PsoriasisIt is a chronic disease that sometimes affects the skin, nails, joints and internal organs. Itching, which can be combined with larger plaques, is manifested by the appearance of pink-red rashes - papules. These papules rise above the surface of the skin. Covered with silver scales that are easily peeled off when peeled.
The disease is often associated with impotence, accelerated ejaculation and Reiter's syndrome. Psoriatic arthritis can occur in extensive psoriasis.
Risk factors
Causes of psoriasisnot yet fully defined. Risk factors for the development of the disease include:
- microbial factor - various types of fungi, mycoplasma;
- neuropsychic trauma, stress;
- endocrine diseases - diabetes, thyroid disease;
- foci of chronic infection, especially streptococcus;
- immune deficiency conditions;
- disorders of protein and lipid metabolism;
- skin and joint damage.
Is psoriasis contagious?
Psoriasis is not contagious. Many researchers focus on the family nature of psoriasis and recognize its genetic nature. Moreover, the disease itself is not hereditary, but prone to it.
If you find similar symptoms, consult your doctor. Do not treat yourself - it is dangerous for your health!
Symptoms of psoriasis
The first symptoms of psoriasis:rash on the skin in the form of bright pink plaques with a scaly surface. The plaques are solitary, rising above the level of healthy skin, located in the elbows and popliteal cavities.
More often, psoriatic plaques form on the knees, elbows, chest, abdomen, back, and scalp, but may appear in all other most unexpected places as the disease progresses.
Initially, the papules are small - 3-5 mm, the color is bright pink. Gradually increasing in size, they are covered with silver coins and merge into larger compounds called plaques.
Fresh elements of papules, as a rule, are bright in color, until red, the "old" ones become more pale. In the early stages of psoriasis, the edges of the papules are not peeled off. Represents a hyperemic border -growth corolla. . .
The main symptom of psoriasis is the Auspitz trio. This triangle can be observed by scratching the surface of the papule with a sharp object. Includes three phenomena:
- stearin stain phenomenon- Folding a large number of silver-white scales, easily separated when broken;
- Psoriatic film symptom- exuded surface prepared with a barbed layer, which opens after peeling of the lower layers of the stratum corneum;
- blood dew phenomenonExposure of superficial capillaries in the form of small blood spots after separation of the psoriatic film.
Symptoms of different types of psoriasis
Clinical types of psoriasis:
- Spotted psoriasis- pale pink is represented by weakly infiltrated spots. Similar to toxidermia.
- Irritated psoriasis- Occurs due to skin exposure to aggressive environmental factors (sunlight, cold, heat) and irritants. The plaque becomes denser in color, increases in size, rises higher than the surface of the skin, and a red band is formed at the edges.
- Seborrheic psoriasis- often develops in patients with seborrhea. The clinical picture is very similar to seborrheic eczema.
- Exudative psoriasis- occurs very often. Occurs due to excessive secretion of an inflammatory fluid - exudate. It absorbs scales and turns them into scales.
- Psoriasis of the palms and soles- either represented by common plaques and papules, or by hyperkeratotic formations resembling calluses and calluses.
- Follicular psoriasis- a rare form of the disease. The rash consists of white miliere nodules with a funnel-shaped sediment in the center.
- Psoriasis of mucous membranes- a rare form of the disease. Occurs in the mucous membrane of the mouth and bladder. It manifests itself in the form of gray-white areas with a red border.
Frequency of psoriatic manifestations
Cyclic exacerbations are characteristic of psoriasis. Most often they occur in autumn and spring.
Pathogenesis of psoriasis
Dermatosis is an inflammatory process associated with the work of immune T cells. As a result of this inflammation, the proliferation of keratinocytes, the main cells of the epidermis, is accelerated.
Psoriasis is a type of dermatosis, a chronic inflammatory disease. Continues in the presence of microbial pathogens that can bind to the surface of the skin.
Everything that happens to the skin under the influence of a pathogen is a classic inflammatory reaction according to the RTCDF principle:
- Rubor - redness;
- Tumor - tuberculosis, edema;
- Calories - fever, fever;
- Dolor - pain;
- Functia laesa - dysfunction.
Redness and thickening of the skin at the site of the lesion, itching, increased keratinization, followed by the formation of scales - all these are manifestations of the inflammatory process, the body's protective response to fight microbial pathogens. When not helped in time, the body often loses.
Some scientists follow the theory of genetic predisposition to disrupt the process of cell division. With such a violation, there is increased cell death and keratinization, followed by growth and the appearance of a large number of incompletely keratinized epithelial cells. However, this theory does not contradict the above microbes.
Classification and stages of development of psoriasis
There is no generally accepted classification of psoriasis.
TraditionallyThere are four types of disease:
- vulgar psoriasis - seborrheic, follicular, wart, exudative, bullous, psoriasis of the palms and soles, psoriasis of the mucous membranes;
- pustular psoriasis;
- psoriatic erythroderma;
- psoriatic arthritis.
