For many centuries, humanity has tried to discover all the secrets of this mysterious skin disease, but much still remains unknown. According to statistics, psoriasis affects 4 to 7% of the population and men and women are equally susceptible to it. Usually, the first signs of psoriasis appear during puberty and can accompany a person throughout his life, sometimes decreasing and disappearing, sometimes increasing in strength.
Causes and risk factors for psoriasis
Psoriasisis a long-term inflammatory process of the skin, considered an autoimmune disease (associated with an allergic response to its tissues). This is a chronic skin disease that affects the cells of the outer layer of the epidermis. The condition usually appears as red and silver scaly skin on the feet, knee, back, chest, etc. In most cases, psoriasis starts in small areas of the skin, which can then spread to large areas of the body. There are numerous causes and risk factors that can contribute to the development of this disease, and there are several theories to explain its appearance.
Autoimmune cause
Some studies suggest that psoriasis can occur due to a combination of genetic and environmental factors such as infections, trauma, stress, and certain medications. These factors can trigger a reaction from the immune system, which begins to fight the body's tissues, including the skin.
However, the processes underlying psoriasis are not yet fully understood. It is important to note that psoriasis is a multiple disease that manifests itself differently in each patient. Studying the mechanisms underlying psoriasis can help develop more effective treatments, reduce the risk of complications and improve patients' quality of life.
Impact of metabolism
Metabolic disorders significantly affect the condition of the skin and immunity in patients with psoriasis. Increased metabolism leads to the formation of toxins and free radicals, which contribute to inflammatory reactions. There is an imbalance in various metabolics.
- With disorders of protein metabolism in patients with psoriasis, the content of albumin in the blood decreases and the content of globulins increases, which increases their sensitization.
- In fat metabolism, an increase in lipid and cholesterol content in the blood is observed.
- Reducing calories and eating plant foods can reduce the activity of psoriatic inflammation.
- Disorders in carbohydrate metabolism almost always occur.
- The metabolism of vitamins and minerals is also impaired, which is manifested by a decrease in the content of vitamins C, A, B6, B12, iron, copper and zinc in the blood, but an increase in the content of vitamin C.
Infectious cause
This theory was widespread in the last century. It was believed that psoriasis could be caused by certain bacteria (streptococci), fungi and viruses, but these hypotheses have not been confirmed scientifically. However, dermatologists point out that any acute infectious process or chronic infection can cause psoriasis to recur. Particular attention is paid to the viral theory. Recent research shows that RNA viruses, such as HIV and other retroviruses, can influence the genetic system and cause the appearance of genes that predispose to the development of psoriasis.
Genetic predisposition
Inheritance of a predisposition to autoimmune reactions is a risk factor for psoriasis. If a person's close relatives suffer from this disease, the likelihood of developing it increases. Several genes may be associated with psoriasis, including the PSORS1-PSORS9 complexes, with PSORS1 thought to be particularly active. It contains the HLA-C, HLA-Cw6, CCHCR1 and CDSN genes, which may contribute to the development of the disease. Genes influence metabolism, immunity and the development of autoimmune processes. However, the presence of these genes does not mean that a person will necessarily develop psoriasis. The development of the disease can be caused by other factors.
Neurogenic cause
Excessive stress on the nervous system, prolonged stress and imbalance of the autonomic nervous system, which provides innervation to blood vessels and internal organs, can be risk factors for the development of psoriasis. These factors can cause an imbalance in the endocrine system, changes in metabolic processes and disturbances in the immunological response, increased irritability or depression, constant fatigue, drowsiness and apathy, which in turn can lead to psoriasis.
Endocrine
Endocrine disorders that occur with psoriasis are quite common and can have a significant impact on the development of the disease. However, the connection between them and psoriasis is not entirely clear and has not been proven. Experts believe that psoriasis patients often suffer from dysfunction of the thyroid gland, pituitary gland and adrenal glands. Women may have problems with their menstrual cycle and men with sexual function.
Symptoms and characteristics of psoriasis
Psoriasis manifests itself not only with skin rashes, but also with other symptoms. It often begins in childhood or adolescence and is associated with hormonal disorders, vegetative-vascular dystonia and stress.
The first signs arefatigueANDmood change. The main symptom is small pink bumps on the skin called papules, covered in whitish scales. The papules are surrounded by a brighter border.
Over time, elements of the rash can combine into large, unusually shaped plaques. The base of each papule isinflammatory infiltrate. The following types of skin rash are distinguished:
- punctiform (no more than 1 mm in diameter);
- teardrop-shaped – (droplet papules up to 2 mm in size);
- coin-shaped – (round coin papules up to 5 mm in size).
The rash also has its own characteristics:
- stearic stain - if you scrape the surface of the papule;
- terminal film: after cleaning the papules from the scales, you can see a transparent film;
- bloody dew (Auspitz phenomenon) – if the integrity of the film is damaged, small drops of blood may appear.
Is psoriasis contagious?
