Psoriasis is a chronic inflammatory disease of the body, accompanied by a predominant skin lesion with the formation of erythematous spots and plaques having clear boundaries and silvery scales on the surface.
The course of this disease is characterized by periods of exacerbation and remission (decrease in symptomatic manifestations). Unfortunately, medicine has not yet identified the exact and reliable cause of psoriasis, but a hereditary factor has been clearly noted, which, in combination with triggering factors, contributes to the triggering moment for the appearance of this disease. A link between the occurrence of psoriasis and the antigens of the HLA system has been revealed.
Between 1 and 5 percent of the world's population suffers from this very unpleasant condition, and light-skinned people are at greater risk of developing psoriasis than black people.
The disease can manifest itself at any age, but the periods of 20-30 years and 50-60 years are considered critical.
Important!Psoriasis is not contagious to others, but it causes inconvenience to the patient himself, since the rashes that appear during the disease are not only a cosmetic defect, but are also accompanied by unpleasant itching. In addition, the manifestation of psoriatic arthritis is possible, which significantly worsens the patient's quality of life.
Most of the time, rashes are localized on the scalp, on the surface of the elbows and knees, in skin folds and genitals. The nails, buttocks and area around the eyebrows can often be affected. The nature and appearance of the rash depends on the type of psoriasis.
Causes of psoriasis
The nature of the appearance of psoriasis has not yet been revealed by medicine; some doctors speak of autoimmune causes. The second theory that explains the occurrence of the disease is a disruption of the normal process of maturation and division of skin cells. Heredity and stress are also considered to be involved.
Genetic predisposition to psoriasis, allergies and frequent disruption of the skin barrier function (strong friction, chemical exposure, influence of alcohol-containing products) can cause exacerbation of the disease.
To known triggers causingpsoriasis, relate:
- Koebner's phenomenon is the appearance of fresh skin rashes at the site of skin irritation in the acute phase of certain dermatoses;
- Sunburn or other types of burns;
- HIV infection;
- Beta-hemolytic streptococcal infection, which causes guttate psoriasis;
- Use of medications (including beta blockers, lithium, angiotensin converting enzyme inhibitors);
- Severe emotional stress;
- Alcohol consumption;
- Smoking tobacco;
- Obesity;
- Hormonal imbalance, especially in women during menopause and pregnancy;
- Digestive system disorders.
The main cause of the development of the disease is excessive and accelerated growth and division of skin cells, associated with the inflammatory process in the dermis. In other words, skin cells located in the bottom layer of the epidermis begin to grow rapidly and put pressure on the cells above them. This process is accompanied by significant peeling of the skin and is called parakeratosis. Excessive stimulation by the immune system is thought to be the main link in the occurrence of this mechanism.
Symptoms and signs of psoriasis
Rashes associated with psoriasis are asymptomatic or itchy. Most often, they are located on the scalp, the extensor surfaces of the knees and elbows, the sacrum and the buttocks (especially at the level of the gluteal fold) and in the genital region. Fingernails and toenails, skin of the eyebrows, armpits and navel may be affected. Rashes can merge with the lesions and cover large anatomical areas and areas of skin between them. Depending on the type of psoriasis, the rash can have different external manifestations.
As a rule, rashes are localized inconspicuously and are represented by erythematous papules or plaques covered with dense, silvery, shiny scales. The rash appears gradually. Remissions and exacerbations occur spontaneously or after exposure to provoking factors.
5-30% of patients developpsoriatic arthritis, which can cause disability for the patient. This process can lead to joint destruction.
Important!Psoriasis does not threaten the patient's life, but it disrupts the patient's self-image. Besides the fact that the patient's appearance changes, it also takes a long time to treat rashes and maintain cleanliness of clothes and bedding, which significantly reduces the patient's quality of life.
Types of psoriasis
- vulgar(ordinary or chronic plaques) psoriasis, in which the rashes have the appearance of individual plaques covered with silvery scaling. The plaques may coalesce as the disease progresses. Among all subtypes, this type of psoriasis is the most common and accounts for approximately 90%.
- reverse psoriasisaccompanied by rashes that appear at the natural folds and can form cracks.
