Psoriasis is an inflammatory skin disease. Occurs when the immune system is compromised. The development of the disease is divided into clear stages - appearance, development, stabilization and regression. Different stages of psoriasis are characterized by the appearance of spots and rashes, painful itching and extensive skin inflammation.
Why is it necessary to distinguish the stages of development of the disease, and what are the features of the course of psoriasis at the beginning of development and recovery?
Why you need to know the stages of psoriasis
The division of psoriasis into stages is used by doctors to select the right therapeutic methods. A drug complex and external agents prescribed to treat inflammation depend on the stage of development of the disease. At the beginning of the manifestation of the disease requires general therapy - vitamin complexes, diet, external aseptic treatment of rashes, for example, a course of UV procedures. Drugs that stimulate the cleansing of the intestines, blood vessels and liver have also been prescribed. Be sure to correct the psychoemotional situation - by a neurologist or psychologist.
In the early stages of the disease do not use strong drugs that suppress the immune system and do not prescribe hormonal ointments. These drugs have a long list of side effects, so they are prescribed only when it is impossible to do without them.
Psoriasis: treatment in acute and remission
In the case of an acute course of the disease, several drugs with different action are prescribed. Immunosuppressants and glucocorticosteroids are often used to relieve inflammation and reduce itching. External treatment is supplemented by photochemical, ultrasound and laser therapy. Also prescribed agents for antiseptic treatment of damaged skin.
In a stable state, they continue to take hormonal anti-inflammatory drugs, gradually reducing their dose. Ointments with a restorative effect are prescribed to repair damaged skin.
In remission - support the body. Adjust your diet, take vitamin and mineral complexes to restore immunity.
Timely treatment
The earlier treatment is started, the easier it is to control psoriasis. Timely therapy limits the spread of skin inflammation, reduces the degree and prevents further peeling. Since psoriasis is often mistaken for an allergic rash in the early stages, it is important to know the first signs in order not to miss the appearance of a skin disease.
Note: Doctors are still investigating the causes of psoriasis. However, it is well known that psoriatic dermatitis is not contagious. The patient cannot be taken from a person or there can be an infection in case of injury. This is our own personal failure in the human body.
Psoriasis is caused by an immune deficiency that can be caused by a variety of factors. Severe stress, poisoning (including strong drugs, industrial emissions, alcohol), previous infection.
Psoriasis is difficult to treat. The disease is prone to recurrence and relapse. And the therapy itself is symptomatic. This is to prevent the formation of new spots and eliminate existing skin itching.
What stage of psoriasis is called primary? How to distinguish early psoriasis from diathesis rash? And how will the disease develop in the future?
Psoriasis: early stage
The first appearance of psoriasis on the skin is similar to acne. The rash often appears on your elbows and knees, or where clothing is pressed tightly against the body (for example, under the waist belt). Rash can also appear on the edges of the hair and under the hair, around the nails and on the nail plates. Sometimes psoriasis occurs on the feet and palms.
Psoriasis almost always manifests itself symmetrically - on the elbows of both hands or on both sides of the waist or on both knees. In the early stages, the pimples themselves (in medical terminology - papules) have a modest appearance. These are:
- pink or red;
- Sharp, blurred edge;
- Small size - acne at the bottom is not more than 2 mm;
- Straight shape - small pimples at the beginning of the disease have almost no swelling, so they look like spots.
As the disease progresses, peels appear on the skin. They are gray or silver, they look white against a red acne background.
The appearance of scales is accompanied by severe itching. If you do not resist and do not scratch, the scales are removed and bright areas of pink young skin appear underneath. Itchy papules are very delicate, sensitive to prolonged scratching - bruises, bleeding.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: stage of development
In the progressive stage, individual pimples combine into a common spot to form so-called psoriatic plaques. It is lifted above the surface of the skin and almost completely covered with peeling. On the edge of psoriatic plaques, there is an unpeeled pink-red edge.
The presence of a border is a sign of a progressive stage of the disease. The width of the rim is 1-2 mm. The skin on it becomes inflamed and looks like parchment paper.
The rim represents the expansion area of the stain. This is already inflamed skin, but not yet peeled. After a while it will be covered with scales. And the patch will expand to cover new areas of skin and create a wider edge.
With the active development of the disease, the adjacent spots merge with each other. At some point, a large, inflamed red spot may appear on the human body.
Psoriatic plaques itch a lot, make people feel uncomfortable, disturb their work, rest and sleep. They grow, cover a large area and form a new rash on clean, healthy skin.
