeling).
Duration of treatment: 35 days.

ICD codes:
L40 Psoriasis vulgaris
L40.3 Palmoplantar pustulosis
L40.4 Guttate psoriasis
L40.9 Psoriasis, unspecified.

Definition: Psoriasis is a chronic recurrent genotypic dermatosis of a multifactorial nature, with a predominant localization of epidermal papules, symmetrically located on the extensor surfaces of the extremities, in the scalp, with possible damage to the nail plates and joints.

Classification:
1. Psoriasis vulgaris (vulgar)
2. Exudative psoriasis
3. Seborrheic psoriasis
4. Rupioid psoriasis
5. Eczematoid psoriasis
6. Warty psoriasis
7. Follicular psoriasis
8. Psoriasis of the palms and soles
9. Nail psoriasis
10. Pustular psoriasis
11. Arthropathic psoriasis
12. Psoriatic erythroderma.

According to the course (stages): progressive, stationary, regressive.

Risk factors: Family history, trauma (physical, chemical), endocrine disorders (pregnancy, menopause), psychogenic factors(psycho-emotional stress), metabolic disorders, infection (eg hemolytic streptococcus in the tonsils), use of certain medications (eg beta-blockers, antimalarials), alcohol abuse.

Diagnostic criteria:
1. Papules are pinkish-red in color, covered with loose silvery-white scales, with a tendency to grow peripherally and merge into plaques of various sizes and shapes. Plaques can be isolated, small or large, occupying large areas of the skin.
2. Predominant localization - extensor surfaces of the upper and lower limbs(especially elbows and knees), scalp, lumbar region.
3. Psoriatic triad:
- the phenomenon of “stearin stain”: characterized by increased peeling when scraped, which makes the surface of the papules resemble a drop of stearin;
- the phenomenon of “terminal film”: after complete removal further scraping of the scales peels off a thin, delicate translucent film covering the entire element;
- the phenomenon of “blood dew” (Auspitz phenomenon): with further scraping, after the “terminal film” is rejected, pinpoint (drip) bleeding occurs on the exposed wet surface.
4. “Thimble” symptom - pinpoint depressions on the surface of the nail plates. Loosening of the nails, brittle edges, discoloration, transverse and longitudinal grooves, deformations, thickening, and subungual hyperkeratosis may also be observed.

List of main diagnostic measures:
1. Microreaction
2. General analysis blood (6 parameters)
3. General urine test
4. Feces on worm eggs
List of additional diagnostic measures:
1. Definition of ALT
2. Determination of ALT
3. Determination of bilirubin
4. Determination of blood sugar
5. Ultrasound of the abdominal organs.

Treatment tactics:
1. Desensitizing therapy (30% sodium thiosulfate 10.0 intravenously daily - course dose 10-15 injections; 10% calcium gluconate 10.0 intravenously daily - course dose 10-15 injections; 10% calcium chloride 10.0 intravenously daily - course dose 10-15 injections) - according to indications.

2. Antihistamine therapy (for severe itching): chloropyramine 25 mg, cetiresin 10 mg, ketotifen 1 mg.

3. Glucocorticoids local application: betamethasone 0.1% ointment,
methylprednisolone 0.1% ointment, triamcinolone acetonide 0.1% ointment, hydrocortisone 1% ointment.
Only weak corticosteroids (Class II) should be applied to the face and skin folds.
For the treatment of skin lesions of other localization it is sufficient effective means Only strong and very strong topical glucocorticosteroids are considered (classes III-IV).
With progressive psoriasis, local or systemic glucocorticosteroids should not be prescribed, as this can cause worsening of the disease up to the development of erythrodermic or pustular forms, which are difficult to respond to drug therapy.

4. Salicylic acid(ointment). Typically, ointments with a concentration of 0.5 to 5% salicylic acid are used. It has antiseptic, anti-inflammatory, keratoplastic and keratolytic effects and can be used in combination with tar and corticosteroids. Salicylic ointment softens the flaky layers of psoriatic elements, and also enhances the effect of local steroids by enhancing their absorption, therefore it is often used in combination with them.
Salicylic acid itself easily penetrates the skin, it is not used on large surfaces and in concentrations greater than 2%, and in children even 2% ointment is applied only to limited areas of the skin. Intolerance is rare, but salicylic acid may cause side effect increased skin inflammation.

