Psoriasis is a chronic inflammatory disease of the body, accompanied by a predominant lesion of the skin with the formation of erythematous spots and plaques that have clear borders 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 of the appearance of this disease. A connection has been revealed between the appearance of psoriasis and the antigens of the HLA system.
Between 1 and 5% of the world's population suffers from this very unpleasant disease, and people with light skin are at a greater risk of developing psoriasis than black people.
The disease can occur 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 causes inconvenience to the patient himself, since the skin rashes that appear during the disease are not only a cosmetic defect, but are also accompanied by unpleasant itching. Furthermore, the manifestation of psoriatic arthritis is possible, which significantly worsens the patient's quality of life.
Mostly, rashes are localized in the scalp, on the surface of the elbows and knees, in the areas of skin folds and genitals. Often the nails, buttocks and the area around the eyebrows can 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 talk about autoimmune causes. The second theory explaining the onset of the disease is a disturbance in the normal process of maturation and division of skin cells. Heredity and stress are also considered the cause.
A genetic predisposition to psoriasis, allergies and frequent disruption of the skin barrier function (strong friction, chemical exposure, influence of alcohol-containing products) can provoke an exacerbation of the disease.
To the known triggers that causepsoriasis, relate:
- The Koebner phenomenon is the appearance of fresh skin eruptions at the site of skin irritation in the acute phase of some dermatoses;
- Sunburn or other types of burns;
- HIV infection;
- Beta-hemolytic streptococcal infection, which causes guttate psoriasis;
- Use of drugs (especially beta-blockers, lithium, angiotensin converting enzyme inhibitors);
- Severe emotional stress;
- Alcohol consumption;
- Smoking tobacco;
- Obesity;
- Hormonal imbalance, especially in women during menopause and pregnancy;
- Disorders in the digestive system.
The main cause of the development of the disease is excessive and accelerated growth and division of skin cells in combination with the inflammatory process in the dermis. In other words, the skin cells found in the bottom layer of the epidermis begin to grow rapidly and put pressure on the cells above. This process is accompanied by significant peeling of the skin and is called parakeratosis. It is believed that excessive stimulation by the immune system is the main link in the occurrence of this mechanism.
Symptoms and signs of psoriasis
Skin rashes associated with psoriasis are asymptomatic or accompanied by itching. Most often they are localized on the scalp, on the extensor surfaces of the knees and elbows, on the sacrum and buttocks (especially in the gluteal crease) and in the genital area. Fingernails, toenails, the skin of the eyebrows, armpits and navel may be affected. Rashes can merge with 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, skin rashes are discretely localized 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 to the patient. This process can lead to joint destruction.
Important!Psoriasis does not threaten the patient's life, but it destroys the patient's self-image. In addition to the fact that the patient's appearance changes, a large amount of time is also required to treat skin rashes and to keep clothes and bedding clean, which significantly reduces the patient's quality of life.
Types of psoriasis
- vulgarpsoriasis (ordinary or chronic plaque), in which the rashes look like individual plaques covered with silvery scaling. Plaques may coalesce as the disease progresses. Among all subtypes, this type of psoriasis is the most common and accounts for approximately 90%.
- inverse psoriasisaccompanied by skin rashes that appear in the area of natural folds and may form cracks.
- guttate psoriasischaracterized by multiple rashes with a diameter of 0. 5-1. 5 cm, often formed after streptococcal pharyngitis.
- palmoplantar psoriasisit manifests as plaques on the palms and soles of the feet, which may fuse.
- nail psoriasisaffects the nail plates in the form of punctate indentations and furrows with discoloration and thickening of the nail. Nail changes with psoriasis often resemble changes from a fungal infection.
- pustular psoriasisaccompanied by the formation of pustules on the palms, soles of the feet or possibly damage to one of the fingers. There may also be a generalized form.
- erythrodermic psoriasisit manifests itself as a sudden or gradual appearance of redness in patients suffering from 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 conduct an external examination of the affected areas of skin and take a complete medical history.
Psoriasis has a general similarity to other dermatological diseases, especially in the early stages of manifestation. It is important to exclude the presence of fungal infections in 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 extensive lesions of areas of the epidermis, visual analysis of scrapings is used. In the process of scraping, peeling intensifies. In place of the removed scale, a smooth, thin film is visible, which peels off under mechanical action and reveals a surface moistened with droplets of blood.
Diagnosing psoriasis in most cases is not difficult, it is enough to simply examine the patient's skin. The doctor must exclude errors in the diagnosis 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, the need for them should be considered. The severity of the disease is mild, moderate and severe depending on the area of skin affected. Damage to less than 10% of the skin is mild in severity. There are more sophisticated methods for assessing disease severity, but these are used in clinical trials.
Treatment of psoriasis
There are numerous factors on which the development of the disease and its various manifestations depend. Therefore, many treatments for psoriasis have been developed. Often these methods are combined, including both pharmacological and non-pharmacological interventions.
The treatment plan is drawn up based on the severity of the disease, the area of skin affected and the severity of the symptoms such as redness, itching, flaking. Age and gender, the stage of the disease and the general condition of the patient, the presence of concomitant diseases are also taken into account, since they can limit the choice of treatment methods.
Treatment of psoriasis should lead to a reduction in clinical manifestations (skin rashes and other symptoms), improvement of the patient's general condition and restoration of his working capacity.
When treating psoriasis, you need to follow a diet and properly care for your 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 pay attention to 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 especially effective in treating psoriasis on the face and hands.
- Pharmacological therapyused as an additional method for effective treatment of psoriasis when ointments do not help. Medicines reduce the inflammatory process, remove swelling and itching, and block the increased activity of skin cells. But it is worth considering that the tablets have many side effects (increased fatigue, lack of appetite, high blood pressure). Therefore, it is very important to follow all the doctor's recommendations regarding the dosage of the drug.
- When psoriasis is localized on 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 injections of antihistaminesblock severe itching, biological drugs have a beneficial effect on the immune system.
Unfortunately, today there are no possibilities for a complete cure of psoriasis. Any treatment for psoriasis is aimed at eliminating the signs of the disease for a long time and prolonging remission. But treatment of psoriasis is necessary, despite the slow chronic course of the disease, since a prolonged absence of therapy can lead to patient disability.