Psoriasis

Psoriasis (also known as squamous lichen) is a chronic, non-infectious and often recurrent skin disease.

Psoriasis, the symptoms of which determine its tendency to damage periarticular tissues, manifests itself in the form of scaly papules, in addition, it is worth noting that this disease is one of the most common skin lesions that occurs at any age.

The etiology of this disease has not yet been fully studied and proven, however, many dermatologists still agree that psoriasis is a condition directly related to inherited genetic pathologies.

Do not self-medicate. At the first sign of illness, see your doctor.

general description

Psoriasis is characterized by the duration and persistence of its own course. Its remissions, which can last several months or several years, meanwhile, indicate its later return and duration for life. Spontaneous cure from this disease is extremely rare.

If you try to determine a specific category of people predisposed to the onset of psoriasis, the solution will not be unequivocal. The fact is that psoriasis, acting as a systemic process, develops not only in people with real immune disorders, but also in people who have certain functional or morphological disorders associated with the functions of various systems and organs.

Belonging to the group of dermatoses, psoriasis is one of the most studied diseases in them. Meanwhile, none of the hypotheses that exist today can fully determine the essence of this disease. Given this, the problems associated with its therapy and prevention are in the same uncertain and, at the same time, acute situation as before. Depending on the specific time period, various ideas about the origin of psoriasis have been put forward. This, in turn, led to the selection of several forms, each of which is based on the results of certain laboratory studies and clinical observations.

• The hereditary nature of the disease. This implies the presence of psoriasis in the framework of the consideration of several generations, in which, consequently, cases of this disease were noted. By the way, it is heredity that is practically considered the main and reliable cause of the development of psoriasis (in this case, psoriasis increases under the influence of various types of provoking factors).
• The metabolic nature of the disease. In this case, disorders in fat metabolism (i. e. cholesterol metabolism), decreased morbidity during periods of hunger, increased amount of phosphorus in psoriatic scales, etc. are considered.
• The viral nature of the disease. In this case, the concept of the direct involvement of a viral infection in the etiology of the disease in question was formed on the basis of numerous long-term clinical observations. Consequently, for the same reason, the infectious (and also viral) nature as a theory of the development of psoriasis is the oldest. Then, the end of the 19th century was marked by cases of the formation of very large groups of psoriatic-type formations, formed in the context of patients suffering from diseases such as scarlet fever and influenza. The systemic nature of the lesion itself, its recurrent and prolonged course, the presence of a connection with meteorological and heliophysical factors, as well as certain features inherent in the evolution of the eruptions characteristic of psoriasis, also acted as confirmation of the infectious nature of the same. illness. At present, viral agents are now being investigated through which the psoriatic process could be triggered.
• Endocrine nature of the disease. The theory of a direct connection between the onset of psoriasis and the endocrine (as well as metabolic) nature in the recent past was supported by many. When examining patients with psoriasis, certain disorders of the endocrine scale were often revealed, which served as justification for the relevance of such a connection. In particular, the disorders associated with the functional state inherent in the sex glands, the influence caused by the menstrual cycle, pregnancy, childbirth and lactation, the pronounced type of changes detected in the study of the pituitary-adrenal system of the patients.
• The neurogenic nature of the disease. It consists of the onset of the disease in the context of a nervous shock that is real for the patient (more precisely, after it has been transferred). In about 30% of cases, exacerbation of the disease occurs precisely on the basis of stress. In this case, patients have a reduced ability to withstand the impact of stress and the subsequent transfer of its consequences. At the same time, the disorders they present (asthenic, vegetative-vascular-visceral, vegetative-vascular-dystonic and asthenodepressive) in combination with neurotic reactions provoke the formation or even exacerbate the characteristics of the predominant vicious circle.

