Psoriasis is an inflammatory chronic disease of the body, accompanied by a predominant lesion of the skin with the formation of erythematous spots and plaques that have clear boundaries and silvery scales on the surface.
The course of this disease is characterized by periods of exacerbation and remission (decreased symptomatic manifestations). Unfortunately, medicine has not yet identified the exact and reliable cause of psoriasis, but a hereditary factor has been clearly noted, which, in combination with trigger factors, contributes to the triggering moment of the appearance of this disease. A connection between the occurrence of psoriasis and HLA system antigens has been revealed.
Between 1 and 5% of the world's population suffer from this very unpleasant disease, and people with fair skin are at greater risk of developing psoriasis than black people.
The disease can manifest itself at any age, but the periods of 20-30 years and 50-60 years are considered critical.
Important!Psoriasis is not contagious to others, but it causes inconvenience to the patient himself, since the rashes that appear during the illness are not only a cosmetic defect, but are also accompanied by unpleasant itching. In addition, the manifestation of psoriatic arthritis is possible, which significantly worsens the patient’s quality of life.
Mostly, the rashes are localized in the scalp, on the surface of the elbows and knees, in the areas of skin folds and genitals. The nails, buttocks and area around the eyebrows can often be affected. The nature and appearance of the rash depends on the type of psoriasis.
Causes of psoriasis
The nature of the occurrence of psoriasis has not yet been revealed by medicine; some doctors talk about autoimmune causes. The second theory that explains the occurrence of the disease is a disturbance in the normal process of maturation and division of skin cells. Heredity and stress are also considered to be the cause.
A genetic predisposition to psoriasis, allergies and frequent disruption of the skin barrier function (strong friction, chemical exposure, the influence of alcohol-containing products) can provoke an exacerbation of the disease.
To the known triggers causingpsoriasis, relate:
- The Koebner phenomenon is the appearance of fresh rashes at the site of skin irritation in the acute phase of some dermatoses;
- Sunburn or other types of burns;
- HIV infection;
- Beta-hemolytic streptococcal infection, which causes guttate psoriasis;
- Use of medications (especially beta blockers, lithium, angiotensin-converting enzyme inhibitors);
- Severe emotional stress;
- Alcohol consumption;
- Smoking tobacco;
- Obesity;
- Hormonal imbalance, especially in women during menopause and pregnancy;
- Disturbances in the digestive system.
The main cause of the development of the disease is excessive, accelerated growth and division of skin cells in combination with the inflammatory process in the dermis. In other words, skin cells that lie in the lower layer of the epidermis begin to grow rapidly and put pressure on the cells that lie above. This process is accompanied by significant peeling of the skin and is called parakeratosis. It is believed that excessive stimulation by the immune system is the main link in the occurrence of this mechanism.
Symptoms and signs of psoriasis
Rashes associated with psoriasis are asymptomatic or accompanied by itching. Most often they are localized on the scalp, extensor surfaces of the knees and elbows, sacrum and buttocks (especially in the gluteal fold), and in the genital area. Finger and toenails, skin in the eyebrows, armpits and navel may be affected. The rashes can merge with the lesions and cover large anatomical areas and areas of skin between them. Depending on the type of psoriasis, the rash may have different external manifestations.
As a rule, the rashes are located discretely and are represented by erythematous papules or plaques, which are covered with dense, silvery, shiny scales. The rash appears gradually. Remissions and exacerbations occur spontaneously or after exposure to provoking factors.
5-30% of patients developpsoriatic arthritis, which may cause disability for the patient. This process can lead to joint destruction.
Important!Psoriasis does not threaten the patient’s life, but it does disrupt the patient’s self-image. In addition to the fact that the patient’s appearance changes, a large amount of time is also required to treat skin rashes and to maintain cleanliness of clothes and bedding, which greatly reduces the patient’s quality of life.
Types of psoriasis
- vulgar(ordinary or chronic plaque) psoriasis, in which the rashes have the appearance of individual plaques covered with silvery peeling. The plaques may coalesce as the disease progresses. Among all the subtypes, this type of psoriasis is the most common and accounts for approximately 90%.
- inverse psoriasisaccompanied by rashes that appear in the area of natural folds and can form cracks.