5. Naftalan oil. A mixture of hydrocarbons and resins, contains sulfur, phenol, magnesium and many other substances. Naftalan oil preparations have
anti-inflammatory, absorbable, antipruritic, antiseptic, exfoliating and reparative properties.
To treat psoriasis, 5-10% naphthalan ointments and pastes are used. Naphthalan oil is often used in combination with sulfur, ichthyol, boric acid, zinc paste.

6. 5% sulfur-tar ointment, which has absorbable properties.

7. Zinc pyrithione. Active substance, produced in the form of aerosols, creams and
shampoos. It has an antiproliferative effect - it suppresses the pathological growth of epidermal cells that are in a state of hyperproliferation. Last property
determines the effectiveness of the drug for psoriasis. The drug relieves inflammation, reduces infiltration and peeling of psoriatic elements.
Treatment is carried out on average for a month. For the treatment of patients with lesions of the scalp, aerosol and shampoo are used (applied 3 times a week), for skin lesions - aerosol and cream (applied 2 times a day). The drug is well tolerated and is approved for use from 3 years of age.

8. Calcipotriol, an analogue of vitamin D3, is registered as medicine in the form of ointment, cream and solution for rubbing into the scalp. Calcipotriol inhibits the proliferation of keratinocytes, accelerates their morphological differentiation, affects the factors of the skin immune system that regulate cell proliferation, and has anti-inflammatory properties. Not recommended for use on the face and genitals. A maximum of 100 grams can be used weekly. ointment, cream or solution.

9. Retinol acetate (114 mg, tablets) 1 tablet every 12 hours for 1 month.
10. In the case of persistent arthropathic, pustular psoriasis, in the absence of effect from the therapy, methotrexate, an antagonist, is prescribed folic acid, suppressing cell mitosis.
Prescribed in tablets: 5 mg every 8 hours (15 mg per day) - once a week, 2-3 courses; injection 25-50 mg once a week, 3-4 injections per course of treatment, taking into account contraindications.

11. For severe psoriasis, phototherapy is used as treatment. A significant place in the treatment of psoriasis belongs to long-wave UV rays in combination with photosensitizers (in the stationary stage).

List of essential medications:
1. 30% sodium thiosulfate, amp
2. 10% calcium gluconate, amp
3. 10% calcium chloride, amp
4. Chloropyramine 25 mg, tablet
5. Cetirezin 10 mg, tablet
6. Ketotifen 1 mg, tablet
7. Betamethasone 0.1% ointment
8. Methylprednisolone 0.1% ointment
9. Triamcinolone acetonide 0.1% ointment
10. Hydrocortisone 1% ointment.
11. Salicylic acid 2% ointment
12. Retinol 114 mg, tablets
13. Activated carbon 0.25 g, tab.

List of additional medications:
1. 5% sulfur-tar ointment
2. 5-10% naphthalan ointments and pastes
3. Zinc pyrithioneate in the form of aerosols, creams, shampoos
4. Calcipotriol (ointment, cream, solution)
5. Methotrexate, 2.5 mg tablet; fl. 0.005 each; 0.05 and 0.1 g.
6. Prednisolone 5 mg amp, tab.
7. Dexamethasone 4 mg amp.

Criteria for transfer to the next stage:
If treatment is effective: dispensary observation Once every 3 months.
Criteria for transfer to hospital: slow dynamics and lack of regression of skin rashes, lack of effect of the therapy.

Classified as difficult to treat skin diseases and has chronic course. IN mild stage can be carried out ambulatory treatment in the hospital. In case of aggravated medical history, if more than 30% of the skin is affected, treatment is carried out in the Central Clinical Hospital(CDB). Successful therapy is carried out only in the Central Clinical Hospital, which has departments based on psoriasis institutes. Psoriasis institutes study in detail the etiology of the development of dermatological problems of patients and provide treatment according to wide range techniques. When each patient chooses the most appropriate treatment options for himself, remission occurs faster and lasts for a long time. The Moscow Institute specializes in the treatment of psoriasis in different stages and uses various methods for this.

