Psoriasis is one of the most common immunological diseases in the practice of a dermatologist. To date, more and more techniques are being developed to treat psoriasis by influencing various mechanisms of its development.
One of these agents is vitamin D and its analogues in various forms (ointment, lotion, cream). The mechanism of action of this vitamin is associated with its inhibition of the proliferation of pathological keratinocytes and the enhancement of their differentiation, as well as with the weakening of the immune response in psoriasis.
Modern approach to the cause of psoriasis
Different approaches and treatment options for psoriasis
Experience with the use of vitamin D and its analogues for the treatment of psoriasis
Modern approach to the cause of psoriasis
At the moment, most experts tend to classify psoriasis as an autoimmune skin disease. Moreover, the role in pathogenesis is assigned, first of all, to T-lymphocytes, which receive information about their own keratinocytes as antigens, as a result of which the production of autoantibodies to them occurs, which is carried out in the epidermis and papillary dermis.
In response to this, due to the constant destruction of the skin, there is a constant stimulation of cell division in the pathological focus, which leads to hyperproliferation.
It has also been proven that psoriasis is inherited – the formation of autoantigens is due to the major histocompatibility complex (HLA). The implementation of the autoimmune process in manifestations on the skin is completed by antigen-presenting cells and anti-inflammatory mediators (cytokines).
In the development of psoriasis, the main place is given to autoimmune mechanisms based on the production of autoantibodies to the cells of the epidermis and papillary layer of the skin. An important role in the mechanism of development of psoriasis is played by the inheritance of the major histocompatibility complex (HLA).
Accounting for clinical features in the treatment of psoriasis
To select a method of treating psoriasis, one should take into account the most well-known clinical features in dermatology:
- The Koebner phenomenon is a tendency to increased formation of psoriatic plaques in places that are often susceptible to traumatization.
- Frequent spontaneous recurrence of psoriatic lesions
- Visible effect of treatment (absence of characteristic manifestations and inflammation) only after a decrease in the overall proliferation activity of the skin (usually temporary, until the next relapse).
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Such features of the inflammatory process are due to the autoimmune mechanism of psoriasis development described above. However, one should not forget about the possibility of cross-reaction to antigens in the tissue components of the joints, or streptococcal proteins, which also makes the role of the microbial focus in the body in the development of psoriasis important.
Different approaches and treatment options for psoriasis
Given the above factors of pathogenesis and different in severity clinical forms of psoriasis (dot-shaped, teardrop-shaped, nummular, plaque, large-plaque, diffuse-plaque, psoriatic erythroderma), presence and severity of complications (psoriatic osteoarthropathy, pustular psoriasis, generalized psoriasis), various treatment options for psoriasis are offered.
Types of therapy for psoriasis
1. Systemic therapy with glucocorticoids and cytostatics. Among cytostatics, cyclosporine is most often used, which has an immunosuppressive effect and thus regulates the immune response in psoriasis. In this case, the drug acts on the T-cell link of immunity. However, the use of such powerful cytostatics entails the risk of infectious diseases and malignancies.
2. In addition to systemic therapy, topical (local) corticosteroid therapy, aimed at immunosuppression and anti-inflammatory action, also plays an important role.
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3. Retinoids (particularly acitretin, tazarotene) are also used topically to treat psoriasis by binding to retinoic acid receptors, thereby inhibiting proliferation and keratinization in the affected skin layers. However, therapy with these drugs, due to increased resorption of the drug through the skin, has a number of side effects - a teratogenic effect when used in pregnant women, as well as a weak irritating effect on the skin, therefore, at the moment, topical treatment is limited to them.
4. One of the promising and effective methods of topical therapy of psoriasis at the moment is the treatment with vitamin D preparations, primarily calcipotriol, as well as its analogues – tacalcitol and calcitriol. The advantage of these drugs lies primarily in their antiproliferative and prodifferentiating action, which is carried out with the help of a specific action on vitamin D receptors.
Experience with the use of vitamin D and its analogues for the treatment of psoriasis
The positive results of treatment with vitamin D preparations are described in numerous studies and confirmed by practice. Inhibition of the proliferation of pathological keratinocytes, which play an important role in the development of psoriasis, is carried out due to the direct binding of vitamin D to the receptors of these cells.
The advantage of vitamin D preparations is that they easily penetrate the cell membrane due to the production in optimal dosage forms of topical action – ointments, creams, lotions.
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The anti-inflammatory effect of vitamin D preparations is also important, which are realized by inhibiting the production of inflammatory mediators in the skin – interleukins and interferons. Combination therapy with vitamin D along with retinoids or glucocorticoids has also proven to be effective.
The main positive effect of vitamin D is realized by inhibiting the proliferation of pathological keratinocytes when binding to their receptors, as well as by normalizing the differentiation of normal keratinocytes.
Side effects of vitamin D supplementation
Vitamin D and its analogues interfere with systemic calcium metabolism. As a result of these changes, such biochemical abnormalities as hypercalcemia and hypercalciuria occur.
Clinically, these disorders may present with seizures. Therefore, when using the drug, dermatologists recommend adhering to dosages appropriate for the sex and age of the patient.
Despite side effects, vitamin D preparations are used for topical treatment of psoriasis and are available as ointments, creams and lotions.
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The effectiveness of vitamin D preparations lies in antiproliferative, differentiating and anti-inflammatory effects. Combination therapy with vitamin D preparations and other topical treatments for psoriasis can achieve successful results.
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