All about psoriasis - how to treat, causes and symptoms, types

For more than two thousand years, mankind has been trying to solve all the riddles of this severe dermatosis, but still much remains unknown. According to statistics, this disease affects from 4 to 7% of the population, women and men are equally susceptible to it. The first signs of psoriasis usually appear during puberty and accompany a person for the rest of his life, then subsiding and disappearing completely, then intensifying.

Can psoriasis be cured?Modern medicine has achieved a lot in the treatment of this chronic dermatosis and is able to provide the patient with a decent level of quality of life.

Causes of psoriasis

Psoriasis is a chronic skin inflammatory process, which modern medicine refers to as autoimmune (associated with allergy to one's own tissues). There are many causes of psoriasis and factors predisposing to the development of this dermatosis, in connection with which a number of theories of its origin have been put forward.

Autoimmune

This is the main theory, as it is well established that the immune system actively responds to certain types of skin exposure. The skin of people suffering from psoriasis is very sensitive to mechanical, physical, and chemical influences. Not only epithelial cells react to such influences, but the entire immune system.

Cellular immunity is impaired: the ratio between the individual subtypes of lymphocytes responsible for the formation of a normal immune response. So, in psoriasis, the number of T-lymphocytes of helpers - helpers regulating immunity - increases, while the number of T-lymphocytes of suppressors, suppressing an excessively strong immune response, decreases. Lymphocytes and some other cells produce cytokines - active substances that stimulate the immune response. Humoral immunity also suffers, an imbalance of antibodies (immunoglobulins) in the blood serum develops, antibodies to the tissues of the patient's body appear.

Inflammation begins against the background of activation of T-lymphocytes, but why they are activated has not been established. In the process of research is also the question of how to suppress the autoimmune response without harming the patient.

Exchange

An imbalance in metabolism has a significant effect on the skin and immunity. In patients with psoriasis, there is an acceleration of metabolism, the appearance of a large amount of toxic free radicals and other toxins that support the inflammatory response. Metabolism is disturbed:

• proteinaceous- the gene of predisposition CDSN stimulates the synthesis of the protein corneodesmosin, which sensitizes (allergenic) the body; the content of albumin proteins in the blood decreases and the content of globulins increases; this condition is called dysproteinemia and further enhances sensitization;
• fatty- the content of lipids and cholesterol in the blood rises; the use of predominantly plant foods and a general decrease in the calorie content of the daily diet can reduce the activity of psoriatic inflammation;
• carbohydrate- almost always violated;
• exchange of vitamins and minerals- the content of vitamin C in the skin increases, the content of vitamins C, A, B6, B12, iron, copper and zinc in the blood decreases.

Infectious

This theory was relevant at the beginning and in the middle of the last century. Certain bacteria (streptococci), fungi and viruses were considered the causative agents of psoriasis. These theories have not been confirmed. But dermatologists note that any acute infectious process or the presence of a permanent focus of infection can provoke relapses. The viral theory occupies a special place. Recent studies have revealed the effect of retroviruses (RNA-containing viruses - HIV, etc. ) on the genetic apparatus with the formation of genes for psoriatic predisposition.

Genetic

The predisposition to autoimmune reactions is inherited. If a person's loved ones suffer from psoriasis, then the likelihood of developing this disease increases many times over. There are genes for predisposition to psoriasis (local complexes PSORS1 - PSORS9, PSORS1 is especially active, it contains the genes HLA-C, HLA-Cw6, CCHCR1 and CDSN, which are responsible for the development of the disease). Genes affect metabolism, immunity and the development of autoimmune processes. But the presence of such genes does not at all guarantee the development of the disease. The influence of provoking factors is of great importance.

Neurogenic

Prolonged stress, high neuropsychic stress, disorders of the autonomic nervous system (innervating the walls of blood vessels and internal organs) can cause the development of psoriasis, causing an imbalance in the endocrine system, impaired metabolic and immunological processes.