Treatment regimen at the Institute of Psoriasis

The Psoriasis Institute offers treatment for patients with moderate to severe disease in a hospital setting. The history of the disease is carefully studied, the patient undergoes medical examination. After drawing up a complete clinical picture, the patient receives high-quality treatment relevant to the given degree of the disease. The therapy protocol is individual for each clinical case; how long the therapy period lasts and how many sessions the patient needs to undergo is determined by the conclusion and recommendation of the treating dermatologist. At the Moscow Institute of Psoriasis, patients undergo medication and physiotherapeutic treatment. Standards of drug therapy:

sedatives;
immunostimulants;
hormonal and non-hormonal drugs;
local and systemic drugs.

Institute of Psoriasis and Ministry of Health Russian Federation prefers a combined method of treating psoriasis, in combination with drug therapy and physiotherapy. Physiotherapeutic treatment at the Institute of Psoriasis is carried out using:

photochemotherapy;
PUVA baths;
selective phototherapy.

Recommendations from dermatologists for the treatment of each degree of psoriasis are different; on average, one course of treatment is 20 days, during which it is possible to alleviate the patient’s condition and put him into a state of remission. But the entire clinical picture may vary depending on the degree of development of psoriasis and individual characteristics human body and how long the therapy will last, even in the same clinical cases, is difficult to determine.

Drug treatment

Drug therapy for psoriasis is determined by the standard of the Ministry of Health of the Russian Federation, according to the recommendation and conclusion of specialists after examining the person. Treatment of psoriasis in a hospital is carried out using:

anticoagulants;
detoxifiers;
retinoids;
cytostatics.

These are special medications that help reduce the affected area, improve regeneration and skin condition, improve general condition patient.

Anticoagulants inhibit the rate of blood clotting, due to which cell growth is inhibited and the progression of rashes stops. There are ointments, creams, and injections based on coagulants.
Detoxifiers help bind and remove toxins from the patient’s body, which are formed due to the death of epidermal cells. Treatment with detoxifiers is administered intravenously.
Retinoid drugs for psoriasis help cleanse the blood of toxins and regenerate the skin. Retinoids are prescribed to the patient on the recommendation of the attending physician, both during hospital treatment and after discharge.
Cytostatics help prevent cell division, this stops rashes and reduces the location of an existing rash on the body.

Fact! Using data medications It is possible to normalize the condition of a patient with psoriasis in order to continue therapy with physiotherapeutic procedures.

UV irradiation in the treatment of psoriasis

Ultraviolet therapy has been successfully used in medical practice at the Central District Hospital and the Institute of Psoriasis for more than 25 years. By influencing skin UV radiation of varying power can reduce the size of rashes, prevent the progression of psoriasis, improve skin condition, and eliminate itching. In medical practice, UV irradiation is carried out by several types of rays.

Alpha ultraviolet rays. This type of UV irradiation is used in combination with special psoralens, which are taken orally by the patient. With the help of psoralens, UV rays are localized at the site of progression of rashes, concentrating maximum dose irradiation in this particular place.
Beta ultraviolet healing. This type UV treatment of psoriasis is based on studying the characteristics of the skin of a particular patient and determining for him minimum dose radiation. A minimum dose of UV ray is directed to a small surface area of the skin; the dose is subsequently increased several times, expanding the area of the irradiated surface.

Various installations are used to treat psoriasis with ultraviolet rays. A variety of UV installations make it possible to treat psoriasis at the most various places localization and in various positions of the patient, both in a lying and standing position, to provide both general and local UV effects on the affected areas of the skin. UV cabins, bathrooms, and local installations are used. How long should UV irradiation sessions last, their duration and quantity, is determined by the degree of damage to the epidermis.

