Psoriasis (aka — squamous lishy) is a non-infectious chronic and often relapsing skin disease. Psoriasis, the symptoms of which determine its tendency to defeat the periarticular tissues, manifests itself in the form of scaly papules, and it is worth noting that this disease is one of the most common skin lesions that occurs at any age.
Psoriasis is characterized by the duration and persistence of its own course. His remissions, which may be as many months or as several years, meanwhile indicate his subsequent return and lifelong duration. Spontaneous treatment of this disease is very rare.
If you try to identify a specific category of persons predisposed to the emergence of psoriasis, then the solution will not be unambiguous. The thing 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.
Relating to the group of dermatoses, psoriasis is one of the most studied diseases in them. Meanwhile, none of those hypotheses that exist today can fully determine the nature of this disease. Given this, the problems associated with its therapy and prevention are in an equally vague and, at the same time, acute situation, as it was before. Depending on the specific period of time, various versions of ideas regarding the origin of psoriasis were suggested. This, in turn, led to the isolation of a number of forms, each of which is based on the results of certain laboratory studies and clinical observations.
- Hereditary nature of the disease. The implication is the presence of psoriasis within the framework of consideration of several generations, when, accordingly, cases of this disease were noted. By the way, heredity is considered as the almost basic and reliable reason for the development of psoriasis (psoriasis is intensified in this case under the influence of various types of provoking factors).
- Exchange nature of the disease. In this case, violations in fat metabolism (ie, in cholesterol metabolism), reduced incidence in periods of hunger, increased phosphorus in psoriatic Flakes, etc.
- The viral nature of the disease. In this case, the concept of direct involvement of a viral infection in the etiology of the disease under consideration has been formed on the basis of numerous and long-term clinical observations. Accordingly, for the same reason, infectious (and viral including) nature as a theory of psoriasis development is the oldest. Thus, the end of the XIX century was marked by the cases of the formation of very large groups of psoriatic-type formations, which are formed against the background of patients suffering from diseases such as scarlet fever and influenza. As a confirmation of the infectious nature of the disease, the systemic nature of the actual lesion, its recurring and prolonged course, the presence of a connection with meteorological and heliophysical factors, as well as certain peculiarities inherent in the evolution of the rash characteristic of psoriasis appeared. As for the present time, now we are looking for those viral agents through which a psoriatic process could be triggered.
- Endocrine nature of the disease. The theory of the direct connection between the onset of psoriasis and endocrine (as well as exchange) nature in the recent past has been supported by many. When examining patients with psoriasis, there were often detected certain disorders of the endocrine level, which was the reason for the relevance of such a connection. In particular, violations associated with the functional state of the sexual glands, the effect of the menstrual cycle, pregnancy, childbirth and lactation, a marked type of change, revealed in the study of the pituitary-adrenal system of patients, were identified
- Neurogenic nature of the disease. It is at the beginning of the disease against the background of a nervous shock to the patient (more precisely — after his transfer). About 30% of cases, the exacerbation of the disease occurs precisely because of stress. In this case, patients have reduced ability to resist to the impact of stress and to the subsequent transfer of its consequences. At the same time, their existing disorders (asthenic, vegetative-vascular-visceral, vegeto-vascular-dystonic and asthenodepressive) in combination with neurotic reactions provoke the formation or even aggravate the features of the vicious circle.
Smoking adversely affects the course of psoriasis. Thus, the association of the disease with smoking among women has been revealed, as well as the increased risk of possible exacerbation of this disease among men who smoke in stressful situations.
The impact of alcohol, in turn, provokes an immune imbalance, and also causes certain changes at the level of the capillaries. Meanwhile, the connection with specific mechanisms, through which ethanol affects the epidermis within the framework of treating psoriasis, is not fully understood at the moment.
There is also information that in practice cases of psoriasis or its aggravation were noted against the use of certain types of medications (alpha and beta interferons, steroid anabolic hormones, captopril, antibiotics (penicillin, levomycetin, tetracycline, etc.) , B group vitamins, beta-blockers).
