PsoriasisIt is a chronic disease that affects the skin, sometimes the nails, joints and internal organs. It is manifested by itching and the appearance of pinkish-red rashes - papules, which can merge into larger plaques. These papules rise above the surface of the skin. They are covered in silvery scales that peel off easily when peeled.
Quite often, the disease is combined with impotence, accelerated ejaculation and Reiter's syndrome. With extensive psoriasis, psoriatic arthritis can occur.
Risk factors
Causes of psoriasisthey have not yet been fully identified. Risk factors for developing the disease include:
- microbial factor - various types of fungi, mycoplasma;
- neuropsychic trauma, stress;
- endocrine diseases - diabetes mellitus, thyroid disease;
- foci of chronic infection, especially streptococcal;
- states of immunodeficiency;
- disorders of lipid and protein metabolism;
- injuries to the skin and joints.
Is psoriasis transmitted?
Psoriasis is not contagious. Many researchers pay attention to the familial nature of psoriasis and recognize its genetic nature. Furthermore, it is not the disease itself that is inherited, but a predisposition to it.
If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of psoriasis
The first symptoms of psoriasis:rashes on the skin in the form of bright pink plaques with a scaly surface. The plates are single, rise above the level of healthy skin, are located on the elbows and in the popliteal cavities.
Most often, psoriatic plaques appear on the skin of the knees, elbows, chest, abdomen, back, and scalp, but as the disease progresses they can appear anywhere else, more unexpected than the integument.
Initially, the papules are small - 3-5 mm, the color is bright pink. Gradually increasing in size, they become covered in silvery scales and fuse into larger formations called plates.
Fresh elements of the papules, as a rule, are bright in color, up to red, "old" ones are more faded. In the initial stage of psoriasis, the edges of the papules do not peel off. They represent a hyperemic boundary -growth corolla. . .
The hallmark of psoriasis is the Auspitz triad. This triad can be observed by scraping the surface of the papule with a sharp object. It includes three phenomena:
- stearin spot phenomenon- stratification of a large number of silvery-white scales, which easily separate when scraped;
- symptom of psoriatic film- exudate surface, consisting of a spiny layer, which opens after detaching the lower layers of the stratum corneum;
- blood dew phenomenon- exposure of the superficial capillaries in the form of small blood spots after the detachment of the psoriatic film.
Signs of different types of psoriasis
Clinical types of psoriasis:
- Spotted psoriasis- represented by weakly infiltrated pale pink spots. It resembles toxidermia.
- Sore psoriasis- occurs due to exposure to the skin of aggressive environmental factors (sunlight, cold, heat) and irritating drugs. The color of the plaque becomes more intense, increases in size, rises more above the surface of the skin, a girdle forms at the edges in the form of redness.
- Seborrheic psoriasis- often develops in patients with seborrhea. The clinical picture is very similar to seborrheic eczema.
- Exudative psoriasis- occurs quite often. It occurs due to excessive secretion of an inflammatory fluid - exudate. It impregnates accumulations of flakes, turning them into crusts of flakes.
- Psoriasis of the palms and soles of the feet- is represented both by common plaques and papules, and by hyperkeratotic formations, similar to corns and calluses.
- Follicular psoriasis- a rare form of the disease. The rash consists of white miliary nodules with a funnel-shaped depression in the center.
- Mucosal psoriasis- a rare form of the disease. It occurs on the mucous membrane of the mouth and bladder. It manifests itself in the form of gray-white areas with a red border.
Frequency of psoriatic manifestations
Cyclic exacerbations are characteristic of psoriasis. Most often they occur in the fall and spring.
Pathogenesis of psoriasis
Dermatosis is an inflammatory process associated with the work of immune T cells. As a result of this inflammation, the proliferation of keratinocytes, the main cells of the epidermis, is accelerated.
Psoriasis, a type of dermatosis, is a chronic inflammatory disease. It proceeds with the participation of microbial pathogens that can bind to the surface of the skin.