Many people believe that psoriasis is contagious, which is why they try to avoid contact with people who suffer from it. This can cause the patient to want to isolate themselves from others and lead to serious psychological problems. However, studies have shown that psoriasis is not transmitted through contact with the patient. If all family members suffer from this disease, this only indicates the presence of a genetic factor in the development of the pathology.
Classification and stages of development of psoriasis
At the moment, there are three main stages in the development of psoriasis:
- A progressive stage, characterized by the constant formation of new skin rashes, accompanied by severe itching.
- The stationary stage, in which new formations stop appearing and existing ones begin to heal.
- A regressive stage where borders appear around the rash and the skin affected by the rash becomes darker in color due to increased pigmentation.
Furthermore, there are different degrees of severity of the pathology:
- Mild degree, when no more than 3% of the skin surface is affected.
- Medium grade, characterized by skin damage of 3-10%.
- Severe degree, in which the disease affects more than 10%.
Types of psoriasis
PsoriasisIt is a chronic skin disease that can manifest itself in various ways. Rashes, their location, and damage to other systems and organs may vary. Based on these characteristics, various forms of psoriasis are distinguished.
Simple (vulgar, plaque)
Plaque psoriasis is the most common form of this disease. Its symptoms include the appearance of bright pink papules covered with white scales.
Elbow psoriasis
This is a typical manifestation of mild plaque psoriasis. A characteristic feature of elbow psoriasis is the presence of one or more permanent "service" plaques on the extensor side of the elbow joints. If these elements are exposed to trauma, an exacerbation occurs.
Guttate psoriasis
Associated with bacterial (most often streptococcal) and viral infections, this type of psoriasis can cause inflammation. This condition often occurs in children and begins with the appearance of small, red, teardrop-shaped papules on the skin of the limbs, body, or face. Papules have a scaly surface and can develop into erosions and ulcers, increasing the risk of infection.
This condition can develop rapidly or gradually become chronic, followed by periods of exacerbation and relief of symptoms. In rare cases, psoriasis can be more serious.
Palmoplantar psoriasis
This type of psoriasis often develops in people involved in manual labor and is often accompanied by severe itching and can lead to complications on the nails. Different subtypes of this type of psoriasis include:
- Fan plate: Large elements on the palmar and plantar surfaces with white scales that merge into fan plates. This subtype is most often found on the hands.
- Circular: ring-shaped scaly elements on the palmar and plantar surfaces.
- Callous: growth of rough epithelium with formation of calluses.
- Pustular: This is a distinct subtype of psoriasis on the palms and soles of barbers. In the areas located under the big toes, blisters and pustules containing pus appear, causing severe itching. The ulcers stick together, then dry out and form crusts. Characteristic elements of psoriasis also appear in other parts of the body.
Leg psoriasis can be associated with varicose veins and occurs mainly in the lower legs.
Nail psoriasis
It may occur as a separate disease or as a complication of another type of psoriasis. The main symptom is small dimples on the nail plate, which have different depths. These dimples are usually more noticeable and painful when pressed than other types of dermatitis. Additionally, symptoms include spontaneous separation of the nail, subungual hemorrhages (especially when wearing tight shoes), changes in the color and surface of the nail, such as trachyonychia and koilonichia.
Scalp psoriasis
It can manifest itself as an independent disease or as part of a general pathological process. One of the characteristic features is tearing and the formation of crusts on part or all of the surface of the head. In this case hair growth is not affected as the function of the hair roots is not impaired. However, humidification poses a danger of infection, which can cause damage to hair follicles.
Seborrheic psoriasis
It occurs due to rupture of skin glands, which produce viscous sebum, causing skin irritation and promoting inflammation - dermatitis. This condition quickly spreads to the entire head, covering it in the form of a cap and is accompanied by severe itching. In the areas behind the ears, watery eyes sometimes develop and infections can develop. A scalp covered in dandruff and scabs can look like a psoriatic crown.
Psoriasis on the face
It usually appears in the area of the nasolabial triangle, in the eyelids, above the eyebrows and in the area behind the ears. The rashes may coalesce, forming large areas of redness and swelling. If the functioning of the sebaceous glands is impaired, the process may be accompanied by weeping, crusting and increased risk of infection.
Psoriasis on the genitals
Psoriasis affecting the genitals is a concomitant process that is usually accompanied by characteristic psoriatic rashes throughout the body, which facilitates its diagnosis.
Psoriatic rashes on the penis in men, on the labia majora in women, and on the surrounding skin areas are oval in shape and slightly raised above the surface of the skin. They are pink and flaky. Practically not accompanied by itching. Sometimes the damaging process extends to the mucous membranes and can take the form of vulvovaginitis in women and balanoposthitis in men.
In obese people, atypical psoriatic rashes can be observed in the folds located near the genitals (inguinals, interbuttocks). In these areas, areas of deep red color appear, which have a mirror surface and do not peel off due to constant wetting.
Why is psoriasis dangerous?