The main sign of a progressive stage is the appearance of new rashes. As new pimples and blemishes stop appearing, the next stage of psoriasis begins - inpatient. This is not a complete victory, but it is a turning point for recovery.
In the stage of progression, psoriasis is almost always accompanied by weakness, fatigue, weakness. Depression is common. Heating is possible.
The duration of the progressive stage of psoriasis can be long, several months.
Pearl: stationary stage
The main symptom of the stationary phase is the cessation of new spots and rashes. At the same time, itching weakens and becomes more tolerable. The rash loses its bright color, changes color, becomes invisible. This is also one of the signs of stabilization of the process.
The pink bands around the plaques disappear when the inflammation stops spreading. Active exfoliation and healing begins, restoring new healthy skin.
Increased peeling in the stationary phase is noticeable to the naked eye. The scales completely cover the entire surface of the psoriatic spot and do not leave room on the rims. Psoriasis takes on the characteristic spotted appearance known to the general public.
Extensive peeling at the stationary stage is not dangerous. When all the dead cells come out of the surface of the psoriasis spot, healthy skin with a light shade of light will remain in place.
Other signs of development or stabilization
In addition to the appearance of rashes, spots, and scaling, there are a number of other signs that can be used to assess the progression of the disease. This is the nature of the itching sensations (strong or tolerable), the general condition, the depressive mood. Both the presence of heat.
At the initial stage, itching is variable and the rash is incomprehensible. In addition, the itching gets worse every day. It becomes unbearable in the acute stage of psoriasis. Disrupts sleep, rest, interferes with work. Itching makes a person nervous because it does not allow him to rest.
Itching is reduced in the stationary stage. Every day - a person feels better. The general state of the psyche changes, the negative and depressive mood weakens. The duration of the inpatient phase is several weeks - between 2 and 5.
Psoriasis in the debilitating phase
The fading stage of psoriasis is the almost complete disappearance of plaques, spots, redness, inflammation, itching. At this stage of the disease, only the different pigmentation of the skin is reminiscent of psoriasis. Former psoriatic spots appear lighter in place. There is a darker shade on the surface of healthy skin.
In some cases, the so-called hyperpigmentation occurs. The skin at the site of the pearl spots is not lighter, but darker. In any case, the differences in skin pigmentation will be visible for another month or two.
Psoriasis after recovery: the possibility of relapse
The likelihood of recurrence of psoriasis is determined by a person's lifestyle, diet, allergic mood and the condition of the body as a whole. It is also determined by the amount of toxins in the body, blood and liver. If you strengthen your immune system and cleanse the body of toxins in the liver, blood vessels and intestines, you can reduce the likelihood of recurrent skin inflammation.
Seasonal relapses of psoriasis, after cleansing, are rare. A person remains susceptible to disease, but the likelihood of its occurrence is significantly reduced.
Cleansing the body of toxins and taking vitamin and mineral complexes help increase immunity. This is especially important during treatment when immunosuppressants are used in the progressive phase of psoriasis. Their need was related to the work of inflammatory mediators. After suppressing the autoimmune defense, the immune system needs to be restored.
Clinical manifestations
Psoriasis, when combined, forms plaques and is characterized by monomorphic eruptions in the form of papules (nodules) of various sizes that can spread to the skin.
At the onset of the disease, the rash is often limited and is represented by single plaques at the sites of the favorite localization (scalp, extensor surface of the elbow, knee joints, sacrum, etc. ).
The plaques are clearly separated from the healthy skin, bright pink or burgundy, covered with loose silver-white scales, and when shaved, you can get a triple event characteristic of psoriasis - "stearin stain", "terminal film", "blood strain. ". . .
Psoriasis has 3 clinical stages: progressive, stationary and regressive.
Classification
Depending on the degree of inflammatory process, the predominant localization of the rash, the severity of the patient's condition and other clinical signs, there are common plaque psoriasis, exudative, arthropathic, pustular, psoriatic erythroderma, psoriasis, psoriasis of the palms and soles of the feet. It should be noted that different clinical options may be present in the same patient at the same time.
Exudative psoriasis is characterized by an overt inflammatory reaction of the skin, sometimes manifested by the presence of lamellar scale crusts on the surface of a multi-layered, swollen cake-like plaque (in such cases, this form of psoriasis is called rupioid). When the crumbs are removed, a weeping surface appears.
In the clinical picture, arthropathic psoriasis, in addition to the usual plaque eruptions, causes damage to the joints, often small, distal, and slightly larger.
