All about psoriasis: how to treat, causes and symptoms, types

For more than two thousand years, humanity has been trying to solve all the riddles of this severe dermatosis, but much still remains unknown. According to statistics, this disease affects 4 to 7% of the population, women and men are equally sensitive to it. The first signs of psoriasis usually appear during puberty and accompany a person for the rest of his life, then they subside and disappear completely, then intensify.

Can psoriasis be cured?Modern medicine has achieved a lot in the treatment of this chronic dermatosis and is able to provide the patient with a decent level of quality of life.

Causes of psoriasis

Psoriasis is a chronic inflammatory process of the skin, which modern medicine defines as autoimmune (associated with allergy to its own tissues). There are many causes of psoriasis and predisposing factors for the development of this dermatosis, in relation to which numerous theories have been advanced about its origin.

Autoimmune

This is the main theory, as it is well known that the immune system actively responds to certain types of skin exposure. The skin of people suffering from psoriasis is very sensitive to mechanical, physical and chemical influences. Not only epithelial cells react to such influences, but the entire immune system.

Cellular immunity is impaired - the ratio of individual lymphocyte subtypes responsible for forming a normal immune response. So, in psoriasis, the number of T-lymphocytes of helpers increases - helpers that regulate immunity, while the number of suppressor T-cells, which suppress an excessively strong immune response, decreases. Lymphocytes and some other cells produce cytokines, active substances that stimulate the immune response. Humoral immunity also suffers, an imbalance of antibodies (immunoglobulins) in the blood serum develops, antibodies to the tissues of the patient's body appear.

Inflammation begins against the background of activation of T lymphocytes, but why they are activated has not been established. In the research process there is also the question of how to suppress the autoimmune response without harming the patient.

Exchange

An imbalance in metabolism has a significant effect on the skin and immunity. In patients with psoriasis, there is an acceleration of metabolism, the appearance of a large amount of toxic free radicals and other toxins that support the inflammatory response. Metabolism is disturbed:

• protein- the CDSN predisposition gene stimulates the synthesis of the corneodesmosine protein, which sensitizes (allergenic) the organism; the protein content of albumin in the blood decreases and the content of globulins increases; this condition is called dysproteinemia and further increases sensitization;
• Fat- the content of lipids and cholesterol in the blood increases; the use of mainly vegetable foods and a general decrease in the calorie content of the daily diet can reduce the activity of psoriatic inflammation;
• carbohydrate- almost always violated;
• exchange of vitamins and minerals- the content of vitamin C in the skin increases, the content of vitamins C, A, B6, B12, iron, copper and zinc in the blood decreases.

Contagious

This theory was relevant at the beginning and middle of the last century. Some bacteria (streptococci), fungi and viruses were considered to be the causative agents of psoriasis. These theories have not been confirmed. But dermatologists note that any acute infectious process or the presence of a permanent focus of infection can provoke relapses. The viral theory holds a special place. Recent studies have revealed the effect of retroviruses (RNA-containing viruses - HIV, etc. ) on the genetic apparatus with the formation of genes for psoriatic predisposition.

Genetic

The predisposition to autoimmune reactions is inherited. If a person's loved ones suffer from psoriasis, the likelihood of developing this disease increases many times. There are genes for psoriasis susceptibility (the local complexes PSORS1 - PSORS9, PSORS1 is particularly active, contains the genes HLA-C, HLA-Cw6, CCHCR1 and CDSN, responsible for the development of the disease). Genes influence metabolism, immunity and the development of autoimmune processes. But the presence of such genes does not guarantee the development of the disease at all. The influence of provoking factors is of great importance.

Neurogenic

Prolonged stress, high neuropsychic stress, disorders of the autonomic nervous system (which innervate the walls of blood vessels and internal organs) can cause the development of psoriasis, causing an imbalance in the endocrine system, alterations in metabolic and immunological processes.

