Psoriasis

psoriasis on the back

Psoriasis (also known as squamous lichen) is a chronic, non-infectious and often recurring skin disease.

Psoriasis, the symptoms of which determine its tendency to damage periarticular tissues, manifests itself in the form of squamous papules, in addition, it is worth noting that this disease is one of the most common skin lesions that occur at any age.

The etiology of this disease has not yet been fully studied and proven, however, many dermatologists still agree that psoriasis is a disorder directly related to inherited genetic pathologies.

Do not self-medicate. At the first sign of illness, see your doctor.

general description

Psoriasis is characterized by the duration and persistence of its course. Its remissions, which can last for several months or several years, meanwhile, indicate its subsequent return and lifelong duration. Spontaneous treatment of this disease is extremely rare.

If you try to determine a specific category of people predisposed to the onset of psoriasis, the solution will not be unique. The fact is that psoriasis, acting as a systemic process, develops not only in people with real immune disorders, but also in people who have certain functional or morphological disorders associated with the functions of various systems and organs.

Belonging to the group of dermatoses, psoriasis is one of the most studied diseases in them. Meanwhile, none of the hypotheses that exist today can fully determine the essence of this disease. That said, the problems related to its therapy and prevention are in the same uncertain and, at the same time, acute situation as before. Depending on the specific time period, various ideas about the origin of psoriasis have been proposed. This, in turn, has led to the selection of a number of forms, each of which is based on the results of certain laboratory studies and clinical observations.

  • The hereditary nature of the disease. This implies the presence of psoriasis in the context of the consideration of several generations, in which, as a result, cases of this disease have been detected. By the way, it is heredity that is considered practically the main and reliable cause of the development of psoriasis (in this case, psoriasis increases under the influence of various types of provoking factors).
  • The metabolic nature of the disease. In this case, disorders of fat metabolism (i. e. cholesterol metabolism), reduced morbidity during periods of hunger, increased amount of phosphorus in psoriatic scales, etc. are taken into account.
  • The viral nature of the disease. In this case, the concept of direct involvement of a viral infection in the etiology of the disease under consideration was formed on the basis of numerous long-term clinical observations. Consequently, for the same reason, the infectious (and even viral) nature as a theory of the development of psoriasis is the oldest. So, the end of the 19th century was marked by cases of the formation of very large groups of psoriatic-type formations, formed against the background of patients suffering from such diseases as scarlet fever and flu. The systemic nature of the actual lesion, its recurrent and prolonged course, the presence of a connection with meteorological and heliophysical factors, as well as some characteristics inherent in the evolution of skin rashes characteristic of psoriasis, also acted as confirmation of the infectious nature of the illness. As for the present moment, the search is underway for those viral agents through which the psoriatic process could be triggered.
  • Endocrine nature of the disease. The theory of a direct connection between the onset of psoriasis and the endocrine (as well as metabolic) nature in the recent past has been supported by many. When examining patients with psoriasis, some disturbances of the endocrine scale were found quite often, which served as a justification for the relevance of such a connection. In particular, disorders associated with the functional state inherent in the sexual glands, the influence caused by the menstrual cycle, pregnancy, childbirth and lactation, the pronounced type of changes detected in the study of the pituitary-adrenal system of patients were highlighted.
  • The neurogenic nature of the disease. It consists in the onset of the disease against the background of a nervous shock that is real for the patient (more precisely, after he is transferred). In about 30% of cases, the exacerbation of the disease occurs precisely on the basis of stress. In this case, patients have a reduced ability to withstand the impact of stress and the subsequent transfer of its consequences. At the same time, the disorders they have (asthenic, vegetative-vascular-visceral, vegetative-vascular-dystonic and asthenodepressive) in combination with neurotic reactions provoke the formation or even exacerbate the characteristics of the prevailing vicious circle.

