For many centuries, humanity has tried to unravel all the secrets of this mysterious skin disease, but much remains unknown. According to statistics, psoriasis affects 4 to 7 percent of the population, and men and women are equally susceptible to it. Normally, the first signs of psoriasis appear during puberty and can accompany a person throughout their life, sometimes decreasing and disappearing, sometimes increasing in strength.
Causes and risk factors for psoriasis
Psoriasisis a long-lasting inflammatory process of the skin, considered an autoimmune disease (associated with an allergic response to its tissues). This is a chronic skin disease that affects the cells in the outer layer of the epidermis. The condition usually appears as red and silvery scaly skin on the feet, knees, back, chest, etc. In most cases, psoriasis starts in small areas of the skin, which can then spread over large areas of the body. There are many causes and risk factors that can contribute to the development of this disease, and there are several theories to explain its occurrence.
Autoimmune cause
Some studies suggest that psoriasis may occur due to a combination of genetic and environmental factors, such as infections, trauma, stress, and certain medications. These factors can trigger a reaction from the immune system, which starts to fight the body's tissues, including the skin.
However, the processes underlying psoriasis are not yet fully understood. It is important to highlight that psoriasis is a multiple disease that manifests itself differently in each patient. Studying the mechanisms underlying psoriasis can help develop more effective treatments, reduce the risk of complications, and improve patients' quality of life.
Impact of metabolism
Metabolic disorders significantly affect the skin condition and immunity in patients with psoriasis. Increased metabolism leads to the formation of toxins and free radicals, which contribute to inflammatory reactions. There is an imbalance in several metabolisms.
- With disturbances in protein metabolism in patients with psoriasis, the albumin content in the blood decreases and the content of globulins increases, which increases its sensitization.
- In fat metabolism, an increase in the content of lipids and cholesterol in the blood is observed.
- Reducing calories and eating plant-based foods can reduce the activity of psoriatic inflammation.
- Disturbances in carbohydrate metabolism almost always occur.
- The metabolism of vitamins and minerals is also impaired, which is manifested by a decrease in the content of vitamins C, A, B6, B12, iron, copper and zinc in the blood, but by an increase in the content of vitamin C.
Infectious cause
This theory was widespread in the last century. It was believed that psoriasis could be caused by certain bacteria (streptococci), fungi and viruses, but these hypotheses have not been scientifically confirmed. However, dermatologists point out that any acute infectious process or chronic infection can cause psoriasis to recur. Particular attention is paid to viral theory. Recent research shows that RNA viruses, such as HIV and other retroviruses, can influence the genetic apparatus and cause the appearance of genes that predispose to the development of psoriasis.
Genetic predisposition
Inheriting a predisposition to autoimmune reactions is a risk factor for psoriasis. If a person's close relatives suffer from this disease, the likelihood of developing it increases. Several genes may be associated with psoriasis, including the PSORS1-PSORS9 complexes, with PSORS1 being considered particularly active. It contains the HLA-C, HLA-Cw6, CCHCR1 and CDSN genes, which may contribute to the development of the disease. Genes influence metabolism, immunity and the development of autoimmune processes. However, the presence of these genes does not mean that a person will necessarily develop psoriasis. The development of the disease can be caused by other factors.
Neurogenic cause
Excessive nervous system stress, prolonged stress, and imbalance of the autonomic nervous system, which provides innervation to blood vessels and internal organs, can be risk factors for developing psoriasis. These factors can cause imbalance in the endocrine system, changes in metabolic processes and disturbances in the immune response, increased irritability or depression, constant fatigue, drowsiness and apathy, which in turn can lead to psoriasis.
Endocrine
Endocrine disorders that occur with psoriasis are quite common and can have a significant impact on the development of the disease. However, the link between them and psoriasis is not entirely clear and has not been proven. Experts believe that psoriasis patients often suffer from dysfunction of the thyroid gland, pituitary gland, and adrenal glands. Women may have problems with their menstrual cycle and men with sexual function.
Symptoms and characteristics of psoriasis
Psoriasis is manifested not only by rashes, but also by other symptoms. It often begins in childhood or adolescence and is associated with hormonal disorders, vegetative-vascular dystonia and stress.
The first signs arefatigueANDchange of mood. The main symptom is small pink bumps on the skin called papules, covered with whitish scales. The papules are surrounded by a brighter border.
Over time, the elements of the rash can combine into large, unusually shaped plaques. The base of each papule isinflammatory infiltrate. The following types of rash are distinguished:
- pinpoint (no more than 1 mm in diameter);
- teardrop-shaped – (droplet papules up to 2 mm in size);
- coin-shaped – (round coin-papules measuring up to 5 mm).
The rash also has its own characteristics:
- stearic stain - if you scrape the surface of the papule;
- terminal film - after cleaning the papules from scales, you can see a transparent film;
- bloody dew (Auspitz phenomenon) – if the integrity of the film is damaged, small drops of blood may appear.
Is psoriasis contagious?