According to ICD-10, there are:
- L40. 0 Psoriasis vulgaris (coin and plaque psoriasis);
- L40. 1 Generalized pustular psoriasis (impetigo herpetiformis, Tsumbusch disease);
- L40. 2 Persistent acrodermatitis;
- L40. 3 Palmar and plantar pustulosis;
- L40. 4 Psoriasis tears;
- L40. 5 Arthropathic psoriasis;
- L40. 8 Other psoriasis;
- L40. 9 Psoriasis, not prescribed
Complications of psoriasis
Without timely and competent treatment, psoriasis begins to adversely affect vital organs and systems: joints, heart, kidneys and nervous system. These conditions can lead to disability and even death.
What is psoriatic arthritis
Psoriatic arthritis is the most severe form of psoriasis because it often causes disability.
Doctors often face this complication. Occurs as a result of inflammatory changes in the joints.
The joints of the hands, wrists, feet and knees are most affected. Over time, the disease can spread to the hips, shoulders and spine. As it progresses, the muscles begin to ache near the affected joints. Patients complain of stiffness, especially in the morning. During the day, body temperature rises frequently.
The clinical picture of psoriatic arthritis develops like normal arthritis: first pain, then swelling, stiffness, and limited mobility. A characteristic feature of this complication is the sausage finger. It appears due to the defeat of all interphalangeal surfaces.
Other complications of psoriasis
A little less commonpsoriatic erythroderma. . .This condition occurs when the skin is completely affected. Patients are concerned about itching and burning, excessive peeling of dead tissue, a strong reaction of the skin to temperature changes.
The following is the most common casepustular psoriasis. . .This complication is associated with the addition of a secondary infection - staphylococci and streptococci. Clinically, pustular psoriasis is accompanied by the appearance of pustules - pustules the size of buckwheat. Pustules appear in different places. They rise above the surface of the skin and are characterized by rapid growth and a tendency to coalesce. Existing symptoms include fever and signs of severe intoxication.
Damage to internal organsextremely rare with psoriasis. As a rule, people who lead a social life are sensitive to them. The genitourinary system is most affected: the kidneys, bladder mucosa and urethra. It causes the development of pyelonephritis, glomerulonephritis, cystitis and urethritis.
Psoriasis can cause damage to the mitral valves by the heart, inflammation of the heart muscle and the outer lining of the heart - myocarditis and pericarditis. Patients with damage to the nervous system complain of crawling sensations, increased irritability or depression, constant fatigue, drowsiness and apathy.
Diagnosis of psoriasis
When to see a doctor
At the first symptoms of psoriasis should consult a doctor: the appearance of pink plaques on the skin with a stained surface.
Preparing for a doctor's visit
You should stop applying the ointment to the skin three days before your doctor's visit. No other special training is needed.
Psoriasis is such a well-known disease that it will not be difficult to diagnose based on external symptoms. Patients can often be diagnosed, as they say, "out of the box. "If necessary, the doctor scratches the surface of the skin to detect the Auspitz trio.
Candidate of Medical Sciences OV Terletsky, together with the co-authors, proposed a diagnostic scheme based on data from the American Rheumatology Association. This includes the following exams:
- complete blood count (including platelets);
- general urinalysis;
- blood chemistry;
- Acute phase reactions of the body - C-reactive protein and rheumatoid factor;
- immunoglobulins - IgA, IgG, IgM, IgE)
- reaction of a complementary compound with gonococcal and chlamydial antigen;
- Wright and Heddelson reactions;
- coagulogram - assessment of blood clotting;
- blood test for borreliosis and toxoplasmosis (according to indications);
- Blood test for HLA.
But there are many diseases under the name of psoriasis. It is necessary to conduct from this point of viewdifferential diagnosisEspecially among papular syphilis, Reiter's syndrome, neurodermatitis, lichen rosacea, systemic lupus erythematosus and seborrheic eczema. Use for this purpose:
- biopsy - compression of a part of the skin with subsequent histological examination;
- laboratory diagnostics - often used to distinguish psoriasis from papular syphilis;
- Blood tests for other latent infections for a better antibiotic choice.
Instrumental diagnostic methodsIt is mainly used for complex forms of psoriasis, which are associated with damage to the joints and internal organs. These include: X-rays of the joints, ultrasound of the heart, kidneys and bladder.
Treatment of psoriasis
Is there an effective treatment for psoriasis?
Although psoriasis is a recurrent disease, it can be completely eliminated if you consult a dermatologist in time to determine the true causes of psoriasis. In the last decade, many systemic and topical drugs have emerged to eliminate the cause of the disease and suppress the mechanism of its development. Drugs that interact with each other using chemical signals (cytokines) have proven to be very good. Eliminate the proliferation of skin creatinocytes
Phototherapy
In 1994, a team from the Department of Dermatovenerology of MAPO SPb applied the treatment of psoriasis.UFO blood- Photomodification of blood with ultraviolet rays.