Classification

As we have already noted, psoriasis acts as a chronic and recurrent disease. Any of its existing forms can be attributed to one of the variants of the classification relevant to psoriasis, in which there is a distribution for pustular or non-pustular psoriasis. In general, the classification is as follows:

  • Pustular psoriasis
    • generalized psoriasis;
    • annular psoriasis (annular pustulosis);
    • palmoplantar psoriasis (psoriasis of the extremities, persistent palmoplantar pustulosis, Barbera pustular psoriasis);
    • chronic form of persistent acrodermatitis (psoriasis of the soles of the feet and palms of the hands, palmar-plantar psoriasis);
    • herpetiform psoriatic impetigo.
  • Non-pustular psoriasis
    • vulgar psoriasis or vulgar psoriasis, simple psoriasis (plaque psoriasis, stable in chronic form);
    • psoriatic erythroderma (erythrodermal psoriasis).

Numerous authors adhere to the need to supplement this classification, thanks to which types or forms of psoriasis in the following variants can be added:

  • seborrhea-like psoriasis (seborrhea psoriasis);
  • Napkin psoriasis;
  • drug-induced psoriasis;
  • "Reversible psoriasis" (psoriasis of skin folds, flexor surfaces).

Psoriasis: symptoms

The first symptoms of psoriasis are the rash of the miliary type of papules, which are characterized by a gradual increase along the periphery, simultaneously transforming them into nummular and lenticular papules and merging with each other, as a result of which plaques of various sizes appear. The development of psoriasis within the skin defines three main stages for it.

First stage

This phase is called progressive, it is caused by the formation of new formations on the skin (actually papules), as well as by the increase in the size of those formations that are already on the skin. This is also accompanied by the formation of an erythematous border around the lesions (this border is defined as a peripheral growth zone). Plaque along the edges is not susceptible to peeling, while peeling, serving as the final stage of inflammation, does not keep up with the process of growth of psoriatic formations.

progressive stage of the course of psoriasis

Second phase

The second phase defines a stationary period in which no new elements appear, however, the existing elements in the form of plaques and papules do not change in size. Generally the appearance of the papules can be completed at any stage, therefore the stationary period can be accompanied by the simultaneous appearance of the miliary, lenticular and nummular papules. We explain what are the three types of papules listed. Hence, nummular papules are elements of a rounded rash with a diameter of 15 to 20 mm (for this reason, these papules are also called coin-shaped). Lenticular papules, in turn, are elements of a rash, flat or convex, oval or round, reminiscent of lentils. And finally, the miliary papules, which have a conical shape of the elements and are therefore similar to hemp seeds. Basically, these papules are small in size, the predominant area is near the hair follicles.

Third stage

This phase is reverse (or regressive). Its main feature is that the rashes gradually disappear, and a whitish border of the pseudosclerotic type is formed around the foci themselves (it is called the Voronov border). During this time, some patients may experience mild itching. As with all subjective sensations, they are mostly expressed insignificantly or even absent altogether.

The appearance of rashes can be noted within any area of the skin, however they are localized predominantly in the area of the surface of the folds of the limbs, especially the elbow and knee joints, the region of the sacrum, the leather scalp (here, in particular, the area along the edge of the hair growth is distinguished, which is referred to as the "psoriatic crown"). Psoriasis on the head, the symptoms of which, although determined by the severity of their own manifestations, do not lead to a change in the structure of the hair, as well as to their falling out.

psoriasis on the head photo 1psoriasis on the head photo 2

Regarding the concentration of the plaques within the extensor surface of the knee and elbow joints, here they often persist for a long period of time from the time the rash generally resolves (this feature defines them as plaques " of duty "). Some patients are faced with the fact that the skin folds in the groin-femoral region or mammary glands, as well as in the axillary glands, are affected, and often such a lesion can be isolated.

Sore psoriasis

It develops against the background of active exposure to the skin with an already existing progressive psoriasis of some irritants, in particular, sun rays or specific ointments, as well as other types of irritants that affect plaques. These plates, in turn, become more convex in shape, the color changes to cherry red, a hyperthermic belt forms within the surrounding area, as a result of which the sharp boundaries become somewhat blurred. This belt, following the resolution of the plaque, takes on a wrinkled appearance.

Spotted psoriasis

This form of the disease manifests itself in the form of mild infiltration (in the general definition, infiltration is the impregnation of tissues with one or another substance) from the elements of the rash. In turn, they look like spots (not papules). Spotted psoriasis develops, as a rule, acutely and is also characterized by a similarity to tooxidermia. As the main method in the differentiation of the disease, the definition of the correspondence of the course of the disease with its characteristic psoriatic triad is used.

