How can you cure eczema and psoriasis

Skin disorders

psoriasis

Millions of people around the world suffer from the inflammatory chronic skin disease psoriasis (psoriasis). Many patents feel stigmatized and marginalized by this non-contagious disease, which appears in the form of reddish to silvery scaly patches of skin. A permanent cure is so far not possible, but epidemiological studies promise to track down the causes and trigger factors of psoriasis in order to develop possible strategies for coping with the disease as well as effective therapies.

Epidemiology - Who Is Affected?

If one looks at the prevalence of psoriasis in the world population, it is noticeable that there is an obvious connection between the frequency of the disease, the geographical location of the place of residence and the ethnicity. In the temperate zones of Europe, an average of two percent of the population is affected. In the northern European countries, on the other hand, psoriasis is much more common. This may be related to the low intensity of the sun's rays and the humidity in these regions.

With regard to the incidence of the disease in men and women, the studies do not reveal any obvious differences; rather, age seems to play a role. In principle, psoriasis can occur at any age. However, two types of psoriasis can be distinguished from one another, which have a very different age structure.

Type 1 psoriasis, which is also known as early-type psoriasis and which makes up around 70 percent of all cases, usually occurs in the second decade of life. The rarer type 2 psoriasis, on the other hand, only shows up after the age of 40 and has an incidence peak at 57 to 60 years. In contrast to type 2 psoriasis, the early type usually has a more severe course of the disease. In addition, certain cell surface characteristics and genetic factors seem to play a special role in type 1, since a much higher familial burden can be identified.

Risk factors

However, it is not just genetic predisposition and various immunological processes in the body that trigger psoriasis. As the epidemiological studies show, numerous external factors can contribute to the onset of the disease or to the worsening of the clinical picture. There was a connection between psoriasis and smoking, alcohol consumption, emotional stress, obesity and climatic influences. There is still a lack of data on other possible triggering factors in order to be able to make concrete statements. The role of nutrition will only become clearer through further targeted research.

Even if knowledge about the disease has expanded considerably in recent years, the exact mechanisms of psoriasis have not yet been fully explored. The causes of the disease are obviously very complex, so that a causal cure has not yet been possible. Thanks to various therapies, the flare-ups can be reduced, delayed or mitigated.

Clinical picture

Psoriasis is characterized by the appearance of small, silvery scales, especially on the elbows, knees and scalp. It can also affect the nails and - in the case of a particularly severe form of psoriasis - the joints (psoriatic arthritis). The disease was previously attributed to a metabolic disorder or a growth disorder of certain skin cells (keratinocytes). Both interpretations are now considered outdated. Although the cause of psoriasis is still not fully understood, we now know that it is a disorder in the immune system of those affected. This inflammation affects the skin's renewal process. While healthy skin renews itself roughly every four weeks, this cycle is shortened to around a week in people with psoriasis: the excessively produced skin cells are transported to the outside, die and then become visible as flakes. It was also found that certain immunological messenger substances (cytokines) occur to an increased extent in psoriatric skin.


Main forms of psoriasis:Main symptoms:Localization:
Psoriasis vulgarisRed, scaly herdHead, elbows, kneecaps
Plaque type of psoriasis vulgarisSevere form of psoriasis vulgaris, usually only heals incompletelyExtensive infestation, also of the chest and back, arms and legs
Guttate type of psoriasis vulgarisSudden appearance of herds the size of a pennyFace, chest and back
Psoriatic arthritisRedness, swelling of joints, pain, possibly also skin affectedOften fingers, wrists, ankles, knees, elbows, e.g. T. spine
Pustular psoriaisRedness and pus vesicles, e.g. T. soresOften the palms and soles of the feet, rarely the whole body

General psoriasis (psoriasis vulgaris) is characterized by pronounced dandruff on the elbows, knees and scalp; in moderate and severe forms, extensive areas of the entire body are affected. The rare forms with purulent pustules (pustular psoriasis) or the variants in problem areas of the body (inverse psoriasis) are particularly persistent. A particularly severe form of psoriasis is psoriatic arthritis, in which the inflammation also spreads to the joints. As a rule, the finger and toe joints are particularly affected here; Pain and joint stiffness are the result.

causes

The exact causes that lead to the development of psoriasis are still not known exactly. It is now assumed that several factors interact and that, in addition to a genetic predisposition for this disease, the immune system plays a central role. A large number of scientific findings suggest that psoriasis is a so-called autoimmune disease: the immune system, whose job it is to protect the body from dangerous foreign substances, is mistakenly directed against the body's own cells.

