Psoriasis

According to WHO, currently 2 to 4% of the world population suffers from psoriasis. This disease affects patients of all ages, but mostly young (15-25 years). Unfortunately, medicine today is not able to completely cure psoriasis, but timely professional treatment significantly improves the quality of life. Therefore, in case of detection of the first symptoms, it is better to consult a doctor immediately.

Psoriasis- It is a dermatosis that manifests itself in the form of scaly papules on the skin. Its differential 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 identified and other irritants are only secondary causes of their occurrence.

During an exacerbation of the disease, the natural processes of formation are disrupted - keratinocytes (cells which mainly consist of human skin). There are also pronounced biochemical changes in the skin. In addition, doctors have recently been able to establish that, during the acute phase of the disease, the functioning of the nervous system also differs from normal. In general, the main reason for the appearance of psoriasis is the presence of dysfunctions in the functioning of the immune system.

Prevalence of psoriasis

Psoriasis is common. At the moment, the incidence statistics are approximately as follows:

• China - 0. 3%;
• USA - 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 none of these cases have been reported so far. If you look at the whole situation, then the proportion of psoriasis is approximately 6 to 8% of all skin diseases.

As already noted, psoriasis manifests itself at any age, but most of the time young people (up to 25 years old) still suffer, and in men and women it occurs with the same frequency.

Epidemiological situation

Based on the causes of occurrence, psoriasis is a non-infectious disease with a pronounced genetic predisposition. Those most at risk of becoming ill are people whose relatives also suffer from this disease (in this case, they only refer to the closest relatives). European researchers have established with certainty that if one of the parents is sick, he has a 14-25% chance of passing it on to his child. If both parents are sick, this probability is already 41-60%.

According to the type of disease development, psoriasis is divided into two groups:

• early;
• evening.

This is evidence that there are two main types of psoriasis (like 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 usually severe and, over time, the disease only progresses.

The causes of type II psoriasis are quite random, so this disease is sporadic. It occurs more often in older people (around 60 years of age). It usually occurs quite easily, but in some cases it can be aggravated by joint and nail damage.

Factors that cause the appearance of psoriasis

Although psoriasis tends to be hereditary, it is usually multifactorial. Anything can trigger this fatal immune system malfunction. Thus, the triggering factors are divided into external and internal (or, in scientific terms, exogenous and endogenous).

exogenous factors

They, in turn, are divided into physical and chemical. The former include the usual mechanical damage to the skin, such as domestic wounds, thermal burns, abrasions, scars, tattoos, scratches, insect bites and pets. Cases of psoriasis at the injection sites were also recorded. X-rays and ultraviolet irradiation also play a significant role. In about 5% of cases, the disease occurs in 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 conditions, such as:

• dermatoses;
• fungal infections;
• contagious impetigo;
• acne;
• dyshidrosis;
• lichen;
• herpes zoster;
• gangrenous pyoderma;
• allergic dermatitis of various natures.

Cases of the disease are known after performing elementary skin diagnostic tests to check the body's reaction to cosmetics, hygiene products, formalin, chromium, nickel and other chemical products.

endogenous factors

The internal causes of psoriasis can be infectious diseases. The latest research in this area suggests that streptococcal infections and HIV are the most likely culprits. Furthermore, symptoms often do not appear during the illness itself, but even after the usual vaccination. In these cases, psoriasis is often difficult to treat.

To induce remission, lithium preparations, beta-blockers, nonsteroidal anti-inflammatory drugs and ACE inhibitors are used. Corticosteroids are contraindicated in this case.

Pregnancy and childbirth

Significant changes in hormone levels caused by pregnancy can also become a triggering factor. A similar pattern is also seen during puberty. It is also interesting that women who already have psoriasis may experience an improvement in their condition during pregnancy (40%). Deterioration is much less common (in just 14% of cases). It is true that after childbirth, in most patients, the condition worsens again (in 54% of cases)

diet and nutrition

These factors usually do not have a noticeable effect on the course of the disease. It is only known with certainty that the heavy consumption of alcohol and cigarettes significantly increases the chance of contracting psoriasis and worsens its course.