Ancient psoriasis

This form of the disease can be considered in terms of symptoms in the form of severe infiltration from the side of the plaques, their general cyanosis, with a hyperkeratotic or warty surface. This type of foci is especially difficult to cure, and their transformation in the future into a malignant tumor formation is not excluded (this happens rarely, but, unfortunately, it is not necessary to exclude this option).

Seborrheic psoriasis

This form of psoriasis, as the name suggests, develops in patients with seborrhea which is already relevant to them. The disease manifests itself on the scalp, in the area behind the auricles, on the chest, in the area of the nasolabial folds, inside the subscapularis and the scapular parts of the back. The emerging psoriatic scales are subject to an intense saturation of sebum, whereby they attach and remain within the surfaces of the plaque, which, therefore, allows the disease to simulate a characteristic picture of seborrheic eczema.

Palmar-plantar psoriasis

The disease can manifest itself both in the form of normal psoriatic plaques and papules, and in the form of hyperkeratotic formations that simulate corns and calluses. In some cases, psoriasis on the hands, the symptoms of which are noted in this case on the palms (or legs - according to the definition, on the soles of the feet) is continuous, manifesting itself in the form of increased thickening or keratinization. Borders of this type of injury are characterized by clarity; in the rarest cases, this form of psoriasis is limited to the appearance of wide ring peels.

psoriasis in the palm of your handfoot psoriasis

Exudative psoriasis

This form of psoriasis is characterized by excessive severity of exudate during an inflammatory reaction, appears in the progressive period of the course of psoriasis. Making its way to the surface of the papule, the exudate provides saturation of the accumulation of scales, thus forming formations that look like crusts. These elements are secondary, let's define them as flaky crusts, the color of these elements is yellowish. After their removal, a slightly bleeding and weeping surface is subject to exposure. Scale crusts, once dried and layered, often form a massive type of conglomerate, resembling an oyster shell (this is already referred to as rupioid psoriasis).

Guttate psoriasis

Guttate psoriasis, the symptoms of which appear suddenly, is characterized by the formation of multiple specks within the skin. Mostly the disease is diagnosed in patients between the ages of 8 and 16. Often, strep infection acts as a precursor to teardrop-shaped psoriasis.

teardrop psoriasis

Nail psoriasis

Nail psoriasis, the symptoms of which involve the isolation of this type of psoriasis in three main forms, depending on the degree of nail damage, can be atrophic, punctate or hypertrophic.

A punctured lesion is considered to be the formation of punctate depressions on the nail plates, which can also be likened to the surface of a thimble. The manifestation of this form of psoriasis is possible in a slightly different version, which, in its specificity, is similar to onychomycosis. In this case, on the inside of the free edge, the nail plate changes color, becomes dull, prone to crumble without much effort. As a sign that allows to differentiate psoriasis, an inflammatory border formed along the periphery of the affected nail plate area is determined. It looks like the edge of a papule within the nail bed, visible through the nail plate.

psoriasis nail photo 1psoriasis nail photo 2

Psoriatic arthritis (psoriasis).

Psoriatic arthritis, the symptoms of which occur due to infiltration, which affects the periarticular tissues with simultaneous damage to the joints, mainly affects the interphalangeal joints. Meanwhile, the possibility of involvement of large joints in the pathological process is not excluded; the joints and joints of the sacroiliac spine are extremely rarely at risk in this regard.

It is important to take into account that psoriatic arthritis, unlike other types of arthritis (which in the general definition mean inflammation of the joints), is formed against the background of an already existing psoriatic rash in the patient, often combined with damage to the nails . In addition, one important point can be distinguished that the onset of this type of arthritis is combined with an exacerbation of psoriasis inside the skin, which, in most cases, acquires an exudative character.

psoriatic arthritis

Irrational treatment of the disease during the period of its progression is often accompanied by the occurrence of a non-specific reaction on the part of the body. It is toxic-allergic in nature and consists in the appearance of redness in the area of the areas not affected by psoriatic plaques, this redness, merging, completely affects the skin. This process is combined with a high temperature (within a range of not more than 39 degrees), as well as an increase in the lymph nodes, a feeling of tight skin, burning and itching. In frequent cases, there is also profuse peeling, thickening and exfoliation of the nails, hair loss. This image already indicates the relevance of psoriatic erythroderma. Erythroderma ends with the restoration of the traditional version of the course of psoriasis.

erythroderma with psoriasis

In general, the relapse of the disease occurs in the autumn-winter, as well as in the spring-summer periods, which is an important factor that must be taken into account, including when prescribing the necessary treatment.

