According to the WHO, currently 2-4% of the world's population suffers from psoriasis. This disease affects patients of all ages, however, most often young people (15-25 years). Unfortunately, current medicine is not able to completely cure psoriasis, but timely professional treatment significantly improves the quality of life. So in case of detection of the first symptoms, it is better to consult a doctor immediately.
Psoriasis- It is a dermatosis, which manifests itself in the form of scaly papules on the skin. Its peculiarity is that in addition to the skin, it is able to affect the joints and nail plates. In the pathogenesis of psoriasis, hereditary factors are clearly identified, and other irritants are only secondary causes of its occurrence.
During an exacerbation of the disease, the natural processes of formation are disturbed - keratinocytes (cells of which human skin mainly consists). There are also pronounced biochemical changes in the skin. In addition, recently doctors were able to establish that during the acute phase of the disease, the functioning of the nervous system also differs from the norm. In general, the main reason for the appearance of psoriasis is the presence of dysfunctions in the functioning of the immune system.
Prevalence of psoriasis
Psoriasis is common. At present, the incidence statistics are approximately as follows:
- China - 0, 3%;
- United States - 1%;
- Denmark - 1-2, 3%;
- Northern Europe - 3%;
- Germany - 1-1, 3%.
It is curious that the indigenous population of South America is not affected by the disease. At least no such case has been reported so far. If you look at the big picture, the proportion of psoriasis is around 6-8% of all skin diseases.
As already noted, psoriasis manifests itself at any age, but most often young people (up to 25 years) still suffer, and in men and women it occurs with the same frequency.
Epidemiological situation
Based on the causes of occurrence, psoriasis is a non-infectious disease with a pronounced genetic predisposition. The people most at risk of getting sick are people whose relatives also suffer from this disease (in this case, only the closest relatives are concerned). European researchers have established with certainty that if one of the parents is sick, then they have a 14 to 25% chance of passing it on to their child. If both parents are sick, this probability is already 41 to 60%.
Depending on the type of disease development, psoriasis can be divided into two groups:
- early;
- late.
This is proof that there are two main types of psoriasis (like diabetes mellitus). The first occurs in humans at an early age (on average 16-22 years), is strictly hereditary in nature and is directly related to the HLA phenotype (HLA-Cw6). The course of the disease is often severe and over time the disease only progresses.
The causes of type II psoriasis are rather random, so this disease is sporadic. It occurs most often in older people (around 60 years old). Usually it takes place quite easily, however, in some cases it can be made worse by damage to the joints and nails.
Factors provoking the onset of psoriasis
Although psoriasis tends to be inherited, it is generally multifactorial. Anything can trigger this fatal dysfunction of the immune system. Thus, the provoking factors are divided into external and internal (or, in scientific terms, exogenous and endogenous).
Exogenous factors
They, in turn, are divided into physical and chemical. The former include the usual mechanical damage to the skin, such as household injuries, thermal burns, abrasions, scars, tattoos, scratches, insect and pet bites. Cases of psoriasis at the injection sites have also been recorded. X-ray and ultraviolet irradiation also play an important role. In about 5% of cases, the disease occurs in summer, and 40% of them are due to sunburn.
Chemical factors are expressed by the toxic effect of harmful chemicals or other irritants on the skin. In addition, psoriasis is also caused by other skin diseases, such as:
- dermatoses;
- fungal infections;
- contagious impetigo;
- acne;
- dyshidrosis;
- lichen;
- shingles;
- gangrenous pyoderma;
- allergic dermatitis of various nature.
There are known cases of the disease after performing basic diagnostic skin tests to find out the body's reaction to cosmetics, hygiene products, formalin, chromium, nickel and other chemicals.
Endogenous factors
The internal causes of psoriasis can be infectious diseases. The latest research in this area suggests that strep infections and HIV are the most likely to be to blame. In addition, often the symptoms do not appear during the disease itself, but even after the usual vaccination. In these cases, psoriasis is often difficult to treat.
In order to induce remission, lithium preparations, beta blockers, nonsteroidal anti-inflammatory drugs and ACE inhibitors are used. Corticosteroids are contraindicated in this case.
Pregnancy and childbirth
Significant changes in hormonal levels caused by pregnancy can also become a provoking factor. A similar pattern is also observed during puberty. It is also curious that women who already suffer from psoriasis can see an improvement in their condition during pregnancy (40%). The deterioration is much less frequent (only in 14% of cases). Certainly, after childbirth in most patients, the condition worsens again (in 54% of cases)
Diet and nutrition
These factors often do not have a noticeable effect on the course of the disease. It is only known with certainty that the abuse of alcohol and cigarettes significantly increases the risk of contracting psoriasis and worsens its course.
