A pathological condition characterized by scaly and nodular changes in the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of the disease.
Psoriasis is a chronic skin and nail disease in which a rash of pink nodules and silvery scales appears on the skin. Usually the nodules coalesce into large plaques, around which the skin quickly becomes covered with scales. With the prolonged development of the disease, damage to the joints is possible, accompanied by impaired movement and constant pain. Different forms of psoriasis differ in the degree of skin damage: the patient may have only subtle spots on the scalp or large plaques on different parts of the body. The possibility of developing psoriasis complications also depends on many factors. This disease is especially dangerous for pregnant women, as the pustular form of the disease can cause miscarriage.
About the disease
Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually occur between the ages of 18 and 35. Often psoriasis appears against the background of cardiovascular disorders, Crohn's disease and depression. Approximately 30% of patients develop joint damage (arthritis). It is impossible to eliminate the main cause of psoriasis, however, symptomatic therapy can significantly ease the course of the disease.
Types of psoriasis
Depending on the predominant symptoms, several types of psoriasis are distinguished:
- plate: characterized by the appearance of classic plates covered with silver scales; preferential location: elbows, knees, torso, scalp;
- teardrop-shaped: the main manifestation is orange-pink nodules from 1 to 10 mm in size;
- nail psoriasis: the nail plates are mainly affected;
- psoriasis of the large folds: rashes appear in the armpits, in the folds of the neck, on the genitals and in other places with excessive friction; this form is more common in obese people;
- scalp psoriasis: the scalp is affected;
- arthropathic psoriasis (psoriatic arthritis): the joints are affected;
- pustular psoriasis: numerous small blisters with pus appear on the patient's skin;
- Psoriatic erythroderma: in addition to the rash, there is a pronounced reddening of the skin in the area of the rash.
Symptoms of psoriasis
Most often, plaques appear on the forearm, lower leg, navel and scalp. The pustular form of psoriasis is characterized by the formation of pus-filled blisters on the skin. At certain times, many patients experience a change in the color and structure of the nails. Damage to the scales of the skin leads to the appearance of accurate bleeding. Patients also complain of itchy skin. Skin changes disappear and reappear periodically.
Other symptoms and signs:
- the appearance of red spots in the area of skin folds;
- numerous rashes occur after infectious diseases and stress;
- slight increase in body temperature;
- the appearance of new skin rashes in the winter months;
- joint pain;
- impaired mobility in the area of the affected joint;
- dryness and hypersensitivity of the skin.
Resorption of the plaques usually starts from the central part, as a result of which the psoriatic elements take on a ring or crown-like shape. Temporary depigmentation (pseudo leukoderma) remains at sites of resolved rashes. During periods of incomplete remission, individual "duty" plaques may remain in certain areas of the skin (most often in the area of the elbow and knee joints).
The most severe types of psoriasis are psoriatic erythroderma and arthropathic psoriasis.
In psoriatic erythroderma, all skin (or almost all) is involved in the pathological process. The skin becomes tight, rough, infiltrated, red in color, with abundant large and small lamellar skin on the surface. Peripheral lymph nodes increase, subfebrile temperature appears, the general condition of patients is disturbed, changes in blood (leukocytosis, elevated ESR), urine (proteinuria) are observed. The development of erythroderma is triggered by irrational, irritating therapy in the progressive stage of psoriasis.
Arthropathic psoriasis is characterized by lesions mainly of the small joints of the hands and feet, less often of the wrist, ankle, intervertebral, etc. , accompanied by severe pain and swelling of the joints, limitation of mobility and their deformations. X-rays reveal lysis of the distal phalanges of the fingers and joint changes similar to rheumatoid arthritis. The Waaler-Rose test and the latex test are usually negative. In the blood, leukocytosis, elevated ESR, hypergammaglobulinemia. Articular involvement may be associated with skin lesions or be isolated over several years.
With all these forms of psoriasis, it is possible for the nails to be damaged in the form of perforated nail plates ("the spike phenomenon"), their blurring or thickening up to onychogryphosis. The course of the disease is chronic and undulating. The seasonality of the process is usually expressed - deterioration in winter with a significant improvement in summer (winter type), less often - vice versa (summer type).
Causes of psoriasis
The exact mechanisms of psoriasis formation are still not understood. It is thought to be an autoimmune disease in which the body's defense system mistakenly attacks healthy tissue. T cells and neutrophils needed to fight pathogens can begin to attack skin cells and joint structures. In this case, characteristic changes occur in the skin, including the formation of blisters with an inflammatory fluid. The expansion of blood vessels in the area of inflammation is accompanied by redness of the skin. Autoimmune disease can be caused by hereditary factors.
Additional risk factors:
- skin infections. First of all, these are bacterial infections caused by streptococcus;
- skin damage from cuts and burns;
- prolonged stress and psychotraumatic factors;
- alcoholism and smoking;
- lack of vitamin D in the body;
- taking certain medications, including lithium and beta-blockers;
- adverse family history. The discovery of psoriasis in a close relative of the patient indicates the possibility of a genetic predisposition to this disease;
- acquired or congenital impairment of immunity. It could be HIV infection, AIDS or another condition.
Despite the discovery of the putative immunopathological causes of psoriasis, the disease remains poorly understood. There are a large number of diseases and lifestyle features that provoke the appearance of hidden factors of predisposition to this disease.
