Psoriasis is a pathological condition characterized by scaly and nodular changes in the skin and nails. Dermatologists are involved in the diagnosis and treatment of the disease.
Psoriasis is a chronic skin and nail disease characterized by a rash of pink nodules and silvery scales. Usually, the nodules merge into large plaques, around which the skin is quickly covered with scales. With long-term development of the disease, joint damage accompanied by mobility impairment and constant pain is possible. Different forms of psoriasis differ in the degree of skin damage: the patient may have only thin spots on the scalp or large plaques in different parts of the body. The likelihood of developing psoriasis complications also depends on many factors. This disease is especially dangerous for pregnant women, because the pustular form of the disease can cause miscarriage.
About the disease
Psoriasis is one of the most common skin diseases. The first signs of skin changes usually occur between the ages of 18 and 35. Psoriasis often occurs against the background of cardiovascular diseases, Crohn's disease and depression. About 30% of patients develop joint damage (arthritis). It is impossible to eliminate the main cause of psoriasis, but symptomatic therapy can significantly alleviate the course of the disease.
Types of psoriasis
Depending on the predominant symptoms, several types of psoriasis are distinguished:
- plate: characterized by the appearance of classic plates covered with silver scales; preferred location: elbows, knees, trunk, scalp;
- in the form of tears: the main manifestation is orange-pink nodules ranging from 1 to 10 mm;
- nail psoriasis: nail plates are mainly affected;
- Psoriasis of the large folds: rashes appear in the armpits, neck folds, genitals and other places with excessive friction; this form is more common in obese people;
- scalp psoriasis: the scalp is affected;
- arthropathic psoriasis (psoriatic arthritis): joints are affected;
- pustular psoriasis: numerous small vesicles with pus appear on the patient's skin;
- psoriatic erythroderma: in addition to the rash, there is a clear reddening of the skin in the area of the rash.
Symptoms of psoriasis
Most often, plaques appear on the forearms, lower legs, navel and scalp. The pustular form of psoriasis is characterized by the formation of pus-filled blisters on the skin. At certain times, many patients experience changes in the color and structure of the nails. Damage to the scales of the skin causes the appearance of precise bleeding. Patients also complain of itchy skin. Skin changes periodically disappear and reappear.
Other symptoms and signs:
- the appearance of red spots in the area of skin folds;
- profuse rashes occur after infectious diseases and stress;
- slight increase in body temperature;
- the appearance of new skin rashes in the winter months;
- joint pain;
- impaired mobility in the affected joint area;
- dryness and sensitivity of the skin.
Resorption of plaques usually begins in the central part, as a result of which the psoriatic elements take on a ring or wreath-like shape. Temporary depigmentation (pseudoleucoderma) remains in places of soluble rashes. During periods of incomplete remission, individual plaques can remain in certain areas of the skin (more often in the elbow and knee joints).
The most severe types of psoriasis are psoriatic erythroderma and arthropathic psoriasis.
In psoriatic erythroderma, all (or almost all) skin is involved in the pathological process. The skin is dense, rough, oozing, red in color, there are many large and small lamellar peeling on the surface. Peripheral lymph nodes increase, subfebrile temperature appears, the general condition of patients deteriorates, changes in blood (leukocytosis, elevated ESR), urine (proteinuria) are observed. In the advanced stage of psoriasis, irrational, irritating therapy helps the development of erythroderma.
Arthropathic psoriasis mainly affects the small joints of the hands and feet, less often wrists, ankles, intervertebral joints, etc. , characterized by severe pain and swelling of the joints, limited mobility and damage accompanied by deformation. X-ray reveals lysis of the distal phalanges of the fingers and joint changes similar to rheumatoid arthritis. Waaler-Rose test and latex test are usually negative. In the blood, leukocytosis, elevated ESR, hypergammaglobulinemia. Articular involvement may be associated with skin lesions or may be isolated over several years.
With all these forms of psoriasis, it is possible to damage the nails in the form of perforated nail plates ("high phenomenon"), their blurring or thickening to onychogryphosis. The course of the disease is chronic and fluctuating. The seasonality of the process is usually expressed - with a significant improvement in the summer and deterioration in the winter (winter type), less often - the opposite (summer type).
Causes of psoriasis
The exact mechanisms of psoriasis are still not understood. It is thought to be an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue. T cells and neutrophils, which are needed to fight pathogens, can begin to attack skin cells and joint structures. In this case, characteristic changes occur in the skin, including the formation of bubbles with an inflammatory fluid. The expansion of blood vessels in the area of inflammation is accompanied by redness of the skin. Autoimmune disease can be caused by hereditary factors.
Additional risk factors:
- skin infections. First of all, these are bacterial infections caused by streptococci;
- skin damage due to cuts and burns;
- long-term stress and psychotraumatic factors;
- alcoholism and smoking;
- lack of vitamin D in the body;
- taking certain medications, including lithium and beta-blockers;
- unfavorable family history. The detection of psoriasis in a close relative of the patient indicates the possibility of a genetic predisposition to this disease;
- violation of acquired or congenital immunity. It could be HIV infection, AIDS or another condition.
Despite the discovery of the alleged immunopathological causes of psoriasis, the disease is still poorly understood. There are many diseases and lifestyle characteristics that lead to the manifestation of hidden factors of predisposition to this disease.
