According to the WHO, currently 2-4% of the world population suffers from psoriasis. This disease affects patients of all ages, however, most often young people (15-25 years). Unfortunately, today 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 best to consult a doctor immediately.
Psoriasis- This is a dermatosis, which manifests itself in the form of scaly papules on the skin. Its distinctive feature is that, in addition to the skin, it is capable of affecting joints and nail plates. In the pathogenesis of psoriasis, hereditary factors are clearly traced, and other irritants are only secondary causes of its occurrence.
During an exacerbation of the disease, the natural processes of formation are disrupted - keratinocytes (cells of which human skin mainly consists). There are also pronounced biochemical changes in the skin. Also, recently, doctors have been 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 malfunctions in the functioning of the immune system.
Prevalence of psoriasis
Psoriasis is common. At present, the incidence statistics are roughly as follows:
- China - 0, 3%;
- United States of America - 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 not a single such case has been reported so far. If you look at the situation as a whole, the percentage of psoriasis is about 6-8% of all skin diseases.
As already noted, psoriasis occurs at any age, but most often young people (up to 25 years old) still suffer, and in both men and women it occurs with the same frequency.
Epidemiological situation
Based on the causes of its onset, psoriasis is a non-infectious disease with a marked genetic predisposition. Those most at risk of getting sick are those people whose relatives also suffer from this disorder (in this case we mean only the closest relatives). European researchers have established with certainty that if one parent is sick, she has a 14-25% chance of passing it on to her child. If both parents are sick, this probability is already 41-60%.
According to the type of development of the disease, psoriasis is divided into two groups:
- soon;
- late.
This is proof that there are two main types of psoriasis (such as 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 the disease progresses over time.
The causes of type II psoriasis are quite random, so this disease is sporadic. It occurs more often in older people (around 60 years old). In general, it proceeds quite easily, however, in some cases, it can be aggravated by damage to the joints and nails.
Factors provoking the appearance of psoriasis
Although psoriasis tends to be inherited, it is generally multifactorial. Anything can trigger that fatal immune system malfunction. Therefore the provocative factors are divided into external and internal (or, in scientific terms, exogenous and endogenous).
Exogenous factors
In turn, they are divided into physicists and chemists. 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-rays and ultraviolet irradiation also play a significant role. In about 5% of all cases, the disease occurs in the summer, and 40% of them are due to sunburn.
Chemical factors are expressed in the toxic effect of harmful chemicals or other irritants on the skin. In addition, psoriasis is also caused by other skin diseases, such as:
- dermatosis;
- fungal infections;
- contagious impetigo;
- acne;
- dyshidrosis;
- lichen;
- fire of saint Anthony;
- gangrenous pyoderma;
- allergic dermatitis of various kinds.
There are known cases of the disease after carrying out elementary diagnostic skin tests to find out the body's reaction to cosmetics, hygiene products, formalin, chromium, nickel and other chemicals.
Endogenous factors
Internal causes of psoriasis can be infectious diseases. The latest research in this area suggests that strep infections and HIV are more likely to be the cause. In addition, symptoms often appear not during the disease itself, but also after the usual vaccination. In these cases, psoriasis is often difficult to treat.
Lithium preparations, beta-blockers, non-steroidal anti-inflammatory drugs and ACE inhibitors are used to induce remission. Corticosteroids are contraindicated in this case.
Pregnancy and childbirth
Significant changes in hormone 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 have psoriasis can experience an improvement in their condition during pregnancy (40%). Deterioration is much less common (in only 14% of cases). True, 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 for certain that the abuse of alcohol and cigarettes significantly increases the chance of getting psoriasis and worsening its course.
Hypocalcemia and hypokalemia
These factors can provoke the appearance of generalized pustular psoriasis. The chances of a favorable outcome in this case are very small.
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 all cases. However, it is only known for certain that they can only worsen the course of the disease and reduce the effectiveness of therapy.
Classification
Several separate types of psoriasis have been identified at this time. They differ greatly in the clinical picture and 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
Vulgar or common psoriasis occurs in most cases. This disease manifests itself as an abundant rash of small bright red papules (from a match head to a pea). After emergence, they grow rapidly, and silvery-white scales appear on their surface. In the future, the papules turn into plaques, which merge into one large lesion. Most often they have clear boundaries that separate them from healthy skin.
When you try to comb or remove the papule, the flaking increases earlier. This phenomenon is known as the "stearin stain symptom" and once all the scales have been removed, a shiny, smooth surface can be found, the "terminal film symptom". If you keep scraping, the capillaries are damaged and droplets of blood are released. This symptom is known as "blood dew".
The development of psoriasis is divided into three main periods:
- progressive (acute);
- stationary;
- termination period.
The success of treatment here depends above all on how correctly the methods of therapy are selected, since, depending on the period, their effectiveness varies significantly.
Period in progression. A feature of this stage is the abundant appearance of a specific rash. In the stage of exacerbation, some parts of the patient's body are covered with small papules, which actively peel off. Peeling in this case is strictly localized and does not affect healthy skin. It is easy to identify acute psoriasis by the characteristic red or pink border that delimits the papule.
