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 pink-red rashes - papules, which can merge into larger plaques. These papules rise above the surface of the skin. They are covered with silvery scales that peel easily when peeled.
Often the disease is combined with impotence, accelerated ejaculation and Reiter's syndrome. Extensive psoriasis can lead to psoriatic arthritis.
Risk factors
Causes of psoriasishave 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;
- immunodeficiency states;
- disorders of lipid and protein metabolism;
- skin and joint injuries.
Is psoriasis transmitted?
Psoriasis is not contagious. Many researchers pay attention to the familial nature of psoriasis and recognize its genetic nature. Moreover, it is not the disease itself that is inherited, but the predisposition to it.
If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous to your health!
Symptoms of psoriasis
The first symptoms of psoriasis:skin rash in the form of light pink plaques with a scaly surface. Plaques are single, rising above the level of healthy skin, located on the elbows and in the popliteal depressions.
More often, psoriatic plaques appear on the skin of the knees, elbows, chest, abdomen, back, and scalp, but as the disease progresses, they can appear in any other, unexpected place on the skin.
Initially, the papules are small - 3-5 mm, the color is light pink. Gradually increasing in size, they are covered with silvery scales and merge into larger formations called plaques.
Fresh elements of papules are usually light in color, to red, the "old" are more faded. In the initial stage of psoriasis, the edges of the papules do not peel. They represent a hyperemic boundary -Corolla growth. . .
The trademark 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 are easily separated when scraped;
- symptom of psoriatic film- exuded surface, made of a prickly layer, which opens after peeling of the lower layers of the stratum corneum;
- the phenomenon of blood dew- exposure of surface capillaries in the form of small blood stains after separation of the psoriatic film.
Signs of different types of psoriasis
Clinical types of psoriasis:
- Observed psoriasis- represented by pale pink slightly infiltrated spots. It resembles toxidermia.
- Irritated psoriasis- occurs due to exposure of the skin to 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 band in the form of redness is formed on the edges.
- Seborrheic psoriasis- often develops in patients with seborrhea. The clinical picture is very similar to seborrheic eczema.
- Exudative psoriasis- occurs quite often. It is caused by excessive secretion of inflammatory fluid - exudate. It impregnates the clusters of scales, turning them into shell-crusts.
- Psoriasis of the palms and soles- represent either common plaques and papules, or hyperkeratotic formations, similar to blisters and blisters.
- Follicular psoriasis- a rare form of the disease. The rash consists of white miliary nodules with a funnel-shaped depression in the middle.
- Mucosal psoriasis- a rare form of the disease. It occurs on the mucous membranes of the mouth and bladder. It manifests itself in the form of a gray-white area with a red border.
Frequency of psoriatic manifestations
Cyclic exacerbations are characteristic of psoriasis. They most commonly 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, accelerates.
Psoriasis, a type of dermatosis, is a chronic inflammatory disease. It continues with the participation of microbial pathogens that can bind to the skin surface.
Everything that happens in the skin under the influence of pathogens is a classic inflammatory reaction according to the principle of RTCDF:
- Rubor - redness;
- Tumor - tuberculosis, edema;
- Calor - fever, fever;
- Dolor - pain;
- Functia laesa - dysfunction.
Redness and thickening of the skin at the sites of the lesion, itching, increased keratinization accompanied by the formation of scales - all these are manifestations of the inflammatory process, the body's protective reactions aimed at combating the microbial pathogen. Without timely outside help, the body is often defeated.
Some scientists adhere to the theory of genetic predisposition to disrupt the process of cell division. With such a violation there is an increased death and keratinization of cells, followed by their growth and the appearance of a large number of incompletely keratinized epithelial cells. But this theory does not in the least contradict the above microbial.
Classification and stages of development of psoriasis
There is no generally accepted classification for psoriasis.
TraditionallyThere are four types of disease:
- vulgar psoriasis - seborrheic, follicular, warty, exudative, bullous, psoriasis of the palms and soles, psoriasis of the mucous membranes;
- pustular psoriasis;
- psoriatic erythroderma;
- psoriatic arthritis.