Psoriasis treatment

Before the appointment of treatment, a thorough examination of the patient is carried out and, already to determine specific measures in it, they are based on the stage of the course of the disease, its clinical variety, the general condition of the patient, the presence of concomitant diseases, the conformity of the manifestations of the disease to seasonality, etc. the fastest and, at the same time, a favorable result of treatment is obtained in the case of simple forms of psoriasis with their short course, even with limited manifestations. In general, the treatment of psoriasis is a rather laborious process and in most cases it is not possible to arrive at a complete cure: the disease simply regresses (that is, it begins a period of its existence without symptoms), which, however, is also a positive result for this.

The main goal of treatment was determined as the maximum possible suppression of symptoms in combination with the addition of preventive measures.

First of all, with psoriasis, a diet is prescribed, in which those foods that provoke an exacerbation of the disease (spicy foods, chocolate, alcoholic beverages) are excluded from the diet. The restriction also applies to the consumption of smoked meats, honey, fried and fatty foods, etc. During the period of exacerbation of the course of the disease, it is recommended to eat more fruits and vegetables (with the exception of red ones: apples, tomatoes, cherries, etc. ), fish and lean (boiled) meats.

The course of psoriasis has a beneficial effect on its treatment in the conditions of health facilities. Taking into account the particular susceptibility of the skin in patients with psoriasis, it is recommended to avoid sun exposure on it in the period from 11 to 16 hours.

As for the drug treatment of psoriasis, it is based on the use of several methods. First of all, these are external agents (creams, ointments, etc. ), drugs for systemic treatment (injections, pills, etc. ) and methods such as phytochemotherapy (phytotherapy), physiotherapy, etc. methods of external treatment. In particular, the following drugs were most commonly used among them:

  • Salicylic ointment. With the help of him, the softening of the formed scales is ensured, which, in turn, offers the possibility of their early elimination along with better absorption of another type of drugs. This ointment (0. 5% or 5%) is applied to the affected areas of the skin in a thin layer, 1-2 times a day. An important feature of the application is the use of a smaller amount of ointment with a significant nature of inflammation (that is, the more the inflammation is more pronounced in the nature of its manifestation, the smaller the amount of ointment used, respectively). Salicylic acid, which serves as the base of the drug, is also found in a number of other ointments used in the treatment of psoriasis.
  • Sulfur tar ointment (5 or 10%). The use of this ointment provides a reduction in inflammatory processes relevant to the skin. Contraindication to use is exudative psoriasis (i. e. psoriasis, accompanied by weeping scabs and scales). It is not possible to apply this ointment to the skin of the face. Tar shampoos are used to treat scalp psoriasis.
  • Naphthalene ointment. It is used to treat the regressive and stationary stages of the disease. The exacerbation or progression of psoriasis determines the inadmissibility of the use of this remedy. With the help of this ointment, intense itching and inflammation are reduced. 5% or 10% ointment is used.
  • Glucocorticoid drugs. Their use provides a decrease in the intensity of inflammation. They are used only in short courses, with the mandatory supervision of a specialist.
  • Ointments containing vitamin D. Such ointments provide an anti-inflammatory effect, while at the same time improving the course of the disease.

As for systemic treatment, it is selected strictly individually and only by the attending physician. As already noted, it means the use of various pills, injections, etc.

Phytochemotherapy as a method of treating psoriasis consists in the exposure to ultraviolet rays of the affected skin areas. A special type of installation is used for this which irradiates such areas without affecting healthy skin.

In general, psoriasis treatment can mean many different schemes implemented in practice, but none of these schemes are generally accepted due to the difference in their course and specificity, so the effectiveness of none of the schemes can be determined equally for all. the patients. We repeat that the treatment of the disease is carried out on a strictly individual basis under the constant supervision of the attending physician.

If symptoms that indicate psoriasis appear, you should contact a dermatologist and an infectious disease specialist.