Psoriasis

Psoriasis (also known as lichen scaly) is a non-infectious chronic and often recurrent skin disease.

Psoriasis, the symptoms of which determine its tendency to damage periarticular tissues, manifests itself in the form of scaly papules, in addition, it is worth noting that this disease is one of the most common skin lesions that occurs at any age.

The etiology of this disease has not yet been fully studied and proven, however, many dermatologists still agree that psoriasis is an ailment directly related to genetic hereditary pathologies.

Do not self-medicate. At the first sign of illness, see your doctor.

general description

Psoriasis is characterized by the duration and persistence of its own course. His remissions, which can be as long as several months or several years, meanwhile, indicate his subsequent return and lifelong duration. Spontaneous cure of this disease is extremely rare.

If you try to determine a specific category of persons predisposed to the onset of psoriasis, then the solution will not be unambiguous. The fact is that psoriasis, acting as a systemic process, develops not only in people with actual immune disorders, but also in people who have certain functional or morphological disorders associated with the functions of various systems and organs.

Pertaining to the group of dermatoses, psoriasis is one of the most studied diseases in them. Meanwhile, none of the hypotheses that exist today can fully determine the essence of this disease. Given this, the problems associated with his therapy and prevention are in the same uncertain and, at the same time, acute situation, as it was before. Depending on the specific time period, various ideas have been proposed regarding the origin of psoriasis. This, in turn, led to the allocation of a number of forms, each of which is based on the results of certain laboratory studies and clinical observations.

• The hereditary nature of the disease. This implies the presence of psoriasis within the framework of consideration of several generations, in which, accordingly, cases of this disease were noted. By the way, it is heredity that is considered as practically the main and reliable cause of the development of psoriasis (in this case, psoriasis increases under the influence of various types of provoking factors).
• The metabolic nature of the disease. In this case, disorders in fat metabolism (i. e. , in cholesterol metabolism), reduced morbidity during periods of hunger, increased amount of phosphorus in psoriatic scales, etc. are considered.
• The viral nature of the disease. In this case, the concept of the direct involvement of a viral infection in the etiology of the disease under consideration was formed on the basis of numerous and long-term clinical observations. Accordingly, for the same reason, the infectious (and viral as well) nature as a theory of the development of psoriasis is the most ancient. So, the end of the 19th century was marked by cases of the formation of very extensive groups of formations of the psoriatic type, formed against the background of patients suffering from diseases such as scarlet fever and influenza. The systemic nature of the actual lesion, its recurrent and prolonged course, the presence of a connection with meteorological and heliophysical factors, as well as certain features inherent in the evolution of rashes characteristic of psoriasis, also acted as confirmation of the infectious nature of the disease. As for the present time, now a search is underway for those viral agents through which the psoriatic process could be triggered.
• Endocrine nature of the disease. The theory of a direct connection between the onset of psoriasis and the endocrine (as well as metabolic) nature in the recent past was supported by many. When examining patients with psoriasis, certain disorders of the endocrine scale were quite often revealed, which served as a justification for the relevance of such a connection. In particular, disorders associated with the functional state inherent in the sex glands, the influence caused by the menstrual cycle, pregnancy, childbirth and lactation, the pronounced type of changes detected in the study of the pituitary-adrenal system of patients were highlighted.
• The neurogenic nature of the disease. It consists in the onset of the disease against the background of a nervous shock that is actual for the patient (more precisely, after it has been transferred). In about 30% of cases, the exacerbation of the disease occurs precisely on the basis of stress. In this case, patients have a reduced ability to withstand the impact of stress and the subsequent transfer of its consequences. At the same time, the disorders they have (asthenic, vegetative-vascular-visceral, vegetative-vascular-dystonic and asthenodepressive) in combination with neurotic reactions provoke the formation or even exacerbate the features of the prevailing vicious circle.