Endocrine

Endocrine disorders in psoriasis are common and mainly play the role of a provoking factor. A clear connection between the two has not been demonstrated. Dermatologists note that patients often have dysfunction of the thyroid gland, adrenal glands and pituitary gland. There are menstrual irregularities in women and sexual function in men.

Symptoms of psoriasis

The main symptoms of psoriasis are skin rashes. But there are other signs as well. The very first manifestations usually appear in adolescence or childhood against the background of hormonal disorders, vegetative-vascular dystonia and prolonged stress.

The disease begins with a feeling of constant fatigue, mood disturbances. Characterized by small pink formations (papules) overlying the surface, dusted from above with whitish desquamation. They are surrounded by a brighter and more imposing border.

The elements of the rash grow and combine into large plaques of bizarre shapes. The base of the papule is an inflammatory infiltrate. By the nature of the rash, psoriasis is divided into:

• point- elements with a diameter not exceeding 1 mm;
• tear- papules-droplets up to 2 mm;
• shaped like a coin- round coin-papules up to 5 mm in size.

Characteristic features of the rash:

• stearin stain- if you scratch, the surface of the papules;
• terminal film- Thoroughly cleaning the surface of the papules from the scales, we will see a transparent film;
• blood dew (Auspitz phenomenon)- having scraped the film and violated its integrity, we will see small bloody droplets protrude on the surface.

Stages of psoriasis

There are three stages of the disease:

1. progressive- the first elements of the rash appear, their number increases, all new areas are captured; rashes also appear when scratching itchy skin or exposure to some external irritating factors (Kebner's phenomenon); in the initial stage of psoriasis, the papules begin to merge into large plaques;
2. stationary- there are no new elements and those that appeared before do not regress;
3. regressive- the rash becomes pale, its base becomes less dense; the rash gradually subsides, the process often begins from the central part, so the plaques can be in the form of rings; if the plaques in psoriasis dissolve from the periphery to the center, then they simply gradually decrease in size and a white ring forms around them - Voronov's pseudoatrophic edge; where there was a rash, white and pigmented areas remain - psoriatic leukoderma.

Occasionally, papules are present on the skin simultaneously in all three stages of development. There are also summer and winter forms with a predominance of exacerbations in summer or winter.

Is psoriasis contagious?

Numerous studies have confirmed that this is not a contagious disease. If infectious pathogens take part in its development, only through a general effect on metabolism, immunity and the genetic apparatus.

Patients often ask:

• How does psoriasis spread?

  Psoriasis is not spread from person to person.

• Is psoriasis hereditary?

  The answer is still negative, but there is a hereditary predisposition in the form of metabolic features and functioning of the immune system, which is passed on to close relatives.

Types of psoriasis

The nature of the rash, their location, damage to other organs and systems in this chronic dermatosis can be different. According to these signs, several types of diseases are distinguished.

Simple (vulgar, plaque)

The most common. Its symptoms are papules of a characteristic bright pink color, covered with white scales. Downstream, plaque psoriasis is divided into the following forms:

• easy- if the lesion covers no more than 3% of the skin; in the progressive stage the papules increase, but then quickly undergo reverse development;
• moderate- the rash takes from 3 to 10%; papules are large, merge into plaques;
• heavy- defeat captures more than 10%; rashes are numerous, they merge, forming a wide variety of forms.

Psoriasis vulgaris proceeds in the form of relapses, alternating with remissions, but there is also a continuous course.

Elbow psoriasis

This is one of the manifestations of a mild form of plaque inflammation. A distinctive feature of psoriasis on the elbows is the constant presence of one or more "proper" plaques on the extensor side of the elbow joints. If these elements are injured, an exacerbation begins.

Guttate psoriasis

In the development of guttate psoriasis, bacterial (most often streptococcal) and viral infections are of great importance. It occurs in childhood. Inflammation begins after an infection. Streptococci secrete toxins (antigens - substances foreign to the human body) that bind to tissue proteins. Antibodies are produced and autoimmune inflammation develops.