Endocrine

Endocrine disorders in psoriasis are common and mainly play the role of a provoking factor. A clear connection between the two has not been proven. Dermatologists note that patients often have dysfunctions of the thyroid gland, adrenal glands, and pituitary gland. There are menstrual irregularities in women and sexual function in men.

Psoriasis symptoms

The main symptoms of psoriasis are skin rashes. But there are other signs as well. The very first manifestations usually appear in adolescence or childhood against the background of hormonal disorders, vegetative-vascular dystonia and prolonged stress.

The disease begins with a feeling of constant fatigue, mood disturbance. Characterized by small, pinkish formations (papules) towering above the surface, powdered from above with whitish peeling. They are surrounded by a brighter, towering rim.

Elements of the rash grow and combine into large plaques of bizarre shapes. The base of the papule is an inflammatory infiltrate. By the nature of the rash, psoriasis is divided into:

• point- elements no more than 1mm in diameter;
• teardrop- papules-droplets up to 2 mm;
• coin-shaped- round papules-coins up to 5 mm in size.

Characteristic features of the rash:

• stearin stain- if you scrape, the surface of the papules;
• terminal film- Thoroughly cleaning the surface of the papules from the scales, we will see a transparent film;
• blood dew (Auspitz phenomenon)- having scraped the film and violating its integrity, we will see small bloody droplets protruding on the surface.

Stages of psoriasis

There are three stages of the disease:

1. progressive- the first elements of the rash appear, their number increases, all new areas are captured; rashes also appear when scratching the itchy skin or exposure to some external irritating factors (Kebner's phenomenon); in the initial stage of psoriasis, papules begin to merge into large plaques;
2. stationary- there are no new elements, and those that appeared earlier do not regress;
3. regressive- the rash turns pale, its base becomes less dense; the rash gradually regresses, the process often begins from the central part, so the plaques can have the form of rings; if plaques in psoriasis dissolve from the periphery to the center, then they simply gradually decrease in size and a white ring forms around them - Voronov's pseudoatrophic rim; where there was a rash, white, pigmented areas remain - psoriatic leukoderma.

Occasionally, papules are simultaneously present on the skin at all three stages of development. There are also summer and winter forms with a predominance of exacerbations in summer or winter.

Is psoriasis contagious?

Numerous studies have confirmed that this is not a contagious disease. If infectious pathogens take part in its development, then only through a general effect on metabolism, immunity and the genetic apparatus.

Patients often ask:

• How is psoriasis spread?

  Psoriasis is not transmitted from person to person.

• Is psoriasis inherited?

  The answer is again negative, but there is a hereditary predisposition in the form of metabolic characteristics and the functioning of the immune system, which is transmitted to close relatives.

Types of psoriasis

The nature of the rash, their location, damage to other organs and systems in this chronic dermatosis may be different. According to these signs, several types of disease are distinguished.

Simple (vulgar, plaque)

The most common. Its symptoms are papules of a characteristic bright pink color, covered with white scales. Downstream, plaque psoriasis is divided into the following forms:

• easy- if the lesion covers no more than 3% of the skin; in the progressive phase, the papules increase, but then they quickly undergo a reverse development;
• moderate- the rash takes from 3 to 10%; papules are large, merge into plaques;
• heavy- the defeat captures more than 10%; rashes are numerous, merge, forming a wide variety of shapes.

Vulgar psoriasis proceeds in the form of relapses, alternating with remissions, but there is also a continuous course.

Elbow psoriasis

This is one of the manifestations of a mild form of plaque inflammation. A distinctive feature of psoriasis on the elbows is the constant presence of one or more "duty" plaques on the extensor side of the elbow joints. If these elements are injured, an exacerbation begins.

Guttate psoriasis

In the development of guttate psoriasis, bacterial (most often streptococcal) and viral infections are of great importance. Occurs in childhood. The inflammation begins after an infection. Streptococci secrete toxins (antigens - substances foreign to the human body) that bind to tissue proteins. Antibodies are produced to them and autoimmune inflammation develops.