Classification

As we have already pointed out, psoriasis acts as a chronic and recurrent disease. Any of its existing forms can be attributed to one of the variants of the relevant classification for psoriasis, in which there is a distribution for pustular or non-pustular psoriasis. In general, the classification is as follows:

• Pustular psoriasis
  • generalized psoriasis;
  • annular psoriasis (pustulosis annulare);
  • palmoplantar psoriasis (psoriasis of the extremities, persistent palmoplantar pustulosis, barber pustular psoriasis);
  • chronic form of persistent acrodermatitis (psoriasis of the soles and palms of the hands, palmar-plantar psoriasis);
  • psoriatic impetigo herpetiformis.
• Nonpustular psoriasis
  • psoriasis vulgaris or psoriasis vulgaris, simple psoriasis (plaque, chronic stable psoriasis);
  • psoriatic erythroderma (erythrodermic psoriasis).

Several authors adhere to the need to complement this classification, which is why types or forms of psoriasis can be added to it in the following variants:

• seborrhea-like psoriasis (seborrheic psoriasis);
• Napkin psoriasis;
• drug-induced psoriasis;
• "Reversible psoriasis" (psoriasis of skin folds, flexor surfaces).

Psoriasis: symptoms

The first symptoms of psoriasis are the eruption of miliary-type papules, which are characterized by a gradual increase along the periphery, at the same time that they transform into nummular and lenticular papules and merge with each other, thus appearing plates of various sizes. The development of psoriasis within the skin defines three main stages for it.

First stage

This stage is defined as a progressive stage, it is caused by the formation of new formations on the skin (actually papules), as well as an increase in the size of those formations that are already on the skin. This is also accompanied by the formation of an erythematous border around the lesions (this border is defined as a zone of peripheral growth). The plaque along the edges is not susceptible to flaking, while the flaking, which acts as the final stage of inflammation, does not keep pace with the growth process of psoriatic formations.

Second stage

The second stage defines a stationary period in which no new elements appear, however, the existing elements in the form of plaques and papules do not change in size. In general, the appearance of papules can be completed at any stage, so the stationary period can be accompanied by the simultaneous appearance of miliary, lenticular and nummular papules. Let's explain what are the three types of papules listed. So, nummular papules are elements of a rounded skin rash with a diameter of 15-20 mm (for this reason, these papules are also called coin-shaped). Lenticular papules, in turn, are elements of a rash, flat or convex, oval or round in shape, resembling lentils. And finally, the miliary papules, which have a conical shape of elements and are therefore similar to hemp seeds. These papules are basically small in size, the predominant area is close to the hair follicles.

Third stage

This stage is inverse (or regressive). Its main characteristic is that the eruptions gradually disappear and a pseudosclerotic-like whitish border forms around the foci (defined as the Voronov border). During this period, some patients may experience mild itching. As for subjective sensations, they are mostly expressed insignificantly, or even completely absent.

The appearance of rashes can be noticed on any area of the skin, however, they are predominantly localized on the area of the surface of the curves of the limbs, in particular, the elbow and knee joints, the sacrum region, the scalp (here, in particular, the area along the edge of hair growth is distinguished, which is defined as "psoriatic crown"). Psoriasis on the head, the symptoms of which, although determined by the severity of its own manifestations, do not lead to a change in the structure of the hair, nor to its loss.

Regarding the concentration of plaques within the extensor surface of the knee and elbow joints, here they tend to persist for a long period of time from the moment the rash resolves in general (this characteristic defines them as plaques of "must"). Some patients are faced with the fact that the skin folds in the groin-femoral region or the mammary glands, as well as in the axillary glands, are affected, and often such a lesion can be isolated.

Irritated psoriasis

It develops against the background of active exposure of the already existing progressive psoriasis skin to certain irritants, in particular, the sun's rays or specific ointments, as well as other types of irritants that affect plaques. These plates, in turn, acquire a more convex shape, the color changes to cherry red, a hyperthermic belt forms within the surrounding area, due to which the sharp boundaries become somewhat blurred. This belt, after the resolution of the plate, acquires a wrinkled appearance.

Spotted psoriasis

This form of the disease manifests itself in the form of mild infiltration (in the general definition, infiltration is the impregnation of tissues with one or another substance) of the elements of the rash. They, in turn, look like spots (not papules). Spotted psoriasis develops, as a rule, acutely, and is also characterized by a similarity to toxidermy. Defining the correspondence of the course of the disease with its characteristic psoriatic triad is used as the main method in the differentiation of the disease.