Hypocalcemia and hypokalemia

These factors can lead to the appearance of generalized pustular psoriasis. The chances of a favorable outcome in this case are very small.

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Pustular psoriasis.

Psychogenic factors

His role today is considered quite controversial. Some researchers claim that the presence of traumatic psychogenic factors causes psoriasis in 60% of cases. However, it is only known with certainty that they can only worsen the course of the disease and reduce the effectiveness of therapy.

Classification

At present, several distinct types of psoriasis have been identified. They differ markedly in clinical picture and degree of effect on the body, so to get an idea of what is at stake it is best to look at the World Wide Web and carefully study the pictures of psoriasis of various aetiologies, as well as familiarize yourself with the description.

psoriasis vulgaris

Psoriasis vulgaris or common occurs in most cases. This disease manifests as an abundant eruption of small, bright red papules (from a match head to a pea). Upon emergence, they grow rapidly and silvery-white scales appear on their surface. In the future, the papules are transformed into plaques, which fuse into a large lesion. They often have clear boundaries that separate them from healthy skin.

When you try to comb or remove the wheal, the scaling first increases. This phenomenon is known as the "stearin spot symptom" and once all scales have been removed, a smooth, shiny surface, the "terminal film symptom", can be found. If you continue to shave, the capillaries are damaged and blood drops are released. This symptom is known as "blood dew".

The development of psoriasis is divided into three main periods:

• progressive (acute);
• stationary;
• resolution period.

The success of the treatment here depends, above all, on how correctly the therapy methods are selected, as, depending on the period, their effectiveness varies significantly.

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Progressive period. A feature of this stage is the abundant appearance of a specific rash. In the exacerbation phase, certain parts of the patient's body are covered with small papules, which actively detach. The peeling, in this case, is strictly localized and does not affect healthy skin. Acute psoriasis is easy to identify by the characteristic red or pink border that borders 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 (small burns, scratches, injections, scratches, 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 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 eruptions, the formation of new papules stops. Plate growth also stops. At this stage, its entire surface is already covered by scales. This period can last for months or even years. However, the latter is relatively rare.

Resolution Period. This period is also called the regressive period, since during it there is a gradual decrease in plaque. At first they stop peeling and then they gradually smooth it out until they completely disappear. If the disease is mild, this phenomenon occurs spontaneously. Treatment only speeds up its onset. Often, the site where the plaques were located stands out against the background of areas of healthy skin by depigmentation or, less frequently, by hyperpigmentation. In psoriasis vulgaris, rashes can occur almost anywhere and are usually located symmetrically (extension surfaces of the elbows and knees). It can also appear on the head, sacrum, hands, palms, soles, groin and armpits. In addition, in many cases, the nail plates are also affected (appearance of pits, loosening, thickening). These symptoms are very similar to those that occur when there is yeast infection, so the final diagnosis is only made after receiving a negative reaction to the fungus spores in a special laboratory study. Psoriasis vulgaris as a whole does not have an overall negative effect on the patient's body and its course is chronic. Periods of exacerbation occur in autumn or winter, while in summer exacerbations are much less common. The main incentive for active treatment lies in the fact that, without proper therapy, psoriatic plaques can cover the body for years, whereas 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 seen in about 2% of patients and occurs either spontaneously or as a result of improperly selected treatment. Although, of course, if the medications used irritate the skin or it is exposed to ultraviolet radiation, the risk of psoriatic erythroderma is much greater. 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 streptococcal infections or hypocalcemia significantly increases the likelihood of such a complication. Abrupt withdrawal of corticosteroids can also worsen the condition. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by diffuse redness of the skin, intense itching and lamellar desquamation.

