According to the WHO, currently 2-4% of the world's population suffers from psoriasis. This disease affects patients of all ages, however, most often young people (15-25 years old). Unfortunately, today medicine is not able to completely cure psoriasis, but timely professional treatment significantly improves the quality of life. So in case of detection of the first symptoms, it is better to immediately consult a doctor.
Psoriasis- This is a dermatosis, which manifests itself in the form of scaly papules on the skin. Its distinctive feature is that, in addition to the skin, it is capable of affecting joints and nail plates. In the pathogenesis of psoriasis, hereditary factors are clearly traced, and other irritants are only secondary causes of its occurrence.
During an exacerbation of the disease, the natural processes of formation are disrupted - keratinocytes (cells of which the human skin mainly consists). There are also pronounced biochemical changes in the skin. In addition, recently, doctors have been able to establish that during the acute phase of the disease, the functioning of the nervous system also differs from the norm. In general, the main reason for the appearance of psoriasis is the presence of malfunctions in the functioning of the immune system.
Prevalence of psoriasis
Psoriasis is common. At the moment, the incidence statistics are approximately as follows:
- China - 0. 3%;
- USA - 1%;
- Denmark - 1-2. 3%;
- Northern Europe - 3%;
- Germany - 1-1. 3%.
It is curious that the indigenous population of South America is not affected by the disease. At least not a single such case has been reported so far. If you look at the situation as a whole, then the proportion of psoriasis is approximately 6-8% of all skin diseases.
As already noted, psoriasis manifests itself at any age, but most often young people (up to 25 years old) still suffer, and in both men and women it occurs with the same frequency.
Based on the causes of occurrence, psoriasis is a non-infectious disease with a pronounced genetic predisposition. The most at risk of getting sick are those people whose relatives also suffer from this ailment (in this case, only the closest relatives are meant). European researchers have established for certain that if one of the parents is sick, then he has a 14-25% probability of passing it on to his child. If both parents are sick, this probability is already 41-60%.
According to the type of development of the disease, psoriasis is divided into two groups:
This is evidence that there are two main types of psoriasis (like diabetes mellitus). The first occurs in humans at an early age (on average 16-22 years), is strictly hereditary in nature and is directly related to the HLA phenotype (HLA-Cw6). The course of the disease is often severe and over time the disease only progresses.
The causes of type II psoriasis are rather random, so this disease is sporadic. It occurs most often in older people (about 60 years old). In general, it proceeds quite easily, however, in some cases, it can be aggravated by damage to the joints and nails.
Factors provoking the appearance of psoriasis
Although psoriasis tends to be inherited, it is generally multifactorial. Anything can trigger that fatal malfunction of the immune system. So provoking factors are divided into external and internal (or, in scientific terms, exogenous and endogenous).
They, in turn, are divided into physical and chemical. The former include the usual mechanical damage to the skin, such as household injuries, thermal burns, abrasions, scars, tattoos, scratches, insect and pet bites. Cases of psoriasis at the injection sites have also been recorded. X-ray and ultraviolet irradiation also plays a significant role. In about 5% of all cases, the disease occurs in the summer, and 40% of them are due to sunburn.
Chemical factors are expressed in the toxic effect of harmful chemicals or other irritants on the skin. In addition, psoriasis is also provoked by other skin diseases, such as:
- fungal infections;
- contagious impetigo;
- herpes zoster;
- gangrenous pyoderma;
- allergic dermatitis of various nature.
There are known cases of the disease after carrying out elementary diagnostic skin tests in order to find out the body's reaction to cosmetics, hygiene products, formalin, chromium, nickel and other chemicals.
Internal causes of psoriasis can be infectious diseases. Recent research in this area suggests that streptococcal infections and HIV are most likely to blame. Moreover, often the symptoms do not appear during the illness itself, but even after the usual vaccination. In these cases, psoriasis is often difficult to treat.
In order to induce remission, lithium preparations, beta-blockers, nonsteroidal anti-inflammatory drugs, and ACE inhibitors are used. Corticosteroids are contraindicated in this case.
Pregnancy and childbirth
Significant changes in hormonal levels caused by pregnancy can also become a provoking factor. A similar pattern is also observed during puberty. It is also curious that women who already have psoriasis may experience an improvement in their condition during pregnancy (40%). Deterioration is much less common (only in 14% of cases). True, after childbirth in most patients, the condition worsens again (in 54% of cases)
Diet and nutrition
These factors often do not have a noticeable effect on the course of the disease. It is only known for certain that alcohol and cigarette abuse significantly increase the chance of getting psoriasis and worsen its course.