The beginning is acute. On the skin of the extremities (less often the body and face), small red papules-tears with a flaky surface appear. With injuries in the area of the rash, small erosions and sores are formed, the risk of infection increases.

Psoriasis quickly takes on a subacute and chronic course. Relapses are replaced by remissions, independent recovery or transition to the adult form of the disease is possible.

Palmar-plantar psoriasis

It develops in those who are engaged in physical labor, is accompanied by severe itching and almost always gives a complication to the nails. There are subspecies:

• plaque-fan-shaped- with large elements on the palmar and plantar surfaces, covered with white scales, merging into fan-shaped plaques; such psoriasis on the hands is more common;
• circular- ring-shaped scaly elements on the palmar and plantar surfaces;
• horny- characterized by the growth of coarse epithelium with the formation of corns;

A separate subspecies is pustular psoriasis on the palms and soles of Barber. Areas under the thumbs of the extremities are covered with vesicles and pustules (with purulent contents), severe itching appears. The abscesses merge, then dry out, forming crusts. Elsewhere on the body, characteristic psoriatic elements develop. The disease often spreads to the nails.

Psoriasis on the legs is maintained and aggravated by varicose veins, in which case the rash will be mainly in the lower leg area.

Nail psoriasis

Damage to the nails can be both independent and a complication. Typical symptoms:

• small dimples of different depths appear on the nail plate; similar nail lesions are found in other dermatitis, but in psoriatic lesions they are deeper and slightly painful when pressed;
• spontaneous slow painless separation of the nail (onycholysis);
• subungual hemorrhages on the toenails, especially if the patient wears tight shoes;
• trachyonychia - clouding and irregularities on the nail plate; a depression is formed in the middle of the nail and the nail becomes like a spoon (koilonychia).

Sometimes the periungual roller is affected with the transition of inflammation to other tissues (psoriatic paronychia).

Scalp psoriasis

Here, the disease proceeds independently or as part of a general pathological process. Characterized by oozing, the formation of crusts on parts or on the entire surface of the head. Hair growth is not affected at the same time: psoriasis on the head does not impair the function of the hair roots. But oozing creates a threat of infection with subsequent damage to the hair follicles.

It flows in waves, then subsiding with the disappearance of the crusts, then again aggravating and accompanied by severe itching, often leading patients to neurosis.

Seborrheic psoriasis

Seborrhea is a condition caused by a malfunction of the sebum-producing skin glands. A viscous oil is produced, irritating the skin and contributing to the development of inflammation - dermatitis.

Seborrheic psoriasis quickly spreads to the entire head, covering it in the form of a cap and accompanied by severe itching. In the areas behind the ear, weeping sometimes develops and an infection joins. The head covered with dandruff and solid crusts sometimes looks like a psoriatic crown.

Psoriasis on the face

Usually, psoriasis on the face is localized in the area of the nasolabial triangle, eyelids, above the eyebrows, in the areas behind the ear. The fused elements of the rash form large areas of redness and swelling. If there is a dysfunction of the sebaceous glands, the process is often accompanied by oozing, crusting, and an increased risk of infection.

Psoriasis on the genitals

This is not an isolated process. Simultaneously with the defeat of the genitals, there are characteristic psoriatic rashes all over the body, so it is not difficult to identify the disease.

Psoriasis on the penis in men and the labia majora in women, as well as on the adjacent skin areas, manifests itself in the form of oval, pink scaly papules slightly rising above the skin. There is practically no itching. Sometimes the process spreads to the mucous membranes and looks like vulvovaginitis in women and balanoposthitis in men.

Atypical psoriatic rashes can be observed in obese people in folds located next to the genitals (inguinal, intergluteal). Here, areas of intense red color with a mirror-like surface are formed without signs of peeling due to constant wetting.

Why is psoriasis dangerous and should it be treated

The danger is that psoriasis can take on a widespread severe form, rashes will occupy more than 10% of the integument. This stage of the disease is difficult, relapses, the elements of the rash are injured and get wet, an infection often joins. Only in time prescribed treatment of psoriasis can stop the process of its spread.