Arthropathy can occur in the presence or before skin lesions. Psoriatic arthritis manifests itself with pain, swelling, and limited mobility in the joints, which vary in intensity from minor arthralgias of individual joints to generalized injuries and disability of patients. Patients with severe skin manifestations (psoriatic erythroderma, pustular psoriasis) are more likely to have arthropathic psoriasis, but a combination of severe joint damage with a relatively limited skin rash is possible.
Pustular psoriasis can be generalized (Tsumbusha) and limited to the presence of palm and base (Barbera). Stressful situations, infections, irrational general or local therapy contribute to the development of this severe form of psoriasis.
Generalized pustular psoriasis occurs with fever, leukocytosis, increased ESR, and generally a serious condition. Suddenly, on the background of bright erythema appear small superficial pustules, accompanied by burning, pain, which may be located on the normal plaques and previously unchanged skin. New pustules appear paroxysmal, occupying large areas of skin. Combined pustules cause the epidermis to separate in the form of "purulent lakes", erythroderma may develop.
Limited pustular psoriasis is more common, the rash is mainly localized in the form of pustules on the palms and heels against the background of erythema and skin infiltration. The course is milder than the generalized, the general condition is satisfactory, but persistent, often recurring. Irritant local therapy is a provocative factor.
Psoriatic erythroderma is a severe form of psoriasis that develops with the gradual progression of the psoriatic process and the combination of plaque elements into the defeat of the entire skin, with acute hyperemia, edema, abundant and large small lamellae, less pityriasis peeling, and skin infiltration. Subjective - severe itching is often noted. The disease can begin with erythroderma. The general condition worsens (fever, weakness, lymph node reaction, heart failure, liver and kidney dysfunction, changes in blood tests, hair loss, etc. ).Wrinkle psoriasis is more common in children and the elderly, especially in patients with diabetes mellitus. The lesions are located under the armpits, under the mammary glands, in the perineum, in the groin-femoral folds, in the umbilicus and are characterized by sharp borders, saturated redness and slight peeling.
Psoriasis of the palms and soles of the feet may be isolated or present simultaneously with damage to other areas of the skin, characterized by the formation of hyperkeratotic foci with clear borders covered with difficult scales and the presence of painful cracks. It is difficult to awaken the characteristic psoriatic trio.
Three clinical stages of psoriasis
Development stage. Exacerbation of the disease under the influence of destructive factors (trauma, psycho-emotional stress, infectious diseases, inadequate treatment methods, etc. ) can develop with the appearance of abundant small nodules prone to peripheral growth and the formation of isolated or contour plates of various sizes. covers large areas of skin up to universal skin lesions.
In the advanced stage, the symptom of an isomorphic reaction (Kebner's phenomenon) is characteristic, which is characterized by the appearance of typical psoriatic eruptions at the site of injury, even a small one.
Stationary stage. In the stationary stage, the appearance of new elements stops and the tendency to peripheral growth of existing plates disappears.
Regressive stage. The regressive stage is characterized by a decrease in the intensity of the color of the plaques, their correction, reduction of desquamation, infiltration, resorption of elements with the formation of foci of hypo- or hyperpigmentation at the site of previous rashes.
Treatment
Treatment of psoriasis is aimed at preventing the proliferation of epithelial cells and the elimination of the inflammatory process, and is determined based on anamnestic data, process form, stage, prevalence, concomitant diseases, patient's age and sex, contraindications to a particular treatment or drugis done.
For mild, limited manifestations of psoriasis, topical external therapy in the form of salicylic ointment, naphthalene preparations, resin or emollient ointment is sufficient. Severe forms of the disease, detoxification, desensitization, anti-inflammatory drugs of various groups, physiotherapy, foreign drugs, etc. Requires complex systemic treatment with use.
This section will present the most modern and effective psoriasis treatment methods and tools available.
Systemic therapy
There are features of patient management at different stages of the psoriatic process. Advanced treatment requires special attention. During this period, hemodesis is determined by 30 percent intravenously. sodium thiosulfate solution i. v. , 10% calcium gluconate solution, it is recommended to apply magnesium sulfate solution, at the same time with hypertension; emollients used externally or 1-2 percent. salicylic ointment.
Aromatic retinoids.Acitretin (neotigazone) is a second-generation monoaromatic retinoid used to treat severe forms of psoriasis at a dose of 10 to 20-30 mg per day, depending on the severity of the skin process. The mechanism of action of acetic acid is to inhibit the proliferation of epidermal cells, normalize keratinization processes. The drug is especially effective in combination with PUVA therapy. When prescribing acitretin, its teratogenic effect should not be forgotten.
