A pathological condition characterized by scaly and nodular changes on the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of the disease.
Psoriasis is a chronic disease of the skin and nails in which a rash of pink nodules and silvery scales appears on the skin. Usually the nodules merge into large plates, around which the skin is quickly covered with scales. With the prolonged development of the disease, joint damage is possible, accompanied by reduced mobility and constant pain. The different forms of psoriasis differ in the degree of skin damage: the patient may have only subtle patches on the scalp or large plaques on different parts of the body. The likelihood of developing complications of psoriasis also depends on many factors. This disease is especially dangerous for pregnant women, since the pustular form of the disease can lead to miscarriage.
about the disease
Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually appear between the ages of 18 and 35. Psoriasis often presents in the context of cardiovascular disorders, Crohn's disease, and depression. Approximately 30% of patients develop joint damage (arthritis). It is impossible to eliminate the root cause of psoriasis, however, symptomatic therapy can significantly alleviate the course of the disease.
types of psoriasis
Depending on the predominant symptoms, several types of psoriasis are distinguished:
- plaque - characterized by the appearance of classic plaques covered with silvery scales; preferential location: elbows, knees, torso, scalp;
- teardrop-shaped: the main manifestation is pink-orange nodules ranging in size from 1 to 10 mm;
- nail psoriasis - nail plates are predominantly affected;
- large-fold psoriasis - rashes occur in the armpits, in the folds of the neck, on the genitals and other places with excessive friction; this form is more common in obese people;
- head psoriasis - the scalp is affected;
- arthropathic psoriasis (psoriatic arthritis) - the joints are affected;
- pustular psoriasis - multiple small vesicles with pus appear on the patient's skin;
- Psoriatic erythroderma - in addition to the rash, pronounced redness of the skin occurs in the area of the rash.
symptoms of psoriasis
Most often, the plaques appear on the forearm, lower leg, navel, and scalp. The pustular form of psoriasis is characterized by the formation of pus-filled blisters on the skin. At certain periods, many patients experience a change in the color and structure of the nails. Damage to the skin scales leads to the appearance of pinpoint bleeding. Patients also complain of itchy skin. Skin changes disappear and reappear periodically.
Other symptoms and signs:
- the appearance of red spots in the area of \u200b\u200bskin folds;
- profuse rashes occur after infectious diseases and stress;
- slight increase in body temperature;
- the appearance of new skin rashes in the winter months;
- joint pain;
- mobility problems in the affected joint area;
- dryness and hypersensitivity of the skin.
The resorption of plaques usually begins from the central part, due to which the psoriatic elements acquire an annular or garland shape. Temporary depigmentation (pseudo leucoderma) remains at the sites of resolved rashes. During periods of incomplete remission, individual "duty" plaques may remain on certain areas of the skin (most often in the area of elbow and knee joints).
The most serious types of psoriasis are psoriatic erythroderma and arthropathic psoriasis.
In psoriatic erythroderma, all (or almost all) of the skin is involved in the disease process. The skin becomes tight, rough, infiltrated, red in color, with abundant desquamation of large and small lamellae on the surface. Peripheral lymph nodes increase, a subfebrile temperature appears, the general condition of patients is disturbed, changes in the blood (leukocytosis, elevated ESR), urine (proteinuria) are observed. The development of erythroderma is promoted by irrational and irritating therapy in the progressive stage of psoriasis.
Arthropathic psoriasis is characterized by lesions predominantly in small joints of the hands and feet, less frequently in the wrist, ankle, intervertebral joints, etc. , accompanied by severe pain and swelling of the joints, limitation of their mobility and deformities. The radiograph reveals lysis of the distal phalanges of the fingers and changes in the joints, similar to rheumatoid arthritis. The Waaler-Rose test and the latex test are usually negative. In the blood, leukocytosis, elevated ESR, hypergammaglobulinemia. Joint involvement may be associated with skin lesions or be isolated for several years.
With all these forms of psoriasis, it is possible to damage the nails in the form of perforated nail plates ("thimble phenomenon"), their dullness or thickening up to onychogryphosis. The course of the disease is chronic and undulating. The seasonality of the process is usually expressed: deterioration in winter with a significant improvement in summer (winter type), less often - vice versa (summer type).
Causes of psoriasis
The exact mechanisms of formation of psoriasis are not yet known. It is believed to be an autoimmune disease in which the body's defense system mistakenly attacks healthy tissue. The T cells and neutrophils needed to fight pathogens can begin to attack cells in the skin and joint structures. In this case, characteristic changes occur on the skin, including the formation of bubbles with an inflammatory fluid. The expansion of blood vessels in the area of inflammation is accompanied by reddening of the skin. Autoimmune disease can be caused by hereditary factors.
Additional risk factors:
- skin infectionsFirst of all, these are bacterial infections caused by streptococci;
- skin damage from cuts and burns;
- prolonged stress and psychotraumatic factors;
- alcoholism and smoking;
- vitamin D deficiency in the body;
- take certain medications, including lithium and beta-blockers;
- unfavorable family history. The discovery of psoriasis in a close relative of the patient indicates the possibility of a genetic predisposition to this disease;
- acquired or congenital impairment of immunity. It could be an HIV infection, AIDS, or another condition.
Despite the discovery of the putative immunopathological causes of psoriasis, the disease remains poorly understood. There are a huge number of diseases and lifestyle features that cause the manifestation of hidden factors of predisposition to this disease.
