Psoriasis is an inflammatory skin disease. Occurs when the immune system malfunctions. The development of the disease is divided into clear stages - onset, progression, stabilization and regression. The different stages of psoriasis differ in the appearance of spots and rashes, painful itching and widespread inflammation of the skin.
Why is it necessary to distinguish between the stages of development of the disease and what are the features of the course of psoriasis at the beginning of development and in the process of recovery?
Why you need to know the stages of psoriasis
The division of psoriasis into stages is used by physicians to make the right choice of therapeutic methods. The complex of drugs and external agents that are prescribed to treat inflammation depends on the stage of development of the disease. At the beginning of the disease, general therapy is needed - vitamin complexes, diet, external aseptic treatment of the rash, such as a course of UV procedures. Drugs that stimulate the cleansing of the intestines, blood vessels, liver are also prescribed. Do not forget to make a correction of the psycho-emotional state - by a neurologist or psychologist.
In the initial stage of the disease, they do not use powerful drugs that suppress the immune system, do not prescribe hormonal ointments. These drugs have a large 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 progressive course of the disease, several drugs with different actions are prescribed. Immunosuppressants and glucocorticosteroids are often used to relieve inflammation and reduce itching. External treatments are complemented by photochemical, ultrasound and laser therapy. Antiseptics are also prescribed to treat damaged skin.
In a stabilized state, they continue to take anti-inflammatory hormonal drugs, gradually reducing their dose. Ointments with a regenerating effect are prescribed to repair damaged skin.
In remission - support the body. Proper nutrition, take vitamin and mineral complexes to restore immunity.
Timeliness of treatment
The earlier you start treatment, the easier it is to control psoriasis. Timely therapy limits the spread of skin inflammation, reduces its degree and prevents subsequent recurrences of peeling. Because psoriasis is often confused with an allergic rash at an early stage, it is necessary to know its initial signs so as not to miss the onset of skin disease.
Note: Doctors are still investigating the causes of psoriasis. But it is definitely known that psoriatic skin inflammation is not contagious. It cannot be taken by a sick person or an infection in case of injury. This is our personal failure in the human body.
The cause of psoriasis is immune deficiency, which can be caused by various factors. Severe stress, poisoning (including powerful drugs, industrial emissions, alcohol), previous infection.
Psoriasis is difficult to treat. The disease is prone to recurrence, relapse. And the therapy itself is symptomatic. It consists in preventing the appearance of new spots and relieving existing itchy skin.
Which stage of psoriasis is called initial? How to distinguish early psoriasis from diathesis rash? And how will the disease develop in the future?
Psoriasis: initial stage
The first appearance of psoriasis on the skin looks like pimples. The rash most often occurs in the bends of the elbows and knees or in places where the clothes are tightly pressed to the body (for example, under the waist belt). Rash can also appear on the edge 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 occurs symmetrically - on the elbows of both hands, or on both sides of the lower back, or on two knees. The pimples themselves (in medical terminology - papules) in the initial stage have a moderate appearance. They have:
- Pink or red;
- Sharp, blurred edge;
- Small size - bud at the base does not exceed 2 mm;
- Flat shape - small pimples at the beginning of the disease have almost no protrusion, so they look like spots.
As pimple disease progresses, flakes of peeling skin appear. They are gray or silvery, against the background of a red pimple look white.
The appearance of scales is accompanied by severe itching. If you do not resist and scratch, then the scales are removed, exposing the shiny areas of pink young skin underneath. It is very thin, vulnerable, with prolonged scratching of itchy papules - injured, bleeding.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: stage of progression
In the progressive stage, individual pimples merge into a common place, forming so-called psoriatic plaques. They are raised above the surface of the skin and are almost completely covered with peeling. There is a non-scaly pink-red edge on the edges of the psoriatic plaques.
The presence of the rim is a sign of a progressive stage of the disease. The width of the rim is 1-2 mm. The skin on it is inflamed, its structure resembles parchment paper.
The rim represents the area of spot expansion. This is skin that is already inflamed but not yet white. After a while it will also be covered with scales. And the patch will expand to cover new areas of skin and form a new wider edge.
In the active development of the disease, the neighboring spots merge with each other. At one point, a large, inflamed red spot may form on the human body.
Psoriatic plaques are very itchy, giving a person unpleasant sensations, disrupting work, rest and sleep. They grow, occupy a large area and form a new rash on clean, healthy skin.
The main sign of the progressive stage is the appearance of new rashes. As soon as new pimples and spots stop appearing, the next stage of psoriasis begins - stationary. This is not yet a complete victory, but it is already a turnaround for recovery.
In the stage of progression psoriasis is almost always accompanied by weakness, fatigue, weakness. Depression is common. Possible temperature.
The duration of the progressive stage of psoriasis can be long, several months.
Psoriasis: stationary stage
The main sign of the stationary stage is the cessation of the appearance of new spots and rashes. At the same time, the itching also weakens, becomes more tolerable. The rash loses its bright color, discolors, becomes invisible. This is also one of the signs that the process is stabilizing.
