Imishanguzo ye-biologic emisha inikeza ithemba kubantu abagulayo
Nakuba kungekho ukwelashwa kwe-plaque psoriasis engapheli, kunezinhlobo ezihlukahlukene zokwelashwa ezingasiza ukukhipha izilinganiso futhi zivimbele amaseli esikhumba ukuba angakhuli ngokushesha. Izinketho zibandakanya amafutha okugcoba, ukwelashwa okulula, nemithi ekhishwa ngodokotela esithathwe ngomlomo noma ngomjovo. Ukunakekelwa kahle kwesikhumba kanye nokukhethwa kwendlela yokuphila kungakusiza futhi ukuba ulawulwe yi-disorder eqhubekayo ithinta abantu abaningi baseMelika abangu-7.5, ngokwe-American Academy of Dermatology.
Imigomo
I-corticosteroids yama-topical, eyaziwa nangokuthi i-steroids, ibhekwa njengendlela ephumelela kakhulu yokwelapha i-psoriasis yamapuletiki. Kodwa-ke, njenge- disorder autoimmune engavamile, i-plaque psoriasis ingadinga okungaphezulu kwalokho. Kwezinye izimo, impendulo yokuziphendukela kwemvelo kuyodingeka ihlolwe ukuvimbela umzimba ukuba ungabangeli ukulimala okuqhubekayo. Ukuze kube sekugcineni, odokotela bavame ukuphendukela ezidakamizwa ezihlose ukuphendula ngomzimba, noma ngokuhlelekile (njengenhlangano yonke) noma ingxenye.
Corticosteroids yezihloko
I-corticosteroids yezihloko zivame ukusetshenziselwa ukwelashwa kwe-solo kubantu abane-psoriasis enobumba obuphansi, futhi zingasetshenziswa kanye nezinye izidakamizwa kubantu abanezilinganiso ezibhekene nezimo ezinzima.
Uma ubeka i-static steroid, i-dermatologist yakho izocabangela indawo nokuqina kwamacwecwe akho. Kulabo abaso ebusweni noma izicathulo, ukulungiswa okungezansi, 1.0% ukulungiselela kungenziwa kubekiwe, kuyilapho i-medium-to-high-potency steroid ingasetshenziswa kwezinye izingxenye zomzimba.
I-steroid ye-topical iyatholakala ngemithi kadokotela kanye nangaphezu kwe-counter ezinhlobonhlobo ze-lotions, ama-creams, ama-ointments, ama-shampoos, ama-foam kanye nama-sprays. Ngenkathi isebenza kahle, ukusebenzisa isikhathi eside noma ukusetshenziswa ngokweqile kungaholela esikhwameni se-atrophy (isikhumba esincane), isimo esivame ukungenakuguqulwa.
Izidakamizwa ezingezona ezeMvelo
Izidakamizwa ezingekho ze-biologic yizo eziye zahlanganiswa kulabhu.
Kunezinhlobo ezintathu ezingezona eziphilayo ezivame ukusetshenziselwa ukwelapha i-psoriasis yama-plaque:
- I-Methotrexate yisidakamizwa esicindezelayo sokuzivikela emzimbeni esiye sahlala iminyaka engaphezu kwengu-50 futhi isebenza ngokunciphisa impendulo yomzimba wonke. Ijwayele ukusetshenziselwa ukwelashwa kokuqala komugqa wokulinganisela kuya kuma-plaque psoriasis. Ngokunciphisa umzimba wonke, i-methotrexate ingabangela imiphumela emibi evela ebusweni besibindi kuya ekunciphiseni komnyoba. Ukuhlolwa kwegazi okuqhubekayo kuyadingeka ukuze ugweme izinkinga zokwelapha.
- I-Cyclosporine iyizidakamizwa ezicindezela ukuzivikela ezifana ne-methotrexate. Isetshenziswa uma i-psoriasis ingaba yinkimbinkimbi noma ingaphenduli okungenani enye yemithi yesistimu. Ngesikhathi i-cyclosporine isebenza masinyane esimisweni somzimba sokuzivikela, sidinga ukuqapha njalo imiphumela emibi, kuhlanganise nokucindezela kwegazi, isibindi sebindi, nokukhubazeka kwezinso.
