Psoriasis is a chronic inflammatory disease of the body, accompanied by predominant damage to the skin with the formation of patches and erythematous plaques that have clear boundaries and silvery scales on the surface.
The course of this disease is characterized by periods of exacerbation and remission (decrease in symptomatic manifestations). Unfortunately, medicine has not yet identified the exact and reliable cause of psoriasis, but a hereditary factor has clearly been observed which, in combination with triggering factors, contributes to the triggering moment of the onset of this disease. A link between the occurrence of psoriasis and antigens of the HLA system was revealed.
Between 1 and 5% of the world's population suffers from this very unpleasant disease, and people with fair skin are at greater risk of developing psoriasis than black people.
The disease can manifest itself at any age, but periods of 20-30 years and 50-60 years are considered critical.
Important!Psoriasis is not contagious for other people, but causes inconvenience to the patient himself, since the rashes that appear during the disease are not only a cosmetic defect, but are also accompanied by unpleasant itching. In addition, the manifestation of psoriatic arthritis is possible, which significantly worsens the patient's quality of life.
Mainly, rashes are localized on the scalp, on the surface of the elbows and knees, in the areas of skin folds and genitals. The nails, buttocks and the area around the eyebrows can often be affected. The nature and appearance of the rash depends on the type of psoriasis.
Causes of psoriasis
The nature of the occurrence of psoriasis has not yet been revealed by medicine, some doctors talk about autoimmune causes. The second theory explaining the occurrence of the disease is a violation of the normal process of maturation and division of skin cells. Heredity and stress are also considered the cause.
A genetic predisposition to psoriasis, allergies and frequent disruption of the skin's barrier function (strong friction, exposure to chemicals, influence of alcohol-containing products) can provoke an exacerbation of the disease.
For known triggers that causepsoriasis, list:
- Koebner's phenomenon is the appearance of fresh rashes at the site of skin irritation in the acute phase of some dermatoses;
- Sunburn or other types of burns;
- HIV infection;
- Beta-hemolytic streptococcal infection, which causes guttate psoriasis;
- Use of medications (mainly beta-blockers, lithium, angiotensin-converting enzyme inhibitors);
- Severe emotional stress;
- Alcohol consumption;
- Smoking tobacco;
- Obesity;
- Hormonal imbalance, especially in women during menopause and pregnancy;
- Digestive system disorders.
The main cause of the development of the disease is excessive and accelerated growth and division of skin cells in combination with the inflammatory process in the dermis. In other words, the skin cells on the bottom layer of the epidermis begin to grow rapidly and put pressure on the cells above. This process is accompanied by significant peeling of the skin and is called parakeratosis. Excessive stimulation of the immune system is believed to be the main link in the occurrence of this mechanism.
Symptoms and signs of psoriasis
Rashes associated with psoriasis are asymptomatic or accompanied by itching. Most often they are located on the scalp, on the extensor surfaces of the knees and elbows, on the sacrum and buttocks (especially the gluteal fold), and in the genital area. Toenails, fingernails, eyebrow skin, armpit skin and navel skin can be affected. Rashes can merge with lesions and cover large anatomical areas and areas of skin between them. Depending on the type of psoriasis, the rash can have different external manifestations.
As a rule, skin rashes are discreetly located and are represented by erythematous papules or plaques, covered by dense, silvery and shiny scales. The rash appears gradually. Remissions and exacerbations occur spontaneously or after exposure to provoking factors.
5-30% of patients developpsoriatic arthritis, which can cause disability to the patient. This process can lead to joint destruction.
Important!Psoriasis does not threaten the patient's life, but it disturbs the patient's self-image. In addition to the change in the patient's appearance, it also takes a lot of time to treat skin rashes and maintain the cleanliness of clothes and sheets, which greatly reduces the patient's quality of life.
Types of psoriasis
- vulgar(common or chronic plaque) psoriasis, in which the rashes look like individual plaques covered with silvery scaling. Plaques may coalesce as the disease progresses. Among all subtypes, this type of psoriasis is the most common and represents approximately 90%.
- inverse psoriasisaccompanied by skin rashes that appear in the area of natural folds and can form cracks.
- guttate psoriasischaracterized by multiple rashes with a diameter of 0. 5-1. 5 cm, often formed after streptococcal pharyngitis.