The pink bands around the perimeter of the plaques disappear when the inflammation stops spreading. Active exfoliation and healing begins, regeneration of new healthy skin.
It is noticeable to the naked eye that the peeling increases in a stationary stage. The scales completely cover the entire surface of the psoriatic spot, leaving no room for the rims. Psoriasis acquires the characteristic scaly appearance, which is generally recognized by the general public.
Extensive peeling in a stationary stage is not dangerous. When all the dead cells come out of the surface of the psoriatic spot, healthy skin with a slight light tinge will remain in place.
Other signs of progression 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 development of the disease. This is the nature of the sensation of itching (severe or tolerable), general condition, depressed mood. And also the presence of temperature.
In the initial stage, the itching is variable and the rash is incomprehensible. In addition, the itching gets worse every day. In the acute stage of psoriasis, it becomes unbearable. Disrupts sleep, rest, interferes with work. The person becomes irritable because the itchy sensations do not allow him to rest.
In the stationary stage, the itching subsides. Every day - a person feels better. The general state of the psyche changes, negativity and depressed moods weaken. The duration of the stationary stage is several weeks - from 2 to 5.
Psoriasis in the fading stage
The disappearing stage of psoriasis is the almost complete disappearance of plaques, spots, redness, inflammation, itching. At this stage of the disease, psoriasis is only reminiscent of different skin pigmentation. In place of the former psoriatic spots it looks lighter. The surface of healthy skin has a darker shade.
In some cases, the so-called hyperpigmentation is formed. The skin at the site of psoriasis spots does not become lighter, but darker. In any case, the differences in skin pigmentation will be visible for another one to two months.
Post-recovery psoriasis: possibility of recurrence
The possibility of recurrence of psoriasis is determined by lifestyle, diet, allergic mood and the condition of the body as a whole. It is also determined by the amount of toxins in his body, blood, liver. You can reduce the likelihood of re-inflammation of the skin if you strengthen the immune system and cleanse the body of toxins in the liver, blood vessels and intestines.
Seasonal relapses of psoriasis are often rare after cleansing. A person remains susceptible to the disease, but the probability of its occurrence is significantly reduced.
Cleansing the body of toxins and taking vitamin and mineral complexes help boost immunity. This is especially important if immunosuppressants have been used during treatment in the advanced stage of psoriasis. Their need is due to the work of mediators of inflammation. After suppressing the autoimmune defense, it is necessary to restore the immune system.
Clinical manifestations
Psoriasis is characterized by monomorphic eruptions in the form of papules (nodules) of various sizes, when they merge, form plaques and they can spread to the skin.
At the beginning of the disease in most cases the rash is limited and is represented by single plaques in the places of its favorite localization (scalp, extensor surface of the elbow, knee joints, sacrum, etc. ).
The plaques are clearly distinguished from healthy skin, bright pink or deep red, covered with loose silvery-white scales, when scraping you can get a triad of phenomena characteristic of psoriasis - "stearin stain", "terminal film", "blooddew ”. . .
There are 3 clinical stages of psoriasis: progressive, stationary and regressive.
Classification
Depending on the degree of the 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, wrinkled psoriasis and psoriasis. It should be noted that different clinical variants may co-exist in one patient.
Exudative psoriasis is characterized by a pronounced inflammatory reaction of the skin, which is manifested by the presence of lamellar scales-crusts on the surface of plaques, sometimes multilayered, resembling a puff cake in appearance (in such cases this form of psoriasis is called rupioid). . When the scales are removed, a weeping surface is revealed.
Arthropathic psoriasis in the clinical picture has, in addition to the usual plaque eruptions, and joint damage, often small, distal, rarely large.
Arthropathy can occur in the presence of skin lesions or precede them. Psoriatic arthritis is manifested by pain, swelling, limited mobility in the affected joints of varying intensity, from minor arthralgias of individual joints to generalized lesions and damage to patients. The risk of arthropathic psoriasis is higher in patients with severe skin manifestations (psoriatic erythroderma, pustular psoriasis), but a combination of severe joint damage with relatively limited skin rash is possible.
Pustular psoriasis can be generalized (Tsumbusha) and limited, involving the palms and soles (Barbera). Stressful situations, infections, irrational general or local therapy contribute to the appearance of this severe form of psoriasis.
Generalized pustular psoriasis is manifested by fever, leukocytosis, elevated ESR, and general severe condition. Suddenly, against the background of bright erythema, small superficial pustules appear, accompanied by a burning sensation, soreness, they can be localized in the area of ordinary plaques and on previously unchanged skin. The new foci of pustulation appear paroxysmal, occupying large areas of skin. Combined pustules cause detachment of the epidermis in the form of "purulent lakes", erythroderma may develop.
Limited pustular psoriasis is more common, the rash is localized mainly on the palms and soles in the form of pustules on the background of erythema and skin infiltration. The course, compared to the generalized, is lighter, with a satisfactory general condition, but constant, with frequent relapses. Irritant topical therapy is a provoking factor.
