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

For over two thousand years, humanity has tried to solve all the puzzles of this serious acne, but much remains unknown. According to statistics, this disease affects 4 to 7% of the population, women and men are equally susceptible to it. The first signs of psoriasis usually appear during puberty and accompany the person for the rest of his life, then 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 capable of providing 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 calls autoimmune (associated with allergy to the tissues themselves). The causes of psoriasis and the factors that predispose to the development of this dermatosis are numerous, which raises several theories about its origin.

Autoimmune

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

Cellular immunity is compromised: the ratio between individual subtypes of lymphocytes responsible for the formation of a normal immune response. Thus, in psoriasis, the number of helper T lymphocytes increases - helpers that regulate immunity, while the number of suppressor T lymphocytes, suppressing 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 appear to the tissues of the patient's body.

Inflammation begins in the context of activation of T lymphocytes, but it has not been established why they are activated. Also in the research process is 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 help in the inflammatory response. Metabolism is disturbed:

• protein- the CDSN predisposition gene stimulates the synthesis of the corneodesmosin protein, which sensitizes (allergens) the body; the protein content of albumin in the blood decreases and the content of globulins increases; this condition is called dysproteinemia and further raises awareness;
• little fat- the content of lipids and cholesterol in the blood increases; the use of predominantly vegetable foods and a general decrease in the caloric 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.

Infectious

This theory was relevant in the beginning and in the middle of the last century. Certain bacteria (streptococci), fungi and viruses have been found 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 cause relapse. Viral theory holds a special place. Recent studies have revealed the effect of retroviruses (viruses containing RNA - HIV, etc. ) on the genetic apparatus with the formation of genes for psoriatic predisposition.

Genetic

The predisposition to autoimmune reactions is hereditary. If a person's loved ones suffer from psoriasis, the likelihood of developing this disease increases many times. There are genes for susceptibility to psoriasis (local complexes PSORS1 - PSORS9, PSORS1 is especially active, contains the genes HLA-C, HLA-Cw6, CCHCR1 and CDSN, responsible for the development of the disease). Genes affect metabolism, immunity and the development of autoimmune processes. But the presence of such genes in no way guarantees the development of the disease. The influence of provocative factors is of great importance.

Neurogenic

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

Endocrine

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

Psoriasis symptoms

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

The disease begins with a feeling of constant fatigue, mood disturbance. Characterized by small pink formations (papules) rising above the surface, sprayed from above with whitish flaking. They are surrounded by a brighter and higher edge.

Elements of the eruption grow and combine into large plates of bizarre shapes. The base of the wheal is an inflammatory infiltrate. By the nature of the rash, psoriasis is divided into:

• to point- elements with a diameter not exceeding 1 mm;
• teardrop- papules-drops of up to 2 mm;
• coin shaped- round coin papules up to 5 mm in size.

Rash features:

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

Stages of psoriasis

There are three stages of the disease:

1. progressive- the first elements of the eruption appear, their number increases, all new areas are captured; skin rashes also appear when scratching the itchy skin or exposure to some external irritating factors (Kebner phenomenon); in the early stage of psoriasis, the papules begin to fuse into large plaques;
2. stationary- there are no new elements and those that appeared before do not regress;
3. regressive- the rash turns pale, its base becomes less dense; the rash gradually regresses, the process usually begins in the central part, so that 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 pseudo-atrophic border; where there was a rash, white and pigmented areas remained - psoriatic leukoderma.

Occasionally, papules are simultaneously present on the skin in all three stages of development. There are also forms of summer and winter 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 participate in its development, then only through a general effect on metabolism, immunity and the genetic apparatus.

Patients often ask:

• How is psoriasis transmitted?

  Psoriasis is not spread from person to person.

• Is psoriasis hereditary?

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

Types of psoriasis

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

Simple (ordinary, plate)

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

• easy- if the lesion does not cover more than 3% of the skin; in the progressive phase, the papules increase, but soon undergo a reverse development;
• moderate- the rash varies from 3 to 10%; the papules are large, they merge into plates;
• heavy- defeat captures more than 10%; skin rashes are numerous, they fuse, forming a wide variety of shapes.