Old psoriasis

This form of the disease can be considered in terms of symptoms in the form of severe infiltration on the side of the plaques, their general cyanosis, with a hyperkeratotic or warty surface. This type of foci is especially difficult to cure, and its transformation in the future into a malignant tumor formation is not excluded (this occurs infrequently, but, unfortunately, it is not necessary to exclude this option).

Seborrheic psoriasis

This form of psoriasis, as its name suggests, develops in patients with seborrhea that is already relevant to them. The disease manifests itself from the scalp, in the area behind the atria, on the chest, in the area of the nasolabial folds, within the subscapular and scapular parts of the back. Emerging psoriatic scales are subject to intense sebum saturation, thus adhering to and remaining within plaque surfaces, thereby allowing the disease to simulate a characteristic picture of seborrheic eczema.

Palmar-plantar psoriasis

The disease may manifest as ordinary psoriatic plaques and papules, or as hyperkeratotic formations that resemble corns and calluses. In some cases, psoriasis on the hands, the symptoms of which are noted in this case on the palms of the hands (or on the legs, by definition, on the soles of the feet) is continuous, manifesting in the form of increased thickening or keratinization. . The limits of this type of injury are characterized by clarity; in rarer cases, this form of psoriasis is limited to the appearance of flaking large rings.

Exudative psoriasis

This form of psoriasis is characterized by an excessive severity of the exudate during an inflammatory reaction, it appears within the progressive period of the course of psoriasis. As it works its way to the surface of the papule, the exudate provides saturation for the accumulation of scales, thus forming scab-like formations. These elements are secondary, define them as crusts-scales, the color of these elements is yellowish. After removal, a slightly bleeding and oozing surface is subject to exposure. Scale crusts, when dry and layered, often form a type of massive conglomerate, resembling an oyster shell (this is already defined as rupioid psoriasis).

Droplet psoriasis

Gouty psoriasis, the symptoms of which appear suddenly, is characterized by the formation of multiple specks within the skin. Most of the disease is diagnosed in patients aged 8 to 16 years. Streptococcal infection often acts as a precursor to tear-shaped psoriasis.

Nail psoriasis

Nail psoriasis, the symptoms of which provide the isolation of this type of psoriasis in three main forms, depending on the degree of nail damage, it can be atrophic, punctual or hypertrophic.

A punctate lesion is considered as the formation of punctate depressions in the nail plates, which can also be compared to the surface of a thimble. The manifestation of this form of psoriasis is possible in a slightly different version, which, in its specificity, is similar to onychomycosis. In this case, within the free edge, the nail plate changes color, becomes dull, prone to crumble without much effort. As a sign that allows to differentiate psoriasis, an inflammatory border formed along the periphery of the area of the affected nail plate is determined. It appears as the edge of a papule within the nail bed, visible through the nail plate.

Psoriatic arthritis (psoriasis)

Psoriatic arthritis, the symptoms of which are manifested due to infiltration, which is relevant to periarticular tissues with simultaneous joint damage, mainly affects interphalangeal joints. Meanwhile, the possibility of participation of large joints in the pathological process is not excluded, the joints and joints of the sacroiliac spine are rarely at risk in this regard.

It is important to note that psoriatic arthritis, unlike other types of arthritis (which in the general definition means inflammation of the joints), forms against the background of a psoriatic rash that already exists in the patient, often combined with nail damage. . In addition, an important point can be distinguished that the appearance of this type of arthritis is combined with an exacerbation of psoriasis within the skin, which, in most cases, acquires an exudative character.

Irrational treatment of the disease during the period of its progression is often accompanied by the appearance of a nonspecific reaction of the body. It is toxic-allergic in nature and consists of the appearance of redness in the area of the areas not affected by psoriatic plaques, this redness, when melting, affects the skin completely. This process is combined with an elevated temperature (in a range of no more than 39 degrees), as well as an increase in lymph nodes, a feeling of tightness in the skin, its burning and itching. In frequent cases, there is also abundant peeling, thickening and exfoliation of the nail plates, hair loss. This image already indicates the relevance of psoriatic erythroderma. Erythroderma ends with the restoration of the traditional version of the psoriasis course.