Many people believe that psoriasis is contagious, so they try to avoid contact with people who suffer from it. This can make the patient want to withdraw from others and lead to serious psychological problems. However, studies have shown that psoriasis is not transmitted through contact with the patient. If all family members suffer from this disease, this only indicates the presence of a genetic factor in the development of pathology.
Classification and stages of development of psoriasis
At the moment, there are three main phases in the development of psoriasis:
- Progressive stage, characterized by the constant formation of new skin rashes, accompanied by intense itching.
- The stationary stage, in which new formations stop appearing and existing ones begin to heal.
- A regressive stage in which borders appear around the rash and the skin affected by the rash becomes darker due to increased pigmentation.
Furthermore, there are varying degrees of severity of the pathology:
- Mild degree, when no more than 3% of the skin surface is affected.
- Medium degree, characterized by 3-10% damage to the skin.
- Severe degree, in which the disease affects more than 10%.
Types of psoriasis
Psoriasisis a chronic skin disease that can manifest itself in different ways. Rashes, their location and damage to other systems and organs can be different. Depending on these characteristics, several forms of psoriasis are distinguished.
Simple (common, plate)
Plaque psoriasis is the most common form of this disease. Its symptoms include the appearance of bright pink papules covered by white scales.
Elbow psoriasis
This is a typical manifestation of mild plaque psoriasis. A characteristic feature of psoriasis on the elbows is the presence of one or more permanent "duty" plaques on the extensor side of the elbow joints. If these elements are exposed to trauma, an exacerbation occurs.
Guttate psoriasis
Associated with bacterial (most often streptococcal) and viral infections, this type of psoriasis can cause inflammation. This condition often occurs in children and begins with the appearance of small, teardrop-shaped red papules on the skin of the limbs, body, or face. The papules have a scaly surface and can develop into erosions and ulcers, increasing the risk of infection.
This condition can evolve quickly or gradually become chronic, followed by periods of exacerbation and attenuation of symptoms. In rare cases, psoriasis can be more serious.
Palmoplantar psoriasis
This type of psoriasis usually develops in people involved in manual labor and is often accompanied by severe itching and can cause nail complications. Various subtypes of this type of psoriasis include:
- Fan-shaped plate: large elements on the palmar and plantar surfaces with white scales that merge into fan-shaped plates. This subtype is most often found on the hands.
- Circular: ring-shaped scaly elements on the palmar and plantar surfaces.
- Callosus: growth of rough epithelium with the formation of calluses.
- Pustular: This is a distinct subtype of barbershop psoriasis on the palms and soles of the feet. In the areas located under the big toes, blisters and pustules containing pus appear, which cause intense itching. The ulcers merge, then dry and form scabs. Elements characteristic of psoriasis also appear on other parts of the body.
Psoriasis on the legs may be associated with varicose veins and appears mainly on the lower part of the legs.
Nail psoriasis
It may occur as a separate disease or as a complication of another type of psoriasis. The main symptom is small dimples on the nail plate, which have different depths. These dimples are generally more visible and painful when pressed than other types of dermatitis. Additionally, symptoms include spontaneous separation of the nail, subungual hemorrhages (especially when wearing tight shoes), changes in the color and surface of the nail such as trachyonychia and koilonychia.
Scalp psoriasis
It can manifest itself as an independent disease or as part of a general pathological process. One of the characteristic features is weeping and the formation of scabs on part or all of the surface of the head. In this case, hair growth is not hindered, since the function of the hair root is not impaired. However, getting it wet creates a threat of infection, which can cause damage to hair follicles.
Seborrheic psoriasis
It occurs as a result of the rupture of skin glands, which produce viscous sebum, causing skin irritation and promoting inflammation - dermatitis. This condition quickly spreads throughout the head, covering it like a cap and is accompanied by intense itching. In the areas behind the ears, weeping and infection sometimes occur. A scalp covered in dandruff and crusts can look like a psoriatic crown.
Psoriasis on the face
It usually appears in the region of the nasolabial triangle, on the eyelids, above the eyebrows and in the areas behind the ears. The rashes may coalesce, forming large areas of redness and swelling. If the functioning of the sebaceous glands is impaired, the process may be accompanied by crying, crusting and an increased risk of infection.
Psoriasis on the genitals
Psoriasis affecting the genitals is a concomitant process that is usually accompanied by characteristic psoriasis rashes all over the body, which makes diagnosis easier.
Psoriatic rashes on the penis in men, on the labia majora in women, and on adjacent areas of the skin are oval in shape and slightly raised above the surface of the skin. They are pink and scaly. Practically not accompanied by itching. Sometimes the injury process spreads to the mucous membranes and can take the form of vulvovaginitis in women and balanoposthitis in men.
In obese people, atypical psoriatic rashes can be observed in the folds located close to the genitals (inguinal, intergluteal). In these areas, areas of intense red appear, which have a mirror-like surface and do not come off due to constant moistening.
Why is psoriasis dangerous?
