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Psoriasis

what does psoriasis look like on the skin

A pathological condition characterized by scaly and nodular changes on the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of diseases.

Psoriasis is a chronic disease of the skin and nails in which a rash of pink nodules and silvery scales appears on the skin. Usually the nodules merge into large plaques, around which the skin is quickly covered with scales. With prolonged development of the disease, joint damage is possible, accompanied by reduced mobility and constant pain. Different forms of psoriasis differ in the degree of skin damage: the patient may have only subtle spots on the scalp or large deposits on different parts of the body. The likelihood of developing psoriasis complications also depends on many factors. This disease is especially dangerous for pregnant women, because the pustular form of the disease can cause miscarriage.

About the disease

Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually appear between the ages of 18 and 35. Psoriasis often occurs against the background of cardiovascular disorders, Crohn's disease and depression. Approximately 30% of patients develop joint damage (arthritis). It is impossible to eliminate the root cause of psoriasis, however, symptomatic therapy can significantly alleviate the course of the disease.

Types of psoriasis

Depending on the predominant symptoms, several types of psoriasis are distinguished:

  • plaque: characterized by the appearance of classic plaques covered with silvery scales; preferential location: elbows, knees, torso, scalp;
  • in the form of a teardrop: the main manifestation is nodules, orange-pink nodules with a size of 1 to 10 mm;
  • nail psoriasis: the nail plates are predominantly affected;
  • psoriasis of large folds: the rash appears in the armpits, in the folds of the neck, on the genitals and other places with excessive friction; this form is more common in obese people;
  • head psoriasis: the scalp is affected;
  • arthropathic psoriasis (psoriatic arthritis): joints are affected;
  • pustular psoriasis: multiple small vesicles with pus appear on the patient's skin;
  • psoriatic erythroderma: in addition to the rash, there is also pronounced redness of the skin in the area of the rash.

Symptoms of psoriasis

Most often, plaques appear in the forearm, lower leg, navel and scalp. The pustular form of psoriasis is characterized by the formation of purulent blisters on the skin. In certain periods, many patients experience a change in the color and structure of the nails. Damage to the scales on the skin leads to the appearance of accurate bleeding. Patients also complain of itchy skin. Skin changes periodically disappear and reappear.

Other symptoms and signs:

  • the appearance of red spots in the area of skin folds;
  • profuse rash occurs after infectious diseases and stress;
  • slight increase in body temperature;
  • the appearance of new skin rashes in the winter months;
  • joint pain;
  • impaired mobility in the area of the affected joint;
  • dryness and hypersensitivity of the skin.

Plaque resorption usually starts from the central part, which is why the psoriatic elements take on a ring shape or a wreath shape. Temporary depigmentation (pseudo leucoderma) remains in places where the rash has resolved. In periods of incomplete remissions, individual "on-call" plaques may remain in certain areas of the skin (more often in the area of the elbow and knee joints).

The most severe types of psoriasis are psoriatic erythroderma and arthropathic psoriasis.

In psoriatic erythroderma, the entire (or almost all) skin is involved in the pathological process. The skin becomes tight, rough, infiltrated, red in color, with abundant large- and small-lamellar peeling on the surface. Peripheral lymph nodes increase, subfebrile temperature appears, the general condition of the patient is disturbed, changes are observed in the blood (leukocytosis, elevated ESR), urine (proteinuria). The development of erythroderma is promoted by irrational, irritating therapy in the progressive stage of psoriasis.

Arthropathic psoriasis is characterized by lesions mostly of the small joints of the hands and feet, less often of the wrists, ankles, intervertebral joints, etc. , accompanied by severe pain and swelling of the joints, limitation of their mobility and deformities. X-ray reveals lysis of the distal phalanges of the fingers and changes in the joints, similar to rheumatoid arthritis. The Waaler-Rose test and the latex test are usually negative. In the blood, leukocytosis, elevated ESR, hypergammaglobulinemia. Joint involvement may be associated with skin lesions or be isolated over a number of years.

In all these forms of psoriasis, it is possible to damage the nails in the form of perforated nail plates ("thimble phenomenon"), their clouding or thickening to onychogryphosis. The course of the disease is chronic and wavy. The seasonality of the process is usually pronounced - worsening in winter with a significant improvement in summer (winter type), less often - vice versa (summer type).

Causes of psoriasis

The exact mechanisms of psoriasis are still not understood. It is thought to be an autoimmune disease in which the body's defense system mistakenly attacks healthy tissue. T cells and neutrophils needed to fight pathogens can begin to attack skin cells and joint structures. In this case, there are characteristic changes on the skin, including the formation of bubbles with inflammatory fluid. The expansion of blood vessels in the area of inflammation is accompanied by reddening of the skin. Autoimmune disease can be caused by hereditary factors.

Additional risk factors:

  • skin infections. First of all, these are bacterial infections caused by streptococcus;
  • skin damage from cuts and burns;
  • prolonged stress and psychotraumatic factors;
  • alcoholism and smoking;
  • lack of vitamin D in the body;
  • taking certain medications, including lithium and beta-blockers;
  • unfavorable family history. The discovery of psoriasis in a close relative of the patient indicates the possibility of a genetic predisposition to this disease;
  • acquired or congenital impairment of immunity. It could be HIV infection, AIDS or some other condition.

Despite the discovery of the supposed immunopathological causes of psoriasis, the disease is still poorly understood. There are a large number of diseases and lifestyle characteristics that cause the manifestation of hidden factors predisposing to this disease.

