psoriasisIt is a chronic disease that affects the skin, sometimes the nails, joints and internal organs. It is manifested by itching and the appearance of pink-red-papule rashes, which can clump into larger plaques. These papules rise above the surface of the skin. They are covered with silver scales that peel easily when peeled.
Very often, the disease is combined with impotence, accelerated ejaculation and Reiter syndrome. With extensive psoriasis, psoriatic arthritis can occur.
Risk factors
Causes of psoriasishave not yet been fully identified. Risk factors for developing the disease include:
- microbial factor - different types of fungi, mycoplasmas;
- neuropsychic trauma, stress;
- endocrine diseases - diabetes mellitus, thyroid disease;
- foci of chronic infection, especially streptococcal;
- immunodeficiency states;
- disorders of lipid and protein metabolism;
- skin and joint injuries.
Is psoriasis transmitted?
Psoriasis is not contagious. Many researchers pay attention to the familial nature of psoriasis and recognize its genetic nature. Moreover, it is not the disease itself that is inherited, but a predisposition to it.
If you find similar symptoms, consult your doctor. Do not treat yourself - it is dangerous to your health!
Symptoms of psoriasis
The first symptoms of psoriasis:rash on the skin in the form of bright pink plaques with a scaly surface. The plaques are single, rising above the level of healthy skin, are located in the elbows and popliteal cavities.
Most often, psoriatic plaques appear on the skin of the knees, elbows, chest, abdomen, back and scalp, but as the disease progresses, they can appear in any other place, most suddenly on the inside.
Initially, the papules are small - 3-5 mm, the color is bright pink. Gradually increasing in size, they are covered with silver scales and merge into larger formations called plates.
The fresh elements of the papules, as a rule, are brightly colored, until red, the "old" ones are more faded. In the initial stage of psoriasis, the edges of the papules do not peel off. They represent a hyperemic limit -growth corolla. . .
The hallmark of psoriasis is the Auspitz trio. This triad can be observed by wiping the surface of the papule with a sharp object. It includes three phenomena:
- stearin stain phenomenon- stratification of a large number of white silver scales, which are easily separated when scratched;
- symptom of psoriatic film- exuded surface, made with a barbed layer, which opens after removing the lower layers of the corneal layer;
- the phenomenon of blood dew- exposure of superficial capillaries in the form of small blood stains after detachment of the psoriatic film.
Signs of different types of psoriasis
Clinical types of psoriasis:
- Spotted psoriasis- represented by poorly infiltrated pale pink spots. It resembles toxiderma.
- Irritated psoriasis- occurs due to exposure to the skin of aggressive environmental factors (sunlight, cold, heat) and irritants. The color of the plaque becomes more intense, increases in size, rises more above the surface of the skin, a band is formed at the edges in the form of redness.
- Seborrheic psoriasis- often develops in patients with seborrhea. The clinical picture is very similar to seborrheic eczema.
- Exudative psoriasis- happens quite often. Occurs due to excessive secretion of an inflammatory fluid - exudate. It impregnates the accumulations of scales, turning them into scaly crusts.
- Psoriasis of the palms and soles- is represented by ordinary plaques and papules, or hyperkeratotic formations, similar to calluses and calluses.
- Follicular psoriasis- a rare form of the disease. The rash consists of white miliary nodules with a funnel-shaped depression in the center.
- Psoriasis of the mucous membranes- a rare form of the disease. Occurs in the mucosa of the mouth and bladder. It manifests itself in the form of gray-white areas with a red border.
Frequency of psoriatic manifestations
Cyclic exacerbations are characteristic of psoriasis. Most often they occur in autumn and spring.
The pathogenesis of psoriasis
Dermatosis is an inflammatory process related to the work of immune T cells. As a result of this inflammation, the proliferation of keratinocytes, the main cells of the epidermis, accelerates.
Psoriasis, a type of dermatosis, is a chronic inflammatory disease. Continues with the participation of microbial pathogens that can bind to the surface of the skin.
Everything that happens on the skin under the influence of the pathogen is a classic inflammatory reaction according to the principle of RTCDF:
- Rubber - redness;
- Tumor - tuberculosis, edema;
- Calories - ethe, ethe;
- Dolor - pain;
- Functia laesa - dysfunction.
Redness and thickening of the skin at the sites of lesions, itching, increased keratinization followed by the formation of scales - all these are manifestations of the inflammatory process, a protective reaction of the body aimed at combating the microbial pathogen. Without outside help in time, the body is often defeated.
Some scientists adhere to the theory of a genetic predisposition to a violation of the cell division process. With such a violation, an increase in cell death and keratinization occurs, followed by their growth and the appearance of a large number of incompletely keratinized epithelial cells. But this theory does not contradict at all the microbial one above.
Classification and developmental stages of psoriasis
There is no generally accepted classification of psoriasis.
TraditionallyThere are four types of disease:
- vulgar psoriasis - seborrheic, follicular, warty, exudative, bullous, psoriasis of the palms and soles, psoriasis of the mucous membranes;
- pustular psoriasis;
- psoriatic erythroderma;
- psoriatic arthritis.