Psoriasis can become very serious when the rash covers more than 10% of the skin. This condition is difficult and prone to recurrence, and the rash can become wet, moist, and susceptible to infection. Only timely and effective treatment of psoriasis can prevent the spread of the disease.
In some cases, psoriasis can be complicated by joint inflammation and the development of psoriatic polyarthritis, which can lead to joint dysfunction. Furthermore, the systemic autoimmune process caused by psoriasis can lead to the development of other autoimmune diseases, serious cardiovascular and digestive pathologies, and neurological reactions.
Ignoring timely psoriasis treatment can lead to complications such as psoriatic erythroderma, which can occur due to inadequate treatment of psoriasis or as a result of exposure to various skin irritants. In psoriatic erythroderma, the skin turns deep pink with a clear distinction between affected and healthy areas, as well as small and large scales. This condition requires emergency medical attention.
Complications of psoriasis
Lack of timely and adequate treatment for psoriasis can seriously harm vital organs and systems of the body, such as joints, heart, kidneys and nervous system. These consequences can lead to disability or even death.
Diagnosis
Normally, the diagnosis of psoriasis is made based on the typical symptoms of skin lesions and their location. In some complex cases, additional tests may be needed to rule out other skin conditions.
Laboratory tests may include:
- Complete blood count, which can detect leukocytosis and anemia in psoriasis.
- Rheumatoid factor (RF) is a protein whose levels may be elevated in systemic inflammatory diseases involving joint damage, but in psoriasis its levels are generally normal.
- The erythrocyte sedimentation rate (ESR) is also usually normal, with the exception of pustular psoriasis and psoriatic erythroderma.
- Uric acid levels can be elevated in psoriasis, which can cause confusion with gout.
- Antibodies against the human immunodeficiency virus (HIV) can be detected in the sudden onset of psoriasis.
Other tests, such as joint x-rays and skin biopsies, may be used in more complex cases to assess the severity of joint damage and distinguish psoriasis from other skin conditions.
Treatment
Psoriasis treatment requires a comprehensive approach, including local treatment of skin lesions, medications, phototherapy and prevention of exposure to factors that worsen the disease. The choice of treatment method depends on the type and severity of psoriasis. Treatment may include:
- external preparations (external ointments, petroleum jelly, paraffin, vegetable oils and creams with an anti-inflammatory effect, the amount of which depends on the nature of the injury and are used daily);
- lotions and shampoos based on salicylic acid, as well as photosensitizers;
- medicines for oral administration (retinoids, vitamin D preparations and others);
- physiotherapeutic procedures;
- Daily baths with bath oil, oat infusion, or sea salt can help soothe the skin and reduce the inflammation that occurs in psoriasis. It is important to avoid hot water and exfoliants, in addition to using moisturizer after showering;
- phototherapy, which involves exposing the skin to ultraviolet light, may also be helpful (avoid burns);
- photochemotherapy with medium wave radiation;
- compliance with a special diet and general regime.
When developing a treatment program, the patient's gender and age, the presence of concomitant diseases, general health and the impact of external factors are taken into account. Sometimes, to cure it, it is enough to change your lifestyle and, in other cases, several treatments are prescribed.
In addition to traditional methods, psoriasis treatment may include the use of modern laser technologies. Laser therapy can reduce the symptoms of pathology, achieve long-term remission and relieve the patient from unpleasant skin rashes and related problems. A special feature of laser therapy is that a special excimer laser acts only on the affected areas of the skin, without affecting healthy ones, which guarantees quick recovery without side effects. Laser therapy is safe and painless, requires no preparation and can be used regularly so that the patient can live without restrictions.
The effectiveness of treatment depends on many factors, including hereditary predisposition, provoking factors, stage of the disease and the specific nature of the lesion, therefore it is recommended first of all to consult a specialist and prescribe treatment measures based on clinical recommendations.
Prevention
Psoriasis is a disease that can be successfully treated if you consult a doctor in a timely manner and receive qualified help. In the simple form of psoriasis, the patient can work without any restrictions, with the exception of working in chemical factories, where being in the workplace can be dangerous.
However, psoriasis can cause complications such as psoriatic arthritis, which can limit work performance and lead to disability.
Preventing psoriasis is an important part of treatment. After recovery, patients need to reconsider their lifestyle, get rid of bad habits, take care of treating other chronic diseases, monitor their diet and increase physical activity, spending more time outdoors and playing sports.
Nutrition for psoriasis
The diet for psoriasis is not strict, but proper nutrition plays an important role in complex treatment. When making nutritional recommendations, patients are advised to:
- Avoid foods to which the body is hypersensitive and exclude them from the diet.
- Choose fresh fruits, vegetables, berries, lean roasted or boiled meat and drink more.
- Avoid the following foods: onions, garlic, radishes, concentrated tea, coffee, alcohol, sweets, salty and acidic foods, as well as foods that may cause an allergic reaction such as orange fruits, honey, nuts, cocoa and eggs.
- Avoid fatty foods of animal origin.