- guttate psoriasischaracterized by multiple rashes with a diameter of 0. 5 to 1. 5 cm, often formed after streptococcal pharyngitis.
- palmoplantar psoriasismanifests itself as plaques on the palms and soles, which may merge.
- nail psoriasisaffects the nail plates in the form of point indentations and grooves with discoloration and thickening of the nail. Nail changes caused by psoriasis often resemble changes caused by a fungal infection.
- pustular psoriasisaccompanied by the formation of pustules on the palms, soles, or possibly a lesion of one of the fingers. There may also be a generalized form.
- erythrodermic psoriasismanifests itself as a sudden or gradual appearance of redness in patients with psoriatic plaques, when the plaques themselves are mild or absent. Usually appears due to improper treatment of psoriasis vulgaris.
Methods for diagnosing psoriasis
When symptoms of psoriasis appear, the patient should consult a dermatologist. He will perform an external examination of the affected skin areas and collect a complete medical history.
Psoriasis has a general similarity with other dermatological diseases, especially in the early stages of manifestation. It is important to exclude the presence of fungal infections of the hands and nails. The seborrheic type of psoriasis requires a special differential diagnosis to exclude seborrheic eczema, pityriasis rosea and papular syphilis.
In case of active disease and significant damage to areas of the epidermis, visual analysis of scrapings is used. During scratching, the coat intensifies. In place of the removed tartar, a thin smooth film is visible, which breaks off under mechanical action and reveals a surface moistened with blood droplets.
In most cases, diagnosing psoriasis is not difficult: it is enough to simply examine the patient's skin. The doctor must exclude diagnostic errors and determine the presence of other diseases and other pathologies occurring against the background of psoriasis.
In rare cases, diagnosis requires a biopsy. If non-classical clinical signs are present, their necessity should be considered. There is mild, moderate, and severe severity of the disease depending on the area of skin affected. Damage to less than 10% of the skin corresponds to mild severity. There are more sophisticated methods for assessing disease severity, but these are used in clinical trials.
Treatment of psoriasis
There are a large number of factors on which the development of the disease and its various manifestations depend. This is why many treatments against psoriasis have been developed. These methods are often combined, including drug and non-drug interventions.
The treatment plan is established based on the severity of the disease, the area of skin affected and the severity of symptoms such as redness, itching, peeling. Age and gender, stage of the disease and general condition of the patient, the presence of concomitant diseases are also taken into account, as they can limit the choice of treatment methods.
Treatment of psoriasis should lead to a reduction in clinical manifestations (rash and other symptoms), improvement in the general condition of the patient and restoration of working capacity.
When treating psoriasis, it is necessary to follow a diet and take good care of the skin, as there is a risk of liver damage. In such cases, it is recommended to reduce the amount of fatty foods in the patient's diet, give up alcohol, sweets (simple sugars) and starchy foods. The emphasis in the diet should be on proteins: lean meat, fish, dairy products, vegetables and fruits. Be sure to watch out for allergic reactions or intolerance to certain products.
To improve the patient's quality of life and get rid of the disease, it is necessary to use an integrated approach:
- Local treatment–Ointments and creams cope well with peeling and itching in small areas where the disease is localized. Hormonal ointments, salicylic acid, retinoids and moisturizers are particularly effective in treating psoriasis of the face and hands.
- Drug therapyused as an additional method of effective treatment of psoriasis when ointments do not help. Medicines reduce the inflammatory process, eliminate swelling and itching, and block increased activity of skin cells. But it should be noted that the tablets have many side effects (increased fatigue, poor appetite, high blood pressure). Therefore, it is very important to follow all the doctor's recommendations regarding the dosage of the medication.
- When psoriasis is localized to the head and neck, usemedicated therapeutic shampoos: antifungal, tar, containing corticosteroids. The shampoo eliminates pathogens of pathological inflammation, removes scales, relieves itching and burning.
- Therapeutic antihistamine injectionsblock severe itching, biological drugs have a beneficial effect on the immune system.
Unfortunately, today there is no possibility of complete cure for psoriasis. Any treatment for psoriasis aims to permanently eliminate the signs of the disease and prolong remission. But treatment of psoriasis is necessary, despite the slow and chronic course of the disease, because prolonged absence of treatment can lead to patient disability.