Psoriasis (also known as lichen planus) is a chronic non-infectious 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 appears at any age.
The etiology of this disease has not yet been fully studied and proven, however, many dermatologists still agree that psoriasis is a disease directly related to inherited genetic pathologies.
Do not self-medicate. At the first sign of illness, consult your doctor.
general description
Psoriasis is characterized by the duration and persistence of its course. His remissions, which can last up to several months or several years, meanwhile, indicate his subsequent return and eternal duration. Spontaneous cure of this disease is extremely rare.
If you try to define a certain category of people predisposed to the appearance of psoriasis, then the solution will not be clear. The fact is that psoriasis, acting as a systemic process, develops not only in people with current immune disorders, but also in people who have certain functional or morphological disorders related to the functions of various systems and organs.
As for 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 therapy and its prevention are in the same precarious and, at the same time, acute situation as before. Depending on the specific time period, different ideas about the origin of psoriasis have been proposed. This, in turn, led to the selection 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. This implies the presence of psoriasis in the context of the examination of several generations, in which, accordingly, cases of this disease have been observed. By the way, it is heredity that is practically considered as the main and reliable cause of the development of psoriasis (in this case, psoriasis grows under the influence of various types of provocative factors).
- Metabolic nature of the disease. In this case are taken into account disorders in fat metabolism (d. M. Th. In cholesterol metabolism), reduced morbidity during periods of starvation, increased amount of phosphorus in psoriatic scales, 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 was formed on the basis of numerous and long-term clinical observations. Therefore, for the same reason, the infectious (and viral as well) nature as a theory of psoriasis development is older. So the end of the 19th century was marked by cases of the formation of very broad groups of psoriatic type formations, formed against the background of patients suffering from diseases such as scarlet fever and influenza. The systemic nature of the current lesion, its recurrent and prolonged course, the presence of a link to meteorological and heliophysical factors, as well as some features inherent in the evolution of characteristic psoriasis rashes, also acted as confirmation of the infectious nature of psoriasis. disease. As of the present time, a search is now being made for those viral agents through which the psoriatic process can be triggered.
- The endocrine nature of the disease. The theory of a direct link between the onset of psoriasis and its endocrine (as well as metabolic) nature in the recent past has been supported by many. During the examination of patients with psoriasis, quite often certain disorders of the endocrine scale were discovered, which served as justification for the importance of such a connection. In particular, the disorders related to the natural functional state of the sex glands, the impact 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 of the onset of the disease against the background of a nervous shock that is current to the patient (more precisely, after it has been transferred). In about 30% of cases, exacerbation of the disease occurs precisely on the basis of stress. In this case, patients have a reduced ability to cope with 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 worsen the features of the prevailing vicious circle.
Distribution
As we have already pointed out, psoriasis acts as a chronic and recurrent disease. Any of its existing forms can be attributed to one of the variants of the relevant classification 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;
- annular psoriasis (annular pustulosis);
- palmoplantar psoriasis (limb psoriasis, persistent palmoplantar pustulosis, barbar pustular psoriasis);
- chronic form of persistent acrodermatitis (psoriasis of the feet and palms, palmar-plantar psoriasis);
- herpetiform psoriatic impetigo.
- Psoriasis not pustular
- psoriasis vulgaris or psoriasis vulgaris, simple psoriasis (plaque, stable chronic psoriasis in chronic form);
- psoriatic erythroderma (erythrodermic psoriasis).
A number of authors adhere to the need to complete this classification, due to which types or forms of psoriasis can be added to it in the following variants:
- psoriasis and seborrhea (seborrhea psoriasis);
- Napkin psoriasis;
- drug-induced psoriasis;
- "Reversible psoriasis" (psoriasis of the skin folds, flexor surfaces).
Psoriasis: symptoms
The first symptoms of psoriasis are the rash of miliary type papules, which are characterized by a gradual growth along the periphery, turning them at the same time into numb papules and lenses and joining together, due to which they appeartiles of different sizes. The development of psoriasis within the skin defines three main stages for it.
The first phase
This stage is defined as a progressive stage, it is caused by the formation of new formations in the skin (actually papules), as well as an increase in the size of those formations that are already in the skin. This is also accompanied by the formation of an erythematous border around the lesions (such a border is defined as the area of peripheral growth). Plaque along the edges is not sensitive to peeling, while peeling, acting as the final stage of inflammation, does not keep pace with the process of growing psoriatic formations.
