Psoriasis is a chronic systemic multifactorial disease with a genetic predisposition that affects the skin and joints. Patients often complain of pinkish-red rashes with silvery-white scales. The rash is accompanied by itching, pain and peeling. When the joints are damaged, their mobility is limited, which can lead to disability of the patient.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only theories of origin:
- neurogenic (appearance of rashes after stress, burns, mental trauma);
- endocrine (especially in the perimenopausal period);
- metabolic (fat metabolism disorder);
- contagious;
- viral (psoriasis antigens are isolated from healthy individuals, but with a high probability of developing psoriasis in the future, and psoriasis is a non-infectious disease);
- genetic.
Psoriasis can be observed in an entire generation with the same risk factors. But the type of inheritance is considered multifactorial. If one of the parents is sick, the child has a 25% chance of getting sick. If both parents are sick - 60-75%.
Viral and genetic theories remain the leaders.
Factors contributing to exacerbation:
- infectious and parasitic diseases, including transmission (HIV, tonsillitis, decayed teeth, hepatitis);
- stress;
- obesity;
- perimenopausal period;
- drugs (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin lesions; dryness leads to increased skin trauma.
Clinical classification
There is no single classification. One of them:
- vulgar (ordinary);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis of the palms and feet;
- pustular psoriasis.
Features of the stream:
- they get sick at any age, cases of psoriasis in children are not uncommon;
- men and women get sick equally;
- worldwide distribution;
- Exacerbations have summer, winter and mixed seasonality.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin with the production of insufficiently mature keratinocytes. A pinkish-red rash covered with silvery-white scales appears.
A trinity of symptoms is characteristic, thanks to which the diagnosis can be made:
- symptom of stearin stain - the number of scales increases when scraped;
- the phenomenon of psoriatic film - when all the scales are broken, a smooth bright red surface appears;
- a definite sign of bleeding - drops of blood appear when the film is scraped. This is due to the uneven extension of papillae in the dermis, expansion of capillaries and their swelling.
Symptoms of psoriasis
- Psoriasis on the body can start with a spot and merge into large damaged areas.
- Psoriasis on the hands is most often localized on the extensor surfaces.
- Psoriasis on the face - rashes often appear behind the ears, on the forehead. It is an independent factor to strengthen the treatment.
- Psoriasis on the scalp is an isolated form, it does not affect the hair, the elements of the rash are located on the edge of the hair, along the "psoriatic crown".
- Psoriasis of the nails - leads to characteristic changes, clearly defines the depressions, the nail looks like a thimble. It may also thicken, become dull, or develop yellow spots under the nail.
- Psoriatic arthritis - painful or painless affects the peripheral joints, often accompanied by inflammation at the attachment of ligaments to the bone, ligaments themselves and fingers.
Characteristics of psoriasis in children
It is characterized by the presence of one or more elements up to 1 cm, they rise above the surface of the skin. Itching is more obvious in children than in adults. After leaking, the spot bleeds and sores form. Psoriasis in children is often localized as a large red spot in the perineal area. In teenagers, spots appear on the palms and feet.
There are three stages of psoriasis:
- Progressive - rash elements increase and are uniformly white, with a narrow red border along the edge;
- Stationary - the growth of the spot stops, a paler strip of skin 2-5 mm wide appears on its edge;
- Regressive stage - the scales gradually fall, the spot decreases and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients turn to a general practitioner, a dermatovenerologist or a rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and tenderness of the joints), history (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). Changes in the skin and joints are revealed during the examination.
Laboratory tests are carried out:
- general blood test (including the number of leukocytes, ESR, platelets);
- general urinalysis;
- biochemical analysis (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
- in difficult cases, a skin biopsy is performed with additional pathohistological examination (acutely expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of clusters of 4-6 or more elements);
- before prescribing biological treatment, an examination is carried out for HIV, viral hepatitis B and C, tuberculosis;
- x-ray of the affected joints;
- CT and MRI for axial lesions;
- EKG.
If necessary, consultations with an infectious disease specialist, phthisis doctor, orthopedic traumatologist, surgeon and other specialists are carried out.
When diagnosing psoriasis, it is worth excluding diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, Zhiber rosea and papular syphilis.
The severity of psoriasis is determined by BSA (Body Surface Area - area of skin affected by psoriasis), PASI (Psoriasis Area and Severity Index - psoriasis prevalence and severity index), DLQI (Dermatology Life Quality Index - dermatological). quality of life index).
PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (Classification Criteria for Psoriatic Arthritis) criteria are used to diagnose psoriatic arthritis.
Treatment of psoriasis
The treatment is complex, aimed at eliminating inflammation, normalizing the proliferation and differentiation of keratinocytes.
Local therapy:
- Ointments and creams containing vitamin D3 and its analogues;
- calcineurin inhibitors;
- glucocorticoids for local use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological drugs.
Use for psoriatic arthritis:
- non-steroidal anti-inflammatory drugs;
- disease modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
For chronic cases, it is recommended to use ointments for psoriasis, for exacerbations, creams for psoriasis are used.
When applying an ointment or cream, do not rub it into the skin or apply a bandage. This can increase the penetration of the drug into the skin and cause side effects.
It is not recommended to use hormonal ointments for more than 4 weeks. The wrong dosage of drugs can either be ineffective or cause side effects. The expected effect of the treatment occurs after 1-2 weeks of use.
There are several ways to use psoriasis creams and ointments containing glucocorticoids:
- continuous mode;
- tandem therapy regimen;
- descending therapy regimen;
- step application mode.
It should be noted that mild and moderately severe forms of psoriasis are treated on an outpatient basis using ointments and creams directly applied to the affected area. In more severe forms, treatment is carried out in hospitals using phototherapy, systemic therapy and biological drugs.
The course of the disease is considered moderately severe, and systemic treatment can be started in the following cases:
- skin areas of aesthetic importance are affected;
- large areas of the head are affected;
- external genital organs are affected;
- palms and feet are affected;
- at least 2 nails are affected;
- There are single elements that cannot be treated locally.
Systemic therapy is carried out only in a hospital, under the strict guidance of doctors, because systemic treatment is associated with a wide range of side effects that can be reduced by choosing individual treatment.
General recommendations for patients with psoriasis:
- minimize skin damage and dryness;
- after applying creams and ointments for psoriasis on your hands, use gloves to prevent the medicine from getting into your eyes;
- use sunscreens with a protection factor of 30;
- avoid stressful situations, consult a psychologist if necessary;
- control your weight, eat rationally.
Diet for psoriasis
Recommendation:
- alkaline drink 1200-1600 ml per day;
- use of lecithin;
- vegetables and fruits;
- porridge;
- lean meat and fish;
- dairy products.
Not recommended:
- citrus;
- bread made from high-grade flour;
- oily fish and meat;
- high-fat dairy products;
- coffee - no more than 3 cups per day;
- products with yeast;
- alcoholic, sweet, sour, smoked, spicy.