Diagnosis of psoriasis
If skin changes appear, you should consult a dermatologist. The doctor of our clinic first performs a general examination of the skin to assess the nature of the rash. Gentle scraping allows you to reveal exfoliating papules and a thin film under the nodules. Beneath the film, there is a moist surface of the skin, prone to small hemorrhages. At the same time, there are atypical signs of psoriasis that resemble other diseases, so the doctor should perform instrumental and laboratory diagnostics.
- Blood analysis. The dermatologist prescribes a venous blood test to rule out other diseases and detect signs of psoriasis. In the treatment room, the nurse treats the skin of the patient's cubital fossa with an antiseptic, puts a tourniquet and takes blood with a syringe. In our laboratory, specialists first of all rule out the presence of rheumatoid factors. In pustular psoriasis, an increase in the sedimentation rate of erythrocytes is often found. High levels of uric acid are detected;
- Examination of pustule fluids. The doctor collects the fluid in a sterile container and sends the material to the laboratory. Microbiological examination does not reveal a bacterial culture, but an increase in the number of neutrophils characteristic of psoriasis is found;
- Skin biopsy. The dermatologist prescribes this study to make an accurate diagnosis for atypical rashes. During the procedure, the doctor treats the skin with an antiseptic, anesthetizes and removes a small area of skin with a scalpel. The tissue material is studied in the laboratory of our clinic using a microscope. The results allow to clarify the cellular composition of the nodes;
- X-ray of the affected joint. The doctor prescribes this study to determine the type of arthritis. Also, in severe complications of arthropathic psoriasis, bone X-ray diagnosis is required;
- Scraping the skin to rule out fungus. The doctor cleans the surface of the skin and, using a special spatula, collects some scales for microbiological examination. This analysis is mainly necessary if rashes appear only in the leg and nail area.
If necessary, a consultation with a rheumatologist is carried out.
Expert opinion
Psoriasis is a disease with many manifestations. It can be almost invisible or it can cause serious health problems. The most dangerous complications of psoriasis are joint damage, which can cause disability in the patient. Also, the disease can lead to autoimmune disorders, in particular, Crohn's disease and ulcerative colitis, metabolic pathology, erectile dysfunction in men. Women suffering from psoriasis may experience infertility and miscarriage. To prevent these complications, it is necessary to consult a doctor immediately after the appearance of suspicious signs and, with an already diagnosed diagnosis, carefully follow all the recommendations of a specialist.
Treatment of psoriasis
The main goal of psoriasis treatment is symptomatic therapy. Patients need medications that reduce inflammation and prevent the formation of skin rashes. In addition to drug therapy, the dermatologist of our clinic necessarily prescribes a special diet for the patient. Normalizing lifestyle and eliminating stress factors can reduce the severity of psoriasis symptoms.
Depending on the situation, a dermatologist can use different methods to treat the disease.
- Administration of corticosteroids. The dermatologist prescribes ointments containing these drugs. Beneficial effects of corticosteroids include reducing tissue inflammation and eliminating itching;
- Vitamin D supplements. Synthetic forms of this vitamin slow down the growth of skin cells, thus preventing the formation of scales and nodules;
- Therapy with drugs containing derivatives of vitamin A. A dermatologist prescribes retinoid-based ointments to reduce inflammation and itching. These drugs increase the skin's sensitivity to light, so sunscreen should be used;
- Use of calcineurin inhibitors. These are immunosuppressants that reduce inflammation. The dermatologist prescribes topical agents such as tacrolimus. Such drugs are used in a short course to prevent the development of side effects and complications;
- Skin treatment with salicylic acid to remove dead cells. A dermatologist prescribes this drug along with corticosteroids for complex skin treatment;
- Using a moisturizer to eliminate dry skin and itching;
- Irradiation of the skin with ultraviolet rays. This safe physiotherapeutic method of treatment improves the functioning of local immunity. The doctor chooses an individual dose of radiation for the patient;
- Phototherapy. This method involves irradiation of the skin using special equipment. Phototherapy combines the technologies of laser therapy and photochemotherapy;
- Joint puncture in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, anesthetizes the tissue and inserts a needle. With the help of a syringe, drugs are injected into the joint cavity to reduce the inflammatory process.
The dermatologist controls all stages of the treatment to achieve the best result and prevent complications. Corticosteroids, retinoids and calcineurin inhibitors are used strictly under the supervision of a specialist.
Prevention of psoriasis
The recommendations of the dermatologist of our clinic will help reduce the severity of skin rashes and soften the course of the disease.
Prevention of psoriasis exacerbations:
- alleviate anxiety and stress by improving sleep, avoiding coffee, and taking prescription painkillers;
- exclusion from the diet of foods containing allergens;
- timely treatment of infectious skin diseases.
reHabiLitatiON
Psoriasis is a chronic disease that cannot be cured. Rehabilitation measures are aimed at preventing relapse. Depending on the form of the disease, physiotherapy, spa treatment, mud therapy, therapeutic baths and other procedures may be prescribed.
Question and answer
Is it possible to treat psoriasis with folk remedies?
There are no methods with proven effectiveness. It is important not to trust dubious types of treatment, but to follow the recommendations of the attending physician.
Does stress affect the course of psoriasis?
Yes, stressful situations can worsen the course of the disease.