- U-Otezla (apremilast) wamukelwa ngo-2014 ukuphatha i-psoriasis ne- psoriatic arthritis , uhlobo lwe-arthritis ye-rheumatoid ehlobene kakhulu ne-psoriasis. I-Otezla isebenza ngokuvimbela i-enzyme, eyaziwa njenge-phosphodiesterase 4, elawula ukuvuvukala kwamangqamuzana. Ngenkathi i-Otezla ibekezelela kahle, ingabangela isifo sohudo, isicuphoso, noma ikhanda uma kuqala. Ngokuvamile, abantu bangase balahlekelwe isisindo noma izimpawu zokucindezeleka.
Izidakamizwa ze-Biologic
Imithi ye-biologic yilabo abenziwe ngamaprotheni abantu noma izilwane. Inani elikhulayo lezinto eziphilayo liye lavunyelwa ekwelapheni i-psoriasis enamandla kakhulu. Ngokungafani ne-methotrexate, i-biologics ihlose ingxenye ethile yempendulo yegciwane lengculaza kunokuba isimiso somzimba samasosha omzimba sisonke.
I-biologics inikezwa ngomjovo noma nge-intravenously (nge-vein). Zivame ukuqondiswa kubantu abane-psoriasis enesisindo esingakaze baphendule kwezinye izifo.
Ama-agent agunyaziwe njengamanje ahlose ingxenye eyodwa yezingxenye ezintathu zezimpendulo zamasosha omzimba:
- I-Cimzia (certolizumab), i- Humira (i-adalimumab) , i- Enbrel (etanercept) , i- Remicade (infliximab) , ne-Simponi (golimumab) ye-block tumor necrosis factor (TNF) , iphrotheni yokubonisa okuhilelekile ekuvuvukeni kwesistimu.
- I-Stelara (ustekinumab) , i- Cosentyx (secukinumab) , i-Siliq (brodalumab), i-Taltz (ixekizumab), ne-Tremfya (guselkumab) ivimba izinhlobo ezahlukene ze-interleukin, iphrotheni ekhiqizwa ngamangqamuzana egazi amhlophe alawula ukumelana nomzimba.
- U-Orencia (abatacept) uvimbela uhlobo lwegciwane elimhlophe elibizwa nge- T-cell , elisebenzisana nesistimu yomzimba ukuze livuselele impendulo yokuvuvukala.
Njengoba izidakamizwa ze-biologic zingandisa ingozi yokutheleleka, noma yikuphi ukusika, ukugula, noma isibonakaliso sokutheleleka kufanele kube ukwelashwa udokotela. Imiphumela emibi evamile ihlanganisa injection site site, izifo zokuphefumula, kanye nezimpawu ezifana nezifo. Ezimweni ezingavamile, ezinye izifo zomdlavuza kanye nezibonakaliso ze-neurologic (ezifana nokuqothulwa kanye ne-multiple sclerosis) zingakhula.
Imithi Exhasekayo
Kunezidakamizwa eziningi zemithi ezivame ukusetshenziselwa ukusekela ukwelashwa okuyinhloko kwe-psoriasis:
- I-Calcipotriol (i-calcipotriene) iyinvithamini D3 efana ne-analog yokuqala eyethulwa ngawo-1990 ukuphatha i-plaque psoriasis engapheli. Kucatshangwa ukuthi kuthuthukisa izimpawu ngokugcizelela ukwedlula ngokweqile kwama- keratinocytes esikhumbeni. Amanye ama-analogs e-vitamin D3 afaka i-calcitriol ne-tacalcitol.
- I-Tazorac (i-tazarotene) i- retinoid ye- topical etholakala ku-vitamin A enganciphisa ukukhiqizwa kwamaseli esikhumba nokuncipha ukuvuvukala. Ibuye ithengiswe ngaphansi kwamagama okuthiwa u-Avage noFabior. Imiphumela emibi ihlanganisa ukucasula isikhumba nokuzwela kwelanga.
- I-Soriatane (i-acitretin) i-retinoid yomlomo ehlangene ngezinye izikhathi ihlanganiswe ne-UV light therapy. Imiphumela emibi ihlanganisa ukuvuvukala kwe-lip, ukulahlekelwa izinwele, nokomiswa kwamehlo, impumulo nomlomo.