A key function in this defense reaction is played by special immune cells in the skin, the so-called Langerhans cells, and the T cells of the immune system, which are certain cells of the white blood cells. The chain of reactions, at the end of which is increased horn production and flaking, inflammation of the skin and the sometimes severe itching, can be imagined as follows: The Langerhans cells, which are located in the lowest layer of the epidermis, are phagocytes. They absorb the body's own cells, which are erroneously classified as dangerous, and which are also known as autoantigens, and migrate from the epidermis via the lymph flow to the lymph nodes. There they present the characteristic features of the autoantigen to the T cells on their surface. This is the signal for the T cells: As soon as they have recognized the characteristics of the autoantigens via special receptors, they become active and release a whole range of messenger substances. These messenger substances (cytokines) are used to exchange information between the immune cells. Some of the messenger substances released by the activated T cells control repair mechanisms for tissue damage and act as growth factors for many cells. In psoriasis, this chain reaction leads to increased and accelerated maturation of the skin cells (keratinocytes), which now accumulate on the surface of the skin and form the typical scales. In addition, the messenger substances attract immune cells to the supposed danger point, in this case the skin, and stimulate the mast cells to release inflammatory substances. Among other things, this leads to an expansion of the blood vessels so that more white blood cells can penetrate the skin tissue, which in turn are activated and release messenger substances. The result is an inflammation of the skin with the typical symptoms of reddening of the skin, swelling and itching, which is kept going by the constant activation of the immune cells and messenger substances.

therapy

  • External applications (topical therapy)
    • Urea (urea pura) - is used for care and treatment in the form of additives in oil, cream and ointments.
    • Salicylic acid - mainly used to peel off the scales. Since this substance is also anti-inflammatory, it can also be used directly for treatment with a relatively mild effect.
    • Coal tar - Has been used for a long time to treat chronic skin diseases. Slows down cell division and relieves itching. However, the tar substances used here are now considered to be carcinogenic, which is why they are only used to a very limited extent, or known products have already been withdrawn from the market.
    • Dithranol (also known as cignolin) - slows down cell division and is very effective, unfortunately this method is extremely time-consuming to treat. Older preparations also had other disadvantages, such as the brown coloration of the surrounding healthy skin, but also of objects that came into contact with the preparation, such as clothing, bed linen and wash basins. There are modern preparations on the market today that can significantly reduce the side effects described above. For example, with the minute therapy, in which dithranol is only applied to the diseased areas for a few minutes and then washed off.
    • Cortisone - a synthetic active ingredient that is modeled on the human hormone in the adrenal cortex. It quickly reduces the inflammatory phenomena. Because of the side effects, cortisone should only be used briefly and only on small areas of the skin. It is not suitable for treating large areas of skin. Cortisone ointments are best suited for the scalp. One effect that is often caused by these preparations is that of skin atrophy (thinning of the skin). The veins then shine through the skin.
    • Vitamin D derivatives - are synthetic substances that are modeled on a hormone that plays an essential role in controlling the immunological and regenerative processes of the skin. They reduce the division activity of the skin cells. The calcipotriol or tacalcitol used are vitamin D derivatives that reduce the risks of vitamin D many times over. These drugs can also have dangerous side effects if overdosed, but they are generally well tolerated. A common treatment method is the combination with light therapy.
    • Active ingredients of the bark of the common Oregon grape, lat. (Mahonia aquifolium) - here specifically the preparation "Rubisan", effective presumably by binding the berberine alkaloids contained therein to the genetic material DNA (DNA adducts).

