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Psoriasis is a multifactorial disease that affects about 4% of the world’s population. Psoriasis affects the skin and joints. Treatment of psoriasis is complex and requires a comprehensive approach. Treatment in Germany is carried out in several directions, which increases the chances of remission.
Causes of the disease
Until the end, the causes of the disease are not clear. There are several theories of pathology development.
- Some scientists believe that the disease is caused by excessive multiplication of skin cells. In this case, further immune attack on the body is secondary, in response to increased cell synthesis. This theory is supported by effective therapy with drugs that block cell multiplication.
- Another theory suggests that psoriasis is an autoimmune disease. Cell multiplication is a consequence of the action of active substances on the skin.
However, what the trigger for the development of the disease is unknown. Skin function also plays an important role in the development of the disease. One of the important functions of the skin is considered to be a barrier function. When it is disrupted by trauma, irritation, friction, pressure, exposure to chemical agents, infections, immune complexes are activated, which subsequently affect the entire skin surface.
Unfortunately, for this pathology, the conditions of occurrence are not always clearly traceable. This does not allow to exclude provoking factors and reduce the likelihood of an attack. Many scientists agree that the primary provoking factor is severe stress. An insignificant role in the occurrence of the disease is played by genetics. Clinical studies have identified genes that are associated with the disease.
Factors that cause psoriasis also include impaired melatonin metabolism or daily release. Melatonin has antioxidant and immunomodulatory properties. Thus, its reduction may be one of the links in the pathogenesis of psoriasis. Autoimmune thyroiditis is often diagnosed in patients.
Clinical Data
All clinical manifestations and symptoms will depend on the form of the disease. Usually, skin manifestations are divided into pustular and non-pustular. Within each group, there are also several subgroups, which are classified according to the area of spread, as well as the localization of the process.
The skin will be thickened in the affected areas due to excessive skin cell division. The skin will be elevated above the healthy areas. Psoriasis is characterized by pale, gray spots. Localization of foci can be any. The dermatologist directly during the examination will look for psoriatic plaques. The disease has a wave-like course.
The most common forms of the disease are as follows:
- psoriasis vulgaris
This is the commonest most widespread form of the disease. It is characterized by abundant rashes of papules of bright red color. The maximum size is a few millimeters (up to the size of a pea). When they appear, they begin to grow rapidly, then scales appear. With the progression of the disease, the papules form plaques. Plaques, in turn, can form a large focus of lesions. Most often, the boundary between the affected tissue and healthy tissue is well traced. For this form of the disease is characterized by the symptom of «stearin spot», when combing the surface of the plaque becomes smooth. On further scratching, due to fragile capillaries, the wounds begin to bleed — the symptom of «blood dew».
During the course of the disease, there are periods of exacerbation, rest and resolution. During the exacerbation period, skin areas are covered with a rash, while it is actively peeling. The rash can occur at the site of any wounds. After a few months, new papules stop appearing. Scales are found on the entire affected surface. After this, a period of resolution begins, when the scales smooth out, the papules disappear. The exacerbation most often develops in the fall and winter time period.
- psoriatic erythroderma. This is the most unpleasant form of the disease due to the peculiarities of the body or improper therapy. With erythroderma, there is reddening of the skin, both affected and healthy areas. There is a pronounced itching. There is peeling of the entire surface of the skin.
- pustular form. This form produces pustules that form in place of the vulgar form of the disease.
- psoriatic arthritis. To date, it is a distinct autoimmune disease.
- nail lesion
Nail lesions occur in 50% of cases and are often accompanied by fungal infection.
Diagnosis
Diagnosis is usually not difficult, it is enough to perform a general examination of the skin masses. In this case, there are no specific blood or urine tests. Only if the process is active in the general blood test will be changes characteristic of inflammation. In rare cases, a skin biopsy is performed, in which Rete’s corpuscles are determined, altered keratinocytes are seen. The technique is well enough worked out, is performed under local anesthesia, after removing a piece of pathological tissue, histological analysis is performed. With psoriasis, pitting hemorrhages are noted, with scraping there are capillary bleeding due to the fragility of blood vessels. The patient in this disease may suffer depression, weakness, increased fatigue. When joints are affected, ultrasound (ultrasound) is performed to determine the severity of joint damage.
Therapeutic measures
The problem of psoriasis has been studied for several decades. This has led to the development of new, narrowly focused therapies. Clinics in Germany use means, which at this stage are still at the trial stage. In case of severe forms of psoriasis or ineffective treatment, the patient can get a place in clinical trials, which gives a chance for remission.
The initial stage in the therapy of psoriasis is to compensate for vitamin D deficiency. For this purpose, high doses of cholecalciferol are prescribed. According to clinical data, its use can achieve remission in 70% of cases. If necessary, drugs affecting the autoimmune link of the pathology are prescribed: efalizumab, thymodepressin, basiliximab and others. Another group of drugs is aimed at blocking the action of inflammatory cytokines.
The initial stage in the therapy of psoriasis is the replenishment When starting the correction is very important to get to a consultation with a highly professional doctor, because only on him depends the correct selection of the scheme of drug therapy. The doctor should take into account the following factors:vitamin D deficiency.
- toxicity
- frequency and severity of adverse complications
- adequate price
- ease of use
- type of psoriasis
- process localization
- severity
- associated pathology
- Associated lesions of joints and nails
In addition to drug therapy, the excimer method is also approved. This is a laser system in which high-intensity ultraviolet radiation is applied to the affected area. One in ten patients develops psoriatic arthritis. The drug apremilast is approved for its treatment.
Initially, before taking tablet forms, ointments, creams and solutions are used. In addition to therapy, a course of ultraviolet irradiation of the affected skin is prescribed.
In December 2018, the results of a study on the TNF-alpha inhibitor certolizumab pegol were published in the Journal of the American Academy of Dermatology. This drug has shown good results in the treatment of psoriasis. The drug has been approved by the Food and Drug Administration. The drug is used in the treatment of psoriasis in adults with moderate to severe disease. The clinical trials were called CIMPASI-1 and CIMPASI-2.
In addition to treating skin manifestations, it is necessary to correct the psychological state of the person. To do this, a course of cognitive-behavioral psychotherapy is conducted. If necessary, antidepressants and antipsychotic drugs are prescribed. After or during the course of therapy, it is recommended to use hydrotherapy at spas with thermal springs.
Cost of treatment and choice of clinic
The full cost of treatment is listed below. The cost of treatment depends on:
- process severity
- concomitant pathology
- joint and nail involvement
Diagnosis ranges from 580 Euros
Diagnosis and conservative treatment — from 1300 Euros
Diagnosis of psoriatic arthritis from 1100 Euros
Treatment of psoriatic arthritis from 2200 Euros
A group of experts helps in choosing a clinic in Germany where psoriasis treatment is performed. The staff is led by Maxim Rykov, who deals with the most complex cases and helps you make the right choice of clinic and specialist. His knowledge of English and German helps him to communicate directly with clinics throughout Germany.
Psoriasis is a complex chronic disease that requires a skilled individualized treatment approach.