I-Tazorac ne-Soriatane zombili zihlukaniswa njengesigaba sokukhulelwa X izidakamizwa futhi ngeke zisetshenziswe ngesikhathi sokukhulelwa ngenxa yobungozi bokukhubazeka kokuzalwa.
Izokwelapha
Ukukhanya kwelanga kungasebenza ngempumelelo ekunciphiseni i-psoriasis yama-plaque, kodwa ukuvezwa isikhathi eside kungabangela ukushisa kwelanga nokuya kwezimpawu ezimbi. Ukuze kube sekugcineni, ukwelashwa kwe-UV ukukhanya, owaziwa nangokuthi i- phototherapy , uye waba yindlela ephephile kulabo abahluleka ukuphendula imithi kuphela.
I-ultraviolet B (i-UVB) imisebe, ikakhulukazi, ikwazi ukungena esikhunjeni bese iphuza ukukhiqizwa kwamakhemikhumba esikhumba ngaphandle kokulimaza. Ukwelashwa kungenziwa ehhovisi likadokotela noma ngeyunithi yasekhaya. Kungakhathaliseki ukuthi yikuphi, inqubo kufanele iqondiswe udokotela we-dermatologist owaziwa nge-phototherapy. Ngenkathi isikhumba sakho singase sibe sibi nakakhulu ngaphambi kokuba sibe ngcono, ukuvumelana njalo kuvumela imiphumela emihle.
Enye indlela yokwelashwa okulula, eyaziwa ngokuthi i-psoralen + UVA (PUVA), ihlanganisa imisebe ye-UVA nomuthi ovuthayo owaziwa ngokuthi i-psoralen, othathwe ngomlomo noma ngomlomo. I-PUVA iyasebenza kakhulu kwi-psoriasis yama-plaque ezinzile kunama-flare acute.
Imithi yokwelapha ngaphezulu
Ngaphandle kwezihumusho ezingavumelekile zemithi ye-corticosteroids yama-topic, kunezinto eziningi ezingaphezu kwe-counter-the-counter (OTC) ezitholakalayo ukuphatha i-plaque psoriasis.
Njengoba abanye bangasebenzisa kangcono kunabanye (futhi abanye bangase babe nolaka kakhulu kuwe), kubalulekile ukukhuluma nodokotela wakho we-dermatologist ngaphambi kokusebenzisa noma yikuphi.
Phakathi kwezinye zezinketho ezithandwa kakhulu:
- I-tar yamalahle isetshenziselwe ukwelapha i-psoriasis iminyaka engaphezu kwengu-100, futhi kukhona abanye ababafunga ngakho. I-tar yamalahle itholakala ngaphandle kwemithi futhi ingatholakala ezinhlobonhlobo zamalungiselelo, kufaka phakathi ama-shampoos, amafutha okugcoba, ama-lotions, ama-creams, nama-Foam. Ngenkathi iphoyisa, ezinye zezimveliso zingase zihlaziye futhi ziphuze kancane.
- I-salicylic acid iyinhlangano ekhonsa amehlo engasiza ekunciphiseni nasekukhipheni izikali zokukhahlela. Iqukethe ezinhlobonhlobo zokucwilisa ama-creams, ama-lotions, namafutha okugcoba. Gwema ukuhlanganisa imikhiqizo eline-salicylic, futhi ungayisebenzisi ezingaphezu kwamaphesenti angama-20 omzimba, ngoba lokhu kungaholela ekutheni ukwephulwa ngokweqile kwe-topical kanye ne-toxicity. Ungayisebenzisi kubantwana.
Amakhambi asekhaya kanye nendlela yokuphila
Ngenkathi kunezinhlobo eziningi zemithi yokugqoka kanye nemikhiqizo ye-OTC etholakalayo ekwelapheni i-psoriasis yama-plaque, kunezindlela zokwelashwa zasendlini kanye nezindlela zokunakekela isikhumba ezingasiza.
Izifo zasekhaya
Inhloso eyinhloko yokwelapha ekhaya ukunciphisa ukushisa, ukushisa nokungahambi kahle kwamapuletiki ngenkathi ususa ngobumnene amaseli esikhumba anqwabelene ngaphandle kokuphuma.
