Psoriasis

Psoriasis (also known as scaly lichen) is a non-infectious chronic and often recurrent skin disease.

Psoriasis, whose symptoms determine its tendency to damage the periarticular tissue, manifests itself in the form of scaly papules, in addition, it is worth noting that this disease is one of the most common skin lesions that occurs 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 disease that is directly related to genetic inherited pathologies.

Do not self-medicate. At the first signs of illness, see a doctor.

general description

Psoriasis is characterized by the duration and persistence of its own course. His remissions, which can last from several months to several years, meanwhile indicate his later return and lifetime. Spontaneous cure of this disease is extremely rare.

If you try to determine a certain category of people predisposed to psoriasis, then the solution will not be unambiguous. 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 related to the functions of various systems and organs.

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

• Hereditary nature of the disease. This implies the presence of psoriasis within the consideration of several generations, in which, accordingly, cases of this disease have been recorded. Otherwise, heredity 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).
• Metabolic nature of the disease. In this case, disorders in fat metabolism (ie cholesterol metabolism), reduced morbidity during periods of starvation, increased amount of phosphorus in psoriatic scales, etc. are considered.
• The viral nature of the disease. In this case, the concept of direct inclusion of viral infection in the etiology of the disease under consideration was formed on the basis of numerous and long-term clinical observations. Accordingly, for the same reason, the infectious (and viral) nature as the theory of the development of psoriasis is the oldest. Thus, the end of the 19th century was marked by cases of the formation of very extensive groups of psoriatic-type formations, formed on the background of patients suffering from diseases such as scarlet fever and influenza. The systemic nature of the actual lesion, its recurrent and prolonged course, the presence of associations with meteorological and heliophysical factors, as well as certain characteristics inherent in the evolution of psoriasis-characteristic rashes, also acted as confirmation of the infectious nature of psoriasis. disease. As far as the present is concerned, the search is underway for those viral agents through which the psoriasis process could be started.
• Endocrine nature of the disease. The theory of a direct link between the occurrence of psoriasis and endocrine (as well as metabolic) nature has been supported by many in the recent past. When examining patients with psoriasis, certain disorders of the endocrine system were very often detected, which served as a justification for the relevance of such an association. Disorders related to the functional state inherent in the gonads, the influence of the menstrual cycle, pregnancy, childbirth and lactation, the type of changes detected in the examination of the pituitary-adrenal system of patients are especially emphasized.
• The neurogenic nature of the disease. It consists of the appearance of the disease in the background of the nervous shock that is relevant for the patient (more precisely, after he was transferred). In about 30% of cases, the exacerbation of the disease is based on stress. In this case, patients have a reduced ability to withstand the effects of stress and the subsequent transmission 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 cause the formation or even worsen the characteristics of the prevailing vicious circle.

Classification

As already mentioned, psoriasis acts as a chronic recurrent disease. Any of the 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 (extremity psoriasis, persistent palmoplantar pustulosis, barber pustular psoriasis);
  • chronic form of persistent acrodermatitis (psoriasis of the soles of the feet and palms, palmar-plantar psoriasis);
  • herpetiform psoriatic impetigo.
• Nonpustular psoriasis
  • psoriasis vulgaris or psoriasis vulgaris, simple psoriasis (plaque, stable psoriasis in chronic form);
  • psoriatic erythroderma (erythrodermic psoriasis).

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

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

Psoriasis: symptoms

The first symptoms of psoriasis are a rash of the miliary type of papule, which is characterized by a gradual increase along the periphery, while at the same time turning into numular and lenticular papules and merging with each other, causing plaques of various sizes. The development of psoriasis within the skin defines three main stages for it.