Hypocalcemia and hypokalaemia
These factors can cause the development of generalized pustular psoriasis. The chances of a favorable outcome in this case are very low.
Pustular psoriasis.
Psychogenic factors
Their role today is considered quite controversial. Some researchers claim that the presence of traumatic psychogenic factors causes psoriasis in 60% of cases. However, it is only known for sure that they can only worsen the course of the disease and reduce the effectiveness of treatment.
Classification
Currently, several distinct types of psoriasis have been identified. They differ markedly in the clinical picture and the degree of effect on the body. Therefore, to get an idea of what is at stake, it is better to look at the World Wide Web and carefully study photos of psoriasis of various etiologies, as well as familiarize yourself with the description.
Vulgar psoriasis
Common or common psoriasis occurs in most cases. This disease manifests as a profuse rash of small bright red papules (from a matchstick to a pea). After emergence, they develop rapidly, and silvery-white scales appear on their surface. In the future, the papules turn into plaques, which merge into one large lesion. Very often they have clear boundaries that separate them from healthy skin.
When you try to comb or remove the papule, the peeling increases first. This phenomenon is known as the "stearin stain symptom" and once all the scales have been removed, a shiny and smooth surface, the "terminal film symptom", can be found. If you keep scratching, the capillaries are injured and droplets of blood are released. This symptom is known as "blood dew".
The development of psoriasis can be divided into three main periods:
- progressive (acute);
- Stationary;
- resolution period.
The success of treatment here depends first of all on how correctly the methods of treatment are selected, since, depending on the period, their effectiveness varies significantly.
Period of progression. A feature of this stage is the profuse appearance of a specific rash. In the exacerbation phase, some parts of the patient's body are covered with small papules, which actively peel off. The peel in this case is strictly localized and does not affect the healthy skin. Acute psoriasis is easy to identify by the characteristic red or pinkish border that borders the papule.
The most characteristic symptoms at this stage are itching and the presence of the so-called Koebner symptom. The latter is expressed by the fact that psoriatic papules appear at the site of any skin lesion (minor burns, scratches, injections, scratching, etc. ). This phenomenon occurs on average two weeks after the injury itself and occurs in 38-76% of all patients.
It is also extremely curious that (much less often) the opposite effect is also observed. Scientists believe that it is caused by the presence in the blood serum of some patients of special factors that inhibit Koebner syndrome.
Stationary period. On average, 2-3 months after the appearance of the first rashes, the formation of new papules stops. The growth of plaques also stops. At this stage, their entire surface is already covered with scales. This period can last for months or even years. However, the latter is relatively rare.
Time to resolution. This period is also called the regressive period, since a gradual decrease in plaque is observed during it. At first they stop peeling, then they gradually smooth out until they disappear completely. If the disease is mild, this phenomenon occurs spontaneously. Treatment only accelerates its onset. Often the place where the plaques were located stands out against the background of healthy skin areas by depigmentation or, which happens a little less often, by hyperpigmentation. With psoriasis vulgaris, rashes can occur almost anywhere and they are usually located symmetrically (extending surfaces of the elbows and knees). May also appear on the head, sacrum, hands, palms, soles, groin and armpits. In addition, in many cases, the nail plates are also affected (appearance of pitted dimples, loosening, thickening). These symptoms are very similar to those that occur with infection with fungi, so the final diagnosis is made only after receiving a negative reaction to fungal spores in a special laboratory study. Vulgar psoriasis as a whole does not have a general negative effect on the patient's body, and its course is chronic. Periods of exacerbation occur in autumn or winter, while in summer exacerbations, on the contrary, are much less frequent. The main incentive for active treatment is that without proper therapy, psoriatic plaques can cover the body for years, while adequate treatment results in improvement after a few months.
Psoriatic erythroderma
Psoriatic erythroderma is one of the most unpleasant forms of this disease. On average, a similar reaction is observed in about 2% of patients and it occurs both spontaneously and as a result of improperly chosen treatment. Although, of course, if the drugs used irritate the skin or if it is exposed to ultraviolet rays, the risk of psoriatic erythroderma is much higher. Most often, psoriatic erythroderma appears suddenly during the first stage of psoriasis. It can be associated with arthritis and generalized pustular psoriasis, and exposure to factors such as strep infections or hypocalcemia greatly increases the likelihood of such a complication. Abrupt withdrawal of corticosteroids can also make the condition worse. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by diffuse redness of the skin, severe itching and lamellar peeling.