Cytostatics.Methotrexate is used as a folic acid antagonist in contraindications to persistent psoriasis and other treatments, mainly affecting actively proliferating cells. Very toxic. There are many methods of application, preferably intramuscular application once a week under strict laboratory supervision.
Immunosuppressants.Cyclosporine-A is prescribed for severe psoriasis that is resistant to other treatments. This drug has an immunosuppressive effect, has an inhibitory effect on cell growth processes, suppresses the secretion of activated lymphocytes by cytokines and the expression of interleukin-1 receptors in immunocompetent cells. With psoriasis is prescribed at a rate of 5 mg per 1 kg of body weight per day.
Non-steroidal anti-inflammatory drugsare prescribed to reduce arthropathic psoriasis, as well as exudative psoriasis and acute inflammation in erythroderma. Daily drug doses and duration of treatment depend on the intensity of the pain syndrome, the degree of inflammation and individual tolerance.
The use of systemic corticosteroids in the treatment of psoriasis is considered inappropriate, which leads to the development of torpid forms of the disease, resistant to various types of therapy. In the case of severe arthropathic psoriasis, long-term intra-articular administration of corticosteroids is possible, the dose and duration of treatment depends on the size and degree of inflammation of the affected joint.
Physiotherapy treatments.One of the most effective treatments is PUVA therapy or photochemotherapy (PCT). PCT is a combined application of long-wave ultraviolet radiation (wavelength between 320 and 420 nm) and the illuminating drug furocoumarin. The use of photosensitizers is due to its ability to increase the skin's sensitivity to ultraviolet rays and stimulate the formation of melanin. PUVA therapy affects the inhibition of cell proliferation, suppression of pathological keratinization, metabolism of prostaglandins and permeability of cell membranes. The peak of the photosensitizing effect occurs 1-3 hours after ingestion of 8-methoxypsoralen. The dose of the drug is selected taking into account the patient's weight. Procedures are released 3-4 times a week for a course of 20-25 sessions.
Local PCT, external photosensitizers are also used.
The combined use of PUVA therapy and retinoids is called Re-PUVA therapy. It has the highest clinical effect in severe psoriasis.
Selective phototherapy (SFT) - ultraviolet radiation in the medium wavelength range (wavelength 280-320 nm) without taking photosensitizers. Less pronounced manifestations of SFT disease are used for contraindications to the appointment of PUVA therapy.
How to recognize psoriasis at an early stage
Treatment of psoriasis is most effective at an early stage. Therefore, it is very important to make a timely diagnosis. Only a dermatologist can tell you if you have psoriasis or any other skin condition. However, you can recognize this disease by several characteristic symptoms:
- In most cases, psoriasis first manifests itself in the folds of the arms and legs, hair loss, or where clothing is in close contact with the body or rubbed - under the trouser belt, various elastic bands or straps.
- At the beginning of the disease, a sharp itchy rash appears, covered with gray or silver skin scales, which are very easily removed.
- If you take the scales, you will see a thin, shiny and slightly moist skin underneath.
- If you take the scale and scrape it with something like a spatula, the blood will appear in the form of small drops. However, it is better not to use the latter method for self-determination of psoriasis - it is very easy to infect.
You need to see a doctor to be sure, because patients themselves often confuse psoriasis with different types of lichen or allergic dermatitis and use drugs that are not suitable for treatment.
What to do if you find signs of the initial stage of psoriasis?
Psoriasis cannot be treated once and for all, so the main goal of therapy is to achieve a stable and long-lasting remission. You need to know that psoriasis quickly becomes chronic without proper treatment: the exacerbation can be up to 9 times a year, the duration can be up to 15 days.
What to do if you suspect psoriasis? Often people make a big mistake by discovering the symptoms of this disease, resorting to "heavy artillery" - hormonal ointments (topical glucocorticosteroids or THCS) without consulting a doctor. In general, patients explain such a step by the fact that they hear from friends that such funds help quickly. This is a big mistake!
What is the danger of such self-medication? Hormonal ointments for psoriasis have many side effects and contraindications. It is highly undesirable to use them without a serious recommendation from a doctor regarding the duration, frequency, area of application on the body, and also without taking into account the individual characteristics of your body.
For effective treatment of early psoriasis, non-hormonal substances such as zinc pyrithione should be used. Zinc pyrition or active zinc is a very effective tool for the treatment of psoriasis, has a complex effect:
- reduces the proliferation of skin cells and suppresses inflammation, peeling and the formation of psoriatic plaques;
- eliminates itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the protective functions of the skin.