Psoriasis is one of the most common skin diseases, and one in every hundredth person suffers it.
Psoriasis is a disease whose development several factors are important at the same time: from hereditary predisposition (psoriasis in relatives) to disorders in the functioning of the nervous, endocrine, immune system and other factors.
The reasons
The causes of psoriasis are not fully understood.
The principle of the disease mechanism is to interrupt the division of skin cells, which causes an autoimmune reaction (autoimmune reaction - occurs inside the body, does not depend on external threats).
The top layer of the skin (epidermis) is composed mainly of keratinocytes - cells that produce keratin. Keratin is a protein whose properties allow it to exercise the protective function of the skin. Keratinocytes form in the deep layers of the epidermis and move slowly to their surface, during movement they mature and acquire new properties.
At the end of their "maturation", keratinocytes form a stratum corneum on the surface of the skin. Then the keratinized cells die and exfoliate from the living ones, thus, the keratinocytes' life path comes to an end. This ensures continuous skin renewal.
The normal path of keratinocytes from the deep layer to the surface takes one month. In psoriasis, the life span is reduced to several days, which leads to the appearance of scaly psoriatic foci, since the skin does not have time to get rid of keratinized cells.
When psoriatic plaques appear, they are usually accompanied by itching and redness. This indicates an autoimmune reaction in the deep layers of the skin, resulting in the swelling of the thick layer of the skin (dermis). The dermis contains blood and lymph vessels.
It is not clear why the keratinocyte formation process is accelerated, but it is known that a hereditary factor plays a significant role.
The development of common psoriasis can begin due to:
- mental trauma and constant stressful conditions;
- damage to the skin;
- transferred infectious disease;
- taking some medications;
- hormonal disorders;
- allergic reactions (typical allergens: citrus fruits, eggs, chocolate);
- alcohol intoxication;
- climate change.
The psoriatic triad is a characteristic symptom of the disease that occurs when the skin is shaved.
Stearin stain(increased peeling after scraping, giving the papules' surface a resemblance to a crushed drop of stearin)
Thermal film(the appearance after the complete removal of the scales from a moist, thin, shiny and translucent surface).
Detect bleeding(the appearance of blood droplets that do not fuse).
What happens to the skin in psoriasis?
In psoriasis, the skin's structure is disturbed, the epidermis becomes thinner, the processes of keratinization of the skin (accumulation of keratin protein) are interrupted and some layers of the normal epidermis disappear. In the next stage of the disease, clusters of cells responsible for the inflammation are found in the protective superficial stratum corneum of the epidermis and in the parakeratosis zone, around the dilated vessels of the skin.
Characteristic scales and plaques appear on the surface of the skin.
Psoriasis is not just a common disease, it has many manifestations and even disguises itself from other diseases.
Psoriasis localization sites:
- elbows and knees;
- sacrum and loin;
- scalp (seborrheic psoriasis);
- flexion surfaces and skin folds: the inner surface of the elbow and knee joints, the groin and armpits, the area under the breast (reverse psoriasis);
- palms and feet surfaces (palmoplantar psoriasis);
- psoriasis of the nail plates.
Common symptoms of psoriasis
The main symptoms of psoriasis are:
- psoriatic plaques;
- stiffness of the affected skin area;
- itch.
Symptoms by type of psoriasis:
- exudative psoriasis (the affected areas of the skin come off and become wet, a yellow crust forms on the surface of the rash);
- intertriginous psoriasis (more common in children, the foci of occurrence are red, with slight flaking, sometimes damp can be confused with diaper rash);
- old psoriasis (it is characterized by large plaques that do not disappear for a long time);
- rupoid psoriasis (another form of chronic psoriasis, characterized by a cone-shaped plaque);
- guttate psoriasis (rash of small papules).
Types of psoriasis
- Common psoriasis (common, plaque);
- Generalized psoriasis (disseminated, postulate);
- Tear-shaped psoriasis (by the type of rash);
- Arthropathic psoriasis (with joint damage);
- Other types of psoriasis (seborrheic and others).
Psoriasis vulgaris is the most common form of the disease.
Psoriasis begins with the appearance of skin rashes, often in small numbers, in typical places: on the elbows and knees. In addition, the characteristic location of the rash is the area of the scalp and trunk. There is usually a clear connection between the appearance of skin rashes and the action of the provoking factor.
The triggering factors for psoriasis can be stress, skin trauma, a recent infectious disease and regular alcohol consumption.
Usually, the exacerbation of the disease occurs in the cold season - this is the type of winter psoriasis. The summer type is more rare. Mixed forms of psoriasis are now seen. Over time, the number of rashes increases. They form characteristic psoriatic plaques. The Kebner phenomenon is observed - the appearance of new plaques in cutaneous trauma sites. As a rule, patients have plaques that remain on the skin even without exacerbation.
The disease flows cyclically:
- Progressive stage (increased number of skin rashes);
- Stationary stage (new eruptions do not appear);
- Regressive stage (regression of rashes, appearance in place of areas of skin without pigment).
Psoriasis vulgaris, photo
Diagnosis
When diagnosing psoriasis, in the first place, a detailed examination of the skin is necessary.