The first phase

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

Second phase

The second phase defines a stationary period in which new elements do not appear, but existing elements in the form of plaques and papules do not change size. In general, the appearance of papules can end at any stage, so the stationary period can be followed by the simultaneous appearance of miliary papules, lenticular and numular papules. Let's explain which are the three types of papules listed. Thus, numular papules are elements of a rounded skin rash with a diameter within 15-20 mm (that is why these papules are also called coins). Lenticular papules are, in turn, elements of a rash, flat or convex, oval or round, lens-like. And, finally, miliary papules, which have a conical shape of the elements and are therefore similar to hemp seed. Basically, these papules are small in size, the predominant area is near the hair follicles.

The third phase

This phase is reversed (or regressive). Its main characteristic is that the rash gradually disappears, and a whitish border of the pseudosclerotic type is formed around the foci themselves (it is defined as Voronov's edge). During this period, some patients may experience mild itching. As for any subjective sensations, they are mostly slightly expressed, or even completely absent.

The appearance of rashes can be noticed within any area of the skin, however, they are predominantly localized in the area of the folds of the limbs, especially in the elbows and knees, in the sacrum, scalp (here the area along the edge of hair growth stands out, defined as"psoriatic crown"). Psoriasis on the head, whose symptoms, although determined by the severity of their own manifestations, do not lead to changes in hair structure, nor to their loss.

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

Irritated psoriasis

It develops against the background of active exposure of the skin with pre-existing progressive psoriasis of certain irritants, especially sunlight or specific ointments, as well as other types of irritants that affect plaques. These plaques, in turn, become more convex in shape, the color changes to cherry red, a hyperthermal band is formed in the surrounding area, due to which the sharp borders become slightly blurred. This belt, after the plaque has cleared, takes on a wrinkled appearance.

Observed psoriasis

This form of the disease manifests itself in the form of mild infiltration (in the general definition, infiltration is the impregnation of tissue by one or another substance) from the elements of the rash. They, in turn, look like spots (not papules). Stiff psoriasis usually develops acutely and is characterized by a resemblance to toxidermia. The definition of the correspondence of the course of the disease with its characteristic psoriatic triad is used as the main method in the differentiation of the disease.

Old psoriasis

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

Seborrheic psoriasis

This form of psoriasis, as its name suggests, develops in patients with seborrhea that is already relevant to them. The disease manifests itself from the scalp, in the area behind the ear shells, on the chest, in the area of the nasolabial folds, within the subscapularis and scapular parts of the back. The resulting psoriatic scabs are subject to intense saturation with sebum, due to which they stick and remain inside the plaque surfaces, which, in this way, allows the disease to simulate the picture characteristic of seborrheic eczema.

Palmar-plantar psoriasis

The disease can manifest either in the form of ordinary psoriatic plaques and papules, or in the form of hyperkeratotic formations that simulate blisters and blisters. In some cases, psoriasis on the hands, whose symptoms in this case are recorded on the palms (or feet - by definition, on the soles) is continuous, which manifests itself in the form of increased thickening or keratinization. . The boundaries of this type of lesion are characterized by clarity, in rare cases this form of psoriasis is limited to the appearance of large ring peeling.

Exudative psoriasis

This form of psoriasis is characterized by excessive strength of exudates during the inflammatory reaction, it occurs in the progressive period of psoriasis. By penetrating to the surface of the papule, the exudate ensures the saturation of the accumulation of scales, thus forming from them formations that look like crusts. These elements are secondary, we define them as scales-crusts, the color of these elements is yellowish. After their removal, a surface that is slightly bleeding and crying is exposed. Flaky crusts, when dried and folded, often form a massive type of conglomerate, resembling an oyster shell (this is already defined as rupioid psoriasis).

Guttate psoriasis

Guttate psoriasis, whose symptoms appear suddenly, is characterized by the formation of multiple spots within the skin. The disease is mainly diagnosed in patients aged 8 to 16 years. Often, streptococcal infection acts as a precursor to tear-shaped psoriasis.

