Psoriasisit is a systemic disease characterized by damage to the skin, musculoskeletal system, functional and morphological disorders of other organs and systems. The main symptoms of pathology: nodular rash, hyperemia, itching on the scalp, palms, feet, extensor surfaces of the elbows and knees. The disease can be diagnosed visually, but to rule out the possibility of the development of accompanying pathologies, laboratory tests and instrumental diagnostic methods are prescribed. Systemic therapy includes taking aromatic retinoids and cytostatic drugs, glucocorticosteroids.
Introduction
The name of the disease comes from the Greek word "psora" - "skin disease", "itch". In the Middle Ages, psoriasis was considered a form of leprosy (leprosy). The symptoms of psoriasis were first described from a professional perspective in 1808 by Robert Whelan in Great Britain. The term "psoriasis" was introduced in 1841 by the Viennese dermatologist Ferdinand Gebra. The pathology is recorded in all latitudes of the world with an uneven frequency between 0. 1 and 3%. Psoriasis develops equally in men and women, but it is more common in girls among children and in men (60-65%) in adults.
Reasons
There are different theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurogenic, endocrine, hereditary. Each of these theories is based on clinical observations and laboratory results.
Most scientists focus on the genetic nature of psoriasis. They claim that this disease is polygenic. If one of the parents is sick, the risk of developing pathology in the child is 8%, father and mother are 41%.
Factors contributing to the development of psoriasis are divided into external and internal.
- External factors include mechanical and chemical damage to the skin, as well as dermatoses.
- Doctors include internal provoking factors: infections (streptococcus and human immunodeficiency virus), drugs (corticosteroids, non-steroidal anti-inflammatory drugs), nervous stress.
Pathogenesis
Today, doctors all over the world recognize the involvement of the immune system in the pathogenesis of psoriasis. The cells of the immune system, which usually react to antigens, begin to attack healthy cells, most often skin cells. As a result of this process, the cells of the epidermal layer divide faster than usual. They do not have time to grow up, so strong relationships are not established between them. Surfacing cells form raised plaques with silvery scales.
Classification
According to the International Statistical Classification of Diseases and Related Health Problems, there are many types of psoriasis.
- ordinary (vulgar). The most commonly recorded form of lichen planus has no complications. This group includes plate and coin mother of pearl.
- Generalized pustular psoriasis- a severe form of pathology complicated by secondary infection. It affects several areas at the same time. Includes Zumbusch syndrome and impetigo herpetiformis.
- Persistent acrodermatitis (Crocker's dermatitis, Setton's dermatitis)— the content of the pustules is sterile, there is no secondary infection. The main areas affected are the fingers and nails.
- Palmar and plantar pustulosis (pustular bacteroid)- develops on the feet and palms. It appears as pustules with sterile contents, which gradually increase in area.
- it is in the form of a teardrop- isolated papules that do not merge into plaques. The most affected areas are the legs, thighs, back, forearms, chest and neck.
- Arthropathic- the clinical course is similar to the rheumatic form of arthritis.
- Other psoriasis (opposite)- conglomerates are localized in armpits, groin and other natural folds. This type includes inverse flexor psoriasis.
- Unspecified psoriasis- combines several types of pathology, the clinical picture is quite wide.
Depending on the seasonality of exacerbation, several types of psoriasis are distinguished:
- summer- aggravation occurs as a result of exposure of the skin to sunlight;
- winter- occurs due to extreme cold affecting the skin.
With non-seasonal psoriasis, there are no periods of remission, the disease occurs throughout the year.
According to the affected skin area:
- limited psoriasis- occupies less than 20% of the body skin;
- common- more than 20%;
- generalized- the whole skin is affected.
Symptoms
Clinical manifestations of psoriasis directly depend on the stage of development of the disease. There are 3 stages.
- Progressive stage. It is characterized by the appearance of papules, itching, the beginning of peeling, peeling and deformation of the nails.
- Stationary stage. New papules do not appear, old rashes do not increase in size, and peeling is moderate.
- Regressive stage. The plaques heal and white depigmented spots form in their places, which no longer cause concern.
Skin rashes are only external symptoms of psoriasis. In fact, the disease affects numerous organs and systems, as well as tendons and joints. For this reason, patients complain of depression, constant feeling of weakness and chronic fatigue.
Complications
Among the complications of psoriasis, psoriatic arthritis and psoriatic erythroderma are especially important. Also, in the absence of timely diagnosis and effective treatment of psoriasis, the risk of developing severe chronic pathologies increases: diabetes mellitus, arterial hypertension and metabolic syndrome.
Diagnostics
Laboratory and instrumental diagnostic methods are used to determine the pathology.
The patient is referred for:
- general clinical analysis of blood and urine;
- blood biochemistry;
- Blood test for C-reactive protein and rheumatic tests;
- coagulogram - evaluation of blood coagulation;
- blood test for human leukocyte antigen.
For complex forms of psoriasis associated with damage to the musculoskeletal system and internal organs, radiography of the joints, ultrasound examination of the kidneys and organs of the urinary system, and echocardiography are prescribed.
There are diseases with similar symptoms. As a result, there is a need for differential diagnosis. To do this, use the following methods:
- biopsy (excision of a part of the skin with additional histological examination);
- laboratory tests - used to distinguish psoriasis from papular syphilis.
Treatment
Psoriasis responds well to symptomatic treatment. A doctor who knows the pathogenesis can choose the treatment method individually. Some of them are aimed at reducing skin rashes, eliminating dryness and itching, while others are aimed at protecting the immune system from "attacking" healthy cells.
Therapeutic tactics directly depend on the severity of the disease and the location of the lesions.
External therapy
Topical glucocorticosteroids are used as monotherapy or in combination with other medications for various forms of psoriasis. They are available in the form of dosage forms - ointments, creams or lotions.
Medicines containing analogs of vitamin D3. If the spread of psoriasis does not exceed 30% of the body surface, it is applied to the affected areas of the skin.
Preparations with activated zinc pyrithione are used in the form of aerosols, creams, and shampoos for the scalp.
Phototherapy
In this case, medium-wave phototherapy and PUVA therapy methods are used for treatment. PUVA therapy is the combined use of long-wave ultraviolet rays (UVA) (320-400 nm) and a photosensitizer (8-methoxypsoralen). PUVA therapy is one of the most effective ways to treat the disease, it is prescribed for the most common vulgar and exudative psoriasis, persistent pathology, heavy infiltration.
Combination therapy
Such treatment includes several therapeutic methods, for example: phototherapy and local corticosteroids; phototherapy and systemic retinoids.
Systemic therapy
It is prescribed for moderate and severe forms of psoriasis. Systemic therapy drugs are mainly prescribed during the development of the disease.
Biological drugs
These drugs are created by genetic engineering methods. They are monoclonal antibodies and are used for therapeutic purposes.
Prognosis and prevention
With timely diagnosis and effective treatment of the pathology, the prognosis is quite favorable. The following are often prescribed as preventive measures: a diet enriched with fish and vegetables, hydrotherapy, a course of herbal medicine, sanatorium-spa treatment and emollients (mainly in the period between relapses - to restore the hydrolipid layer).