Advances in Modern Treatment of Psoriasis

Overview

Psoriasis is a great mental stress for the patient and also for his environment. The disease can be kept by suitable treatment within a socially and subjectively acceptable stare. Rotational therapy which is suitable in these patients makes fit possible to alternate therapeutic methods and thus to delay the development of side-effects or undesirable effects of the used drngs. A more rapid therapeutic start is achieved by a suitable combination of antipsoriatic drugs which reduce also the risk of the development of side-effects. At present a wide range of treatment is available. Nowadays we have already more extensive knowledge of the mechanistu of antipsoriatics at a cellular level which reveals also their aimed interference with the pathogenetic chain of the disease. Among classical methods phototherapy and photochemotherapy hold an important place. A modem trend is narrowband-monochromatic UVB phototherapy (311 nm). Its modification with balneotherapy (TOMESA) is suitable also for out-patient treatment. In PUVA treatment fit is important to take finto account the cumulative dose which at a level of 1000 J/cm2 increases the risk of dermal malignity, in particular spinocellular carcinoma. In severe forms of psoriasis also retinoidy, the immunosuppressive cyclosporin A and the cytostatic methotrexate proved useful. It seems that despite the immunosuppressive effect of cyklosporín A there is no great risk of the development of malignity, although fit cannot yet be fully evaluated. The wide range of local therapeutic possibilities is extended by vitamin D analogues which are suitable also in combination with retinoidy as they increase their effect. They are suitable also in combination with PUVA treatment, UVB phototherapy, methotrexate, cyclosporin A. The most retem local preparation in the treatment of psoriasis is the selective retinoid tazarotene which acts on the altered target objects of the cell - the keratinocyte. It is suitable also in combined treatment. The approach to the psoriasic pacient must be comprehensive and individual and it is essential to provide him with medical care also during periods of remission.

Key words:
psoriasis - phototherapy - cyclosporin A - retinoids - methothrexate selective retinoid tasarotene- vitamin D -