pustular psoriasis

It is also a serious form of psoriasis. It is characterized by the appearance of abscesses, which often remain the only symptom. Much less often, they are combined with the classic symptoms of psoriasis vulgaris. Pustular psoriasis is generalized and localized. The second differs only because the abscesses in this case are concentrated only in the area of the palms or soles.

psoriatic arthritis

Currently, psoriatic arthritis is classified as an autoimmune disease in its own right. It is expressed in damage to bones and muscles in patients who are already suffering from psoriasis or are at high risk of the disease due to family history. Very often, psoriatic arthritis is associated with classic psoriasis as well as psoriatic nail lesions. This disease is diagnosed by the occurrence of back pain, accompanied by the following conditions:

• lack of a clearly indicated reason for the appearance;
• the patient's age is over 40;
• deep uncaused pain in the lower back or buttocks;
• indistinct location of pain;
• pain reduction after exercise;
• pain or stiffness is felt in the early morning or evening;
• the presence of pain with an excellent general state of the musculoskeletal system.

Nail plate psoriasis

Psoriasis vulgaris is often accompanied by nail injuries. In this case, its marked dystrophy is observed, as well as characteristic symptoms of fungal infections. It is a frequent companion of psoriatic arthritis. Considering that about 4% of the world's population suffer from common psoriasis, 30-50% of them also have nail psoriasis.

psoriasis treatment

Unfortunately, currently, medicine is not yet able to cure psoriasis, as this requires a much deeper knowledge of the peculiarities of how the basic mechanisms of the human immune system function. Since this type of research is progressing very slowly and the disease itself does not pose a specific threat to life, symptomatic therapy is currently the priority. Before starting treatment, the patient needs a thorough examination, as each organism contains an individual set of factors that influence the course of the disease. Gender, age, occupation, general health, type of psoriasis - all of these must be taken into account when prescribing therapeutic therapy. An important role is also played by establishing the nature of the disease course, individual drug susceptibility, and the current stage of the disease.

General activities

First, the doctor needs to determine the patient's mental and physical state, assess the general state of his body, and find out how tolerant he is to the disease. The best prerequisites for effective treatment are a good rest, remaining in a calm environment, switching to a less intensive work mode, or a short hospital stay. Various methods of psychotherapy (rehabilitation in bathing resorts with the use of cognitive-behavioral therapy, etc. ) have also shown themselves very well. It is also very important for the patient to know that the healing process is proceeding as it should, because without a quick effect, around 40% of patients lose faith in the effectiveness of the therapy and start to ignore it. It is important to remember that psoriasis is a chronic disease, so the safety of therapy must be taken into account. Many drugs are toxic and can build up in the body, turning into a time bomb. An addictive effect is also possible, so it's best to keep the most potent drugs until the really dangerous symptoms appear.

Disease course and long-term prognosis

The course of psoriasis is often unpredictable. Modern doctors have barely achieved this, so as before, psoriasis remains an unpleasant and uncontrollable disease. In each case, the procedure is completely individualized, so that any attempt to predict the course of the disease, as well as the duration of the exacerbation and remission phases, is doomed to early failure. Only one thing pleases - despite the difficulty of the 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 patients' quality of life, compared to the latter, is very insignificant. Statistics show that, with proper treatment, most patients with psoriatic arthritis remain functional and can lead full lives. If necessary therapy is absent, or the disease progresses with complications, joint deformities can develop with the development of severe pathologies. However, these complications are only found in a very small number of patients with psoriasis. Most patients can count on the gradual stabilization of the condition and the appearance 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. An effective treatment for psoriasis can now be obtained in any major city. And although, as you know, ultimate recovery cannot be achieved, diet, medications, and special procedures will do their job quickly. Also, you will not need long-term treatment in a hospital. The doctor's job is simply to get around the first two stages of psoriasis quickly and bring the person into remission. After that, the patient can only take care of himself, follow instructions and forget about the disease for a long time.