The ability of sunlight to have beneficial effects on the skin for many diseases, including psoriasis, has been known since ancient times. In the early 20th century, a group of German scientists suggested that ultraviolet radiation had a therapeutic effect on exposed skin, and that this possibility would occur when ultraviolet radiation was applied to the blood. After all, this is a kind of fabric. This hypothesis was confirmed in 1924 by the first UV exposure session in Germany.
The therapeutic effect of ultraviolet rays on the blood is due to profound structural changes at the molecular-atomic level, which are captured by immunocompetent organs - liver, spleen, bone marrow and lymphoid tissue. These changes are perceived by the organs as an alarm signal and therefore produce ten times more immune complexes. In this case, ultraviolet light is a kind of "whip" that forces the body to sharply increase its defenses to fight the disease.
The effect of PT is also worth noting -inexhaustible ultraviolet therapy. . . Given the chronic nature of psoriasis, which is associated with numerous complications of the internal organs caused by various microbial pathogens, this method of treatment is important. The longer the germs stay in the body, the wider the habitat. These microscopic creatures occupy more and more anatomical areas with blood and lymph flow. Once inside the tissues, they try to penetrate as deeply as possible into the intercellular spaces. There, they form micro-colonies protected by dead, destroyed cells and leukocyte shafts. For this reason, microorganisms can remain inaccessible to antibiotics for years. Something between life and death - they easily compensate for the lack of food by entering a state of suspended animation.
The ability of ultraviolet rays helps to destroy the "shelter" of microbes. They create favorable conditions for the penetration of antibiotics and other drugs that cause psoriasis.
The application of ultraviolet radiation to the skin is also relevant. It is the most popular treatment using this principlePUVA treatment. . . Although less effective than ultraviolet radiation of the blood. The therapeutic effect does not last long, relapse may occur two weeks after the end of treatment.
Drug treatment
The following drugs gave good results:
- derivatives of vitamin A, which reduce the rate of maturation of keratinocytes and normalize cell differentiation;
- immunosuppressants that reduce the activity of T-lymphocytes, which increase the division of epidermal cells;
- drugs for the treatment of malignant tumors that inhibit the proliferation and growth of atypical skin cells.
What ointments and creams are effective in the treatment of psoriasis
Ointments and creams with anti-inflammatory components will help alleviate the patient's condition.
How to treat psoriasis of the scalp
The ointment is not effective in the treatment of psoriasis of the scalp. In addition to medication and ultraviolet treatment, a special shampoo can be used.
How to treat psoriasis on the elbows and arms
Psoriasis on the elbows and arms is treated in the same way as on the rest of the body. The peculiarity of the course of psoriasis in this area is that the skin of the hands is exposed to physical, mechanical and chemical effects, which is considered an aggravating factor in the course of the disease.
Is monoclonal antibody treatment effective for psoriasis?
Monoclonal antibody treatment for psoriasis is very effective. Monoclonal antibody drugs are antibodies produced in the laboratory in a manner similar to those produced by human immune cells. Monoclonal antibodies selectively target the targets responsible for the development of the disease.
How to recognize and treat psoriasis in children
In children, psoriasis often progresses more severely and is disguised as other diseases (eczema, erysipelas, herpes) that complicate the diagnosis. Therapies are the same as for adults: phototherapy, medication and topical treatment.
What baths to take with psoriasis
Aloe baths can help reduce inflammation and itching.
How to treat psoriasis according to Pegano
The Pegano method for treating psoriasis involves bowel cleansing, diet and herbal teas. The effectiveness of this method has not been proven by clinical studies.
The role of nutrition in treatment
Nutrition greatly affects the course of psoriasis. Alcohol, salty, spicy, acidic, nuts, citrus fruits, honey, chocolate and smoked meats should be excluded during treatment.
Which sanatoriums provide rest for the treatment of psoriasis
For psoriasis, spa treatments at sea are preferred in an area with a hot, dry climate and very sunny days. The most suitable for this are the Crimean resorts.
Folk ways
Some folk remedies can help reduce itching and swelling of the skin in patients with mild to moderate psoriasis. These methods include:
- cream with aloe extract;
- fish oil applied to the skin with a bandage for six hours a day for four weeks;
- Cream with Oregon grape extract.
Forecast. Prevention
Psoriasis is not a sentence. If the patient seeks timely professional help from a specialist who can determine the true causes of the disease and prescribe effective treatment, the disease will be defeated.
The simple form of psoriasis manifests itself with only one skin defect. Therefore, the patient does not need special conditions to work. The exception is work in a chemical plant: in this case, stay in the workplace should be excluded.
It is worth remembering that psoriasis can cause complications. Psoriatic arthritis often develops. Severe forms can limit the performance of duties in the workplace and can lead to complete disability in the future.
Prevention of psoriasis is an integral part of therapeutic measures to eliminate one of the most serious skin diseases. After recovery, the patient should completely reconsider his lifestyle, eliminate bad habits, pay attention to the treatment of chronic diseases of other organs, adjust his diet, include outdoor walks and sports in his daily routine.
Are they admitted to the army with psoriasis?
Severe forms of psoriasis are sufficient grounds to declare a conscript unfit for military service, mild forms - limited compliance.