Everything that happens in the skin under the influence of the pathogen is a classic inflammatory reaction according to the principle of RTCDF:
- Rubor - redness;
- Tumor - tubercle, edema;
- Calor: fever, fever;
- Pain - pain;
- Functia laesa - dysfunction.
Redness and thickening of the skin at the sites of the lesion, itching, increased keratinization followed by the formation of scales - all these are manifestations of the inflammatory process, a protective reaction of the body aimed at fighting the microbial pathogen. Without timely outside help, the body is often defeated.
Some scientists adhere to the theory of a genetic predisposition to a violation of the cell division process. With such a violation, an increase in cell death and keratinization occurs, followed by their growth and the appearance of a large number of not fully keratinized epithelial cells. But this theory does not contradict the aforementioned microbe in the slightest.
Classification and stages of development of psoriasis
There is no generally accepted classification of psoriasis.
Traditionallythere are four types of the disease:
- vulgar psoriasis - seborrheic, follicular, warty, exudative, bullous, palms and feet psoriasis, mucosal psoriasis;
- pustular psoriasis;
- psoriatic erythroderma;
- psoriatic arthritis.
According to ICD-10, there are:
- L40. 0 Psoriasis vulgaris (coin and plaque psoriasis);
- L40. 1 Generalized pustular psoriasis (herpetiform impetigo, Tsumbusch's disease);
- L40. 2 Persistent acrodermatitis;
- L40. 3 Palmar and plantar pustulosis;
- L40. 4 Psoriasis tear;
- L40. 5 Arthropathic psoriasis;
- L40. 8 Other psoriasis;
- L40. 9 Psoriasis, unspecified
Complications of psoriasis
Without timely and competent treatment, psoriasis begins to adversely affect vital organs and systems: joints, heart, kidneys and nervous system. These conditions can lead to disability and even death.
What is psoriatic arthritis?
Psoriatic arthritis is the most severe form of psoriasis, as it often causes disability.
Doctors most often face this complication. It occurs due to inflammatory changes in the joints.
The joints of the hands, wrists, feet and knees are the most affected. Over time, the disease can spread to the hip, shoulder, and spine joints. With further progression, the muscles begin to ache near the affected joints. Patients complain of stiffness of movement, especially in the morning. Their body temperature is often elevated during the day.
The clinical picture of psoriatic arthritis develops like ordinary arthritis: first there is pain, then swelling, stiffness and limited mobility. A characteristic symptom of this complication is a sausage finger. It appears to be due to the defeat of all interphalangeal surfaces.
Other complications of psoriasis
A little less commonpsoriatic erythroderma. . .This condition occurs when the skin is completely affected. Patients are worried about itching and burning, profuse peeling of dead tissues, a strong reaction of the skin to a change in temperature.
The next most frequent occurrence ispustular psoriasis. . .This complication is associated with the addition of a secondary infection - staphylococci and streptococci. Clinically, pustular psoriasis is accompanied by the appearance of pustules - pustules the size of a buckwheat grain. Pustules appear in different places. They rise above the surface of the skin, are characterized by rapid growth and a tendency to merge. To the existing symptoms are added high fever and signs of severe intoxication.
Injuries of the internal organssuffering from psoriasis are now extremely rare. As a rule, people who lead an asocial lifestyle are sensitive to them. The genitourinary system is most often affected: the kidneys, the mucous membrane of the bladder and the urethra. This leads to the development of pyelonephritis, glomerulonephritis, cystitis and urethritis.
On the part of the heart, psoriasis can cause damage to the mitral valves, inflammation of the heart muscle and the outer lining of the heart - myocarditis and pericarditis. With nerve damage, patients complain of a crawling sensation, increased irritability or depression, constant fatigue, drowsiness and apathy.