- guttate psoriasischaracterized by multiple skin rashes with a diameter of 0. 5-1. 5 cm. Often formed after streptococcal pharyngitis.
- palmoplantar psoriasismanifests itself as plaques on the palms and soles, which can merge.
- nail psoriasisaffects the nail plates in the form of pinpoint indentations and grooves with discoloration and thickening of the nail. Nail changes with psoriasis often resemble changes with a fungal infection.
- pustular psoriasisaccompanied by the formation of pustules on the palms, soles, or possibly damage to one of the fingers. There may also be a generalized form.
- erythrodermic psoriasismanifests itself as a sudden or gradual appearance of redness in patients with psoriatic plaques, when the plaques themselves are mild or absent. Usually appears due to improper treatment of vulgar psoriasis.
Methods for diagnosing psoriasis
When symptoms of psoriasis appear, the patient should consult a dermatologist. He will conduct an external examination of the affected areas of the skin and collect a complete medical history.
Psoriasis has a general similarity with other dermatological diseases, especially in the first stages of manifestation. It is important to exclude the presence of fungal infections in the hands and nails. The seborrheic type of psoriasis requires special differential diagnosis to exclude seborrheic eczema, pityriasis rosea and papular syphilis.
In case of active disease and large lesions of areas of the epidermis, visual analysis of scrapings is used. In the process of scraping, peeling intensifies. In place of the removed scale, a smooth, thin film is visible, which comes off under mechanical action and reveals a moistened surface with droplets of blood.
Diagnosing psoriasis in most cases is not difficult; it is enough to simply examine the patient’s skin. The doctor must rule out errors in diagnosis and determine the presence of other diseases and other pathologies that occur against the background of psoriasis.
In rare cases, diagnosis requires a biopsy. If non-classical clinical signs are present, the need for it should be considered. There is mild, moderate and severe severity of the disease based on the area of skin affected. Damage to less than 10% of the skin corresponds to mild severity. There are more sophisticated methods for assessing the severity of the disease, but these are used in clinical trials.
Treatment of psoriasis
There are a large number of factors on which the development of the disease and its various manifestations depend. Therefore, many treatments for psoriasis have been developed. Often these methods are combined, including both drug and non-drug interventions.
The treatment plan is drawn up depending on the severity of the disease, the area of skin affected and the severity of symptoms such as redness, itching, peeling. Age and gender, stage of the disease and general condition of the patient, the presence of concomitant diseases are also taken into account, as they may limit the choice of treatment methods.
Treatment of psoriasis should lead to a reduction in clinical manifestations (rashes and other symptoms), improvement in the general condition of the patient and restoration of his ability to work.
When treating psoriasis, it is necessary to follow a diet and properly care for the skin, as there is a risk of liver damage. In such cases, it is recommended to reduce the amount of fatty foods in the patient’s diet, give up alcohol, sweets (simple sugars) and starchy foods. The emphasis in the diet should be on proteins: lean meat, fish, dairy products, vegetables and fruits. Be sure to pay attention to allergic reactions or intolerance to certain products.
To improve the patient’s quality of life and get rid of the disease, it is necessary to use an integrated approach:
- Local treatment–Ointments and creams cope well with peeling and itching in small areas where the disease is localized. Hormonal ointments, salicylic acid, retinoids, and moisturizing creams are especially effective in treating psoriasis on the face and hands.
- Drug therapyused as an additional method of effective treatment of psoriasis when ointments do not help. Medicines reduce the inflammatory process, remove swelling and itching, and block the increased activity of skin cells. But it is worth considering that the tablets have many side effects (increased fatigue, lack of appetite, high blood pressure). Therefore, it is very important to follow all doctor’s recommendations regarding the dosage of the drug.
- When psoriasis is localized on the head and neck, usemedicated therapeutic shampoos: antifungal, tar, containing corticosteroids. The shampoo eliminates pathogens of pathological inflammation, removes scales, relieves itching and burning.
- Therapeutic antihistamine injectionsblock severe itching, biological drugs have a beneficial effect on the immune system.
Unfortunately, today there are no possibilities for a complete cure for psoriasis. Any treatment for psoriasis is aimed at eliminating signs of the disease for a long time and prolonging remission. But treatment of psoriasis is necessary, despite the slow chronic course of the disease, since prolonged absence of therapy can lead to disability of the patient.