According to ICD-10, there are:
- L40. 0 Psoriasis vulgaris (psoriasis in the form of coins and plaques);
- L40. 1 Generalized pustular psoriasis (impetigo herpetiformis, Tsumbusch's disease);
- L40. 2 Persistent acrodermatitis;
- L40. 3 Palmar and plantar pustulosis;
- L40. 4 Tears of psoriasis;
- L40. 5 Arthropathic psoriasis;
- L40. 8 Other psoriasis;
- L40. 9 Psoriasis, unspecified
Complications of psoriasis
Without timely and competent treatment, psoriasis begins to negatively 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 because it often causes disability.
This complication is most often faced by doctors. It occurs as a result of inflammatory changes in the joints.
The joints of the hands, wrists, feet and knees are most affected. Over time, the disease can spread to the hip, shoulder and spine joints. As it progresses, 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 in the manner of ordinary arthritis: first there is pain, then swelling, stiffness and limited mobility. A characteristic symptom of this complication is the sausage finger. It occurs due to damage to all interphalangeal surfaces.
Other complications of psoriasis
Slightly less oftenpsoriatic erythroderma. . .This condition occurs when the skin is completely affected. Patients are concerned about itching and burning, abundant peeling of dead tissue, a strong skin reaction to a change in temperature.
The next most common 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 buckwheat grains. Pustules appear in different places. They rise above the surface of the skin, are characterized by rapid growth and a tendency to coalesce. Existing symptoms are accompanied by high fever and signs of severe intoxication.
Lesions of internal organswith psoriasis are now extremely rare. As a rule, they are subject to people who lead an antisocial lifestyle. The genitourinary system is more often affected: kidneys, bladder mucosa and 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 damage to the nervous system, patients complain of a feeling of crawling, increased irritability or depression, constant fatigue, drowsiness and apathy.
Diagnosis of psoriasis
When to see a doctor
It is necessary to consult a doctor at the first symptoms of psoriasis: the appearance on the skin of light pink plaques with a scaly surface.
Preparing to see a doctor
Three days before visiting the doctor, you should stop applying medicated ointments to the skin. No other special training is required.
Psoriasis is such a recognizable disease that it will not be difficult to diagnose based on external signs. Patients can often be diagnosed, as they say, "out of the box. "If necessary, the doctor scrapes the surface of the skin to detect the Auspitz triad.
OV Terletskiy, Ph. D. , along with co-authors, proposed a diagnostic scheme developed based on data from the American Rheumatological Association. Includes the following reviews:
- 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 and chlamydial antigen;
- Wright and Heddelson reactions;
- coagulogram - assessment of blood clotting;
- blood test for borreliosis and toxoplasmosis (as indicated);
- blood test for HLA.
However, there are many diseases under the guise of psoriasis. In this regard, it becomes necessary to implementdifferential diagnosis, especially between papular syphilis, Reiter's syndrome, neurodermatitis, rosacea lichen, systemic lupus erythematosus, and seborrheic eczema. To do this, use:
- biopsy - tearing off a piece of skin with subsequent histological examination;
- laboratory diagnosis - often used to distinguish psoriasis from papular syphilis;
- blood tests for other hidden infections for a better choice of antibiotics.
Instrumental diagnostic methodsit is mainly used for complicated forms of psoriasis associated with damage to 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
Despite the fact that psoriasis is a persistent recurrent disease, it can be completely eliminated provided that you consult a dermatologist in time, who can determine the true causes of psoriasis. In the last decade, many drugs of systemic and local action have appeared, aimed at eliminating the causes and suppressing the mechanism of disease development. Drugs that interact with chemical signals (cytokines) have proven to be very good. They remove the increased proliferation of skin creatinocytes.
Phototherapy
In 1994, the team of the Department of Dermatovenerology MAPO SPb introduced a method of treating psoriasis usingUFO blood- photomodification of blood by ultraviolet light.
The ability of sunlight to have a beneficial effect on the skin in many 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 kind of fabric. This assumption was confirmed by the first session of exposure to blood UV rays, which was held in Germany in 1924.