Psoriasis can become very serious when the rash covers more than 10 percent of the skin. This condition is difficult and prone to recurrence, and the rash can become moist, moist, and susceptible to infection. Only timely and effective treatment of psoriasis can prevent the spread of the disease.
In some cases, psoriasis can be complicated by joint inflammation and the development of psoriatic polyarthritis, which can lead to joint dysfunction. Furthermore, the systemic autoimmune process caused by psoriasis can lead to the development of other autoimmune diseases, serious cardiovascular and digestive diseases, and neurological reactions.
Ignoring timely treatment of psoriasis can lead to complications, such as psoriatic erythroderma, which can occur due to improper treatment of psoriasis or as a result of exposure to various irritants on the skin. In psoriatic erythroderma the skin becomes intense pink with a clear distinction between the affected and healthy areas, as well as small and large flakes. This condition requires emergency medical attention.
Complications of psoriasis
Lack of timely and adequate treatment for psoriasis can severely damage the body's vital organs and systems, such as the joints, heart, kidneys, and nervous system. These consequences can lead to disability or even cause death.
Diagnostics
Typically, the diagnosis of psoriasis is made based on the typical symptoms of the skin lesions and their location. In some complex cases, additional tests may be needed to rule out other skin diseases.
Laboratory tests may include:
- Complete blood count, which can detect leukocytosis and anemia in psoriasis.
- Rheumatoid factor (RF) is a protein whose levels may be elevated in systemic inflammatory diseases involving joint damage, but in psoriasis its levels are generally normal.
- The erythrocyte sedimentation rate (ESR) is also usually normal, with the exception of pustular psoriasis and psoriatic erythroderma.
- Uric acid levels may be elevated in psoriasis, which can lead to confusion with gout.
- Antibodies to the human immunodeficiency virus (HIV) may be detected with the sudden onset of psoriasis.
Other tests, such as joint x-rays and skin biopsies, can be used in more complex cases to assess the severity of joint damage and distinguish psoriasis from other skin diseases.
Treatment
Treatment of psoriasis requires a comprehensive approach, including local treatment of skin lesions, medications, light therapy, and prevention of exposure to factors that worsen the disease. The choice of treatment method depends on the type and severity of psoriasis. Treatment may include:
- external preparations (external ointments, petroleum jelly, paraffin, vegetable oils and creams with anti-inflammatory effects, the quantity of which depends on the nature of the lesion and is used daily);
- lotions and shampoos based on salicylic acid, as well as photosensitizers;
- drugs for oral administration (retinoids, vitamin D preparations and others);
- physiotherapeutic procedures;
- Daily baths with bath oil, oatmeal tea, or sea salt can help soften the skin and reduce the inflammation that occurs with psoriasis. It is important to avoid hot water and scrubs and use a moisturizer after bathing;
- light therapy, which involves exposing the skin to ultraviolet light, can also be useful (avoid burns);
- photochemotherapy using medium wave radiation;
- compliance with a special diet and general regime.
When developing a treatment program, the patient's gender and age, the presence of concomitant diseases, the general state of health and the impact of external factors are taken into account. Sometimes, to cure it, it is enough to change your lifestyle and in other cases several courses of treatment are prescribed.
In addition to traditional methods, psoriasis treatment may include the use of modern laser technologies. Laser therapy can reduce the symptoms of the disease, achieve long-term remission and relieve the patient from unpleasant rashes and related problems. A peculiarity of laser therapy is that a special excimer laser acts only on the affected areas of the skin, without affecting the healthy ones, guaranteeing rapid recovery without side effects. Laser therapy is safe and painless, requires no preparation and can be used regularly so that the patient can live without restrictions.
The effectiveness of treatment depends on many factors, including hereditary predisposition, provoking factors, the stage of the disease and the specific nature of the lesion, so it is recommended to first consult a specialist and prescribe therapeutic measures based on clinical recommendations.
Prevention
Psoriasis is a disease that can be successfully treated if you timely consult a doctor and receive qualified help. In the simple form of psoriasis the patient can work without any restrictions, except for work in chemical plants, where staying on the job can be dangerous.
However, psoriasis can cause complications, such as psoriatic arthritis, which can limit work performance and lead to disability.
Prevention of psoriasis is an important part of treatment. After recovery, patients need to reconsider their lifestyle, eliminate bad habits, take care of the treatment of other chronic diseases, monitor their diet and increase physical activity, spend more time outdoors and play sports.
Nutrition for psoriasis
The diet for psoriasis is not strict, but proper nutrition plays an important role in the complex treatment. When making nutritional recommendations, patients are advised to:
- Avoid foods to which the body is hypersensitive and exclude them from the diet.
- Prefer fresh fruit, vegetables, berries, baked or boiled lean meat and drink more.
- Avoid the following foods: onions, garlic, radishes, concentrated tea, coffee, alcohol, sweets, salty and acidic foods, as well as foods that can cause an allergic reaction such as orange, honey, nuts, cocoa and eggs.
- Avoid fatty foods of animal origin.