In general, the recurrence of the disease occurs in the autumn-winter, as well as in the spring-summer periods, which is an important factor that must be taken into account, even when prescribing the necessary treatment.

psoriasis treatment

Before the appointment of treatment, a full examination of the patient is carried out, and already to determine specific measures on it, they are based on the stage of the course of the disease, in its clinical variety, the general condition of the patient, on the presence of concomitant diseases, the conformity of the manifestations of the disease with seasonality, etc. the fastest and at the same time a favorable result of treatment is achieved in the case of uncomplicated forms of psoriasis with its short course, as well as with limited manifestations. In general, the treatment of psoriasis is a rather laborious process, and in most cases it is not possible to reach a complete cure: the disease simply recedes (that is, a period of its existence without symptoms begins), which However, it is also a positive result for it.

The main goal of treatment was determined to be the maximum possible suppression of symptoms in combination with the addition of preventive measures.

First of all, with psoriasis, a diet is prescribed in which those foods that provoke an exacerbation of the disease (spicy food, chocolate, alcoholic beverages) are excluded from the diet. The restriction also applies to the consumption of smoked meats, honey, fried foods and fatty foods, etc. During the period of exacerbation of the course of the disease, it is recommended to eat more fruits and vegetables (except for red ones - apples, tomatoes, cherries, etc. ), fish and lean (boiled) meats.

The course of psoriasis has a beneficial effect on its treatment in the conditions of sanitary facilities. Taking into account the special susceptibility of the skin in patients with psoriasis, it is recommended to avoid sun exposure on it in the period from 11 to 16 hours.

As for the drug treatment of psoriasis, it is based on the use of various methods. First of all, these are external agents (creams, ointments, etc. ), systemic treatment drugs (injections, pills, etc. ) and methods such as phytochemotherapy (phytotherapy), physiotherapy, etc. external treatment methods. In particular, the following drugs were the most used among them:

• Salicylic ointment. With its help, the softening of the formed scales is ensured, which, in turn, provides the possibility of their early removal along with better absorption of other types of drugs. This ointment (0. 5% or 5%) is applied to the affected areas of the skin in a thin layer, 1-2 times a day. An important feature of the application is the use of a smaller amount of ointment with a significant nature of inflammation (that is, the more pronounced the inflammation in the nature of its manifestation, the less amount of ointment is used, respectively). Salicylic acid, which acts as the base of the drug, is also found in other ointments used in the treatment of psoriasis.
• Sulfur tar ointment (5 or 10%). The use of this ointment provides a reduction of the inflammatory processes relevant to the skin. Contraindication for use is exudative psoriasis (that is, psoriasis, accompanied by oozing crusts and scales). You cannot apply this ointment on the skin of the face. Tar shampoos are used to treat psoriasis of the scalp.
• Naphthalene ointment. It is used to treat the regressive and stationary stages of the disease. The exacerbation or progression of psoriasis determines the inadmissibility of the use of this remedy. With the help of this ointment, intense itching and inflammation are reduced. A 5% or 10% ointment is used.
• Glucocorticosteroid drugs. Its use provides a decrease in the intensity of inflammation. They are used only in short courses, with the mandatory supervision of a specialist.
• Ointments containing vitamin D. Such ointments provide an anti-inflammatory effect, and at the same time improve the course of the disease.

As for systemic treatment, it is selected strictly individually and only by the attending physician. As already noted, it means the use of various pills, injections, etc.

Phytochemotherapy as a method of treating psoriasis consists of exposing the affected skin areas to ultraviolet rays. For this, a special type of installation is used that irradiates such areas without affecting healthy skin.

In general, the treatment of psoriasis can mean many different schemes implemented in practice, but none of these schemes is generally accepted due to the difference in their course and specificity, therefore the effectiveness of any of the schemes cannot be determined. equally for all patients. Let us repeat that the treatment of the disease is carried out strictly individually under the constant supervision of the attending physician.

If symptoms that indicate psoriasis appear, it is necessary to contact a dermatologist and an infectious disease specialist.