According to ICD-10, there are:
- L40. 0 Psoriasis vulgaris (coin and plaque psoriasis);
- L40. 1 Generalized pustular psoriasis (impetigo herpetiformis, Tsumbusch disease);
- L40. 2 Persistent acrodermatitis;
- L40. 3 Palmar and plantar pustules;
- L40. 4 Psoriasis teardrops;
- L40. 5 Arthropathic psoriasis;
- L40. 8 Other psoriasis;
- L40. 9 Psoriasis, unspecified
Complications of psoriasis
Without timely and competent treatment, psoriasis begins to adversely affect vital organs and systems: joints, heart, kidneys and nervous system. These conditions can lead to disability and even death.
What is psoriatic arthritis
Psoriatic arthritis is the most severe form of psoriasis, as it often causes disability.
Doctors face this complication more often. Occurs as a result of inflammatory changes in the joints.
The joints of the hands, wrists, ankles and knees are the most affected. Over time, the disease can spread to the joints of the hips, shoulders and spine. As further progress is made, the muscles begin to ache near the affected joints. Patients complain of stiffness of movement, especially in the morning. Their body temperature often rises throughout the day.
The clinical picture of psoriatic arthritis develops in the manner of ordinary arthritis: first, there is pain, then swelling, stiffness, and limited mobility. A characteristic symptom of this complication is a sausage finger. Appears due to loss of all interphalangeal surfaces.
Other complications of psoriasis
Slightly less commonpsoriatic erythroderma. . .This condition occurs when the skin is completely affected. Patients are concerned about itching and burning, large skin of dead tissue, a strong skin reaction to a change in temperature.
The next most common event ispustular psoriasis. . .This complication is associated with the addition of a secondary infection - staphylococci and streptococci. Clinically, pustular psoriasis is associated with the appearance of pustules - pustules the size of a buckwheat. Pustules appear in different places. They rise above the surface of the skin, are characterized by rapid growth and a tendency to coalesce. Existing symptoms are accompanied by high fever and signs of serious intoxication.
Lesions of internal organswith psoriasis are now extremely rare. As a rule, people who lead an antisocial lifestyle are sensitive to them. The genitourinary system is most often affected: kidneys, bladder mucosa and urethra. This leads to the development of pyelonephritis, glomerulonephritis, cystitis and urethritis.
On the heart side, psoriasis can cause damage to the mitral valves, inflammation of the heart muscle and the outer mucosa of the heart - the myocardium and pericardium. With damage to the nervous system, patients complain of a crawling sensation, increased nervousness or depression, constant fatigue, drowsiness, and apathy.
Diagnosis of psoriasis
When you see a doctor
Symptomatically it is necessary to consult a doctor at the first symptoms of psoriasis: the appearance on the skin of bright pink plaques with a thin surface.
Preparing to visit a doctor
Three days before visiting a doctor, you should stop applying medicinal oils to the skin. No other special training is required.
Psoriasis is a disease so well known that it will not be difficult to diagnose on the basis of external signs. Often, a diagnosis can be made to patients, as they say, "out of the box. "If necessary, the doctor wipes the surface of the skin to detect the Auspitz trio.
OV Terletskiy, Candidate of Medical Sciences, together with the co-authors, proposed a diagnostic scheme developed based on data from the American Rheumatological Association. It includes the following exams:
- complete blood count (with platelets);
- general urine analysis;
- blood chemistry;
- acute phase reactions of the body - reactive protein C and rheumatoid factor;
- immunoglobulins - IgA, IgG, IgM, IgE)
- complement binding reaction with gonococcal and chlamydial antigen;
- Wright and Heddelson reactions;
- coagulogram - assessment of blood clotting;
- blood test for borreliosis and toxoplasmosis (as indicated);
- blood test for HLA.
However, there are many diseases under the guise of psoriasis. In this regard, it becomes necessary to performdifferential diagnosis, in particular between papular syphilis, Reiter syndrome, neurodermatitis, rosacea lichen, systemic lupus erythematosus, and seborrheic eczema. For this purpose, use:
- biopsy - capture of a part of the skin with subsequent histological examination;
- laboratory diagnosis - often used to distinguish psoriasis from papular syphilis;
- blood tests for other hidden infections for a better selection of antibiotics.
Instrumental diagnostic methodsused mainly for complicated forms of psoriasis associated with damage to joints and internal organs. These include: X-rays of the joints, ultrasound of the heart, kidneys and bladder.
Treatment of psoriasis
Is there an effective treatment for psoriasis
Despite the fact that psoriasis is a recurring disease, it can be completely eliminated provided you consult a dermatologist in a timely manner, who can identify the true causes of psoriasis. Over the last decade, many drugs of systemic and local action have emerged, aimed at eliminating the cause and suppressing the mechanism of disease development. Drugs that interact with each other using chemical signals (cytokines) are very well proven. They eliminate the increased proliferation of skin creatinocytes.
Phototherapy
In 1994, the team of the Dermatovenereology Department of MAPO SPb introduced a method of treating psoriasis usingUFO blood- photomodification of blood with ultraviolet light.
