Psoriasis is a chronic systemic multifactorial 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 damage to the patient.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only theories of origin:
- neurogenic (the 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 individuals who are healthy, but with a high probability of developing psoriasis in the future, while psoriasis is a non-infectious disease);
- genetic.
Psoriasis can be traced back to an entire generation of people with the same risk factors. But the type of inheritance is assumed to be 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 leading.
Factors that contribute to exacerbations:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, carious teeth, hepatitis);
- stress;
- obesity;
- perimenopausal period;
- drugs (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.
Stream features:
- suffer at any age, cases of psoriasis in children are not uncommon;
- men and women suffer equally;
- worldwide distribution;
- There is summer, winter and mixed seasonality of exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin with the production of insufficiently mature keratinocytes. Pinkish-red rashes covered with silvery-white scales appear.
A triad of symptoms is characteristic, thanks to which a diagnosis can be made:
- symptom of stearic stain - when scraping, the number of scales increases;
- the phenomenon of the psoriatic film - when all the scales are scraped off, a smooth shiny red surface appears;
- symptom of spot bleeding - drops of blood appear when the film is scraped. This is due to uneven elongation of the papillae in the dermis, expansion of the capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start as a patch and merge into large areas of damage.
- Psoriasis of the hands is most often localized on the extensor surfaces.
- Psoriasis on the face - the rash often appears behind the ears, on the forehead. This is an independent factor for improving treatment.
- Psoriasis of 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, "psoriatic crown".
- Psoriasis of the nails - leads to characteristic changes, point-like depressions, the nail looks like a thimble. It may 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 attachment of the ligaments to the bone, the ligaments themselves, and the fingers.
Characteristics of psoriasis in children
It is 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 sores 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 increase and are uniformly white in color, with a narrow red border along the edge;
- Stationary - the growth of the spot stops, a strip of paler skin with a width of 2-5 mm appears along the 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, dermatovenerologist or rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and joint tenderness), history (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). During examination, changes are found on the skin and joints.
Laboratory tests are performed:
- general blood test (including 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 additional pathohistological examination (sharply expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements);
- before prescribing biological treatment, a test for HIV, viral hepatitis B and C and tuberculosis is carried out;
- radiography of the affected joints;
- CT and MRI for axial lesions;
- EKG.
If necessary, consultations are held with an infectious disease specialist, a phthisiologist, an orthopedic traumatologist, a 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 Area - the area of skin affected by psoriasis), PASI (Psoriasis Area and Severity Index - index for the prevalence and severity of psoriasis), DLQI (Dermatology Life Quality Index - dermatological index of the quality oflife).
The PEST (Psoriasis Epidemiological Screening Tool) and CASPAR (Psoriatic Arthritis Classification Criteria) 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 with vitamin D3 and its analogs;
- calcineurin inhibitors;
- glucocorticoids for topical application;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological drugs.
For psoriatic arthritis use:
- nonsteroidal anti-inflammatory drugs;
- disease modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
In chronic cases, the use of psoriasis ointments is recommended, in case of exacerbation, psoriasis creams 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. Incorrect dosage of medication can 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 therapeutic regimen;
- step mode of application.
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. In more severe forms, treatment is carried out in hospitals with phototherapy, systemic therapy and biological drugs.
The course of the disease is considered moderate and systemic treatment can be started in the following cases:
- areas of the skin 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 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, which can be reduced by choosing individual treatment.
General recommendations for patients with psoriasis:
- minimization of injury and drying of the skin;
- after applying creams and ointments for psoriasis on your hands, use gloves to prevent the medicine from getting into your eyes;
- use sunscreen products with a protection factor of 30;
- avoid stressful situations, consult a psychologist if necessary;
- control your weight, eat rationally.
Diet for psoriasis
Recommended:
- alkaline drink 1200-1600 ml daily;
- use of lecithin;
- vegetables and fruits;
- mess;
- lean meat and fish;
- dairy products.
It is not recommended:
- citrus fruits;
- bread from premium flour;
- fatty fish and meats;
- high-fat dairy products;
- coffee - no more than 3 cups per day;
- yeast products;
- alcohol, sweets, sour, smoked, spicy.