- palmoplantar psoriasisit manifests as plaques on the palms and soles, which can fuse together.
- nail psoriasisaffects the nail plates in the form of indentations and punctual grooves with discoloration and thickening of the nail. Nail changes with psoriasis often resemble changes from a fungal infection.
- pustular psoriasisaccompanied by the formation of pustules on the palms of the hands, soles of the feet or possibly damage to one of the fingers. There may also be a generalized form.
- erythrodermic psoriasismanifests as sudden or gradual appearance of redness in patients with psoriatic plaques, when the plaques themselves are mild or absent. It usually appears due to inadequate treatment of psoriasis vulgaris.
Methods for diagnosing psoriasis
When symptoms of psoriasis appear, the patient should consult a dermatologist. He will perform an external examination of the affected areas of the skin and collect a complete medical history.
Psoriasis presents a general similarity with other dermatological diseases, especially in the early stages of manifestation. It is important to exclude the presence of fungal infections on the hands and nails. The seborrheic type of psoriasis requires special differential diagnosis to exclude seborrheic eczema, pityriasis rosea, and papular syphilis.
In case of active disease and large lesions in areas of the epidermis, visual analysis of scrapings is used. During the scraping process, the peeling intensifies. In place of the removed scale, a smooth, thin film is visible, which comes off under mechanical action and reveals a surface moistened with droplets of blood.
Diagnosing psoriasis in most cases is not difficult, it is enough to simply examine the patient's skin. The doctor must exclude diagnostic errors and determine the presence of other diseases and other pathologies that occur against the background of psoriasis.
In rare cases, diagnosis requires a biopsy. If non-classical clinical signs are present, the need should be considered. The severity of the disease is mild, moderate and severe based on the area of skin affected. Damage to less than 10% of the skin corresponds to mild severity. There are more sophisticated methods for assessing the severity of the disease, but these are used in clinical trials.
Psoriasis treatment
There are a large number of factors on which the development of the disease and its various manifestations depend. Therefore, many treatments for psoriasis have been developed. Often these methods are combined, including drug and non-drug interventions.
The treatment plan is drawn up depending on the severity of the disease, the area of skin affected and the severity of symptoms such as redness, itching and peeling. Age and gender, stage of the disease and general condition of the patient, the presence of concomitant diseases are also taken into account, as they can limit the choice of treatment methods.
Treatment of psoriasis should lead to a reduction in clinical manifestations (skin rashes and other symptoms), improvement of the patient's general condition and restoration of his ability to work.
When treating psoriasis, it is necessary to follow a diet and properly care for your skin, as there is a risk of liver damage. In such cases, it is recommended to reduce the amount of fatty foods in the patient's diet, abandon alcohol, sweets (simple sugars) and foods rich in starch. The emphasis in the diet should be on proteins: lean meats, fish, dairy products, vegetables and fruits. Be sure to pay attention to allergic reactions or intolerance to certain products.
To improve the patient's quality of life and get rid of the disease, it is necessary to use an integrated approach:
- Local treatment–Ointments and creams cope well with peeling and itching in small areas where the disease is localized. Hormonal ointments, salicylic acid, retinoids, and moisturizing creams are especially effective in treating psoriasis on the face and hands.
- Drug therapyused as an additional method of effective treatment of psoriasis when ointments do not help. Medicines reduce the inflammatory process, relieve swelling and itching, and block the increased activity of skin cells. But it is worth considering that the tablets have many side effects (increased fatigue, lack of appetite, hypertension). Therefore, it is very important to follow all the doctor's recommendations regarding the dosage of the medication.
- When psoriasis is located on the head and neck, usemedicated therapeutic shampoos: antifungal, tar, containing corticosteroids. The shampoo eliminates pathogens of pathological inflammation, removes scales, relieves itching and burning.
- Therapeutic antihistamine injectionsblock intense itching, biological medicines have a beneficial effect on the immune system.
Unfortunately, today there is no possibility of a complete cure for psoriasis. Any treatment for psoriasis is aimed at eliminating signs of the disease for a long time and prolonging remission. But treatment of psoriasis is necessary, despite the slow chronic course of the disease, since prolonged absence of therapy can lead to the patient's disability.