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The evolution of psoriasis treatment

Psoriasis is one of the most common skin diseases that humanity has encountered in ancient times. Many famous personalities suffered from psoriasis: Winston Churchill, Benjamin Franklin, Henry Ford, Joseph Stalin, Vladimir Nabokov, Britney Spears, Kim Kardashian [1].

In the 21st century, this problem has become global. In the United States, for example, more than 3% of the population suffers from psoriasis, and about 11% in the Scandinavian countries. The growing incidence and social significance of this pathology were reflected both in a special resolution of the World Health Organization (WHO) assembly on psoriasis, adopted in May 2014 [2], and in the WHO global report published in 2016 [3].

“Itchy condition”
Today, most specialists are inclined to believe that the basis of the disease are immunological disorders that occur for various reasons. It is well known that the development of psoriasis is associated with a genetic predisposition. A special group of genes was identified, the presence of which increases the risk of developing pathology. Thus, psoriasis can be inherited. If both parents suffer from psoriasis, the risk of its transmission is up to 75%, and in the presence of the disease in the mother or father – up to 40% [4, 5]. But in order to “launch” a disease in a gene carrier, it is necessary to have exposure to provocative factors, which include infections, metabolic disorders, stress factors, toxic effects, etc.

With psoriasis, there is a significant acceleration (speed 7-8 times higher) of skin cell division. Newly formed cells differ from normal ones. A large number of abnormal cells and triggers the inflammatory process, which is supported by special substances – cytokines [6].

Psoriasis can occur in a person of any age, including a child, but most often the onset of the disease occurs in 16–25 years [3]. It is characterized by a chronic progressive course with frequent exacerbations, and the process begins most often with rashes on the skin in the form of small, ranging from a pinhead to a lentil kernel, bright pink papules, the surface of which is covered with silver-white scales. Gradually, they increase in size and can merge with each other, forming larger lesions – plaques. Plaques are clearly delimited from surrounding healthy skin, have a bright pink or red color and are also covered with silver-white scales. Rashes can cause severe itching (the name of the disease comes from the ancient Greek ψωριασις (“psoriasis”), which translates as “itchy condition”). Often the skin of the scalp (62%) and the nail plates are affected. Moreover, all manifestations of psoriasis, in addition to physical suffering, cause significant psychological discomfort, patients are shy of their disease [7, 8, 9].

In addition, 5-12% of patients with psoriasis develop psoriatic arthritis – a chronic inflammatory process in the joints, especially severe form. The difficulty lies in the fact that articular symptoms are not always manifested with extensive skin lesions. Joints can be affected already in the early stages of the disease, when the lesion area is relatively small, while subjective sensations may not be [10]. It is for this reason that the diagnosis of psoriatic arthritis is often made late, because at first the patient consults a dermatologist with complaints of skin rashes. A dermatologist draws attention to “his” symptoms. As a rule, the patient gets an appointment with a rheumatologist much later. The result is disappointing: psoriatic arthritis is a chronic pain, limitation of mobility, and in the most severe cases – disability of the patient.

Successful and timely treatment started leads to a decrease in the size of the plaques or their complete disappearance.

Treatment: from x-ray to gene
The very first external remedies for the treatment of psoriasis appeared at the turn of the XVIII – XIX centuries. They were made on the basis of poisonous arsenic and were used almost until the middle of the twentieth century. Doctors also tried to use mercury, from the beginning of the 20th century – X-rays and even pure radium, discovered by Pierre and Marie Curie (the latter method, fortunately, was not widespread, since Maria herself died of aplastic anemia quite soon due to high doses of radiation). Other – not so radical – anti-psoriatic drugs used at that time include salicylic and pyrogallic acids, preparations containing tar, sulfur, naphthalan, solidol, etc. [11]. However, evidence-based treatment for psoriasis has appeared relatively recently.

Traditional outdoor therapy
In the 50s of the last century, the first ointments were created on the basis of synthetic retinoids – substances that are similar in structure to vitamin A. They have proven themselves well in clinical practice, but without the side effects of increased dryness, thinning and peeling of healthy skin. not done.

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