Hypocalcemia and hypokalemia
These factors can provoke the appearance of generalized pustular psoriasis. The chances of a favorable outcome in this case are very small.
Their role today is considered quite controversial. Some researchers claim that the presence of traumatic psychogenic factors provokes psoriasis in 60% of all cases. However, it is only known for certain that they can only worsen the course of the disease and reduce the effectiveness of therapy.
At the moment, several separate types of psoriasis have been identified. They differ markedly in the clinical picture and the degree of effect on the body, therefore, in order to have an idea of what is at stake, it is better to look at the World Wide Web and carefully study the photos of psoriasis of various etiologies, as well as familiarize yourself with the description.
Vulgar or common psoriasis occurs in most cases. This disease manifests itself as a profuse rash of small, bright red papules (from a match head to a pea). After they appear, they quickly grow, and silvery-white scales appear on their surface. In the future, papules are transformed into plaques, which merge into one extensive lesion. Very often they have clear boundaries that separate them from healthy skin.
When you try to comb or remove the papule, the flaking first increases. This phenomenon is known as the "stearin spot symptom, " and once all scales have been removed, a shiny, smooth surface, the "terminal film symptom, " can be found. If you continue scraping, capillaries are injured and blood droplets are released. This symptom is known as "blood dew".
The development of psoriasis is divided into three main periods:
- progressive (acute);
- resolution period.
The success of treatment here most of all depends on how correctly the methods of therapy are selected, since, depending on the period, their effectiveness varies significantly.
Progressing period. A feature of this stage is the profuse appearance of a specific rash. In the exacerbation phase, certain parts of the patient's body are covered with small papules, which are actively peeling off. Peeling in this case is strictly localized and does not affect healthy skin. It is easy to identify acute psoriasis by the characteristic red or pinkish border that limits the papule.
The most characteristic symptoms at this stage are itching and the presence of the so-called Koebner's symptom. The latter is expressed in the fact that psoriatic papules appear at the site of any skin injury (minor burns, scratches, injections, scratches, etc. ). This phenomenon occurs on average two weeks after the injury itself and occurs in 38-76% of all patients.
It is also extremely curious that (much less often) the opposite effect is also observed. Scientists believe that it is caused by the presence in the blood serum of some patients of special factors that inhibit Koebner's syndrome.
Stationary period. On average, 2-3 months after the appearance of the first rashes, the formation of new papules stops. The growth of plaques also stops. At this stage, their entire surface is already covered with scales. This period can last for months or even years. However, the latter is relatively rare.
Period of resolution. This period is also called a regressive period, since a gradual decrease in plaque is observed during it. At first, they stop peeling, and then gradually smooth out until they completely disappear. If the disease is mild, this phenomenon occurs spontaneously. Treatment only accelerates its onset. Often, the place where the plaques were located stands out against the background of healthy skin areas by depigmentation or, which happens somewhat less often, by hyperpigmentation. With psoriasis vulgaris, rashes can occur almost anywhere, and they are usually localized symmetrically (extensor surfaces of the elbows and knees). May also appear on the head, sacrum, hands, palms, soles, groin and armpits. In addition, in many cases, the nail plates are also affected (the appearance of punctate pits, loosening, thickening). These symptoms are very similar to those that occur when infected with fungi, so that the final diagnosis is made only after receiving a negative reaction to fungal spores in a special laboratory study. Psoriasis vulgaris as a whole does not have a general negative effect on the patient's body, and its course is chronic. Periods of exacerbation occur in autumn or winter, while in summer exacerbations, on the contrary, are much less common. The main incentive for active treatment lies in the fact that, without appropriate therapy, psoriatic plaques can cover the body for years, while adequate treatment causes improvement after a few months.
Psoriatic erythroderma is one of the most unpleasant forms of this disease. On average, a similar reaction is observed in about 2% of patients and it occurs both spontaneously and as a result of improperly selected treatment. Although, of course, if the drugs used irritate the skin or it is exposed to ultraviolet radiation, the risk of psoriatic erythroderma is much higher. Most often, psoriatic erythroderma appears suddenly during the first stage of psoriasis. It can be combined with arthritis and generalized pustular psoriasis, and exposure to factors such as streptococcal infections or hypocalcemia significantly increases the likelihood of such a complication. Abrupt withdrawal of corticosteroids can also worsen the condition. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by diffuse reddening of the skin, severe itching and lamellar peeling.