With actual HIV infection, the course of psoriasis becomes heavier, and is accompanied by various complications. Meanwhile, the mechanisms of HIV that provoke psoriasis in patients are not finally clarified in their specificity and impact.
Psoriasis, as we initially noted, can manifest itself at any age, and as regards the sex of the patients most affected by this disease, here, it can be said, the chances of the disease are equal for both men and women.
As we have already noted, psoriasis acts as a chronic and recurrent disease. Any of its existing forms can be classified as one of the versions relevant for psoriasis classification, in which there is a distribution of pustular or non-pustular psoriasis. In general, the classification is as follows:
- Pustular psoriasis
- generalized psoriasis
- anular psoriasis (anulular pustulosis)
- Palmoplacental psoriasis (psoriasis of limbs, palmomalental persistent chronic pustulosis, psoriasis of pustular Barbera)
- chronic form of persistent acrodermatitis (psoriasis of the soles and palms, psoriasis palmar-plantar)
- herpetiform psoriasis impetigo
- Non-insipid psoriasis
- vulgar psoriasis or psoriasis vulgaris, simple psoriasis (plaque-like, stable psoriasis in chronic form)
- psoriatic erythroderma (psoriasis erythrodermatic).
Some authors adhere to the need to supplement this classification, due to which it can be added to types or forms of psoriasis in the following versions:
- seborine-like psoriasis (seborrheic psoriasis)
- psoriasis of Napkin;
- drug-induced psoriasis
- «reversible psoriasis» (psoriasis of skin folds, flexural surfaces).
Primary elements appearing on psoriasis on the skin have the appearance of flat inflamed papules — a seal of a reddish-pinkish hue, slightly elevated above the skin level, with clearly defined contours. The surface of these seals is covered with characteristic scales: they are dry, easily fall off, are arranged in a loose manner, have a silvery white hue. Due to the peculiar specificity of the morphological structure that the papules have, a triad of symptomatic manifestations can be identified at the pathognomonic level, which can be determined by scraping off the seal surface (for which a scalpel or just a fingernail is used).
So, initially the crushing of the scales determines the correspondence to the picture, similar to the scaling of the frozen stearin. Further, due to the absence of a granular layer, the horny and prickly-layer binder, the compact layers of horny plates are separated in the manner of the film, which in turn leads to the exposure of the moist surface within the spiky layer. Subsequent scraping, with minor effort, causes damage to the capillaries of the elongated papillae, which causes droplets of blood to be released.
The first symptoms of psoriasis are the eruption of the miliary type of papules, which are characterized by a gradual increase along the periphery, while simultaneously turning them into papules of nummular and lenticular and fusing with each other, thereby producing plaques of various sizes. Development within the skin of psoriasis determines for him three main stages.
- First Stage
This stage is defined as a progressive stage, it is caused by the formation of new formations (the papules themselves) on the skin, as well as an increase in the sizes of those formations that already exist on the skin. This is also accompanied by the formation of an erythematous curb around the foci (such a curb is defined as a zone of peripheral growth). The plaque on the edges is not susceptible to peeling, while the scaling, acting as the final stage of inflammation, does not succeed in the process of growth of psoriatic formations somewhat.
The acute phase of psoriasis can be accompanied by the appearance of psoriatic papules even on the spot with minor skin trauma that can occur against the background of a sunburn, a scratch, a prick, etc. Non-rational therapies implemented within the progressing period can cause a sharp Aggravation, in which the lesion can be completely skin, also a similar option is relevant in the occurrence of stressful situations. All this leads to the development of psoriatic erythroderma.
With the passage of time, the appearance of new papules may stop, just as the peripheral growth of already existing formations will stop, while peeling, on the contrary, may worsen, thus affecting the entire surface of the skin (or mucous membrane), after which Second stage.