Photochemotherapy

The Institute for the Study of Psoriasis in Moscow provides physiotherapeutic treatment of patients using photochemotherapy. This method is used to treat vulgar, exudative, erythrodermic and pustular types of psoriasis. The treatment method consists of long-wave UV exposure to foci of inflammation, taking photosensitizers orally, which increase the effectiveness of exposure to UV radiation on the body. UV rays have a positive effect on the skin with psoriasis, they relieve inflammatory process, activate the synthesis of melanin in the skin, have an immunostimulating effect. When the skin is exposed to UV rays, photosensitizers are concentrated in the epidermis. After 3 hours, DNA synthesis of epidermal cells selectively stops, epidermal chemical reaction, which leads to the death of lymphocytes and keratocytes. The patient begins remission, the epidermis layer is renewed. The photochemotherapy treatment protocol is as follows:

the photosensitizer Methoxalen or Ammifurin is taken orally;
UV irradiation of the location of the rash is carried out with a power of 0.25-1 J/cm;
The UV dose gradually increases by 0.5 J/cm.

Clinical test results after the UV session determine the duration of the patient’s treatment. How many days a patient will need to undergo photochemotherapy depends on the test results, which determine the recommendations of the attending physician. One course of patient treatment consists of 20-25 sessions. At severe forms psoriasis, the patient needs to undergo 2-4 courses of photochemotherapy.

PUVA baths for psoriasis

The treatment regimen for psoriasis in the hospital using PUVA baths is reminiscent of UV photochemotherapeutic treatment and includes UV exposure to the localized areas of psoriatic rashes after taking a bath with photosensitizing drugs. This method of therapy is less aggressive than taking photosensitizing drugs orally. This is due to the fact that photosensitizing drugs, when taken orally, cause such adverse reactions like nausea renal failure, gastrointestinal disorders. PUVA bath provides only local exposure to photosensitizers, which is gentle on the body. The procedure for treating psoriasis with PUVA baths is as follows:

The patient takes a bath for 15-25 minutes with photosensitizers, which are solutions of Ammifurin or Mitoxalen. An alcoholic 3% solution of Ammifurin is diluted with water, 1:3 according to body weight, but not more than 180 mm per bath. Mitoxalen is produced in capsules; for a patient to take one procedure, up to 50 capsules of the drug are used, which are diluted in water, according to the patient’s body weight.
Local or general UV irradiation of the patient, with a radiation power of 0.25-1 J/cm.
Rest, sleep.

PUVA baths have a relaxing effect on the patient’s body; after such a procedure, the patient is allowed 1.5-2 hours of rest or sleep. The course of treatment consists of 25 sessions, which last several days, sometimes weeks.

Important! The number of procedures required to provide assistance is prescribed by the attending physician, depending on the course of the disease and the characteristics of the body.

PUVA baths are performed both for the treatment of patients and for the prevention of psoriasis in remission.

Selective phototherapy

A medical study of test results and observations of patients from the Institute of Psoriasis shows that selective phototherapy increases the persistence of remission by up to 80%. Selective phototherapy is performed for patients with 30% skin lesions, with manifestations of psoriasis medium degree and in severe forms of the disease, with vulgar and exudative forms of psoriasis. Selective phototherapy involves exposure to combined UV radiation, mid-wave and long-wave ultraviolet rays. The method of selective phototherapy varies in intensity:

The first direction is the effect of a minimum dose of UV on the body and its subsequent increase, bringing it to a maximum in a few days. Minimum phototoxic dose of UV. The first session for the patient begins with exposure to a minimum dose of UV, 0.5 J/cm, with an increase in the dose of UV by 0.5 J/cm with each subsequent session in the absence of redness, burns, allergic reactions on the skin. The treatment protocol determines the duration of the procedure and the number of sessions.
The second method involves UV radiation at a certain dose throughout the entire treatment period. A standard phototoxic dose of mid- and long-wave UV radiation is prescribed throughout the entire course of treatment. Treatment with UV radiation of the same power is carried out for several days, repeating 2-3 courses with breaks.

Photosensitizers are not used in selective phototherapy. The Institute settles on a standard number of sessions of selective phototherapy to provide patients urgent help at different stages of psoriasis development and to introduce a state of long-term remission. These are 20-30 sessions with breaks of several days, if the patient’s condition requires it. For severe dry skin, which is often observed in patients during selective phototherapy, the patient is prescribed nourishing creams and ointments. The institute conducts restorative procedures for patients several days after completing the main rehabilitation course.