The most characteristic symptoms at this stage are itching and the presence of the so-called Koebner symptom. The latter is expressed in the fact that psoriatic papules appear at the site of any skin lesion (minor burns, scratches, injections, scrapes, 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. It also stops the growth of the plaques. 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.
Termination period. This period is also called the regressive period, since a gradual decrease in plaque is observed during it. At first, they stop peeling, then gradually smooth out until they completely disappear. 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 somewhat less often, by hyperpigmentation. With psoriasis vulgaris, rashes can occur almost anywhere and are usually located symmetrically (extensor surfaces of the elbows and knees). It can also appear on the head, sacrum, hands, palms, soles of the feet, groin and armpits. In addition, in many cases, the nail plates are also affected (appearance of dotted dimples, loosening, thickening). These symptoms are very similar to those that occur when infecting fungi, so the final diagnosis is made only after receiving a negative reaction to the fungal spores in a special laboratory study. Psoriasis vulgaris as a whole does not have a general negative effect on the patient's body, and its course is chronic. Periods of flare-ups occur in the fall or winter, while flare-ups are much less frequent in summer. The main incentive for active treatment lies in the fact that without adequate therapy, psoriatic plaques can cover the body for years, while proper treatment causes 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 occurs both spontaneously and as a result of improperly selected treatment. Although, of course, if the drugs used irritate the skin or it is exposed to ultraviolet radiation, the risk of psoriatic erythroderma is much higher. Most often, psoriatic erythroderma appears suddenly during the first stage of psoriasis. It can be combined with arthritis and generalized pustular psoriasis, and exposure to factors such as strep infections or hypocalcemia significantly increases the likelihood of this complication. Abrupt discontinuation of corticosteroids can also worsen the condition. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by widespread redness of the skin, severe itching and lamellar peeling.
Pustular psoriasis
Even 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 in bone and muscle damage in patients who already suffer from psoriasis or have a high risk of the disease due to a family history. Most often psoriatic arthritis is associated with classic psoriasis, as well as psoriatic lesions of the nails. This disease is diagnosed by the occurrence of back pain, accompanied by the following conditions:
- lack of a clearly stated reason for appearance;
- the patient's age is over 40 years;
- causeless deep pain in the lower back or buttocks;
- indistinct localization of pain;
- pain reduction after exercise;
- pain or stiffness is felt early in the morning or in the evening;
- the presence of pain with an excellent general state of the musculoskeletal system.
Nail psoriasis
Most often, psoriasis vulgaris is accompanied by damage to the nails. In this case, their pronounced dystrophy is observed, as well as the characteristic symptoms of fungal infections. It is a frequent companion of psoriatic arthritis. Considering that about 4% of the world population suffers from ordinary psoriasis, then 30-50% of them also suffer from nail psoriasis.
Treatment of psoriasis
Unfortunately, at present, medicine is not yet able to cure psoriasis, as this requires much deeper knowledge of the peculiarities of the work of the basic mechanisms of the human immune system. As this type of research is progressing 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, since each organism contains an individual set of factors that influence the course of the disease. Gender, age, profession, general health, type of psoriasis - all this must be taken into account when prescribing therapeutic therapy. An important role is also played by the determination of the nature of the course of the disease, individual susceptibility to drugs and the current stage of the disease.
General activities
First of all, the doctor must determine the mental and physical condition of the patient, assess the general condition of his body and find out how tolerant he is to the disease. The best prerequisites for effective treatment are a good rest, a stay in a quiet environment, a change to a less intensive mode of work, or a short-term hospitalization. Various methods of psychotherapy (rehabilitation in seaside resorts with the use of cognitive-behavioral therapy, etc. ) have also proved to be quite good. It is also very important for the patient to know that the healing process is proceeding as it should, because, without receiving a quick effect, about 40% of patients lose confidence in the effectiveness of the therapy and begin to ignore it. It is important not to forget that psoriasis is a chronic disease, so the safety of therapy must be taken into consideration. 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 best to keep the strongest drugs until the really dangerous symptoms appear.
Disease course and long-term prognosis
The course of psoriasis is often unpredictable. Modern doctors have practically not succeeded in this, therefore, as before, psoriasis remains an unpleasant and uncontrollable disease. In any case, we proceed completely individually, so that any attempt to make a prognosis on the course of the disease, as well as on the duration of the phases of exacerbation and remission, is preventively doomed to fail. Only one thing pleases: despite the difficulty of 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 psoriatic arthritis patients remain functional and can lead fulfilling lives. If the necessary therapy is absent or the disease proceeds with complications, joint deformities can develop with the further development of serious pathologies. However, such complications are found only in a very limited number of patients with psoriasis. Most patients can count on a gradual stabilization of the condition and the onset of long-term remissions (more than two years). In very rare cases, the disease proceeds mainly in the active phase, however, in this case, it can be effectively localized. Effective psoriasis treatment today can be obtained in any major city. And, although, as you know, it is not possible to achieve final recovery, diet, medications and special procedures will quickly do their job. Plus, you won't need long-term care in a hospital. The doctor's job 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.