Diagnosis of psoriasis
If skin changes appear, you should consult a dermatologist. The doctor of our clinic first conducts a general examination of the skin to assess the nature of the rash. Gentle scraping allows you to reveal peeling papules and a thin film under the nodules. Beneath the film is the moist surface of the skin, prone to small hemorrhages. At the same time, there are atypical symptoms of psoriasis that resemble other diseases, so the doctor should conduct instrumental and laboratory diagnostics.
- Blood test. A dermatologist prescribes a venous blood test to rule out other diseases and detect signs of psoriasis. In the treatment room, the nurse treats the skin of the patient's cubital fossa with an antiseptic, applies a tourniquet and draws blood with a syringe. In our laboratory, specialists first rule out the presence of rheumatoid factors. Increased erythrocyte sedimentation rate is often found in pustular psoriasis. High levels of uric acid are detected;
- Examination of the fluid of the pustules. The doctor collects the fluid in a sterile container and sends the material to the laboratory. Microbiological examination does not reveal a bacterial culture, but an increase in the number of neutrophils, characteristic of psoriasis;
- Skin biopsy. A dermatologist prescribes this study to make an accurate diagnosis for atypical rashes. During the procedure, the doctor treats the skin with an antiseptic, anesthetizes and removes a small area of the skin with a scalpel. Tissue material is studied under a microscope in the laboratory of our clinic. The results allow us to clarify the cellular composition of the nodules;
- X-ray of the affected joint. The doctor prescribes this study to determine the type of arthritis. Also, X-ray diagnosis of bones is required in severe complications of arthropathic psoriasis;
- Scrape the skin to remove the fungus. The doctor cleans the surface of the skin and, using a special spatula, collects several scales for microbiological examination. This analysis is primarily necessary only if rashes occur in the area of the feet and nails.
If necessary, a rheumatologist is consulted.
Expert opinion
Psoriasis is a disease with many manifestations. It can be almost invisible or cause serious health problems. The most dangerous complications of psoriasis are joint damage that can cause disability in the patient. Also, the disease can cause autoimmune disorders, especially Crohn's disease and ulcerative colitis, metabolic pathology, erectile dysfunction in men. Women suffering from psoriasis may experience infertility and miscarriage. To avoid these complications, it is necessary to consult a doctor immediately after the appearance of suspicious symptoms, and with an already diagnosed diagnosis, it is necessary to carefully follow all the recommendations of a specialist.
Treatment of psoriasis
The main goal of psoriasis treatment is symptomatic therapy. Patients need drugs that reduce inflammation and prevent skin rashes. In addition to drug therapy, the dermatologist of our clinic prescribes a special diet for the patient. Normalizing lifestyle and eliminating stress factors can reduce the severity of psoriasis symptoms.
Depending on the condition, a dermatologist can use different methods to treat the disease.
- Administration of corticosteroids. A dermatologist prescribes ointments containing these drugs. The beneficial effect of corticosteroids is to reduce inflammation in tissues and eliminate itching;
- Vitamin D supplements. Synthetic forms of this vitamin slow down the growth of skin cells, thereby preventing the formation of scales and nodules;
- Therapy with drugs containing derivatives of vitamin A. A dermatologist prescribes retinoid-based ointments to reduce inflammation and itching. These drugs increase the skin's sensitivity to light, so sunscreen should be used;
- Use of calcineurin inhibitors. These are immunosuppressants that reduce inflammation. The dermatologist prescribes local agents such as tacrolimus. Such drugs are used in a short course to prevent the development of side effects and complications;
- Skin treatment with salicylic acid to remove dead cells. A dermatologist prescribes this drug together with corticosteroids for complex skin treatment;
- Using a moisturizer to relieve dry skin and itching;
- Irradiation of the skin with ultraviolet rays. This safe physiotherapeutic treatment method improves the activity of local immunity. The doctor selects the individual radiation dose for the patient;
- Phototherapy. This method consists of irradiating the skin using special devices. Phototherapy combines laser therapy and photochemotherapy technologies;
- Joint puncture in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, anesthetizes the tissues and inserts a needle. With the help of a syringe, drugs are injected into the joint cavity to reduce the inflammatory process.
A dermatologist monitors all stages of treatment to achieve the best result and prevent complications. Corticosteroids, retinoids and calcineurin inhibitors are used strictly under the supervision of a specialist.
Prevention of psoriasis
The recommendations of the dermatologist of our clinic will help reduce the severity of skin rashes and ease the course of the disease.
Prevention of exacerbation of psoriasis:
- relieve anxiety and stress by improving sleep, avoiding coffee, and taking prescription sedatives;
- exclusion of foods with allergens from the diet;
- timely treatment of infectious skin diseases.
Rehabilitation
Psoriasis is a chronic disease that cannot be cured. Rehabilitation measures are aimed at preventing relapses. Depending on the form of the disease, physiotherapy, spa treatment, mud treatment, therapeutic baths and other procedures can be prescribed.
Questions and answers
Is it possible to treat psoriasis with folk remedies?
There are no methods that have been proven to be effective. It is important not to rely on dubious types of treatment, to follow the recommendations of the attending physician.
Does stress affect the progression of psoriasis?
Yes, stressful situations can aggravate the course of the disease.