Nail psoriasis

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

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

Psoriatic arthritis

Psoriatic arthritis, whose symptoms are manifested due to infiltration, which is relevant for periarticular tissues with simultaneous damage to the joints, mainly affects the interphalangeal joints. Meanwhile, the possibility of including large joints in the pathological process is not excluded; the joints and articulations of the sacroiliac spine are extremely rarely compromised in this regard.

It is important to note that psoriatic arthritis, unlike other types of arthritis (which by general definition refers to inflammation of the joints), occurs on the background of psoriatic rash that already exists in the patient, often in combination with nail damage. . In addition, an important point can be singled out that the onset of this type of arthritis is combined with the worsening of psoriasis within the skin, which in most cases takes on an exudative character.

Irrational treatment of the disease in the period of its progression is often accompanied by the appearance of a non-specific reaction of the body. It is toxic-allergic in nature and consists of redness in areas not affected by psoriatic plaques, this redness, when combined, affects the skin completely. This process is combined with fever (in the range of no more than 39 degrees), as well as enlarged lymph nodes, a feeling of tight skin, tingling and itching. In frequent cases, there is abundant peeling, thickening and peeling of nail plates, hair loss. This picture already indicates the importance of psoriatic erythroderma. Erythroderma ends with the restoration of the traditional version of the course of psoriasis.

In general, recurrence of the disease occurs in the autumn-winter period, as well as in the spring-summer period, which is an important factor to consider, including when prescribing the necessary treatment.

Treatment of psoriasis

Before prescribing treatment, a thorough examination of the patient is performed, and in order to determine specific measures, they are based on the stage of the disease, its clinical diversity, general condition of the patient, the presence of comorbidities, compliance with seasonal manifestations, etc. . the fastest, and at the same time, favorable treatment result is achieved in uncomplicated forms of psoriasis with a short course, as well as with limited manifestations. In general, the treatment of psoriasis is quite a laborious process and in most cases it is not possible to achieve a complete cure - the disease simply recedes (or begins a period of its existence without symptoms), which, however, is also a positive result.

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

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

The course of psoriasis has a beneficial effect on its treatment in sanitary conditions. Taking into account the special sensitivity 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 treatment of psoriasis with drugs, it is based on the use of several methods. First of all, these are external means (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 are the most commonly used:

• Salicylic ointment. With its help, the softening of the formed scales is ensured, which in turn provides the possibility of their early elimination with better absorption of other types 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 fat with a significant nature of inflammation (that is, the more pronounced the inflammation in the nature of its manifestation, the less fat is used for it). Salicylic acid, which acts as a base for the drug, is also found in a number of other ointments used to treat psoriasis.
• Sulfur tar grease (5 or 10%). The use of this ointment reduces inflammatory processes that are relevant to the skin. Contraindication for use is exudative psoriasis (ie psoriasis, accompanied by weeping crusts and scales). You cannot apply this ointment on the skin of the face. Tar shampoos are used to treat scalp psoriasis.
• Naphthalene ointment. It is used to treat the regressive and stationary phases of the disease. Exacerbation or progression of psoriasis determines the inadmissibility of using this drug. With the help of this ointment, intense itching and inflammation are reduced. 5% or 10% fat is used.
• Glucocorticosteroid drugs. Their use ensures a reduction in the intensity of inflammation. They are used only in short courses, with the obligatory supervision of a specialist.
• Fats that contain vitamin D. Such fats have anti-inflammatory effects, while improving the course of the disease.

As for systemic treatment, it is selected strictly individually and only by a doctor. As already mentioned, this means the use of various tablets, injections, etc.

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

In general, the treatment of psoriasis can mean many different schemes applied in practice, but none of these schemes is generally accepted due to differences in their course and specificity, so the effectiveness of any scheme cannot be determined equally for all patients. Let us repeat that the treatment of the disease is carried out on a strictly individual basis under the constant supervision of a physician.

If symptoms suggestive of psoriasis occur, a dermatologist and infectologist should be consulted.