The therapeutic effect of ultraviolet rays on the blood is associated with profound structural changes at the molecular-atomic level, which affect the immunocompetent organs - liver, spleen, bone marrow and lymphoid tissue. The organs consider these changes as an alarm signal and therefore produce tens of times more immune complexes. In this case, ultraviolet light is a type of "whip" that forces the body to dramatically increase its defenses in the fight against disease.
It should also be noted the PT effect -without the basis of ultraviolet therapy. . . This method of treatment is important, given the chronic nature of psoriasis, associated with a number of internal organ complications caused by various microbial pathogens. The longer the microbes are in the body, the wider their habitat becomes. These microscopic creatures affect more and more anatomical areas through the flow of blood and lymph. Once in the tissues, they try to penetrate as deep as possible into the intercellular spaces. There they form microcolonies, protected by the remains of dead, destroyed cells and a leukocyte axis. Therefore, microorganisms may be out of the 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 to destroy microbial "shelters". They create favorable conditions for the penetration of antibiotics and other drugs that affect the cause of psoriasis.
Skin application of ultraviolet radiation is also relevant. The most well-known method of treatment according to this principle isPUVA therapy. . . Although it is less effective than ultraviolet radiation of the blood. The therapeutic effect does not last long, relapse can occur two weeks after the end of treatment.
Drug treatment
Of the drugs, the following worked well:
- vitamin A derivatives that reduce the rate of keratinocyte maturation and normalize cell differentiation;
- immunosuppressants that reduce T-lymphocyte activity, which contributes to increased epidermal cell division;
- drugs to treat malignant tumors that inhibit the reproduction and growth of atypical skin cells.
Which 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 medications and ultraviolet treatment, a special shampoo can also be used.
How to treat psoriasis on the elbows and hands
Psoriasis on the elbows and hands is treated by the same methods as on the rest of the body. The peculiarity of the course of psoriasis in this area is that the skin of the hands is exposed to physical, mechanical and chemical influences, which is considered an aggravating factor in the course of the disease.
Is the treatment of monoclonal antibodies for psoriasis effective?
Monoclonal therapy with antibodies for psoriasis is very effective. Monoclonal antibody drugs are laboratory-produced antibodies similar to those produced by human immune cells. Monoclonal antibodies selectively target targets responsible for disease development.
How to recognize and treat psoriasis in children
In children, psoriasis often progresses more violently and is disguised as other diseases (eczema, erysipelas, herpes), which complicates the diagnosis. The methods of therapy are similar to those for adults: phototherapy, medications and topical treatment.
Which baths should be taken with psoriasis
Aloe baths can help reduce inflammation and itching.
How to treat psoriasis according to Pegan
Pegano methods for treating psoriasis include bowel cleansing, diet and herbal teas. The effectiveness of this method has not been proven in clinical studies.
The role of diet in treatment
Diet greatly affects the course of psoriasis. Alcohol, salty, spicy, pickled, nuts, citrus fruits, honey, chocolate and smoked meat should be excluded during treatment.
Which sanatoriums show rest for the treatment of psoriasis
For psoriasis it is better that the spa treatment takes place at sea in a region with a warm, dry climate and lots of sunny days. The most suitable for this are the resorts of Crimea.
Folk ways
Some folk remedies can help reduce itching and flaking of the skin in patients with mild to moderate psoriasis. These methods include:
- cream with aloe extract;
- fish oil applied to the skin in a bandage for six hours a day for four weeks;
- cream with Oregon grape extract.
Forecast. Prevention
Psoriasis is not a sentence. If the patient has in time sought qualified help from a specialist who can determine the true causes of the disease and prescribe effective treatment, then the disease will be defeated.
A simple form of psoriasis is manifested only by skin damage. Therefore, the patient does not need special working conditions. The exception is working in a chemical factory: in this case, staying in the workplace will have to be ruled out.
It is worth remembering that psoriasis can cause complications. Psoriatic arthritis usually develops. Its severe forms can limit the performance of duties at work and lead to complete disability in the future.
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 revise his lifestyle, eliminate bad habits, pay attention to the treatment of chronic diseases of other organs, adjust the diet, include outdoor walks and sports in the daily routine.
Do they take psoriasis in the military?
Severe forms of psoriasis are a sufficient basis for declaring a conscript incapable of military service, mild forms - limited abilities.