Psoriasis: causes, symptoms, diagnosis and treatment.
Psoriasis is a chronic non-communicable disease that can affect several organs: skin, joints, heart, kidneys.
Most often, mild psoriasis appears on the skin as well-defined reddish-pink papules (nodules that rise above the surface of the skin), which merge into plaques with silvery-white scales.
In moderate and severe forms of the disease, the inflammatory process leads to damage to the musculoskeletal system and cardiovascular system. Psoriasis has a relapsing course (recurrence of symptoms after complete or partial recovery) and a tendency to cause comorbidities that impair patients' quality of life.
Causes of psoriasis
The disease can be based on several triggers. However, it is not yet known exactly which of them are primary and which are secondary. Immune system dysfunction is considered the main cause that explains the occurrence of psoriasis. Cells meant to destroy disease-causing agents begin to attack their own cells (especially the skin). As a result, an inflammatory process develops, which causes accelerated cell division of the epidermis (epidermal hyperplasia) and the formation of psoriatic papules and plaques.
An inadequate immune response is most often due to genetic traits.
Psoriasis is often inherited.
Currently, more than 40 chromosomal regions associated with the risk of developing psoriasis have been identified. The onset of the disease can be caused by a weakening of the immune system against the background of stress, infectious and endocrine diseases. Psoriasis often accompanies allergic and immunodeficiency conditions, which are based on a violation of the immune response. In addition, psoriasis can be triggered by certain medications (antidepressants, beta-blockers, non-steroidal anti-inflammatory drugs).
Psoriasis classification
Depending on the location of the pathological process, several types of psoriasis are distinguished. The most common is vulgar, orcommon psoriasiswhen well-defined pink papules appear on the skin, which merge into plates covered with silvery-white scales. In case of damage to the scalp (seborrheic psoriasis) eruptions in the form of yellowish scales may descend on the forehead, forming a seborrheic "crown". In patients with metabolic disorders, plaques may present with exudate, a fluid secreted during inflammatory processes. exudative psoriasis). In childhood and adolescence, especially after streptococcal infections, the disease can become acute, with many bright red teardrop-shaped papules appearing on the skin with mild scaling and infiltration.guttate psoriasis). Sometimes there is pustular psoriasis, which is characterized by the appearance of pustules deep in the reddened skin, most often on the arch of the feet or the palms of the hands.psoriatic erythrodermacan occur against the background of exacerbation of common psoriasis under the influence of provoking factors. Dry white scales cover the skin, it becomes bright red, swollen and hot to the touch. run a lotgeneralized Zumbusch psoriasis. It is characterized by the fact that small purulent vesicles appear on the reddened skin, which, when merging, form "purulent lakes".psoriatic arthritisaccompanied by joint damage and develops simultaneously with or precedes rashes.
Symptoms of Psoriasis
The cutaneous form of psoriasis is accompanied by the appearance of bright pink dotted papules, sometimes in the form of droplets. Fusing together, they form plates covered in silvery-white scales.
The rashes are located on the extensor surfaces of the arms and knee joints, the scalp, the lower back, and the sacrum.
The top layer of plaques is formed by scales that are easily removed from the dead epidermis. Initially, they occupy the center of the plate, and then fill its entire area. When the scales are removed, a bright red surface is revealed. Sometimes the plaque is surrounded by a pink border - a zone of further growth, while the surrounding skin does not change. The rash is accompanied by intense itching. With psoriatic erythroderma, patients develop fever (fever with chills) and severe itching against the background of rashes all over the skin and enlarged lymph nodes.
With a long course of the disease, hair and nails can fall out.
Generalized Zumbusch psoriasis is very difficult. Purulent eruptions cover the entire skin and are accompanied by severe fever and intoxication. Psoriatic joint damage is characterized by pain and redness of the skin over joint surfaces. Any movement is difficult, inflammation of the ligaments and tendons develops. With psoriasis, nail plates are often affected, while pinpoint depressions appear on the surface of the nail (a "thimble" symptom).
Small, reddish, yellowish-brown spots appear under the nail plate at the base ("oil stain"). Dystrophic changes in nails and hair often develop.
In children, especially babies, the symptoms of psoriasis have their own specifics.
In the area of redness that occurs in the skin folds, effusion and slight peeling of the upper layer of the epidermis may occur. This image resembles diaper rash or candidiasis. Sometimes, rashes appear on the skin of the face or in the genital area.
Psoriasis diagnosis
It is possible to identify the disease based on the symptoms of the psoriatic triad (white stearic surface of the papule; bright reddish film after the scales peel off and blood protrusion after their removal).
An additional feature is the Koebner phenomenon. It lies in the fact that in the area of skin irritation, after 7-12 days, erythematous and scaly rashes appear (areas of redness and peeling in the area of scratches, scratches). Sometimes, to confirm the diagnosis, a histological examination of a biopsy of the affected skin area is performed. In addition, a clinical and laboratory examination is required: a clinical blood test, a biochemical blood test (total protein, protein fractions, C-reactive protein, ALT, AST, LDH, creatinine, electrolytes: potassium, sodium, chlorine, calcium ).
Which doctors to contact
If rashes appear, which often occur against the background of infectious diseases, skin injuries, stress, you should consult a therapist or dermatologist. In case of systemic damage to the patient's body, he can be referred to an ophthalmologist, endocrinologist, gynecologist or other specialists.
Treatment
Psoriasis affects both the skin and the musculoskeletal system, as well as the internal organs. When the rash appears only on the skin, local preparations of glucocorticosteroids, ointments containing synthetic analogues of vitamin D3, activated zinc, salicylic acid and other components are recommended. Hormone creams should be used with caution on atrophy-prone skin.
It is necessary to take into account the possibility of hormonal disorders with prolonged use of steroid creams.
The effectiveness of hormonal creams is increased in combination with salicylic acid, analogues of vitamin D. For the treatment of severe forms of psoriasis, second-generation aromatic retinoids, based on acitretin, are used. The drug slows down the proliferation of epidermal cells, normalizes the process of keratinization and has an immunomodulatory effect. Phototherapy (medium wave UV therapy and PUVA) in combination with retinoids is also recommended. As systemic therapy, the physician may prescribe immunosuppressive agents. If necessary, prescribe detoxification and desensitization therapy, plasmapheresis.
Complications of psoriasis
In 10% of patients, psoriatic arthritis develops, affecting the spine, joints of the arms and legs. Patients suffer from joint pain and morning stiffness. Features of psoriatic arthritis include asymmetry of the sites of its manifestation, which can be combined with nail damage. Psoriasis is often accompanied by concomitant or comorbid conditions.
Due to inflammatory vascular lesions, the risk of coronary heart disease and stroke increases.
It is also possible to develop diabetes and Crohn's disease. In some cases, complications from psoriasis can lead to disability.
Psoriasis prevention
Psoriasis prevention measures are mainly aimed at strengthening the immune system. Skin care should include hydration and nutrition. With a predisposition to allergies, it is necessary to control nutrition, avoiding fatty and spicy foods, excessive consumption of carbohydrates, potatoes. A mandatory component of psoriasis prevention should be vitamin therapy.
In addition, the functioning of the immune system largely depends on the state of the nervous system. People who are hyper-responsible, have a busy work schedule, and experience constant negative psycho-emotional impact are more prone to autoimmune diseases, including psoriasis. Therefore, psoriasis prevention, along with physical healing measures (abandonment of bad habits, physical activity), should also provide psycho-emotional comfort.
IMPORTANT!
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For proper diagnosis and treatment, you should contact your doctor.