The beginning is acute. On the skin of the extremities (less often the body and face), small red papules appear with a flaky surface. With lesions in the area of the rash, small erosions and sores are formed, the risk of infection increases.

Psoriasis rapidly takes a subacute and chronic course. Relapses are replaced by remissions, independent recovery or transition to the adult form of the disease is possible.

Palmar-plantar psoriasis

It develops in those who are engaged in physical work, is accompanied by severe itching and almost always gives a complication to the nails. There are subspecies:

• fan-shaped plate- with large elements on the palmar and plantar surface, covered with white scales, which merge into fan-shaped plates; such psoriasis on the hands is more common;
• circular- ring-shaped scaly elements on the palmar and plantar surfaces;
• cornea- characterized by the growth of coarse epithelium with the formation of calluses;

A separate subspecies is pustular psoriasis on Barber's palms and soles. The areas under the thumbs of the extremities are covered with blisters and pustules (with purulent contents), severe itching appears. The abscesses merge, then dry out, forming scabs. In other parts of the body the characteristic psoriatic elements develop. The disease often spreads to the nails.

Leg psoriasis is maintained and aggravated by varicose veins, in which case the rash will be mainly in the lower leg area.

Nail psoriasis

Nail damage can be independent or a complication. Typical symptoms:

• small dimples of different depths appear on the nail plate; similar nail lesions are found in other dermatitis, but in psoriatic lesions they are deeper and slightly painful when pressed;
• spontaneous slow and painless separation of the nail (onycholysis);
• subungual hemorrhages on the toenails, especially if the patient is wearing tight shoes;
• trachyonichia - opacity and irregularity on the nail plate; a depression forms in the center of the nail and the nail becomes like a spoon (koilonychia).

Sometimes the periungual roller is affected by the transition of inflammation to other tissues (psoriatic paronychia).

Scalp psoriasis

Here, the disease proceeds independently or as part of a general pathological process. Characterized by oozing, crusting on parts or the entire surface of the head. At the same time hair growth is not affected: psoriasis on the head does not affect the function of the hair roots. But the oozing creates a threat of infection resulting in damage to the hair follicles.

It flows in waves, then subsides with the disappearance of the scabs, then again worsening and accompanied by severe itching, which often leads patients to neurosis.

Seborrheic psoriasis

Seborrhea is a condition caused by a malfunction of the glands in the skin that produce sebum. A viscous oil is produced, which irritates the skin and contributes to the development of inflammation - dermatitis.

Seborrheic psoriasis quickly spreads to the whole head, covering it in the form of a cap and accompanied by severe itching. In the areas behind the ear, crying sometimes develops and an infection joins. The head covered with dandruff and solid scabs sometimes looks like a psoriatic crown.

Psoriasis on the face

Usually, psoriasis on the face is localized in the area of the nasolabial triangle, eyelids, above the eyebrows, in the areas behind the ear. The fused elements of the rash form large areas of redness and swelling. If there is a dysfunction of the sebaceous glands, the process is often accompanied by crying, crusting and an increased risk of infection.

Psoriasis on the genitals

This is not an isolated process. Simultaneously with the defeat of the genitals, there are characteristic psoriatic rashes all over the body, so it is not difficult to identify the disease.

Psoriasis on the penis in men and labia majora in women, as well as on adjacent skin areas, manifests itself in the form of oval and pink scaly papules that rise slightly above the skin. There is practically no itch. Sometimes the process spreads to the mucous membranes and resembles vulvovaginitis in women and balanoposthitis in men.

In obese people, atypical psoriatic rashes can be observed in folds located near the genitals (inguinal, intergluteal). Here, areas of deep red color are formed with a mirror surface without signs of peeling due to constant wetting.

What is the danger of psoriasis and whether it should be treated

The danger is that psoriasis can take a widespread severe form, the rashes will occupy more than 10% of the integument. This stage of the disease is difficult, relapses, the elements of the rash are injured and get wet, an infection often joins. Only over time can the treatment of psoriasis stop the process of its spread.