Thin skin, bleeding in places, loose plaques are signs of psoriasis. In the presence of these symptoms, the doctor performs a series of diagnostic measures to exclude the presence of other events with similar manifestations. For the final diagnosis, blood tests, smears and skin biopsies are performed as needed. If the joints are affected, magnetic resonance imaging (MRI) is prescribed and X-rays are taken to identify the lesions.
Psoriasis vulgaris, treatment
Psoriasis is a systemic disease with cutaneous manifestations, requiring complex treatment: local and systemic therapy. The disease is chronic and treatment aims to reduce the number and severity of exacerbations and achieve an acceptable skin condition for the patient.
In the progressive stage of psoriasis, all aggressive procedures are canceled: ultraviolet irradiation, bathing. It is important that patients with psoriasis handle the skin with care and with care, do not hurt it to avoid exacerbations and the appearance of new plaques.
Diet for psoriasis
Psoriasis is often accompanied by liver disease, so it is important to avoid alcohol, fatty, fried or smoked foods. It is also important to be moderate in your intake of carbohydrates, as this changes the pH of the skin and increases the risk of rash infection.
Prophylaxis
Prevention of psoriasis consists of maintaining a healthy lifestyle. This helps prevent other illnesses from occurring, as the body's immune system is protected from stress and can withstand external threats.
Prevention measures for psoriasis include:
- proper skin care;
- relaxing massage to improve blood circulation;
- adequate nutrition, it is advisable to avoid allergenic foods and exclude (limit) the intake of spicy, fatty, preserved, smoked, salty foods, in addition to citrus fruits;
- dairy-vegetable diet;
- a sufficient amount of moisture in the body;
- elimination of alcohol and smoking and other bad habits;
- increased physical activity;
- walks outdoors;
- avoidance of stressful situations;
- taking vitamins from groups A, B, C, D, E;
- choose loose clothing made of natural materials that does not skin and cause irritation.
Means for the treatment of psoriasis
Systemic therapy for psoriasis aims to reduce the proliferation of the skin epithelium, stabilizing the keratinization of skin cells and cell membranes. For this, preparations based on vitamin A (retinoids), cytostatics are used. Of the most modern treatments, so-called biologicals are used, which neutralize substances that cause inflammation.
For many years, UFOs have been used - treatment with group B ultraviolet rays (in tanning beds, group A rays), which reduce inflammation and contribute to the death of altered cells. PUVA therapy is the simultaneous use of ultraviolet radiation and a special substance that increases the skin's sensitivity to it.
An effective remedy for psoriasis
Local treatment is no less important than systemic treatment. Helps to reduce skin inflammation. Medicines are prescribed depending on the stage of psoriasis.
Progressive stage
- exfoliating ointments and lotions;
- hormonal anti-inflammatory ointments with calcitriol;
- emollients to relieve itching and dry skin.
Stationary stage
- UVB therapy;
- concentrated exfoliating ointments;
- emollients to restore the skin and reduce dryness.
Regressive stage
- concentrated exfoliating ointments;
- emollients to restore the skin and reduce dryness.
Cream for psoriasis
Creams and ointments for psoriasis have different purposes and are used at different stages of the disease. Hormonal anti-inflammatory ointments and creams are used to stop inflammatory processes in the skin. There are several classes of hormonal drugs. They have different absorption capacities and different activities. When used on children, they try to avoid the application of hormonal drugs to the face and neck, the area of the skin folds - places where the skin is thinner. Local preparations based on calcipotriol (a derivative of vitamin D) also have an inflammatory effect. This is a later generation of drugs. They are not currently used during pregnancy and lactation.
Salicylic ointment and salicylic acid lotion are designed to remove flakes from the skin with severe flaking. Salicylic acid not only has an exfoliating effect, but also increases the effectiveness of local hormonal medications. In the stationary and regressive stage, when inflammation becomes less active, agents based on salicylic acid are used in greater concentration.
Means to restore the structure of the skin and eliminate dryness are used throughout the treatment period, as well as in conjunction with ultraviolet irradiation to reduce itchy skin. Once the seizures subside, these products help maintain the skin's protective properties and reduce the risk of new rashes.
An effective cream for psoriasis
The modern approach to care and assistance for dry skin is based on saturation of the epidermis with moisture and is called corneotherapy (derived from "cornea" - corneal layer, or cornea, of the epidermis).
Corneotherapy aims to restore the stratum corneum of the epidermis and its protective functions, which allows to improve the condition of the skin as a whole. The work of corneotherapy founder Albert Kligman allowed the creation of special means - emollients.
How do emollients work?
within 1 hour after applying the emollients: - the condition of the skin improves, due to the fact that the emollients "trap" the moisture in it.
6 hours after application of emollients: - the structure of the skin is restored due to the content of special natural restorative lipids (ceramides and other useful fats).
24 hours after application of emollients: - the clinical improvement of the condition of the skin occurs due to the penetration of moisturizing components in the deep layers of the epidermis and restoration of the superficial layers of the skin (up to 24 hours from the beginning of the application).