Psoriasis diagnostics
When to see a doctor
It is necessary to consult a doctor at the first symptoms of psoriasis - the appearance on the skin of bright pink plaques with a flaky surface.
Prepare to visit a doctor
Three days before visiting a doctor, you should stop applying medicinal ointments to the skin. No other specific training is required.
Psoriasis is such a recognizable disease that it will not be difficult to diagnose it on the basis of external signs. Often, a diagnosis can be made to patients, as they say, "outside the box". If necessary, the doctor scrapes the surface of the skin to detect the Auspitz triad.
OV Terletskiy, Candidate of Medical Sciences, together with the co-authors, proposed a diagnostic scheme developed on the basis of data from the American Rheumatological Association. It includes the following exams:
- complete blood count (with platelets);
- general urine analysis;
- blood chemistry;
- acute phase reactions of the body - C-reactive protein and rheumatoid factor;
- immunoglobulins - IgA, IgG, IgM, IgE)
- complement binding reaction with gonococcal antigen and chlamydia;
- the reactions of Wright and Heddelson;
- coagulogram - evaluation of blood clotting;
- blood test for borreliosis and toxoplasmosis (according to indications);
- blood test for HLA.
However, there are many diseases in the guise of psoriasis. In this regard, it becomes necessary to leaddifferential diagnosis, particularly among papular syphilis, Reiter's syndrome, neurodermatitis, lichen rosacea, systemic lupus erythematosus and seborrheic eczema. To do this, use:
- biopsy - pinching a piece of skin with subsequent histological examination;
- laboratory diagnostics - often used to distinguish psoriasis from papular syphilis;
- blood tests for other hidden infections for better selection of antibiotics.
Instrumental diagnostic methodsmainly used for complicated forms of psoriasis associated with damage to the joints and internal organs. These include: x-rays of the joints, ultrasound of the heart, kidneys and bladder.
Treatment of psoriasis
Is there an effective treatment for psoriasis?
Although psoriasis is a persistently recurring disease, it can be completely eliminated provided that you promptly consult a dermatologist, who can identify the true causes of psoriasis. In the last decade, many drugs of systemic and local action have appeared, aimed at eliminating the cause and suppressing the mechanism of the development of the disease. Drugs that interact with each other via chemical signals (cytokines) have proven to be very effective. They eliminate the increased proliferation of cutaneous creatinocytes.
Phototherapy
In 1994, the team of the Department of Dermatovenereology of the MAPO SPb introduced a method of treating psoriasis usingUFO blood- photomodification of blood with ultraviolet light.
The ability of sunlight to have a beneficial effect on the skin for numerous diseases, including psoriasis, has been known since time immemorial. In the early twentieth century, a group of German scientists suggested that since ultraviolet light has a healing effect on exposed skin, this effect is likely to occur when ultraviolet radiation is applied to the blood. After all, this is also a type of fabric. This hypothesis was confirmed by the first UV exposure session on blood, which was held in Germany in 1924.
The therapeutic effect of ultraviolet rays on the blood is associated with profound structural changes at the atomic-molecular level, which are captured by immunocompetent organs: liver, spleen, bone marrow and lymphoid tissue. These changes are seen by the organs as an alarm signal and therefore produce dozens of times more immune complexes. In this case, ultraviolet light is a kind of "whip" that forces the body to drastically increase its defenses to fight the disease.
Also noteworthy is the PT effect -unleashing ultraviolet therapy. . . This method of treatment is important, given the chronic nature of psoriasis, which is associated with numerous internal organ complications caused by a variety of microbial pathogens. The longer the microbes are in the body, the larger their habitat becomes. These microscopic creatures capture more and more anatomical areas through the blood and lymphatic flow. Once in the tissues, they strive to penetrate as deeply as possible into the intercellular spaces. There they form microcolonies, protected from the remains of dead and destroyed cells and a leukocyte pit. Due to this, microorganisms can be out of reach of antibiotics for years. They easily compensate for the lack of nutrients by entering a state of suspended animation, something between life and death.
