This dissertation is devoted to the optimization of complex treatment and prolongation of psoriasis remission. Psoriasis is one of the most common dermatoses and occupies one of the leading places among the current problems of modern dermatology. In recent decades, there has been an increase in the incidence of psoriasis, including in Ukraine. There is a tendency to "rejuvenate" the contingent of patients suffering from psoriasis, as well as a more severe clinical course of this dermatosis with resistance to a number of common methods of treatment.
The etiology of psoriasis is still unclear, and the pathogenesis of this dermatosis is debatable. Accumulated significant scientific material indicates the importance of genetic, immune, endocrine and metabolic disorders in the development of psoriasis. At the present stage, psoriasis is considered to be a genetically determined, chronic, autoimmune, polysystemic disease involving a number of organs and systems of the body in the pathological process and the corresponding morphological and functional changes.
The importance of disorders of lipid metabolism in the pathogenesis of psoriasis is also pointed out. In particular, it is believed that this dermatosis occurs against the background of changes in cholesterol metabolism. It is believed that psoriasis is a kind of "lipoidosis" of the skin, or "cholesterol diathesis". The rationale for this is that cholesterol is a major component of the intercorneocytic cementum of the epidermis of the skin and is involved in keratinization. Significant importance in the pathogenesis of psoriasis is given to the violation of mitotic activity and processes of differentiation of skin epidermocytes, which is caused by an anomaly and imbalance of lipids in cell membranes. However, the establishment of appropriate violations of the level of the lipid spectrum in areas of skin affected by psoriatic rash are contradictory. This is due to the fact that psoriasis is characterized by a chronic wave-like course with alternating periods of clinical exacerbations and remissions in different seasons of the year. Chronic recurrent psoriasis is defined in the classification taking into account climatic and meteorological factors. At the same time, taking into account the clinical exacerbation of the cutaneous psoriatic process, the following seasonal types of dermatosis are distinguished: autumn-winter, autumn-summer and post-seasonal (mixed). In this regard, it is advisable to study the level of the lipid spectrum in areas of skin affected by psoriatic rash and blood of patients with psoriasis, taking into account the existing autumn-winter, spring-summer and off-season types of dermatosis and changes in the clinical picture of the disease. according to the seasons of the year. It is also important to establish a possible correlation between lipid spectrum levels in areas of skin affected by psoriatic rash and blood of psoriasis patients with autumn-winter, spring-summer and off-season types, as well as the severity of skin psoriasis.
The results of these studies are important for establishing certain features of changes in biochemical processes in the body of patients with psoriasis with different seasonal types of dermatosis and the latest additional arguments about their importance in the pathogenesis of this disease.
At the present stage, the main characteristics of the pathological process are: immune inflammation, accompanied by activation of T-lymphocytes, excessive production of mediators of the immune response. The pathological process is also characterized by an imbalance of lipid metabolism, in particular, there is a decrease in the level of high-density lipoprotein (HDL) and an increase in the level of low-density lipoprotein (LDL). The pathological process of cholesterol accumulation triggers the production of pro-inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α). In chronic inflammation, TNF-α affects the lipid profile, in particular the level of LDL, due to a decrease in the concentration of apolipoproteins. Moreover, TNF-α affects the qualitative composition of lipoproteins, stimulating the production and oxidation of low-density lipoproteins (LDL) and at the same time reducing the level of HDL. Oxidized LDL not only exacerbates inflammation, but also contributes to the accumulation of cholesterol in lysosomes, which leads to cell death. On the other hand, HDLs have the function of reverse cholesterol transport, antioxidant capacity and anti-inflammatory properties by regulating dendritic cell differentiation and reducing T cell activation and interleukin-12 (IL-12) production. However, their corresponding properties decrease during chronic inflammation, such as psoriasis.
