Psoriasis is a chronic multifactorial systemic disease with a genetic predisposition that affects the skin and joints. Patients often complain of a pinkish red rash 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 the patient's disability.
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 during the perimenopausal period);
- metabolic (fat metabolism disorder);
- infectious;
- viral (psoriatic antigens are isolated from healthy individuals, but with a high probability of developing psoriasis in the future, while psoriasis is a non-contagious disease);
- genetic.
Psoriasis can be traced back to an entire generation of people with the same risk factors. But the type of inheritance is supposed to be multifactorial. If one of the parents is sick, then 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 exacerbations:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, tooth decay, hepatitis);
- stress;
- obesity;
- perimenopausal period;
- medications (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin injuries; dryness, leading 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 soles;
- pustular psoriasis.
Flow characteristics:
- they get sick at any age; cases of psoriasis in children are not rare;
- men and women get sick equally;
- prevalence across the globe;
- There is summer, winter and mixed seasonality of irritations.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin with the production of sufficiently mature keratinocytes. Pink-red rashes appear, covered with silver-white scales.
A trio of symptoms is characteristic, thanks to which a diagnosis can be made:
- stearin stain symptom - when it itches, the number of scales increases;
- psoriatic film phenomenon - when all the scales are scraped off, a shiny red smooth surface appears;
- a symptom of accurate bleeding - when the film is scratched, drops of blood appear. This is due to the uneven extension of the papillae in the dermis, the expansion of the capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start with a spot and merge into large areas of damage.
- Psoriasis on the hands is most often localized on the extensor surfaces.
- Psoriasis on the face - the rash often appears behind the ears, on the forehead. It is an independent factor for improving treatment.
- Psoriasis on the scalp is an isolated form, it does not affect the hair, the elements of the rash are located along the edge of the hair, "psoriatic crown".
- Nail psoriasis - leads to characteristic changes, emphasizes the depressions, the nail looks like a finger. It can also thicken, become dull, or develop yellow spots under the nail.
- Psoriatic arthritis - affects peripheral joints with or without pain, often with inflammation at the connection of ligaments with bone, the ligaments themselves and the fingers.
Characteristics of psoriasis in children
They are characterized by the presence of one or several elements up to 1 cm, they rise above the surface of the skin. Itching in children is more pronounced than in adults. After scratching, the spot bleeds and scars form. In children, psoriasis is often localized in the perineal area as a large red spot. In teenagers, spots appear on the palms and soles.
There are three stages of psoriasis:
- Progressive - the elements of the rash grow and have a uniform white color, with a narrow red edge along the edge;
- Stationary - the growth of the spot stops, a strip of paler skin appears along the edge 2-5 mm wide;
- Regressive phase - the scales gradually fall, the point decreases and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients are referred to the general practitioner, dermatovenerologist or rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and tenderness of joints), anamnesis (season of irritations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). After the examination, changes in the skin and joints are observed.
Laboratory tests are performed:
- general blood analysis (including the number of leukocytes, ESR, platelets);
- general analysis of urine;
- biochemical analysis (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
- in difficult situations, a skin biopsy is performed with further pathohistological examination (strongly expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements);
- before prescribing biological treatment, an examination for HIV, viral hepatitis B and C and tuberculosis is performed;
- x-ray of affected joints;
- CT and MRI for axial lesions;
- EKG.
If necessary, consultations are carried out with an infectious disease specialist, phthisisist, orthopedic traumatologist, surgeon and other specialists.
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 - skin area affected by psoriasis), PASI (Psoriasis Area and Severity Index - psoriasis prevalence and severity index), DLQI (Dermatology Life Quality Index - dermatological quality indexof life).
To diagnose psoriatic arthritis, the PEST (Psoriasis Epidemiology Examination Tool) and CASPAR (Classification Criteria for Psoriatic Arthritis) criteria are used.
Treatment of psoriasis
The treatment is complex, aimed at eliminating inflammation, normalizing proliferation and differentiation of keratinocytes.
Local therapy:
- ointments and creams with vitamin D3 and its analogues;
- calcineurin inhibitors;
- glucocorticoids for local use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressive;
- biological drugs.
For psoriatic arthritis use:
- non-steroidal anti-inflammatory drugs;
- disease modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
For chronic cases, it is recommended to use psoriasis ointments, for exacerbations, psoriasis creams are used.
When applying ointment or cream, do not rub it into the skin and do not 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. Incorrect dosage of drugs may be ineffective or may cause side effects. The expected treatment effect occurs after 1-2 weeks of use.
There are several ways to use creams and ointments for psoriasis that contain glucocorticoids:
- continuous mode;
- way of therapy together;
- discount therapy regimen;
- application mode opens.
It is worth noting that the treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis using ointments and creams directly on the affected area. For more severe forms, treatment is carried out in hospitals using phototherapy, systemic therapy and biological medications.
The course of the disease is considered moderate and systemic treatment can be started in the following cases:
- skin areas of aesthetic importance are affected;
- large areas of the head are affected;
- the external genitalia are affected;
- palms and soles are affected;
- at least 2 nails are affected;
- There are single elements that cannot be handled locally.
Systemic therapy is performed only in the hospital, under the strict guidance of doctors, since systemic treatment is associated with a wide range of side effects, which can be reduced by choosing individual treatment.
General recommendations for patients with psoriasis:
- minimize trauma and drying of the skin;
- after applying psoriasis creams and ointments to your hands, use gloves to prevent the medicine from getting into your eyes;
- use sunscreens with protection factor 30;
- avoid stressful situations, consult a psychologist if necessary;
- control your weight, eat rationally.
Diet for psoriasis
Recommended:
- alkaline drink 1200-1600 ml per day;
- the use of lecithin;
- vegetables and fruits;
- porridge;
- lean meat and fish;
- dairy products.
Not recommended:
- citrus fruits;
- bread made from premium flour;
- fatty fish and meat;
- high-fat dairy products;
- coffee - no more than 3 cups a day;
- yeast products;
- alcohol, sweets, pickles, smoked, spicy.