Second phase
The second stage defines a stationary period in which new elements do not appear, however, 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 may be associated with the simultaneous appearance of miliary papules, lenses and numular papules. Let's explain what the three types of papules are listed. So, numular papules are elements of a rounded skin rash in diameter within 15-20 mm (for this reason, these papules are also called coin-shaped). Lentil papules, on the other hand, are elements of a blush, flat or convex, oval or round in shape, resembling lentils. And, finally, the miliary papules, which have a conical shape of the elements and thus are similar to hemp seed. Basically, these papules are small in size, the predominant area is close to the hair follicles.
The third stage
This phase is the opposite (or regressive). Its main feature is that the rash gradually disappears and around the foci itself a white border of the pseudosclerotic type is formed (defined as the edge of Voronov). During this period, some patients may experience mild itching. As for any subjective sensations, they are mostly expressed insignificantly, even absent at all.
The appearance of rashes can be observed in any area of the skin, however, they are mainly localized in the area of the surface of the limbs, in particular, the joints of the elbow and knee, the sacrum region, the scalp (here, in particular, the area along the edge is distinguishedof hair growth, which is defined as "psoriatic crown"). Psoriasis on the scalp, the symptoms of which, although determined by the severity of their manifestations, do 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 "task" plaques). Some patients face the fact that skin folds in the groin-femoral region or mammary glands as well as in the armpit 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, sunlight or specific ointments, as well as other types of irritants affecting the plaques. These plates, on the other hand, become more convex in shape, the color changes to cherry red, within the surrounding area a hyperthermic band is formed, due to which the sharp borders become somewhat blurred. This strip, following the resolution of the plate, takes on a wrinkled appearance.
Spotted psoriasis
This form of the disease manifests itself in the form of slight infiltration (in the general definition, infiltration is the impregnation of tissues with one or another substance) by the elements of the rash. They, on the other hand, look like spots (not papules). Spotted psoriasis develops, as a rule, acutely, and is also characterized by a resemblance to toxiderma. As the main method in the differentiation of the disease, the determination 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 by plaques, their general cyanosis, with hyperkeratotic or warty surface. This type of foci is particularly difficult to cure, and their future transformation into a malignant tumor formation is not ruled out (this rarely happens, but, unfortunately, it is not necessary to rule out this option).
Seborrheic psoriasis
This form of psoriasis, as its name suggests, develops in patients with seborrhea that is already important to them. The disease is manifested by the scalp, in the area behind the kidneys, in the chest, in the area of nasolabial folds, within the subcutaneous and scapular parts of the back. The manifested psoriatic scales are subjected to intense saturation with sebum, due to which they stick together and remain inside the plaque surfaces, which, in this way, allows the disease to simulate a characteristic appearance of seborrheic eczema.
Palmar-plantar psoriasis
The disease can appear either in the form of common 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 observed in this case on the palms of the hands (or on the feet - by definition, on the feet) is persistent, which manifests itself in the form of increased obesity or keratinization. . The boundaries of this type of lesion are characterized by clarity; in rarer cases, this form of psoriasis is limited to the appearance of peeling with large rings.
Exudative psoriasis
This form of psoriasis is characterized by excessive severity of exudate during an inflammatory reaction; appears in the progressive period of the course of psoriasis. Making its way to the surface of the papule, the exudate ensures the saturation of the accumulation of scales, thus forming from them formations that look like crusts. These elements are secondary, define them as flame crust, the color of these elements is yellow. After removing them, a slightly bloody and weeping surface is subjected to exposure. When dried and stratified, scaly crusts often form a kind of massive conglomerate, resembling a seashell (this has already been defined as rupioid psoriasis).
Throat psoriasis
Psoriasis guttate, the symptoms of which appear suddenly, is characterized by the formation of numerous spots within the skin. The disease is mainly diagnosed in patients aged 8 to 16 years. Often, streptococcal infection acts as a precursor to tear-shaped psoriasis.
Psoriasis of the nails
Nail psoriasis, the symptoms of which provide isolation of this type of psoriasis in three main forms, depending on the degree of nail damage, can be atrophic, spotty or hypertrophic.
A point lesion is considered to be the formation of dotted depressions on the nail plates, which can also be compared to the surface of a sheath. The appearance of this form of psoriasis is possible in a slightly different version, which, in its specificity, is similar to onychomycosis. In this case, inside the free edge, the nail plate changes color, becomes dull, prone to destruction without much effort. As a sign that makes it possible to differentiate psoriasis, an inflammatory border formed along the periphery of the affected area of the nail plate is defined. It appears as the edge of a papule inside the nail bed, visible through the nail plate.
Psoriatic arthritis (psoriasis).