Psoriasis vulgaris evolves in the form of relapses, alternating with remissions, but it also has a continuous course.

Elbow psoriasis

This is one of the manifestations of a mild form of plaque inflammation. A distinguishing feature of psoriasis on the elbows is the constant presence of one or more "plantar" 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. The inflammation starts after an infection. Streptococci secrete toxins (antigens - substances foreign to the human body) that bind to tissue proteins. Antibodies are produced against them and autoimmune inflammation develops.

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

Psoriasis quickly takes on a subacute and chronic course. Relapses are replaced by remissions, making it possible to recover independently or transition to the adult form of the disease.

Palmar-plantar psoriasis

It develops in those who do physical work, is accompanied by intense itching and almost always causes complications in the nails. There are subspecies:

• fan shaped plate- with large elements on the palmar and plantar surfaces, covered by white scales, merging into fan-shaped plates; this psoriasis on the hands is more common;
• Circular- scaly ring-shaped elements on the palmar and plantar surfaces;
• horny- characterized by the growth of thick epithelium with callus formation;

A separate subspecies is pustular psoriasis on Barber's palms and soles. The areas under the thumbs of the extremities are covered by vesicles and pustules (with purulent content), with intense itching. Abscesses fuse and then dry, forming crusts. In other parts of the body, characteristic psoriatic elements develop. The disease usually spreads to the nails.

Psoriasis in the legs is maintained and aggravated by varicose veins, in which case the rash will occur mainly on the lower leg.

Nail psoriasis

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

• small dimples of different depths appear in the nail plate; similar nail lesions are found in other dermatitis, but in psoriatic lesions they are deeper and slightly painful when pressed;
• painless, slow and spontaneous separation of the nail (onycholysis);
• subungual bleeding on the toenails, especially if the patient wears tight shoes;
• trachyonychia - turbidity and irregularities in the nail plate; a depression is formed in the middle of the nail and the nail becomes like a spoon (koilonychia).

Sometimes, the periungual roller is affected with the transition from inflammation to other tissues (psoriatic paronychia).

Scalp psoriasis

Here, the disease proceeds independently or as part of a general pathological process. It is characterized by exudation, the formation of crusts on parts or on the entire surface of the head. Hair growth is not affected at the same time: psoriasis on the head does not impair the function of the hair roots. But the secretion creates a threat of infection with subsequent damage to the hair follicles.

It flows in waves, then decreasing with the disappearance of the crusts, then again getting worse and accompanied by intense itching, often leading patients to neurosis.

Seborrheic psoriasis

Seborrhea is a disease caused by a malfunction of the sebum-producing skin glands. A viscous oil is produced that irritates the skin and contributes to the development of inflammation - dermatitis.

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

Psoriasis on the face

Usually, psoriasis on the face is located in the area of the nasolabial triangle, on the 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 usually accompanied by crying, the formation of crusts and an increased risk of infection.

Psoriasis on the genitals

This is not an isolated process. Simultaneously with the defeat of Organs genitals, characteristic psoriatic eruptions appear throughout the body, so it is not difficult to identify the disease.

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

Atypical psoriatic skin rashes can be seen in obese people in folds located close to the genitals (inguinal, intergluteal). Here, areas of intense red color with a mirrored surface are formed without signs of flaking due to constant wetting.

What is the danger of psoriasis and if it needs to be treated

The danger is that psoriasis can take on a generalized severe form, skin rashes will occupy more than 10% of the skin. This stage of the disease is difficult, relapses, the elements of the rash are injured and get wet, an infection often joins. Only with time can the prescribed treatment for psoriasis interrupt the process of its spread.

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

In the context 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 arthrosis, Crohn's disease, etc. ), as well as severe cardiovascular pathology, systemic diseasesdigestive, neurological reactions.