The ability of sunlight to have a beneficial effect on the skin for many diseases, including psoriasis, has been known since ancient times. In the early twentieth century, a group of German scientists suggested that since ultraviolet light has a healing effect on exposed skin, this effect is likely to occur when ultraviolet radiation is applied to the blood. After all, it is also a kind of fabric. This assumption was confirmed by the first session of UV exposure in the blood, which was held in Germany in 1924.
The therapeutic effect of ultraviolet rays in the blood is accompanied by profound structural changes at the molecular-atomic level, which are captured by immunocompetent organs - liver, spleen, bone marrow and lymphoid tissue. These changes are considered by the organs as an alarm signal, and therefore they produce tens of times more immune complexes. In this case, ultraviolet light is a kind of "whip" that forces the body to dramatically increase its defenses to fight disease.
It is also worth mentioning the PT effect -cancellation of ultraviolet therapy. . . This method of treatment is important, given the chronic nature of psoriasis, associated with numerous internal organ complications caused by a variety of microbial pathogens. The longer germs are in the body, the wider their habitat becomes. These microscopic creatures capture more and more anatomical areas through the bloodstream and lymph. Once inside the tissues, they try to penetrate as deep as possible into the intercellular spaces. There they form microcolonies, protected by the remnants of dead, destroyed cells and a leukocyte shaft. Because of this, microorganisms may be out of the reach of antibiotics for years. They easily compensate for the lack of nutrients by entering a state of suspended animation - something between life and death.
The ability of ultraviolet rays helps to destroy microbial "shelters". They create favorable conditions for the penetration of antibiotics and other drugs that affect the cause of psoriasis.
Dermal application of ultraviolet radiation is also important. The most famous method of treatment using this principle isPUVA therapy. . . Although it is less effective than ultraviolet radiation of blood. The therapeutic effect does not last long, a relapse may occur two weeks after the end of treatment.
Drug treatment
Of the medicines, the following worked well:
- vitamin A derivatives, which reduce the rate of keratinocyte maturation and normalize cell differentiation;
- immunosuppressants that reduce the activity of T lymphocytes, which contribute to increased epidermal cell division;
- drugs for the treatment of malignant tumors that inhibit the reproduction and growth of atypical skin cells.
Which oils and creams are effective in treating psoriasis
Ointments and creams with anti-inflammatory ingredients will help alleviate the patient's condition.
How to treat scalp psoriasis
Ointments are not effective in treating scalp psoriasis. In addition to medication and ultraviolet treatment, a special shampoo can be used.
How to treat psoriasis on the elbows and arms
Psoriasis on the elbows and arms is treated with the same methods as on the rest of the body. The peculiarity of the course of psoriasis in this area is that the skin of the hands is subject to physical, mechanical and chemical influences, which is considered an aggravating factor in the course of the disease.
Is monoclonal antibody treatment for psoriasis effective?
Monoclonal antibody therapy for psoriasis is very effective. Monoclonal antibody drugs are laboratory-produced antibodies similar to those produced by human immune cells. Monoclonal antibodies selectively target the targets responsible for the development of the disease.
How to recognize and treat psoriasis in children
In children, psoriasis often progresses more violently and disguises itself as other diseases (eczema, erysipelas, herpes), which complicates the diagnosis. The methods of therapy are similar to those for adults: phototherapy, medication and local treatment.
What bathroom to do with psoriasis
Aloe vera baths can help reduce inflammation and itching.
How to treat psoriasis according to Pegano
The Pegano method for treating psoriasis includes bowel cleansing, diet and herbal teas. The effectiveness of this method has not been proven by clinical studies.
The role of nutrition in treatment
Nutrition greatly affects the course of psoriasis. During treatment, it is necessary to exclude alcohol, salty, spicy, pickled, nuts, citrus, honey, chocolate and smoked meats.
Which sanatoriums show rest for treating psoriasis
For psoriasis, bath treatment is preferably done at sea in a region with a warm and dry climate and many sunny days. The most suitable for this are the Crimean resorts.
Popular ways
Some folk remedies can help reduce itching and itching of the skin in patients with mild to moderate psoriasis. These methods include:
- cream with aloe extract;
- fish oil applied to the skin with a bandage worn for six hours a day for four weeks;
- cream with oregano grape extract.
Forecast. prevention
Psoriasis is not a sentence. If the patient has timely sought qualified help from a specialist who can determine the true causes of the disease and prescribe effective treatment, then the disease will be defeated.
The simple form of psoriasis is manifested only by a skin defect. Therefore, the patient does not need special working conditions. The exception is work in a chemical plant: in this case, staying in the workplace will have to be excluded.
It is worth remembering that psoriasis can cause complications. Most often, psoriatic arthritis develops. Its severe forms can limit the performance of tasks at work, and in the future lead to complete disability.
Prevention of psoriasis is an integral part of therapeutic measures to eliminate one of the most serious skin diseases. After recovery, the patient should completely reconsider his lifestyle, eliminate bad habits, pay attention to the treatment of chronic diseases of other organs, adjust diet, include outdoor walks and sports in the daily routine.
Do they get psoriasis in the military?
Severe forms of psoriasis are reason enough to declare a recruit unfit for military service, mild forms - with limited fitness.