Diagnosis of psoriasis

If changes occur on the skin, it is necessary to consult a dermatologist. The doctor of our clinic first performs a general examination of the skin in order to assess the nature of the rash. Soft scraping allows you to reveal scaly papules and a thin film under the nodules. Beneath the film is a moist surface of the skin, prone to small bleeding. At the same time, there are atypical signs of psoriasis that resemble other diseases, so the doctor must conduct instrumental and laboratory diagnostics.

  • Blood analysis. A dermatologist prescribes a venous blood analysis to rule out other diseases and detect signs of psoriasis. In the treatment room, the nurse treats the skin of the patient's cubital fossa with an antiseptic, puts on a tourniquet and takes blood with a syringe. In our laboratory, specialists first of all rule out the presence of rheumatoid factors. An increase in the sedimentation rate of erythrocytes is often found in pustular psoriasis. Elevated levels of uric acid are detected;
  • Examination of pustule fluid. The doctor collects the fluid in a sterile container and sends the material to the laboratory. Microbiological examination does not reveal a bacterial culture, but an increase in the number of neutrophils characteristic of psoriasis was found;
  • Skin biopsy. A dermatologist prescribes this study in order to establish an accurate diagnosis for atypical rashes. During the procedure, the doctor treats the skin with an antiseptic, anesthetizes and removes a small area of skin with a scalpel. The tissue material is studied in the laboratory of our clinic with the help of a microscope. The results make it possible to clarify the cellular composition of the nodule;
  • X-ray of the affected joint. The doctor prescribes this study to determine the type of arthritis. Also, in case of severe complications of arthropathic psoriasis, X-ray diagnostics of bones is required;
  • Scraping the skin to rule out fungus. The doctor cleans the surface of the skin and with a special spatula collects several scales for microbiological examination. This analysis is first of all necessary if the rash appears only in the area of the feet and nails.

If necessary, a consultation with a rheumatologist is performed.

Expert opinion

Psoriasis is a disease with numerous manifestations. It can be either almost invisible or cause serious health problems. The most dangerous complications of psoriasis are joint damage, which can cause disability in the patient. Also, the disease can lead to autoimmune disorders, in particular, Crohn's disease and ulcerative colitis, metabolic pathology, erectile dysfunction in men. Women suffering from psoriasis may experience infertility and miscarriage. In order to prevent these complications, it is necessary to consult a doctor immediately after the appearance of suspicious signs, and with an already diagnosed diagnosis, carefully follow all the recommendations of the specialist.

Treatment of psoriasis

The main goal of psoriasis treatment is symptomatic therapy. Patients need medications that reduce inflammation and prevent skin rashes. In addition to drug therapy, the dermatologist of our clinic necessarily prescribes a special diet for the patient. Normalizing lifestyle and eliminating stress factors can reduce the severity of psoriasis symptoms.

Depending on the situation, the dermatologist can use different methods to treat the disease.

  • Administration of corticosteroids. A dermatologist prescribes ointments containing these drugs. Beneficial effects of corticosteroids include reducing tissue inflammation and eliminating itching;
  • Vitamin D supplements. Synthetic forms of this vitamin slow down the growth of skin cells, thus preventing the formation of scales and knots;
  • Therapy with drugs containing derivatives of vitamin A. The dermatologist prescribes ointments based on retinoids to reduce inflammation and itching. These drugs increase the sensitivity of the skin to light, so sunscreens must be used;
  • Use of calcineurin inhibitors. These are immunosuppressants that reduce inflammation. A dermatologist prescribes topical agents such as tacrolimus. Such drugs are used in a short course to prevent the development of side effects and complications;
  • Skin treatment with salicylic acid to remove dead cells. A dermatologist prescribes this drug together with corticosteroids for complex skin treatment;
  • Using a moisturizing cream to get rid of dry skin and itching;
  • Irradiation of the skin with ultraviolet light. This safe physiotherapeutic method of treatment improves the functioning of local immunity. The doctor selects the individual dose of radiation for the patient;
  • Phototherapy. This method involves irradiating the skin using special devices. Phototherapy combines the technologies of laser therapy and photochemotherapy;
  • Joint puncture in severe psoriasis. The doctor treats the skin at the injection site with an antiseptic, anesthetizes the tissues and inserts a needle. With the help of a syringe, drugs are injected into the joint cavity to reduce the inflammatory process.

The dermatologist controls all stages of the treatment in order to achieve the best result and prevent complications. Corticosteroids, retinoids and calcineurin inhibitors are used strictly under the supervision of a specialist.

Prevention of psoriasis

The recommendations of our clinic's dermatologist will help reduce the severity of skin rashes and ease the course of the disease.

Prevention of psoriasis exacerbations:

  • relieve anxiety and stress by improving sleep, avoiding coffee and taking prescription sedatives;
  • exclusion from the diet of food containing allergens;
  • timely treatment of infectious skin diseases.

Rehabilitation

Psoriasis is a chronic disease that cannot be cured. Rehabilitation measures are aimed at preventing relapse. Depending on the form of the disease, physiotherapy, spa treatment, mud therapy, therapeutic baths and other procedures may be prescribed.

Questions and answers

Is it possible to treat psoriasis with folk remedies?

There are no methods with proven effectiveness. It is important not to trust dubious types of treatment, but to follow the doctor's recommendations.

Does stress affect the course of psoriasis?

Yes, stressful situations can worsen the course of the disease.