Sometimes the disease is complicated by inflammation in the joints with the formation of psoriatic arthritis, against which the function of the joints can be significantly impaired.

Against the background of a systemic autoimmune process, which has a significant effect on the patient's condition, other autoimmune diseases often develop (rheumatoid arthritis, some types of arthrosis, Crohn's disease, etc. ), as well as severe cardiovascular pathology, diseases of the digestive system, neurological reactions.

If you do not start the treatment of psoriasis on time, the patient's condition will dramatically worsen and lead to disability.

There is also such a complication as psoriatic erythroderma, which develops with improper or insufficient treatment of psoriasis, as well as when various irritating factors are exposed to the inflamed skin. The skin acquires a bright pink color with a clear delimitation of the affected areas from healthy ones, small and large lamellar peeling. Such a patient requires emergency medical attention.

Is psoriasis treated?

Yes, and quite successfully, but complete recovery cannot be guaranteed.

Treatment methods

Autoimmune inflammation requires individually selected complex therapy, lifestyle changes, nutrition, and the elimination of all bad habits. Modern medicine has proposed three basic principles for the successful treatment of psoriasis:

• strict adherence to the algorithms for the prescribed therapy;
• regular monitoring of the effectiveness of the therapy;
• timely correction of the prescribed therapy with its insufficient effectiveness.

Nutrition for psoriasis

There is no special diet for psoriasis, but nutrition is of great importance. Therefore, when prescribing a complex treatment, recommendations on nutrition are necessarily given:

• identify increased sensitivity of the body to certain foods and exclude them from the diet;
• give preference to fresh vegetables, non-acidic fruits and berries, boiled and baked lean meat, drink more;
• what not to eat with psoriasis:
  1. products containing essential oils - onions, garlic, radishes;
  2. drinks containing caffeine (concentrated tea, coffee), alcohol;
  3. everything is saltier, sour and sweet, rich;
  4. products that promote sensitization (allergization) of the body - orange fruits, honey, nuts, cocoa, eggs;
  5. do not eat fatty animal products.

Pegano diet for psoriasis

This diet was developed by American physician John Pegano, but has not found official medical recognition. The principle of building the Pegano diet for psoriasis is associated with alkalinization of the body by selecting the correct diet. According to this principle, all products are divided into:

• alkali-forming (two-thirds in the daily diet) - non-acidic fruit and berry mixtures and juices, vegetables (exclude those causing increased gas formation);
• acid-forming (one third of the diet) - meat, fish, dairy products, beans, peas, potatoes, cereals, sweets and baked goods.

Patients are advised to drink mineral water without gas, drinking water up to 1. 5 liters per day, plus other liquids drunk (compotes, juices, etc. )

Drug therapy

Mild psoriasis is treated with topical medications. Severe and rapidly progressing forms of the disease are treated mainly in a hospital setting with the prescription of drugs of general (systemic) action.

External psoriasis treatment

The medicine is selected by a dermatologist. For psoriasis vulgaris with dry constricting plaques, ointments are suitable, if oozing develops (with seborrheic), then creams and medicinal solutions are used. In order to avoid resistance (resistance) of the organism to a certain drug, it is changed over time.

In the acute (progressive) stage, the following external therapy is carried out:

• agents that have a softening effect - boric petroleum jelly, 2% salicylic ointment;
• effective non-hormonal ointments for psoriasis containing activated zinc pyrithionate; they suppress infection and have a cytostatic (suppress tissue proliferation) effect;
• external agents containing glucocorticosteroid (GCS) hormones;
• a combined agent with calcipotriol (an analogue of vitamin D3) and corticosteroids betamethasone; perfectly suppresses the inflammatory process.

External treatment of psoriasis in the stationary stage:

• ointments that dissolve scales (keratolytic) and have an anti-inflammatory effect - 5% naphthalan, boron-naphthalan, tar-naphthalan;
• corticosteroid drugs.