Classification

As we have already noted, psoriasis acts as a chronic and recurrent disease. Any of its existing forms can be attributed to one of the variants of the classification relevant for psoriasis, in which there is a distribution for pustular or non-pustular psoriasis. In general, the classification is as follows:

• Pustular psoriasis
  • generalized psoriasis;
  • anular psoriasis (anular pustulosis);
  • palmoplantar psoriasis (psoriasis of the extremities, persistent palmoplantar pustulosis, barbera pustular psoriasis);
  • chronic form of persistent acrodermatitis (psoriasis of the soles and palms, palmar-plantar psoriasis);
  • herpetiform psoriatic impetigo.
• Non-pustular psoriasis
  • psoriasis vulgaris or psoriasis vulgaris, simple psoriasis (plaque, stable psoriasis in chronic form);
  • psoriatic erythroderma (erythrodermic psoriasis).

A number of authors adhere to the need to supplement this classification, due to which types or forms of psoriasis can be added to it in the following variants:

• seborrhea-like psoriasis (seborrhea psoriasis);
• Napkin's psoriasis;
• drug-induced psoriasis;
• "Reversible psoriasis" (psoriasis of skin folds, flexor surfaces).

Psoriasis: symptoms

The first symptoms of psoriasis are the rash of the miliary type of papules, which are characterized by a gradual increase along the periphery, while simultaneously transforming them into nummular and lenticular papules and merging with each other, due to which plaques of various sizes appear. The development of psoriasis within the skin defines three main stages for it.

First stage

This stage is defined as a progressive stage, it is caused by the formation of new formations on the skin (actually papules), as well as an increase in the size of those formations that are already on the skin. This is also accompanied by the formation of an erythematous border around the lesions (such a border is defined as a zone of peripheral growth). The plaque along the edges is not susceptible to peeling, while peeling, acting as the final stage of inflammation, does not keep pace with the growth process of psoriatic formations.

Second stage

The second stage defines a stationary period in which new elements do not appear, however, the existing elements in the form of plaques and papules do not change in size. In general, the appearance of papules can be completed within any stage, therefore the stationary period can be accompanied by the simultaneous appearance of miliary papules, lenticular and nummular papules. Let us explain what the three listed types of papules are. So, nummular papules are elements of a rounded skin rash in diameter within 15-20 mm (for this reason, these papules are also called coin-shaped). Lenticular papules, in turn, are elements of a rash, flat or convex, oval or round in shape, resembling lentils. And, finally, miliary papules, which have a conical shape of elements and are thus similar to hemp seed. Basically, these papules are small in size, the predominant area is near the hair follicles.

Third stage

This stage is reverse (or regressive). Its main feature is that the rashes gradually disappear, and a whitish border of the pseudosclerotic type is formed around the foci themselves (it is defined as the Voronov's rim). During this period, some patients may experience mild itching. As for any subjective sensations, they are mostly expressed insignificantly, or even absent altogether.

The appearance of rashes can be noted within any areas of the skin, however, they are predominantly localized in the area of the surface of the bends of the limbs, in particular, the elbow and knee joints, the region of the sacrum, the scalp (here, in particular, the area along the edge of hair growth is distinguished, which is defined as"Psoriatic crown"). Psoriasis on the head, the symptoms of which, although determined by the severity of their own manifestations, does not lead to a change in the structure of the hair, as well as to their loss.

As for the concentration of plaques within the extensor surface of the knee and elbow joints, here they often persist for a long period of time from the moment the rash resolves in general (this feature defines them as "duty" plaques). Some patients are faced with the fact that skin folds in the groin-femoral region or the mammary glands, as well as in the axillary glands, are affected, and often such a lesion can be isolated.

Irritated psoriasis

It develops against the background of active exposure to the skin with an already existing progressive psoriasis of certain irritants, in particular, the sun's rays or specific ointments, as well as other types of irritants that affect plaques. These plaques, in turn, become more convex in shape, the color changes to cherry red, a hyperthermal belt forms within the surrounding area, due to which the sharp boundaries become somewhat blurred. This belt, following the resolution of the plaque, takes on a wrinkled appearance.

Spotted psoriasis

This form of the disease manifests itself in the form of mild infiltration (in the general definition, infiltration is the impregnation of tissues with one or another substance) from the elements of the rash. They, in turn, look like spots (not papules). Spotted psoriasis develops, as a rule, acutely, and it is also characterized by a similarity with toxidermia. As the main method in differentiating the disease, the definition of the correspondence of the course of the disease with its characteristic psoriatic triad is used.

