Solution "Psoriderm" in the treatment of psoriasis of the scalp

The defeat of the scalp observed in 50% of patients with psoriasis. Changes in the skin at various different forms of psoriasis. Thus, in vulgar psoriasis plaques epidermal-dermal, clearly defined, are covered with silvery-white scaling.

When seborrheic psoriasis scales thick, glued, infiltration is less marked. Exudative psoriasis is characterized by profuse desquamation, erythema, plaque intensive.

In psoriasis lesion of the scalp may not be accompanied by subjective sensations, however, most patients complain of itching. The rash may spread to the forehead, forming a characteristic "psoriatic crown," capturing skin of the neck, to appear behind the ears. If you erased the boundaries plaque psoriasis may not be as pronounced in these cases, the diagnosis is very difficult. Psoriasis of the scalp may be complicated by bacterial infections, eczematization [1].

Psoriasis of the scalp should be differentiated from seborrheic dermatitis and lichen asbestovidnym. When seborrheic dermatitis noted erythema and scaling with fat, scales glued to the surface, infiltration is virtually nonexistent. When asbestovidnom herpes scalp is covered with thick, stick to the hair scales, like tiles [1].

Often, a cosmetic defect causes patients severe emotional stress, despite the fact that hair cover psoriatic lesions. A number of patients there is fear of baldness. In reality, hair loss can be observed as a result of scratching and is not a sign of psoriasis. It was noted that patients with lesions of the scalp reduced quality of life is more pronounced than in patients with damage to other parts of the body [6].

For the treatment of psoriasis of the scalp is used ectylotic, tar, corticosteroids (CS), calcipotriol [7]. However, the use of a number of these drugs are uncomfortable or cause some problems. Thus, ectylotic often used under occlusive dressing, after which it is difficult to wash off. Tar has an unpleasant smell, its use is contraindicated in the acute stages of the disease. At the present time are based on the combined resources of calcipotriol and betamethasone dipropionate, which are not yet registered on the territory of Belarus [4]. The advantages of a potentiation of the effects of the COP and analogs of vitamin D, the possibility of more prolonged therapy. For maintenance therapy of psoriasis of the scalp to effectively use shampoos with zinc, tar, selenium, salicylic acid. When seborrheic psoriasis in the combined therapy of systemic antifungal agents are added (ketoconazole or itraconazole) and local funds. [2]

Drugs of choice for the treatment of exacerbations and relapses of psoriasis are corticosteroids (CS). Currently, there are plenty of corticosteroids, different degrees of activity (Table 1).

Table 1. Classification of local corticosteroids on activity levels.

To date, the most active of the COP for the local application of all registered local COP in Belarus is clobetasol propionate 0.05%. The local side effects of the drug include skin atrophy, striae, telangiectasia, perioral dermatitis, steroid acne, hypertrichosis, activation of viral, fungal or bacterial infection, congestive hyperemia (rozatseopodobny dermatitis). Systemic effects may occur only at very long-term use on large areas of skin. In order to prevent a rapid and substantial proceeds of the drug into the systemic circulation, it should not be applied to the skin with high BAS's face, the inner surface of the shoulders and thighs, skin, reproductive organs [5].

Treatment of lesions of the scalp ointments and creams is extremely inconvenient for the patient, causing discomfort and irritation, reduces the quality of life. More rational use of drugs as a solution in which no major cosmetic problem. One of these drugs produced in the form of ointments and creams, and the solution is "Psoriderm" (company ╚Pharmacare╩). Vials containing 25 ml of 0.05% clobetasol solution. Today it is - the only preparation containing clobetasol propionate solution, allowed to be used in Belarus.

"Psoriderm" inhibits the itch of psoriasis, eliminates congestion and provides anti-inflammatory and immunosuppressive action of the local. The main mechanism of action is associated with inhibition of phospholipase A2, thereby reducing the level of arachidonic acid, which plays a key role in inflammation. "Psoriderm", as well as other COP, inhibits proliferation of T - cells in the skin of patients with psoriasis, inhibits the formation of immune complexes and stimulates apoptosis of activated T - lymphocytes [3].

Materials and Methods.

We observed 52 patients (18 women and 34 men) with various forms of psoriasis and lesions of the scalp. The average age was 40,0 ╠ 11,6 years, duration of rash on the scalp was 8,3 ╠ 4,7 years. Vulgar form of psoriasis of the scalp was observed in 18 patients (34.6%), exudative - 14 patients (26.9%) and seborrheic - in 20 patients (38.5%). Before the study began, the fifth day of therapy and after treatment were measured in patients of psoriasis severity index, and evaluated the severity of psoriasis of the scalp.