External treatment of psoriasis in the resolving stage:

• the same keratolytic ointments, but in a higher concentration: 10% tar-naphthalan ointments;
• ointments based on analogs of vitamin D3 - within 6 - 8 weeks; suppresses the inflammatory process and peeling of the rash.

For the treatment of nail psoriasis, special varnishes are used that suppress the development of the pathological process. It is recommended to treat periungual phalanges with moisturizing gels.

Systemic treatment of psoriasis

• drugs that relieve inflammation and intoxication - calcium chloride, sodium thiosulfate, unitiol in the form of injections;
• tablets for psoriasis, which suppress the processes of proliferation (multiplication of epithelial cells) - cytostatics that suppress the activity of the immune system, analogs of vitamin A, corticosteroid hormones;
• biological agents containing human monoclonal antibodies of the IgG class, acting on certain links of inflammation by suppressing the synthesis of cytokines; it is a very effective modern drug that is administered by injection;
• vitamins for psoriasis help restore metabolism and keratinization of epithelial cells; doctors prescribe vitamins A, E, D3, group B.

Folk remedies for psoriasis

Any treatment for psoriasis, including with the use of folk remedies, can only be prescribed by a doctor. Self-treatment can lead to the opposite effect: the spread of the disease.

As part of complex therapy, the following methods can be used:

• grease- product of processing of industrial oils; to prepare the ointment, you need to buy a medical solid oil at a pharmacy; recipe: in 0. 5 kg of solid oil, add 50 g of honey and half a package of baby cream; procedures are carried out daily; in the pharmacy, you can buy ready-made preparations based on solidol.
• baking soda- a folk remedy for psoriasis, which helps to cleanse crusts, relieves itching; recipe for soda applications: take 60 g of soda, dissolve in 0. 5 liters of water, soak a gauze cloth in the solution, fold it in several layers and apply to the lesion for 20 minutes; after the procedure, blot the skin and apply any emollient ointment on it; treatment of psoriasis with soda is carried out once a day;
• mummy- has a pronounced anti-inflammatory effect, relieves itching well; can be taken orally once a day, 0. 2 g for two weeks; external therapy is carried out with a solution of mummy; it is applied to dry itchy plaques twice a day; treatment of psoriasis on the head is carried out by rinsing the scalp with a mummy solution after washing;
• sea salt- relieves inflammation, itching well; baths with sea salt: take 1 kg of salt, dilute in two liters of water and add to the bath; take a bath for 15 minutes, then rinse the solution under a warm shower, blot the body with a towel and apply an emollient ointment; treat psoriasis with baths no more than twice a week;
• clay- has a pronounced cleansing effect, adsorbing on its surface toxins formed as a result of inflammation and improper metabolism; helps to dry, eliminate crusts and itching; you can take any clay, but it is better to buy blue clay in a pharmacy; pieces of clay must be dried well, broken with a hammer, diluted with water and allowed to stand for several hours; put the resulting plate-like clay on a napkin (up to 3 cm thick) and apply to the foci of inflammation for three hours; to treat psoriasis with clay every other day.

Important: the treatment of psoriasis at home with folk remedies should be carried out with caution and strictly according to the doctor's prescription. Such treatment will help one patient, while in another it can cause an exacerbation and rapid spread of inflammation. Therefore, if, against the background of ongoing therapy, the patient's condition has worsened, it is necessary to immediately stop it and consult a doctor.

Home treatment for psoriasis

When treating psoriasis at home, it is important to follow dietary recommendations, lead a healthy lifestyle, exclude bad habits and strictly follow all the prescriptions of a dermatologist.

How to cure psoriasis at home? Some patients try to cleanse themselves of toxins and toxins using all kinds of unconventional methods (enemas, etc. ). This can give exactly the opposite result: the work of the digestive tract will be disrupted and an exacerbation will begin. Modern medicine recognizes cleansing the body in the form of proper nutrition and getting rid of bad habits.

It is important to follow all the doctor's prescriptions and pay attention to how the prescribed therapy works. If it is not effective enough, the doctor will replace the treatment, achieving the maximum therapeutic effect.