Old psoriasis

This form of the disease can be considered in terms of symptoms in the form of severe infiltration from the side of plaques, their general cyanosis, with a hyperkeratotic or warty surface. This type of foci is especially difficult to cure, and their transformation in the future into a malignant tumor formation is not excluded (this happens infrequently, but, unfortunately, it is not necessary to exclude this option).

Seborrheic psoriasis

This form of psoriasis, as its name suggests, develops in patients with seborrhea that is already relevant to them. The disease manifests itself from the scalp, in the area behind the auricles, on the chest, in the area of the nasolabial folds, within the subscapularis and scapular parts of the back. The emerging psoriatic scales are subject to intense saturation with sebum, due to which they stick together and remain within the plaque surfaces, which, thereby, allows the disease to simulate a picture characteristic of seborrheic eczema.

Palmar-plantar psoriasis

The disease can manifest itself either in the form of ordinary psoriatic plaques and papules, or in the form of hyperkeratotic formations that simulate calluses and calluses. In some cases, psoriasis on the hands, the symptoms of which are noted in this case on the palms (or on the legs - according to the definition, on the soles) is continuous, which manifests itself in the form of increased thickening or keratinization. The boundaries of this type of lesion are characterized by clarity; in more rare cases, this form of psoriasis is limited to the appearance of large-ring peeling.

Exudative psoriasis

This form of psoriasis is characterized by excessive severity of exudate during an inflammatory reaction; it appears within the progressive period of the course of psoriasis. Making its way to the surface of the papule, the exudate provides saturation of the accumulation of scales, thereby forming from them formations that look like crusts. These elements are secondary, define them as flake-crusts, the color of these elements is yellowish. Following their removal, a slightly bleeding and weeping surface is subject to exposure. Scale-crusts, when dried and layered, often form a massive type of conglomerate, resembling an oyster shell (this is already defined as rupioid psoriasis).

Guttate psoriasis

Guttate psoriasis, the symptoms of which appear suddenly, is characterized by the formation of multiple specks within the skin. Mostly the disease is diagnosed in patients aged 8 to 16 years. Often, streptococcal infection acts as a precursor to teardrop-shaped psoriasis.

Psoriasis of nails

Psoriasis of the nails, the symptoms of which provide the isolation of this type of psoriasis in three main forms, depending on the degree of nail damage, it can be atrophic, point or hypertrophic.

A punctate lesion is considered as the formation of punctate depressions on the nail plates, which can also be compared to the surface of a thimble. The manifestation of this form of psoriasis is possible in a slightly different version, which, in its specificity, is similar to onychomycosis. In this case, within the free edge, the nail plate changes color, becomes dull, prone to crumbling without much effort. As a sign that makes it possible to differentiate psoriasis, an inflammatory border formed along the periphery of the affected nail plate area is determined. It is presented as the edge of a papule within the nail bed, visible through the nail plate.

Psoriatic (psoriasis) arthritis

Psoriasis arthritis, the symptoms of which are manifested due to infiltration, which is relevant to the periarticular tissues with simultaneous damage to the joints, mainly affects the interphalangeal joints. Meanwhile, the possibility of involvement of large joints in the pathological process is not excluded; the joints and articulations of the sacroiliac spine are extremely rarely at risk in this regard.

It is important to take into account that psoriatic arthritis, unlike other types of arthritis (which in the general definition mean inflammation of the joints), is formed against the background of a psoriatic rash that already exists in the patient, often combined with nail damage. In addition, an important point can be distinguished that the onset of this type of arthritis is combined with an exacerbation of psoriasis within the skin, which, in most cases, acquires an exudative character.

Irrational treatment of the disease during the period of its progression is often accompanied by the occurrence of a nonspecific reaction from the body. It is toxic-allergic in nature and consists in the appearance of redness in the area of areas not affected by psoriatic plaques, this redness, merging, affects the skin completely. This process is combined with an elevated temperature (within a range of no higher than 39 degrees), as well as an increase in lymph nodes, a feeling of tight skin, its burning and itching. In frequent cases, there is also profuse flaking, thickening and exfoliation of the nail plates, hair loss. This picture already indicates the relevance of psoriatic erythroderma. Erythroderma ends with the restoration of the traditional version of the course of psoriasis.