Arthritis Psoriasis, whose symptoms are manifested due to infiltration, which is important for periarticular tissues with concomitant joint damage, mainly affects the interphalangeal joints. Meanwhile, the possibility of involvement of the large joints in the pathological process is not excluded, the joints and joints of the sacroiliac spine are extremely rare in danger in this regard.
It is important to note that psoriatic arthritis, unlike other types of arthritis (which in the general definition means inflammation of the joints), forms against the background of a psoriatic rash that already exists in the patient, often combined with nail damage. . Moreover, an important point can be discerned that the onset of this type of arthritis is combined with an exacerbation of psoriasis within the skin, which, in most cases, takes on an exudative character.
Irrational treatment of the disease during the period of its progression is often accompanied by the appearance of a nonspecific reaction from the body. It is toxic-allergic in nature and consists of the appearance of redness in the area of areas not affected by psoriatic plaques, this redness, when combined, completely affects the skin. This process is combined with an elevated temperature (within an interval not higher than 39 degrees), as well as an increase in lymph nodes, a feeling of tightness of the skin, burning and itching. In frequent cases, there is profuse shedding, thickening and exfoliation of the nail plates, hair loss. This photo already shows the importance of psoriatic erythroderma. Erythroderma completes the restoration of the traditional version of the psoriasis course.
In general, the recurrence of the disease occurs in the autumn-winter period, as well as in the spring-summer periods, which is an important factor to consider, including the appointment of the necessary treatment.
Treatment of psoriasis
Before scheduling treatment, a thorough examination of the patient is done and already to determine the specific measures in it, they are based on the stage of the disease course, on its clinical variety, the general condition of the patient, on the presence of concomitant diseases, complianceof manifestations of the disease with seasonality, etc. , faster and, at the same time, a favorable treatment result 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 achieve a complete cure - the disease simply regresses (i. e. , begins a period of its existence without symptoms), which, however, it is also a positive result for him.
The main goal in treatment was determined to be the maximum possible suppression of symptoms in combination with the addition of preventive measures.
First of all, with psoriasis, a diet is prescribed, in which those foods that provoke a worsening of the disease (spicy foods, chocolate, alcoholic beverages) are excluded from the diet. The restriction also applies to the consumption of smoked meat, honey, fried and fatty foods, etc. During the period of deterioration of the course of the disease, it is recommended to eat more fruits and vegetables (except red ones: apples, tomatoes, cherries, etc. ), lean fish and meat (boiled).
The course of psoriasis has a beneficial effect on its treatment in terms of sanitary-resort facilities. Given the special sensitivity of the skin in patients with psoriasis, it is recommended to avoid sun exposure in it in the period from 11 to 16 hours.
As for the medical treatment of psoriasis, it is based on the use of several methods. First of all, these are external agents (creams, ointments, etc. ), systemic treatment medications (injections, pills, etc. ) and methods such as phytochemotherapy (phytotherapy), physiotherapy, etc. external treatment methods. In particular, the following medications are most commonly used among them:
- Salicylic ointment. With its help the softening of the formed scales is provided, which, in turn, offers the possibility of their early elimination together with the better absorption of another type of medicine. 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 considerable nature of inflammation (i. e. , the more pronounced the inflammation is in the nature of its manifestation, the less amount of ointment is usedfor him, respectively). Salicylic acid, which acts as the base of the medicine, 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 oil provides a reduction of inflammatory processes related to the skin. Contraindication to use is exudative psoriasis (d. M. Th. Psoriasis, accompanied by itching and tearing scales). You can not apply this ointment on the skin of the face. Tar shampoos are used to treat scalp psoriasis.
- Naphthalene ointment. Used to treat regressive and stationary stages of the disease. The worsening or progression of psoriasis determines the inadmissibility of using this drug. With the help of this ointment, itching and intense inflammation are reduced. A 5% or 10% ointment is used.
- Glucocorticosteroid drugs. Their use provides a reduction 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 offer an anti-inflammatory effect, while at the same time improving the course of the disease.
As for systemic treatment, it is chosen strictly individually and only by the attending physician. As already mentioned, it means the use of various pills, injections, etc.
Phytochemotherapy as a method of treating psoriasis consists of ultraviolet exposure in the affected areas of the skin. For this, a special type of installation is used, which radiates such areas without affecting healthy skin.
In general, the treatment of psoriasis may mean many different schemes applied in practice, but none of these schemes is generally accepted due to the change in their course and specificity, therefore the effectiveness of any of the schemes can not be determined in a wayequal for all patients. Let us reiterate 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.