  • Bath and light therapy:
    • Fish therapy with reddish sucking barbel (Garra rufa): The patients bathe for three weeks for about two hours a day with about 200 "kangal fish" in special therapy tubs. The fish remove the flakes of skin from the affected patient quickly and without side effects. Then the patients receive a short UV radiation in the solarium as well as skin care creams.
    • Narrow spectrum UVB therapy - known after the irradiation devices with 311 nanometers wavelength of light. Psoriasis is most sensitive in the range between 310 and 313 nm, which is why 311 nm radiation is now the method of choice for whole and partial body radiation. Due to the lower erythema effect, the tolerance is better than with broadband UVB and SUP lamps. This therapy is often combined with topical treatments to further increase its effectiveness.
    • Selective ultraviolet phototherapy (SUP) - Is a combination of UVA and UVB. It works quickly and intensively, but must be optimally adapted to the skin conditions of the person in order to avoid sunburn. Incidentally, this applies to all radiation therapies.
    • PUVA therapy (Psoralen + UVA) - This method is available in two forms, on the one hand as a bath or internally using tablets. In the latter, preparations such as psoralen or meladinin are used to increase the skin's sensitivity to light and thus increase the effectiveness of UVA rays. The PUVA therapy presumably leads to a photo-inactivation of the hyperreactive T cells, since psoralen, a furocoumarin, enters into molecular binding reactions to nucleic acids and protein structures.
    • Balneophototherapy - mainly known as sole photo therapy. This method is intended to simulate the conditions at the Dead Sea. Between 60 and 90% of patients respond well to very well to this type of treatment. The patient first bathes in a solution containing a lot of brine for about 20-30 minutes, and then briefly - if possible with skin that is still wet. d. H. to be irradiated with an intense UVB light source in the range of a few minutes.
    • Laser therapy - The excimer laser is one of the latest developments in light therapy. It is a xenon chloride gas laser. It generates monochromatic light with a wavelength of 308 nm. The laser works in the UV narrowband spectrum. In contrast to the fanned out cone of light in light cabins, the laser generates a bundled beam. With the small optical window of the laser head, it is possible to apply a therapeutically high dose of radiation specifically to diseased skin areas within a short period of time without exposing the surrounding healthy skin to radiation. The laser is particularly suitable for treating small, stubborn foci of inflammation on the skin. The laser has proven itself in the treatment of various diseases that respond to UV therapy. It is mainly used for psoriasis and vitiligo. The required therapy time is significantly lower compared to conventional light cabins due to the high irradiance of the laser. Hard-to-reach regions of the skin, such as folds of the skin or the bends of the joints, can be reached more easily than with therapy in light cabins. Depending on the sensitivity of the diseased skin area, the therapeutically necessary dose can be adjusted in a targeted manner. Laser light is currently the most effective physical therapy for treating psoriasis.

  • Internal applications (systemic therapy)
    • Methotrexate (MTX) - This drug comes from cancer therapy, inhibits the growth of cells and suppresses the immune system. The intake must be checked by a doctor because of the side effects.
    • Vitamin A derivatives - These derivatives, the retinoids such as acitretin, are often combined with radiation. These also act on the skin cells. It is important that these substances can lead to a deformity of the child during pregnancy in women up to two years after treatment. Furthermore, these substances are known for their pronounced side effects.
    • Cortisone - The tablets, ointments or syringes used here are actually only pure emergency medicine, as this can also result in a rebound and other serious side effects. Nonetheless, treatment with cortisone-containing preparations is considered to be a cost-effective standard, especially as the “first step” during the initial psoriasis treatment.
    • Immunosuppressive substances like Cyclosporin A - These substances come from transplant medicine and suppress the immune system. These substances are now a focus of research because research results indicate that psoriasis is an autoimmune disease.
    • Fumaric acid ester - A drug called Fumaderm is currently available, which is a mixture of different fumaric acid esters (monomethyl fumarate and monoethyl fumarate) and is generally recognized as being effective on the basis of studies. Although fumaric acid also occurs in the human metabolism (citric acid cycle), it is not free of side effects in the dosage used (especially: diarrhea, colicky abdominal pain and hot flashes). Treatments with this drug are mainly used when the infestation is severe. The success rate is around 50%, those patients who tolerate it because of the side effects report quite good results, but the rest of them had to do it because of the above Discontinue side effects or due to a massive worsening of the blood values ​​(in particular the liver and kidney values). Despite this, this drug is currently considered to be one of the preferred forms of drug therapy.
    • Biologicals - A distinction is made here between two types: the T-cell-inhibiting agents efalizumab and the TNF-a antagonists (adalimumab, infliximab, etanercept). These are biotechnologically produced substances that either belong to the group of monoclonal antibodies (efalizumab, adalimumab, infliximab) or to the group of fusion proteins (etanercept). These substances represent a new, currently still very expensive therapy option (costs: € 15,000 to more than € 20,000 per patient and year). They are approved for adult patients with moderate to severe plaque-type psoriasis. However, the attending physician must weigh up whether the patient might be eligible for one of the classic systemic therapies (methotrexate, ciclosporin A, fumaric acid ester) or for light therapy. Only if these therapy options do not work, are not tolerated or there are contraindications to them, he may use the biologicals. If these prerequisites are met, the therapy will be covered by the health insurance.
    [All: © Wikipedia.de]