- Second Stage
The second stage defines a stationary period, in which new elements do not appear, but already 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, because the stationary period can be accompanied by the simultaneous appearance of miliary papules, papular lenticular and nummular. Let us explain what the three types of papules are. Thus, numular papules are elements of a skin rash of round shape in diameter within 15-20 mm (for this reason these papules are also called coin-like). Lenticular papules, in turn, are elements of rash, flat or convex type, oval or round, resembling lentils. And, finally, miliary papules that have a conical form of elements and have similarity due to this with hemp seed. In general, these papules are small in size, the preferred location is near the hair follicles.
Often a common type of rash is formed, in which papules correspond to lenticular formations, at this stage the process of development stops. This variant of psoriasis is caused, as a rule, by a local infection, centered within the tonsil zone, which determines tonsillogenic psoriasis. The stationary period following the cessation of further growth of the papule is often accompanied by the formation in its environment of folding in the form of a stratum corneum whose width can be 2-7 mm. After the resorption of the psoriatic foci is complete, hypopigmentation (a lighter part formed in the skin area) manifests itself, and, on the contrary, hyperpigmentation (accompanied by a darker patch within the skin area) leads to a slightly less complete resolution of the resorption. Both variants, and hypopigmentation, and hyperpigmentation by the nature of the manifestation are temporary.
- Third Stage
This stage is reverse (or regressive). The main feature of it is that gradually the rashes disappear, and around the foci a whitish border of the pseudosclerotic type is formed (it is defined as the rim of Voronov). During this period, some patients may experience mild itching. As for any subjective sensations, they are mostly expressed little, if not completely absent.
The resolution of psoriatic formations occurs in their central part. This is accompanied by the appearance of semi-ring shapes, characteristic of the progressive period of psoriasis. In this case, it should be borne in mind that accompanying the central resolution of plaques can their peripheral growth. Because of the difference in the mutual arrangement of psoriatic formations, which differ in shape and width, large foci are formed from outlines similar to garlands, and in the general examination of the cutaneous integument of the affected surface, all this pattern of manifestations is similar to the geographic map.
The appearance of rashes may occur within any areas of the skin, but they are primarily located in the area of the surface of the limb folds, in particular, the elbows and knee joints, the sacrum, the scalp (here, in particular, the region is distinguished along the edge of hair growth, Which is defined as a «psoriatic crown»). Psoriasis on the head, the symptoms of which, although determined by the severity of their own manifestations, do not lead to a change in the structure of the hair, and also to their loss.
As for the concentration of plaques within the extensor surface of the knee and elbow joints, here they are often preserved for a long period of time from the moment the rash is resolved in the general variant (a similar feature defines them as «on-duty» plaques). Some patients face the fact that the skin folds in the inguinal-femoral region or the area of the mammary glands, as well as in the axillary gland, are affected, and this lesion can often have an isolated character.
If we are talking about the latter variant, in which skin folds are affected in an isolated manner, then this flow is accompanied by a high humidity, due to which there is no peeling, at the same time, lesions have a similarity to the infectious type of diaper rash (eg, candidiasis Or with streptococcal intertrigo). Signs of psoriasis in this case are characterized by a pronounced degree of infiltration, the absence of a corneous coronoid in the peripheral surface of the plaques, in addition, it becomes possible to isolate during the course of the disease two symptoms from the psoriatic triad considered above, which in this case is a psoriatic film with bloody dew.
As the features of the rashes, characteristic for the disease, we can distinguish their prevalence and symmetry (this refers primarily to the clinic manifestations of vulgar psoriasis). In some cases, the pronounced progression, which is actual for the course of the pathological process of the disease in the absence of its resolution, leads to the formation of a continuous type of skin lesion within certain parts of the body (this is determined by diffuse psoriasis), and also completely of the skin (in this case, the lesion determines universal psoriasis ). In extremely rare cases, the location of the elements of the rash is concentrated within a limited area of the skin (for example, the penis or skin of the scalp) in an asymmetric version, with bands on one side of the body.