Also a severe form of psoriasis. It is characterized by the appearance of abscesses, which often remain the only symptom. Much less often they are combined with the classic symptoms of psoriasis vulgaris. Pustular psoriasis is generalized and localized. The second differs only in that the abscesses in this case are concentrated only in the area of the palms or soles.
Currently, psoriatic arthritis is classified as an autoimmune disease in its own right. It is expressed in the defeat of bones and muscles in patients who already suffer from psoriasis or have a high risk of the disease from a family history. Very often psoriatic arthritis is combined with classic psoriasis, as well as psoriatic nail lesions. This disease is diagnosed by the occurrence of back pain, accompanied by the following conditions:
- lack of a clearly indicated reason for the appearance;
- the patient's age is over 40;
- causeless deep pain in the lower back or buttock;
- indistinct localization of pain;
- reduction of pain after exercise;
- pain or stiffness is felt early in the morning or at night;
- the presence of pain with an excellent general condition of the musculoskeletal system.
Psoriasis of the nail plates
Very often, psoriasis vulgaris is accompanied by nail damage. In this case, their pronounced dystrophy is observed, as well as symptoms characteristic of fungal infections. It is a frequent companion of psoriatic arthritis. If we take into account that about 4% of the world's population suffer from ordinary psoriasis, then 30-50% of them also have psoriasis of the nails.
Unfortunately, at present, medicine is still not able to cure psoriasis, since this requires a much deeper knowledge of the peculiarities of the work of the basic mechanisms of the human immune system. Since this type of research is progressing rather slowly, and the disease itself does not pose a particular threat to life, symptomatic therapy is currently the priority. Before starting treatment, the patient needs a thorough examination, since each organism contains an individual set of factors that influence the course of the disease. Gender, age, profession, general health, type of psoriasis - all this must be taken into account when prescribing therapeutic therapy. An important role is also played by the establishment of the nature of the course of the disease, individual susceptibility to drugs and the current stage of the disease.
First of all, the doctor needs to determine the mental and physical condition of the patient, assess the general condition of his body and find out how tolerant he is to the disease. The best prerequisites for effective treatment are good rest, staying in a calm environment, switching to a less intensive mode of work, or a short-term hospitalization. Various methods of psychotherapy (rehabilitation in sea resorts with the use of cognitive-behavioral therapy, etc. ) have also proven themselves quite well. It is also very important that the patient knows that the healing process is going on as it should, because, without receiving a quick effect, about 40% of patients lose faith in the effectiveness of therapy and begin to ignore it. It is important not to forget that psoriasis is a chronic disease, therefore, the safety of therapy must be taken into account. Many drugs are toxic and can build up in the body, turning into a time bomb. An addictive effect is also possible, so it is better to save the most potent drugs until the really dangerous symptoms appear.
Disease course and long-term prognosis
The course of psoriasis is often unpredictable. Modern doctors have practically not succeeded in this, therefore, as before, psoriasis remains an unpleasant and uncontrollable disease. In each individual case, it proceeds completely individually, so that any attempt to make a prognosis regarding the course of the disease, as well as the duration of the phases of exacerbation and remission, is doomed to failure in advance. Only one thing pleases - despite the difficulty of treatment, it rarely poses a real threat to the patient's life. As for psoriatic arthritis, this disease is much easier than rheumatoid arthritis, and the decrease in the quality of life of patients, in comparison with the latter, is very insignificant. Statistics show that with proper treatment, most patients with psoriatic arthritis remain functional and can lead a fulfilling life. If the necessary therapy is absent, or the disease proceeds with complications, joint deformities may develop with the further development of severe pathologies. However, such complications are found only in a very small number of patients with psoriasis. Most patients can count on a gradual stabilization of the condition and the appearance of long-term remissions (more than two years). In very rare cases, the disease mainly occurs in the active phase, however, in this case, it can be effectively localized. An effective treatment for psoriasis today can be obtained in any major city. And, although, as you know, the final recovery cannot be achieved, the diet, special drugs and procedures will quickly do their job. Also, you will not need long-term treatment in a hospital. The doctor's task is only to quickly bypass the first two stages of psoriasis and bring the person to remission. After that, the patient can only take care of himself, follow the instructions and forget about the disease for a long time.