The ability of ultraviolet rays helps destroy microbial "havens". They create favorable conditions for the penetration of antibiotics and other drugs that affect the cause of psoriasis.
The cutaneous application of ultraviolet radiation is also relevant. The most famous treatment method that uses this principle isPUVA therapy. . . Although it is less effective than ultraviolet irradiation of the blood. The therapeutic effect does not last long, a relapse can occur two weeks after the end of treatment.
Pharmacological treatment
From the medications, the following worked well:
- vitamin A derivatives, which reduce the rate of maturation of keratinocytes and normalize cell differentiation;
- immunosuppressants that reduce the activity of T lymphocytes, which contribute to increasing the division of epidermal cells;
- drugs for the treatment of malignant tumors that inhibit the reproduction and growth of atypical skin cells.
What ointments and creams are effective in treating psoriasis
Ointments and creams with anti-inflammatory components will help alleviate the patient's condition.
How to treat scalp psoriasis
Ointments are not effective in treating scalp psoriasis. In addition to drugs and ultraviolet treatment, you can use a special shampoo.
How to treat psoriasis on elbows and arms
Psoriasis in the elbows and arms is treated with the same methods as the rest of the body. The peculiarity of the course of psoriasis in this area is that the skin of the hands is subject to physical, mechanical and chemical influences, which is considered an aggravating factor in the course of the disease.
Is monoclonal antibody treatment for psoriasis effective?
Monoclonal antibody therapy for psoriasis is very effective. Monoclonal antibodies are laboratory-produced antibodies similar to those produced by human immune cells. Monoclonal antibodies selectively target the targets responsible for the development of the disease.
How to recognize and treat psoriasis in children
In children, psoriasis often proceeds more violently and masks itself from other diseases (eczema, erysipelas, herpes), which complicates the diagnosis. The methods of therapy are similar to those for adults: phototherapy, medication and topical treatment.
What baths to do with psoriasis
Aloe baths can help reduce inflammation and itching.
How to cure psoriasis according to Pegano
The Pegano method for the treatment of psoriasis includes bowel cleansing, diet and herbal teas. The effectiveness of this method has not been proven by clinical studies.
Role of nutrition in treatment
Nutrition greatly affects the course of psoriasis. During the treatment, it is necessary to exclude alcohol, salty, spicy, pickled, nuts, citrus fruits, honey, chocolate and smoked meats.
What sanatoriums show rest for the treatment of psoriasis
For psoriasis it is preferable that the spa treatments take place on the sea in a region with a warm and dry climate and many sunny days. The most suitable for this are the resorts of the Crimea.
folk ways
Some folk remedies can help reduce itching and peeling of the skin in patients with mild to moderate psoriasis. These methods include:
- cream with aloe extract;
- fish oil applied to the skin with a coated bandage for six hours a day for four weeks;
- cream with oregon grape extract.
Forecast. Prevention
Psoriasis is not a sentence. If the patient promptly sought qualified help from a specialist who can establish the true causes of the disease and prescribe effective treatment, the disease will be defeated.
The simple form of psoriasis occurs only with a skin defect. Therefore, the patient does not need special conditions for work. Work in a chemical plant is an exception: in this case, the permanence in the workplace must be excluded.
It is worth remembering that psoriasis can cause complications. Most often, psoriatic arthritis develops. Its severe forms can limit the exercise of labor functions and in the future lead to complete disability.
Prevention of psoriasis is an integral part of therapeutic measures to eliminate one of the most serious skin diseases. After recovery, the patient must completely review his lifestyle, get rid of bad habits, pay attention to the treatment of chronic diseases of other organs, regulate nutrition, include outdoor walks and sports in the daily routine.
Do they catch up with psoriasis in the army?
Severe forms of psoriasis are sufficient grounds for declaring a conscript unfit for military service, mild forms - of limited eligibility.