Psoriasis in children, the symptoms of which are noted not in the formation of characteristic nodules, but in the appearance of erythematous foci, is primarily localized in the area of skin folds. Psoriatic lesions are manifested in the form of pink-red areas, often they are characterized by peeling (in some cases such areas resemble intertrigo). The appearance of rashes in children is often characterized by their concentration in the areas for psoriasis atypical (genitalia, natural folds and face). Quite often the formation of the first psoriatic eruptions is noted in the region of the scalp, while a few infiltrated erythema possesses a cluster of scaly crusts. Most often the location of the rash is concentrated within the red border of the lips, as well as along the mucous cheeks and tongue.
If you stop at the clinic, which is to damage the oral mucosa, thus highlighting the psoriasis of the mouth, it can be noted that the nature of this lesion is determined by the specific form of the disease. In the formation of psoriatic plaque within the bottom of the oral cavity, the focus can be characterized by irregularity of outlines, and its surface may resemble a naleplennuyu film. In an environment of such center in any case there is an inflammatory corolla. Extremely rare cases indicate that along with psoriatic eruptions in patients there is a burning sensation. The pronounced nature of the eruption is acquired during the period accompanying the exacerbation of the psoriatic process within the skin, but they disappear simultaneously from the skin and from the mucous membrane of the mouth, not always.
Pustular psoriasis is accompanied by involvement of the mucosa in the pathological process much more often compared with the usual form of the disease. In this case, the language is liable to defeat. In addition to the above picture of the course of psoriasis in the classical form of its manifestation, other variants of it are distinguished, including an exceptionally special type of form with its characteristic flow, manifested in the form of erythroderma and arthritis. A characteristic feature of pustular psoriasis is that it manifests itself in the form of purulent elements of surface specificity. In addition, pustular psoriasis can manifest itself in disseminated form (which determines the type of Tsumbush), as well as in the form of damage to the soles and palms (determines the type of Barber). Consider the symptoms inherent in various forms of the disease.
- Irritable psoriasis
It develops against the background of active exposure to the skin with the already existing progressive psoriasis of certain irritants, in particular, sun rays or specific ointments, as well as other types of stimuli affecting plaques. These plaques, in turn, become more convex in shape, the color changes to cherry red, within the surrounding area, a hyperthermal belt is formed, due to which sharp boundaries become somewhat blurred. This belt, following the resolution of the plaque, becomes wrinkled.
- 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 substance or another) from the elements of the rash. They, in turn, look like spots (and not papules). Develops spotted psoriasis, as a rule, is acute, and it is also similar to it with toxemia. As the main method for differentiation of the disease, the definition of the correspondence of the course of the disease with the psoriatic triad peculiar to it is used.
- Older psoriasis
This form of the disease can be considered as part of the symptomatology in the form of severe infiltration from the side of plaques, their common cyanosis, with a hyperkeratotic or warty surface. This type of foci is especially difficult to heal, and their transformation into a malignant tumor formation is not excluded in the future (this happens infrequently, but unfortunately this option is not necessary).
- Seborrheic psoriasis
This form of psoriasis, as one might assume from its name, develops in patients with a seborrhea that is already relevant to them. There is a disease from the scalp, in the area behind the auricles, on the chest, in the area of nasolabial folds, within the subscapular and scapular parts of the back. Emerging psoriatic flakes are subject to intense soaking with sebum, which causes their clumping and retention within the surfaces of the plaques, which, therefore, allows the disease to simulate the pattern characteristic of seborrheic eczema.
- Palmar-plantar psoriasis
The disease can be manifested either in the form of ordinary psoriatic plaques and papules, or in the form of hyperkeratotic formations simulating callosity and corn. 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. For the boundaries of this type of lesion, crispness is characteristic, in rare cases this form of psoriasis is limited to the appearance of large-ringed scaling.
