Psoriasis: causes, symptoms, diagnosis and treatment.
Psoriasis is a chronic non-communicable disease that can affect various organs: skin, joints, heart, kidneys.
Most often, mild psoriasis appears on the skin as well-defined pink-red papules (nodules that rise above the surface of the skin), which merge into plaques with silvery-white scales.
In moderate and severe forms of the disease, the inflammatory process leads to damage to the musculoskeletal system and the cardiovascular system. Psoriasis has a relapsing course (recurrence of symptoms after complete or partial recovery) and a tendency to cause comorbidities that impair the quality of life of patients.
Causes of psoriasis
The disease may be based on several triggers. However, it is still not known exactly which of them are primary and which are secondary. Dysfunction of the immune system is considered as the leading cause explaining the occurrence of psoriasis. Cells aimed at destroying disease-causing agents begin to attack their own cells (primarily skin). As a result, an inflammatory process develops, which causes accelerated cell division of the epidermis (epidermal hyperplasia) and the formation of psoriatic papules and plaques.
An inadequate immune response is most often due to genetic characteristics.
Psoriasis is very often inherited.
Currently, more than 40 chromosome regions have been identified that are associated with the risk of developing psoriasis. The onset of the disease can be caused by a weakening of the immune system against the background of stress, infectious, endocrine diseases. Psoriasis often accompanies allergic and immunodeficiency conditions, which are based on a violation of the immune response. In addition, psoriasis can be triggered by certain medications (antidepressants, beta-blockers, non-steroidal anti-inflammatory drugs).
Classification of psoriasis
Depending on the localization of the pathological process, various types of psoriasis are distinguished. The most common is vulgar, orcommon, psoriasiswhen well-defined pink papules appear on the skin, which merge into plaques covered with silvery-white scales. In case of damage to the scalp (seborrheic psoriasis) rashes in the form of yellowish scales can descend on the forehead, forming a seborrheic "crown". In patients with metabolic disorders, plaques may show exudate, a fluid secreted during inflammatory processes (exudative psoriasis). In childhood and adolescence, especially after streptococcal infections, the disease can become acute, with many bright red teardrop-shaped papules appearing on the skin with slight peeling and infiltration (guttate psoriasis). Sometimes there is pustular psoriasis, which is characterized by the appearance of pustules against the background of reddened skin, more often in the area of the arch of the feet or palms.Psoriatic erythrodermamay occur against the background of exacerbation of ordinary psoriasis under the influence of provoking factors. Dry white scales cover the skin, it becomes bright red, swollen and hot to the touch. Runs very hardgeneralized Zumbusch psoriasis. It is characterized by the fact that small purulent vesicles appear on the reddened skin, which, merging, form "purulent lakes".Psoriatic arthritisaccompanied by damage to the joints and develops simultaneously with rashes or precedes them.
Symptoms of psoriasis
The skin form of psoriasis is accompanied by the appearance of bright pink dotted papules, sometimes in the form of droplets. Merging, they form plaques covered with silvery-white scales.
Rashes are located on the extensor surfaces of the arms and knee joints, on the scalp, on the lower back and sacrum.
The top layer of plaques is formed by easily removed scales of dead epidermis. Initially, they occupy the center of the plaque, and then fill its entire area. When the scales are removed, a shiny bright red surface is revealed. Sometimes the plaque is surrounded by a pink rim - a zone of further growth, while the surrounding skin does not change. The rash is accompanied by intense itching. With psoriatic erythroderma, patients develop fever (fever with chills) and severe itching against the background of rashes all over the skin, and lymph nodes increase.
With a long course of the disease, hair and nails may fall out.
Generalized Zumbusch psoriasis is very difficult. Purulent eruptions cover the entire skin and are accompanied by severe fever and intoxication. Psoriatic joint damage is characterized by pain and redness of the skin over the articular surfaces. Any movement is difficult, inflammation of the ligaments and tendons develops. With psoriasis, the nail plates are very often affected, while pinpoint depressions appear on the surface of the nail (a "thimble" symptom).
Small, reddish and yellowish-brown spots appear under the nail plate at the base (symptom of "oil spot"). Dystrophic changes in nails and hair often develop.
In children, especially infants, the symptoms of psoriasis have their own specifics.
In the area of redness that occurs in the skin folds, effusion and slight peeling of the upper layer of the epidermis may occur. This picture resembles diaper rash or candidiasis. Sometimes rashes appear on the skin of the face or in the genital area.
Diagnosis of psoriasis
It is possible to identify the disease on the basis of the symptoms of the psoriatic triad (white stearic surface of the papule; reddish shiny film after peeling off the scales and pinpoint protrusion of blood after its removal).
An additional feature is the Koebner phenomenon. It lies in the fact that in the area of skin irritation, after 7-12 days, erythematous-scaly rashes appear (areas of redness and peeling in the area of scratches, scratches). Sometimes, to confirm the diagnosis, a histological examination of a biopsy of the affected skin area is performed. In addition, a clinical and laboratory examination is necessary: a clinical blood test, a biochemical blood test (total protein, protein fractions, C-reactive protein, ALT, AST, LDH, creatinine, electrolytes: potassium, sodium, chlorine, calcium).
Which doctors to contact
If rashes appear, which often occur against the background of infectious diseases, skin injuries, stress, you should consult a therapist or dermatologist. In case of systemic damage to the patient's body, they can be referred to an ophthalmologist, endocrinologist, gynecologist or other specialists.
Psoriasis affects both the skin and the musculoskeletal system, as well as internal organs. When rashes appear only on the skin, local glucocorticosteroid preparations, ointments containing synthetic analogues of vitamin D3, activated zinc, salicylic acid and other components are recommended. Hormonal creams should be used with caution on skin prone to atrophy.
It is necessary to take into account the possibility of hormonal disorders with prolonged use of steroid creams.
The effectiveness of hormonal creams is increased in combination with salicylic acid, analogs of vitamin D. For the treatment of severe forms of psoriasis, second-generation aromatic retinoids, which are based on acitretin, are used. The drug slows down the proliferation of epidermal cells, normalizes the process of keratinization, and has an immunomodulatory effect. Phototherapy (medium wave UV and PUVA therapy) in combination with retinoids is also recommended. As a systemic therapy, the doctor may prescribe immunosuppressive agents. If necessary, prescribe detoxification and desensitizing therapy, plasmapheresis.
Complications of psoriasis
In 10% of patients, psoriatic arthritis develops, affecting the spine, joints of the arms and legs. Patients suffer from joint pain and morning stiffness. The features of psoriatic arthritis include the asymmetry of the places of its manifestation, which can be combined with damage to the nails. Psoriasis is often accompanied by concomitant or comorbid diseases.
Due to inflammatory vascular lesions, the risk of coronary heart disease and stroke increases.
It is also possible to develop diabetes and Crohn's disease. In some cases, complications of psoriasis can lead to disability.
Prevention of psoriasis
Measures to prevent psoriasis are aimed primarily at strengthening the immune system. Skin care should include hydration and nutrition. With a predisposition to allergies, it is necessary to control nutrition, avoiding fatty and spicy foods, excessive consumption of carbohydrates, potatoes. A mandatory component of the prevention of psoriasis should be vitamin therapy.
In addition, the functioning of the immune system largely depends on the state of the nervous system. People who are hyper-responsible, have a busy work schedule, and experience constant negative psycho-emotional impact are more prone to autoimmune diseases, including psoriasis. Therefore, the prevention of psoriasis, along with physical healing measures (giving up bad habits, physical activity), should also provide for the achievement of psycho-emotional comfort.
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.