Diagnosis of psoriasis
If skin changes appear, you should see a dermatologist. The doctor at our clinic first performs a general skin examination to assess the nature of the rash. Gentle scraping allows you to detect desquamated papules and a thin film under the nodules. Under the film, a moist skin surface is located, prone to small hemorrhages. At the same time, there are atypical signs of psoriasis that resemble other diseases, so the doctor should carry out laboratory and instrumental diagnostics.
- Blood test. The dermatologist prescribes a venous blood test to rule out other diseases and detect signs of psoriasis. In the treatment room, the nurse treats the skin of the patient's cubital fossa with an antiseptic, applies a tourniquet, and draws blood with a syringe. In our laboratory, specialists first of all exclude the presence of rheumatoid factors. In pustular psoriasis, an increase in the erythrocyte sedimentation rate is often found. Elevated levels of uric acid are detected;
- Examination of the fluid from the pustules. The doctor collects the liquid in a sterile container and sends the material to the laboratory. The microbiological examination does not reveal a bacterial culture, but an increase in the number of neutrophils characteristic of psoriasis is found;
- Skin biopsy. The dermatologist prescribes this study to make an accurate diagnosis of atypical rashes. During the procedure, the doctor treats the skin with an antiseptic, anesthetizes, and removes a small area of skin with a scalpel. The tissue material is studied in the laboratory of our clinic using microscopy. The results allow to clarify the cellular composition of the nodules;
- X-ray of the affected joint. The doctor prescribes this study to determine the type of arthritis. Also, in severe complications of arthropathic psoriasis, X-ray diagnosis of bones is required;
- Skin scraping to rule out fungus. The doctor cleans the surface of the skin and, using a special spatula, collects various scales for microbiological examination. This analysis is mainly necessary if the rashes occur only in the area of the foot and nails.
If necessary, a consultation with a rheumatologist is made.
expert opinion
Psoriasis is a disease with many manifestations. It can be almost invisible or cause serious health problems. The most dangerous complications of psoriasis are joint damage, which can cause disability in the patient. Also, the disease can lead to autoimmune disorders, in particular, Crohn's disease and ulcerative colitis, metabolic pathology, erectile dysfunction in men. Women suffering from psoriasis can experience infertility and miscarriage. In order to prevent these complications, it is necessary to consult a doctor immediately after the appearance of suspicious signs, and with an already diagnosed diagnosis, carefully follow all the recommendations of a specialist.
psoriasis treatment
The main goal of treating psoriasis is symptomatic therapy. Patients need drugs that reduce inflammation and prevent the formation of skin rashes. In addition to drug therapy, the dermatologist of our clinic necessarily prescribes a special diet for the patient. Normalizing lifestyle and eliminating stressors can reduce the severity of psoriasis symptoms.
Depending on the situation, a dermatologist may use different methods to treat the disease.
- Administration of corticosteroids. The dermatologist prescribes ointments containing these drugs. The beneficial effects of corticosteroids include reducing inflammation in the tissues and eliminating itching;
- Vitamin D supplements. Synthetic forms of this vitamin slow down the growth of skin cells, thus preventing the formation of scales and nodules;
- Drug therapy containing vitamin A derivatives. A dermatologist prescribes retinoid-based ointments to reduce inflammation and itching. These medications increase the skin's sensitivity to light, so sunscreen should be used;
- Use of calcineurin inhibitors. These are immunosuppressants that reduce inflammation. The dermatologist prescribes topical agents such as tacrolimus. Such drugs are used in a short course to prevent the development of side effects and complications;
- Skin treatment with salicylic acid to remove dead cells. A dermatologist prescribes this drug along with corticosteroids for complex skin treatments;
- Using a moisturizer to get rid of dry, itchy skin;
- Irradiation of the skin with ultraviolet light. This safe physiotherapeutic treatment method improves the functioning of local immunity. The doctor selects an individual dose of radiation for the patient;
- Phototherapy. This method involves irradiation of the skin with special devices. Phototherapy combines the technologies of laser therapy and photochemotherapy;
- Joint puncture in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, anesthetizes the tissues and inserts a needle. With the help of a syringe, drugs are injected into the joint cavity to reduce the inflammatory process.
The dermatologist controls all stages of treatment in order to achieve the best result and prevent complications. Corticosteroids, retinoids, and calcineurin inhibitors are used strictly under the supervision of a specialist.
psoriasis prevention
The recommendations of the dermatologist of our clinic will help reduce the severity of skin rashes and alleviate the course of the disease.
Prevention of exacerbations of psoriasis:
- relieve anxiety and stress by improving sleep, avoiding coffee, and taking prescription sedatives;
- exclusion from the diet of foods containing allergens;
- timely treatment of infectious skin diseases.
Rehabilitation
Psoriasis is a chronic disease that has no cure. Rehabilitation measures are aimed at preventing relapses. Depending on the form of the disease, physiotherapy, spa treatment, mud therapy, therapeutic baths and other procedures may be prescribed.
Questions and answers
Is it possible to treat psoriasis with home remedies?
There are no methods with proven efficacy. It is important not to trust dubious types of treatment, but to follow the recommendations of the attending physician.
Does stress affect the course of psoriasis?
Yes, stressful situations can aggravate the course of the disease.