Sometimes the disease is complicated by inflammation of the joints with the formation of psoriatic arthritis, against which the function of the joints can be significantly impaired.

Against the background of a systemic autoimmune process, which has a significant effect on the patient's condition, other autoimmune diseases often develop (rheumatoid arthritis, some types of osteoarthritis, Crohn's disease, etc. ), as well as severe cardiovascular pathologies, diseases of the apparatusdigestive system, neurological reactions.

If you do not start psoriasis treatment in time, the patient's condition will drastically worsen and lead to disability.

There is also such a complication as psoriatic erythroderma, which develops with improper or insufficient treatment of psoriasis, as well as when various irritating factors are exposed to inflamed skin. The skin acquires a bright pink color with a clear demarcation of the affected areas by healthy ones, small and large lamellar peeling. Such a patient requires emergency medical attention.

Is psoriasis treated?

Yes, and successfully, but full recovery cannot be guaranteed.

Methods of treatment

Autoimmune inflammation requires individually selected complex therapy, lifestyle changes, nutrition and the elimination of all bad habits. Modern medicine has proposed three basic principles for the effective treatment of psoriasis:

• strict adherence to algorithms for prescribed therapy;
• regular monitoring of the effectiveness of therapy;
• timely correction of the prescribed therapy with its insufficient effectiveness.

Nutrition for psoriasis

There is no special diet for psoriasis, but nutrition is of great importance. Therefore, when prescribing complex treatment, nutrition recommendations are necessarily given:

• identify an increased sensitivity of the body to certain foods and exclude them from the diet;
• give preference to fresh vegetables, non-acidic fruits and berries, boiled and cooked lean meat, drink more;
• what not to eat with psoriasis:
  1. products containing essential oils - onions, garlic, radishes;
  2. caffeinated drinks (concentrated tea, coffee), alcohol;
  3. everything is more salty, sour and sweet, rich;
  4. products that promote sensitization (allergization) of the body: orange fruit, honey, nuts, cocoa, eggs;
  5. do not eat fatty animal products.

Pegano diet for psoriasis

This diet was developed by the American doctor John Pegano, but has not found official medical recognition. The building principle of the Pegano diet for psoriasis is associated with alkalizing the body by selecting the correct diet. According to this principle, all products are divided into:

• alkali formation (two thirds in the daily diet) - non-acidic fruit and berry mixtures and juices, vegetables (exclude those that cause increased gas formation);
• acid formation (one third of the diet) - meat, fish, dairy products, beans, peas, potatoes, cereals, sweets and pastries.

Patients are advised to drink mineral water without gas, drinking water up to 1. 5 liters per day, plus other liquids drunk (compotes, juices, etc. )

Pharmacological therapy

Mild psoriasis is treated with topical medications. Severe and rapidly progressing forms of the disease are treated mainly in the hospital setting with the prescription of drugs of general (systemic) action.

Treatment of external psoriasis

The medicine is selected by a dermatologist. For psoriasis vulgaris with dry constricting plaques, ointments are suitable, if oozing develops (with seborrheic), creams and medicinal solutions are used. In order to avoid the resistance (resistance) of the organism to a certain drug, it is changed over time.

In the acute (progressive) stage, the following external therapy is performed:

• agents that have a softening effect - boric petroleum jelly, 2% salicylic ointment;
• effective non-hormonal ointments for psoriasis containing activated zinc pyrithionate; they suppress infection and have a cytostatic effect (suppress tissue proliferation);
• external agents containing glucocorticosteroid hormones (GCS);
• a combined agent with calcipotriol (a vitamin D3 analog) and betamethasone corticosteroids; perfectly suppresses the inflammatory process.

External treatment of psoriasis in the stationary phase:

• ointments that dissolve scales (keratolytic) and have an anti-inflammatory effect - 5% naphthalan, boron-naphthalane, tar-naphthalane;
• corticosteroid medications.