Phakathi kwezinye izinketho eziphumelelayo:
- Amanzi okugcoba okwenziwa nge-Epsom usawoti, amafutha ommbiwa, ubisi, noma amafutha omnqumo anganciphisa isikhumba ngenkathi ephakamisa ngobumnene izilinganiso ezivela engxenyeni yangaphandle yesikhumba (i-epidermis). Sebenzisa amanzi okushisa kuphela; Amanzi ashisayo angasusa amafutha omzimba masinyane futhi ashiye isikhumba sesikhumba kunanini ngaphambili.
- Ama-moisturizers angenamafutha , njengamafutha e-petroleum jelly, i-aloe vera gel, noma amafutha ommbiwa, angasiza ekwehleni kwamaseli ngenkathi ebamba umswakama esikhumbeni. Lezi zinhlayiya ezicebileyo ezinomsoco kufanele zisetshenziswe ngemuva kokugeza ukulwa nokulahlekelwa komswakama.
- Njengoba kukhonjisiwe, ilanga lemvelo linganciphisa ukwanda ngokweqile kwamangqamuzana esikhumba kepha kudinga ukulinganiselwa kumaminithi angu-10 okuvezwa ngokuqondile ngosuku. Ungathuthukisa kancane kancane isikhathi sokutshala kodwa njalo uyenze ngenkathi ugqoke isikrini esincane se-SPF 30 esincane.
Indlela ephelele yokwelapha i-psoriasis kufanele ihlale ihilela ukuzivocavoca, ukunciphisa ukucindezeleka, ukudla okunamafutha aphansi okune-omega-3 fatty acids, nokugwema udoti kanye nogwayi.
Ukunakekelwa kwesikhumba
Ukunakekelwa kwesikhumba okuhle kubalulekile ukulawula izimpawu zakho ze-plaque psoriasis. Okuphakathi kwalokhu ukugwema izinsipho ezidliwayo, ukukhipha ama-scrubs, kanye nokuhlanza iziphuzo neziphuzo eziphuza utshwala. Lezi zingaphazamisa isikhumba sakho esibucayi futhi singenza ngisho nokuvuleka.
Amanye amathiphu okunakekela isikhumba okubalulekile afaka:
- Hlanza futhi uphuze isikhumba sakho kanye kanye nsuku zonke ukuze ugweme ukuma.
- Khetha insipho emhlophe noma ukuhlanza okwenzelwe i-psoriasis.
- Sebenzisa indwangu elithambile noma izandla zakho ukuze uphakamise. Ungalokothi usebenzise i-loofah noma noma yini engakwazi ukukhipha noma ukucasula isikhumba sakho.
- Geza ngamanzi afudumele. Amanzi ashisayo adala imithwalo yegazi esele ivuliwe kakade futhi ikwazi ukuhlukumeza amafutha omzimba omningi kakhulu.
- Ungadluli isikhumba sakho ngaphezulu. Uma wenza ngokwengeziwe, isikhumba sakho sizoba. Susa kuphela lezo zingxenye zomzimba wakho ezidinga.
- Ezinyangeni zasebusika, shiya u-lotion ukukhanya kuze kufike ukhilimu omuncu okhulayo ukukhokhela ukulahlekelwa komswakama.
- Gwema amakha nama-colognes aqukethe utshwala.
- Ngenkathi kufanele ugweme izimonyo uma une-psoriasis ebusweni, ungazama ukusebenzisa i -concealer ephephile isikhumba njengoDermablend noma i-Covermark, abanye abayisebenzisayo ukufihla ukushisa nezibazi.
- Phuza amaningi amanzi-okungenani izibuko eziyisishiyagalombili ngosuku. Ukwenza kanjalo isikhumba somzimba njengoba kwenza wonke umzimba wakho.
> Imithombo:
> I-American Academy of Dermatology (AAD) Umsebenzi Weqembu, et al. "Iziqondiso zokunakekela ukuphathwa kwe-psoriasis kanye ne-psoriatic arthritis: isigaba 6. Imihlahlandlela yokunakekelwa kokwelashwa kwe-psoriasis kanye ne-psoriatic arthritis: izethulo ezisekelwe ecaleni kanye neziphetho ezisekelwe ebufakazini." J Am Acad Dermatol . 2011 Jul; 65 (1): 137-74. I-DOI: 10.1016 / j.jaad.2010.11.055.
> National Psoriasis Foundation. "Okulinganiselwe ku-Severe Psoriasis ne-Psoriatic Arthritis: Izidakamizwa ze-Biologic." Portland, Oregon.