- Exudative psoriasis
For this form of psoriasis is characterized by excessive expression of exudate with an inflammatory reaction, it appears in the progressing period of psoriasis. Making their way to the surface of the papule, the exudate ensures saturation of flocculent deposits, thereby forming out of them formations that look like crusts. These elements are secondary, define them as scaly crusts, the color of these elements is yellowish. After their removal, exposure is slightly bleeding and a wet surface. Scales-crusts with drying and layering often form a massive conglomerate type resembling an oyster shell (this is already defined as rupoid psoriasis).
- Teardrop psoriasis
Teardrop psoriasis, the symptoms of which appear suddenly, is characterized by the formation of multiple spots within the skin. Mostly the disease is diagnosed in patients aged 8 to 16 years. Often, as a precursor to guttate psoriasis, the factor is streptococcal infection.
- Nail psoriasis
Psoriasis of the nails, the symptoms of which provide the selection of this variety of psoriasis in three basic forms, depending on the degree of nail damage can be atrophic, point or hypertrophic.
Point lesion is considered as a formation on the nail plates of a point type depression, which can also be compared with the surface of a thimble. The manifestation of this form of psoriasis is possible in a slightly different version, which in its specificity resembles onychomycosis. In this case, within the free edge, the nail plate changes color, becomes dull, and is prone to crumbling without much effort. As an attribute that allows to differentiate psoriasis, an inflammatory fringe formed along the periphery of the portion of the nail plate that has undergone injury is determined. It is represented in the form of the edge of the papule within the nail bed, which is translucent through the nail plate.
The atrophic form of psoriasis of nails is characterized by the apparent thinning that has arisen in the substance of the nail, which occurred without previous inflammatory changes. In this case, there is a gradual and simultaneously significant thinning of the nail plate, separating it from the nail bed with a gradual disappearance, as a result of which there remains only a small residue of a grayish hue near the socket.
- Psoriatic (psoriatic) arthritis
Psoriatic arthritis, the symptoms of which are manifested due to infiltration, which is relevant for periarticular tissues with simultaneous joint damage, mainly affects the interphalangeal joints. Meanwhile, the possibility of involving large joints in the pathological process is not ruled out, the joints and articulations of the sacroiliac spine are extremely dangerous in this respect.
Initially, patients complain only of the appearance of pain in the joints, a little later the swelling of the affected area is determined, then certain movements are subjected to certain restrictions. The possibility of dislocations and subluxations is not excluded. Radiographs determine the relevance of osteoporosis with a simultaneous narrowing of the joint gap. The process can end with the onset of ankylosis (immobility of the joint due to the fusion between the joint surfaces) and persistent articular deformities, which, in turn, develops disability.
It is important to consider that psoriatic arthritis, unlike the other varieties of arthritis (which in the general definition implies inflammation of the joints), is formed against the background of the already existing psoriatic rash in the patient, often combined with nail damage. In addition, an important point can be identified and the fact that the beginning of this type of arthritis is combined with exacerbation of psoriasis within the skin, which, in most cases, acquires an exudative character.
Irrational treatment of the disease during its progression is often accompanied by the emergence of a nonspecific reaction from the body. It is toxic and allergic in nature and consists in the appearance of redness in the area of zones not affected by psoriatic plaques, reddening it, merging, affects the skin completely. This process is combined with fever (within no more than 39 degrees), as well as enlarged lymph nodes, a feeling of stiffened skin, burning and itching. In frequent cases, too, there is abundant peeling, thickening and detachment of the nail plates, hair loss. This picture points to the relevance of psoriatic erythroderma. Erythroderma is completed by the restoration of the traditional variant 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 setting the necessary treatment.
Treatment of psoriasis
Prior to the appointment of a thorough examination of the patient, and to determine the specific measures it is based on the stage of the disease, on its clinical variety, the general condition of the patient, on the presence of concomitant diseases, the conformity of manifestations of the seasonal disease, etc. A well-known fact is What is the fastest, and at the same time, favorable result of treatment is achieved in the case of uncomplicated forms of psoriasis with a short duration of their flow, and also with limited ti manifestations. In general, the treatment of psoriasis is a rather laborious process, and in most cases it can not be fully cured — the disease simply regresses (that is, the period of its existence without symptoms occurs), which, however, is also a positive result for it.