To analyze the clinical manifestations of changes in the treatment of the index used PASI, which describes the nature of the lesion of the scalp. In addition, the severity of erythema, desquamation and infiltration - estimated in points system from 0 to 3: 0 - no sign, 1 - poorly defined symptom, 2 - Moderate symptom, 3 - strongly marked feature. Area covered by the scalp also evaluated in points: in the area of ​​lesions less than 10% - 1 point, 10 to 29% - 2 points, from 30 to 49% - 3 points, from 50 to 69% - 4 points, from 70 to 89 % - 5 points, and from 90 to 100% - 6 points. PASI index for the scalp was calculated by the formula: PASI = (0,1 в point prevalence of lesions of the head в score the extent of damage the scalp). ═

General therapy of patients with psoriasis was administered in accordance with the protocols of treatment of dermatological patients in Belarus. Solution "Psoriderm" applied to the scalp, the indications for its use was extended for psoriasis of the scalp, and resistance to diseases carried out earlier therapeutic interventions, age over 12 years. Patients applied the solution "Psoriderm" on the scalp, gently rubbing it into the skin, 2 times a day to achieve clinical benefit, then - once a day. The solution was applied for 10 days.

The results.

All patients tolerated the drug well, side effects were noted. Dynamics of clinical indicators - erythema, desquamation and infiltration are shown in Figure 1.

In Fig. 1. The dynamics of clinical manifestations of psoriasis of the scalp in the treatment solution "Psoriderm."

The treatment is on the 5th day of application of the solution "Psoriderm" statistically significant improvement, expressed as a decrease in infiltration, scaling, and erythema (p <0,05).

PASI index before treatment was 2,4 ╠ 0,1 points, 5 days after starting treatment with a solution "Psoriderm╩ - 1,8 ╠ 0,2 points (p <0.001) and 10 days - 0,9 ╠ 0,2 score (p <0.001) (Fig. 2).

In Fig. 2. Dynamics of component index PASI, describing the rash on the scalp, in the treatment solution "Psoriderm"

Thus, the pronounced clinical effect was observed already at day 5 after treatment. In 9 patients (17.3%) showed complete regression of clinical symptoms, the remaining patients recorded a significant improvement (82.7%).

Patients report comfort application and cosmetic benefits of the solution "Psoriderm" before traditional treatment creams and ointments.

Conclusions:

1. Solution "Psoriderm" is an effective treatment for psoriasis of the scalp, can achieve remission in 17.3% of patients and significant improvement in 82.7% of patients within 10 days.

2. Application of the solution "Psoriderm" allows for significant reduction of clinical symptoms of psoriasis of the scalp (erythema, desquamation, infiltration) is on the fifth day of application.

References:

1. Adaskevich, VP Inflammatory Skin Diseases: A Practical Hands-on / VP Adaskevich. - Minsk: LLC "DoktorDizayn," 2003. - 120 sec.

2. Adaskevich, VP Orungal in the treatment of seborrheic dermatitis, rosacea, seborrheic psoriasis and palmar-plantar pustulosis / VP Adaskevich, V. Kozlovskaya / / Russian Journal of Skin and Venereal Diseases. - 2004. - № 4. - S. 31-34.

3. Soroka, NF Glucocorticoid hormones in the therapeutic practice / NF Soroka. - MH.: Altiora - Live Paint, 2006. - 46.

4. Calcipotriol plus betamethasone dipropionate scalp formulation is effective and well tolerated in the treatment of scalp psoriasis: a phase II study / S. Buckley et al. / / Dermatology .- 2008. - Vol. 217. - P. 107 - 113.

5. Frangos, JE Clobetasol propionate emollient formulation foam in the treatment of corticosteroid-responsive dermatoses / JE Frangos, AB Kimball / / Expert. Opin. Pharmacother. - 2008. - Vol. 9. - P. 2001-2007.

6. The Burden of Psoriasis Is Not Determined by Disease Severity Only / MR Heydendael et al. / / Journal of Investigative Dermatology Symposium Proceedings. - 2004. - Vol. 9. - P. 131-135.

7. Wozel, G Psoriasis treatment in difficult locations: scalp, nails, and intertriginous areas / G. Wozel / / Clin. Dermatol. - 2008. - Vol. 26 (5). - P. 448-459.

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