In general, the recurrence of the disease occurs in the autumn-winter, as well as in the spring-summer periods, which is an important factor that needs to be taken into account, including when prescribing the necessary treatment.

Psoriasis treatment

Before the appointment of treatment, a thorough examination of the patient is carried out, and already to determine specific measures in it, they are based on the stage of the course of the disease, on its clinical variety, the general condition of the patient, on the presence of concomitant diseases, the conformity of the manifestations of the disease to seasonality, etc. the fastest, and, at the same time, a favorable result of treatment is achieved in the case of uncomplicated forms of psoriasis with their short course, as well as with limited manifestations. In general, the treatment of psoriasis is a rather laborious process, and in most cases it is not possible to come to a complete cure - the disease simply regresses (that is, a period of its existence without symptoms begins), which, however, is also a positive result for it.

The maximum possible suppression of symptoms in combination with the addition of preventive measures was determined as the main goal in treatment.

First of all, with psoriasis, a diet is prescribed in which foods that provoke an exacerbation of the disease (spicy food, chocolate, alcoholic beverages) are excluded from the diet. The restriction also applies to the consumption of smoked meats, honey, fried and fatty foods, etc. During the period of exacerbation of the course of the disease, it is recommended to eat more fruits and vegetables (with the exception of red ones: apples, tomatoes, cherries, etc. ), fish and lean meats (boiled).

The course of psoriasis has a beneficial effect on its treatment in the conditions of sanitary-resort facilities. Taking into account the special susceptibility of the skin in patients with psoriasis, it is recommended to avoid exposure to the sun on it in the period from 11 to 16 hours.

As for the drug treatment of psoriasis, it is based on the use of several methods. First of all, these are external agents (creams, ointments, etc. ), systemic treatment drugs (injections, pills, etc. ) and methods such as phytochemotherapy (phytotherapy), physiotherapy, etc. methods of external treatment. In particular, the following drugs were most commonly used among them:

• Salicylic ointment. With its help, the softening of the formed scales is ensured, which, in turn, provides the possibility of their early elimination along with better absorption of another type of drugs. This ointment (0. 5% or 5%) is applied to the affected areas of the skin in a thin layer, 1-2 times a day. An important feature of the application is the use of a smaller amount of ointment with a significant nature of inflammation (that is, the more inflammation is more pronounced in the nature of its manifestation, the less amount of ointment is used for it, respectively). Salicylic acid, which acts as the base of the drug, is also found in a number of other ointments used in the treatment of psoriasis.
• Sulfur tar ointment (5 or 10%). The use of this ointment provides a reduction in inflammatory processes that are relevant to the skin. Contraindication to use is exudative psoriasis (i. e. psoriasis, accompanied by weeping crusts and scales). You can not apply this ointment to the skin of the face. Tar shampoos are used to treat scalp psoriasis.
• Naphthalene ointment. It is used to treat the regressive and stationary stages of the disease. The exacerbation or progression of psoriasis determines the inadmissibility of using this remedy. With the help of this ointment, intense itching and inflammation are reduced. A 5% or 10% ointment is used.
• Glucocorticosteroid drugs. Their use provides a decrease in the intensity of inflammation. They are used only in short courses, with the obligatory supervision of a specialist.
• Ointments containing vitamin D. Such ointments provide an anti-inflammatory effect, while at the same time they improve the course of the disease.

As for systemic treatment, it is selected strictly individually and only by the attending physician. As already noted, it means the use of various pills, injections, etc.

Phytochemotherapy as a method of treating psoriasis consists in ultraviolet exposure to the affected skin areas. For this, a special type of installation is used, which irradiate such areas without affecting healthy skin.

In general, the treatment of psoriasis can mean many different schemes implemented in practice, but none of these schemes is generally accepted due to the difference in their course and specificity, therefore the effectiveness of any of the schemes cannot be equally determined for all patients. Let us repeat that the treatment of the disease is carried out on a strictly individual basis under the constant supervision of the attending physician.

If symptoms appear that indicate psoriasis, it is necessary to contact a dermatologist and an infectious disease specialist.