External treatment of psoriasis in the resolution phase:

• the same keratolytic ointments, but in higher concentration: 10% tar-naphthalane ointments;
• ointments based on analogs of vitamin D3 - within 6 - 8 weeks; suppresses the inflammatory process and peeling of the rash.

For the treatment of nail psoriasis, special paints are used that suppress the development of the pathological process. It is recommended to treat the periungual phalanges with moisturizing gels.

Systemic treatment of psoriasis

• drugs that relieve inflammation and intoxication - calcium chloride, sodium thiosulfate, Unitiol in the form of injections;
• tablets for psoriasis, which suppress the processes of proliferation (multiplication of epithelial cells) - cytostatics that suppress the activity of the immune system, analogues of vitamin A, corticosteroid hormones;
• biological agents containing human monoclonal antibodies of the IgG class, which act on certain inflammatory bonds by suppressing the synthesis of cytokines; is a very effective modern drug that is administered by injection;
• vitamins for psoriasis help restore metabolism and keratinization of epithelial cells; doctors prescribe vitamins A, E, D3, group B.

Folk remedies for psoriasis

Any treatment for psoriasis, even with the use of folk remedies, can only be prescribed by a doctor. Self-treatment can lead to the opposite effect - the spread of the disease.

As part of complex therapy, the following methods can be used:

• Fat- industrial oil processing product; to prepare the ointment, you need to buy a medical solid oil at a pharmacy; recipe: in 0, 5 kg of solid oil, add 50 g of honey and half a pack of baby cream; procedures are carried out daily; in the pharmacy you can buy ready-made preparations based on solidol.
• sodium bicarbonate- a folk remedy for psoriasis, which helps to clean the scabs, relieves itching; recipe for soda applications: take 60 g of soda, dissolve in 0, 5 liters of water, soak a gauze cloth in the solution, fold it in several layers and apply to the lesion for 20 minutes; after the procedure, wipe the skin dry and apply an emollient ointment on it; treatment of psoriasis with soda is carried out once a day;
• mummy- has a pronounced anti-inflammatory effect, relieves itching well; can be taken orally once a day, 0, 2 g for two weeks; external therapy is carried out with a mummy solution; applied to dry itchy plaques twice a day; treatment of psoriasis on the head is carried out by rinsing the scalp with mummy solution after washing;
• sea salt- relieves inflammation, itching well; sea salt baths: take 1 kg of salt, dilute in two liters of water and add to the bath; take a bath for 15 minutes, then rinse the solution under a hot shower, pat the body with a towel and apply an emollient ointment; treat psoriasis with baths no more than twice a week;
• clay- has a pronounced purifying effect, adsorbing toxins formed as a result of inflammation and improper metabolism on its surface; helps to dry, eliminate scabs and itching; you can take any clay, but it is better to buy blue clay at the pharmacy; pieces of clay must be dried well, broken with a hammer, diluted with water and left to stand for several hours; put the resulting plate-like clay on a napkin (up to 3 cm thick) and apply to the foci of inflammation for three hours; to cure psoriasis with clay every other day.

Important: treatment of psoriasis at home with folk remedies should be carried out with caution and strictly according to the doctor's prescription. Such treatment will help one patient, while in another it can cause an exacerbation and rapid spread of inflammation. Therefore, if, against the background of therapy, the patient's condition has worsened, it is necessary to stop him immediately and consult a doctor.

Home treatment for psoriasis

When treating psoriasis at home, it is important to follow dietary recommendations, lead a healthy lifestyle, rule out bad habits and strictly follow all the prescriptions of a dermatologist.

How to cure psoriasis at home? Some patients try to cleanse themselves of toxins and toxins using all kinds of unconventional methods (enemas, etc. ). This can give exactly the opposite result - the work of the digestive tract will be disrupted and an exacerbation will begin. Modern medicine recognizes cleansing of the body in the form of proper nutrition and the elimination of bad habits.

It is important to follow all the prescriptions of the doctor and pay attention to how the prescribed therapy works. If it is not effective enough, the doctor will replace the treatment, achieving the maximum therapeutic effect.