Pustular psoriasis
Also a severe form of psoriasis. It is characterized by the appearance of abscesses, which often remain the only symptom. Much less often they are associated with the classic symptoms of psoriasis vulgaris. Pustular psoriasis is generalized and localized. The second differs only in that the abscesses in this case are concentrated only in the area of the palms or soles of the feet.
Psoriatic arthritis
Currently, psoriatic arthritis is classified as an autoimmune disease in its own right. It is expressed by bone and muscle damage in patients who already have psoriasis or who are at high risk of contracting the disease due to a family history. Very often, psoriatic arthritis is associated with classic psoriasis, as well as psoriatic lesions of the nails. This disease is diagnosed by the appearance of back pain, accompanied by the following conditions:
- the absence of a clearly stated reason for the appearance;
- the patient's age is over 40;
- deep pain without a cause in the lower back or buttock;
- indistinct localization of pain;
- reduction of pain after exercise;
- pain or stiffness is felt early in the morning or at night;
- the presence of pain with an excellent general condition of the musculoskeletal system.
Psoriasis of the nail plates
Very often psoriasis vulgaris is accompanied by damage to the nails. In this case, their pronounced dystrophy is observed, as well as symptoms characteristic of fungal infections. It is a frequent companion of psoriatic arthritis. Considering that around 4% of the world's population suffers from regular psoriasis, 30-50% of them also suffer from nail psoriasis.
Psoriasis treatment
Unfortunately, at the present time, medicine is still not able to cure psoriasis, since this requires a much more in-depth knowledge of the peculiarities of the work of the basic mechanisms of the human immune system. Since this type of research progresses rather slowly and the disease itself does not pose a particular threat to life, symptomatic therapy is currently the priority. Before starting treatment, the patient needs a thorough examination, because each organism contains an individual set of factors that influence the course of the disease. Gender, age, occupation, general health, type of psoriasis - all this should be taken into account when prescribing therapeutic treatment. An important role is also played by establishing the nature of the course of the disease, individual sensitivity to drugs and the current stage of the disease.
General activities
First of all, the doctor should determine the mental and physical condition of the patient, assess the general condition of his body and determine how well he tolerates the disease. The best prerequisites for effective treatment are good rest, a quiet stay, a change to a less intensive mode of work, or short-term hospitalization. Various methods of psychotherapy (rehabilitation in a seaside resort with recourse to cognitive-behavioral therapy, etc. ) have also proved their worth. It is also very important for the patient to know that the healing process is going as it should, because without a rapid effect about 40% of patients lose confidence in the effectiveness of therapy and begin to ignore it. It is important to remember that psoriasis is a chronic disease, therefore, the safety of the treatment should be taken into account. Many drugs are toxic and can build up in the body, turning into a time bomb. An addictive effect is also possible, so it is better to keep the strongest drugs until the appearance of the really dangerous symptoms.
Evolution of the disease and long-term prognosis
The course of psoriasis is often unpredictable. Modern doctors have hardly succeeded in this. Therefore, as before, psoriasis remains an unpleasant and uncontrollable disease. In each case, it takes place completely individually, so any attempt at prognosis regarding the course of the disease, as well as the duration of the phases of exacerbation and remission, is doomed to failure in advance. . Only one thing pleases - despite the difficulty of the treatment, it rarely poses a real threat to the patient's life. As for psoriatic arthritis, this disease is much easier than rheumatoid arthritis, and the decrease in the quality of life of patients, compared to the latter, is very insignificant. Statistics show that with proper treatment, most patients with psoriatic arthritis remain functional and can lead fulfilling lives. If the necessary treatment is absent or the disease becomes more complicated, joint deformities may develop with the further development of serious pathologies. However, such complications are only found in a very small number of patients with psoriasis. Most patients can count on gradual stabilization of the condition and the onset of long-term remissions (more than two years). In very rare cases the disease progresses mainly in the active phase, however, in this case it can be effectively localized. Effective treatment for psoriasis today can be obtained in any major city. And, although, as you know, the final recovery cannot be achieved, the diet, drugs and special procedures will quickly do their job. Plus, you won't need long-term treatment in a hospital. The doctor's task is only to quickly bypass the first two stages of psoriasis and bring the person into remission. After that, the patient can only take care of himself, follow the instructions and forget about the disease for a long time.