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

There is also a complication such as psoriatic erythroderma, which develops with inadequate 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 delimitation of the affected areas since the healthy ones, small and large lamellar peeling. This patient requires emergency medical attention.

Is psoriasis treated?

Yes, and quite successfully, but complete recovery cannot be guaranteed.

Treatment methods

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

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

Nutrition for psoriasis

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

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

Pegan diet for psoriasis

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

• alkali builders (two thirds of the daily diet) - non-acidic fruits and mixtures and juices of red fruits, vegetables (exclude those that cause an increase in gas formation);
• acid builders (one third of the diet) - meat, fish, dairy, beans, peas, potatoes, cereals, sweets and cakes.

Patients are advised to drink still mineral water, drink water up to 1. 5 liters per day, in addition to other liquids consumed (jams, juices, etc. )

Drug therapy

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

Treatment of external psoriasis

The medicine is selected by a dermatologist. For psoriasis vulgaris with dry constrictive plaques, ointments are suitable; if there is secretion (with seborrhea), then creams and medicinal solutions are used. To avoid the resistance (resistance) of the organism to a certain medication, it is changed over time.

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

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

External treatment of psoriasis in the stationary phase:

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

External treatment of psoriasis in the resolution phase:

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

For the treatment of nail psoriasis, special varnishes are used that suppress the development of the pathological process. It is recommended to treat 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 proliferation processes (multiplication of epithelial cells) - cytostatics that suppress the activity of the immune system, vitamin A analogues, corticosteroid hormones;
• biological agents containing human monoclonal antibodies of the IgG class, acting on certain inflammation bonds suppressing the synthesis of cytokines; it is a very effective modern drug, administered by injection;
• vitamins for psoriasis help to restore the metabolism and keratinization of epithelial cells; doctors prescribe vitamins A, E, D3, group B.

Folk remedies for psoriasis

Any treatment for psoriasis, including 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:

• grease- product from the processing of industrial oils; to prepare the ointment, you need to buy a solid medical oil at the pharmacy; recipe: in 0, 5 kg of solid oil, add 50 g of honey and half a pack of baby cream; the procedures are performed daily; at the pharmacy, you can buy ready-made solidol-based preparations.
• sodium bicarbonate- a folk remedy for psoriasis, which helps to clean scabs, relieves itching; recipe for soda applications: take 60 g of soda, dissolve in 0. 5 liters of water, wet a gauze cloth in the solution, fold in several layers and apply the lesion for 20 minutes; after the procedure, dry the skin and apply any emollient ointment; the treatment of psoriasis with soda is carried out once a day;
• Mommy- 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 performed with a mummy solution; it is applied to dry plaques that itch twice a day; the treatment of psoriasis on the head is carried out by rinsing the scalp with a mummy solution after washing;
• sea salt- relieves inflammation, itching well; baths with sea salt: take 1 kg of salt, dilute in two liters of water and add to the bath; bathe for 15 minutes, then rinse the solution in a hot bath, wipe the body with a towel and apply an emollient ointment; treat psoriasis with baths at most twice a week;
• clay- has a pronounced cleaning effect, adsorbing toxins formed on its surface as a result of inflammation and inadequate metabolism; helps to dry, eliminate crusts and itching, it can take any clay, but it is better to buy blue clay at the pharmacy; the clay pieces must be very dry, broken with a hammer, diluted in water and left to rest for several hours; place the resulting plate-shaped clay on a napkin (up to 3 cm thick) and apply to the spots of inflammation for three hours; to treat psoriasis with clay on alternate days.

Important: the treatment of psoriasis at home with home remedies should be done with caution and strictly according to the doctor's prescription. This treatment will help one patient, while in another it can cause an exacerbation and rapid spread of inflammation. Therefore, if, in the context of therapy, the patient's condition has worsened, it is necessary to stop 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, exclude bad habits and strictly follow all the dermatologist's prescriptions.

How to cure psoriasis at home? Some patients try to clear 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 stopped and an exacerbation will start. Modern medicine recognizes cleansing the body in the form of proper nutrition and getting rid of bad habits.

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