As the main goal in treatment, the maximum possible suppression of symptoms in combination with the addition of prophylactic measures is determined.
First of all, with psoriasis, a diet is prescribed, in which the products that trigger the exacerbation of the disease (spicy foods, chocolate, alcoholic beverages) are excluded from the diet. The restriction also applies to eating smoked foods, honey, fried and fatty foods, etc. During the exacerbation of the disease, it is recommended to consume more fruits and vegetables (except for red ones: apples, tomatoes, cherries, etc.), fish and low-fat meat (boiled) varieties.
Its beneficial effect on the course of psoriasis is its treatment in sanitary facilities (Baku, Pyatigorsk, Israel, etc.). Given the special susceptibility of the skin in patients with psoriasis, it is recommended that the sun is not exposed to it from 11 to 16 hours.
As for the medicinal treatment of psoriasis, it is based on the application of several methods. First of all, they are external agents (creams, ointments, etc.), systemic treatment preparations (injections, tablets, etc.) and methods such as phytotherapy (phytotherapy), physiotherapy, etc. Light forms of the disease are often dispensed with by the need to apply to them Methods of external treatment. In particular, the greatest prevalence in use among them were the following drugs:
- Salicylic ointment. It provides softening of the formed scales, which, in turn, provides the possibility of their quickest elimination along with the best absorption of another type of medications. Apply this ointment (0.5% or 5%) 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 inflammation (that is, the inflammation is more pronounced in the nature of the manifestation, so, accordingly, a smaller amount of ointment is used for it). Salicylic acid, serving as the basis of the drug, is also contained in a number of other ointments used in the treatment of psoriasis (Diprosalic et al.)
- Ointment sulfur-tar (5 or 10%). Using this ointment provides a reduction in inflammatory processes that are relevant to the skin. Contraindication to use is exudative psoriasis (ie psoriasis, accompanied by soaking crusts and scales). Do not apply this ointment on the face. To treat psoriasis of the head, tar tar shampoos are used.
- Naphthalene ointment. It is used to treat regressing and stationary stages of the disease. Exacerbation or progression of psoriasis determine the inadmissibility of using this tool. With this ointment, intense itching and inflammation decrease. A 5% or 10% ointment is used.
- Glucocorticosteroid preparations. Their use provides a reduction in the intensity of inflammation. Applied only by short courses, with mandatory supervision by a specialist. These drugs include Elokom, Lokoid, etc.
- Antralin. This ointment promotes inhibition in psoriasis of cell division within the surface layers of the skin, in addition its action contributes to the reduction of characteristic ecdysis. Used in the form of applying to the skin for a period of one hour, after which it is washed off.
- Ointments containing a vitamin D. Such ointments provide an anti-inflammatory effect, while they improve the course of the disease. One of the drugs in this group is Calciportiol, which is applied twice a day to areas of the skin that have undergone inflammation.
- «Skin-cap.» In this case we are talking about aerosols, creams and shampoos used in the treatment of psoriasis in the scalp. Creams and aerosols are used twice a day when applied to the scalp, shampoo is applied thrice a week.
As for systemic treatment, it is selected strictly individually and only by the attending physician. As already noted, it means the use of various tablets, injections, etc.
Phytochemotherapy as a method of treatment of psoriasis consists of ultraviolet action on affected areas of the skin. To do this, a special type of plant is used, which irradiates such areas without affecting the 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 flow and specificity, therefore, the effectiveness of any of the schemes can not be identically determined for all patients . Let us repeat that the treatment of the disease is carried out in strictly individual order with the constant supervision of the attending physician.
If symptoms appear that indicate psoriasis, you need to contact a dermatologist and an infectious disease specialist.