Psoriatic erythroderma is a severe form of psoriasis, which develops with gradual progression of the psoriatic process and fusion of plaque elements to the defeat of the whole skin, characterized by acute hyperemia, edema, skin infiltration with abundant large and small lamellar pylases. Subjectively - severe itching is often noted. The disease can begin with erythroderma. The general condition worsens (fever, weakness, lymph node reaction, heart failure, impaired liver and kidney function, changes in blood tests, hair loss, etc. ).
Wrinkle psoriasis is more common in children and the elderly, especially in patients with diabetes. The lesions are located in the armpits, under the mammary glands, in the perineum, inguinal-femoral folds, in the navel and are characterized by sharp borders, deep red color and light peeling.
Psoriasis of the palms and soles may exist in isolation or concomitantly with damage to other areas of the skin; The characteristic psoriatic triad is difficult to induce.
Three clinical stages of psoriasis
Stage of progress. Under the influence of provoking factors (trauma, psycho-emotional stress, infectious diseases, inadequate methods of treatment, etc. ) may exacerbate the disease with the appearance of an abundance of small nodules prone to peripheral growth, and the formation of plaques of various sizes andforms that can be isolated or occupy large areas of skin to universal skin lesions.
The progressive stage is characterized by a symptom of an isomorphic reaction (Kebner's phenomenon), which is characterized by the fact that typical psoriatic eruptions appear at the site of injury, even slightly.
Stationary stage. In the stationary stage, the appearance of new elements ceases and the tendency for peripheral growth of existing plaques disappears.
Regression stage. The regression stage is characterized by a decrease in the intensity of the color of the plaques, their alignment, reduction of desquamation, infiltration, resorption of elements with subsequent formation of foci of hypo- or hyperpigmentation at the site of previous rashes.
Healing
Treatment of psoriasis is aimed at suppressing the proliferation of epithelial cells and eliminating the inflammatory process and is prescribed taking into account the anamnestic data, form, stage, spread of the process, comorbidities, age and sex of the patient, contraindications fora particular method of treatment or medicine.
For mild, limited manifestations of psoriasis, topical external therapy in the form of salicylic ointment, naphthalene preparations, tar or emollient ointments is sufficient. Severe forms of the disease require complex systemic treatment using detoxification, desensitizing, anti-inflammatory drugs from different groups, physiotherapeutic methods of therapy, external drugs and others.
This section will present the available and most modern effective methods and tools for the treatment of psoriasis.
Systemic therapy
There are peculiarities in the management of patients at different stages of the psoriatic process. Advanced treatment requires special care. During this period, hemodez is prescribed intravenously, 30 percent. sodium thiosulfate solution i / v, 10% calcium gluconate solution, in concomitant hypertension, it is recommended to introduce a solution of magnesium sulfate; emollient creams or 1-2 percent are used externally. salicylic ointment.
Aromatic retinoids.Acitretin (neotigazone) - a representative of the second generation of monoaromatic retinoids is used to treat severe forms of psoriasis in a dose of 10 to 20-30 mg per day, depending on the severity of the skin process. The mechanism of action of acitretin is to inhibit the proliferation of epidermal cells, to normalize the processes of keratinization. The drug is particularly effective in combination with PUVA therapy. When prescribing acitretin, you should not forget its teratogenic effect.
Cytostatics.Methotrexate is used in cases of persistent psoriasis and in the presence of contraindications for other treatments, as a folic acid antagonist, acts mainly on actively proliferating cells. Very toxic. There are many methods of administration, preferably intramuscular administration once a week under strict laboratory control.
Immunosuppressants.Cyclosporine-A is prescribed in cases of severe, widespread psoriasis, resistant to other therapies. This drug has an immunosuppressive effect, has an inhibitory effect on cell growth processes, inhibits the secretion of activated cytokine lymphocytes and the expression of interleukin-1 receptors on immunocompetent cells. In psoriasis it is prescribed at the rate of 5 mg per 1 kg of body weight per day.
Non-steroidal anti-inflammatory drugsare prescribed for arthropathic psoriasis, as well as to reduce acute inflammation in exudative psoriasis and erythroderma. Daily doses of drugs and duration of treatment depend on the intensity of the pain syndrome, the degree of inflammation and individual tolerance.
The use of systemic corticosteroid drugs in the treatment of psoriasis is considered inappropriate, it leads to the development of torpid forms of the disease, resistant to various types of therapy. In cases of severe arthropathic psoriasis, intra-articular administration of long-term corticosteroids is possible, the dose and duration of treatment depend on the size of the affected joint and the degree of inflammation.
Physiotherapy treatments.One of the most effective treatments is PUVA therapy or photochemotherapy (PCT). PCT is a combined use of long-wave ultraviolet radiation (wavelength from 320 to 420 nm) and photosensitizing drugs furocoumarin. The use of photosensitizers is due to their ability to increase the skin's sensitivity to ultraviolet rays and stimulate the formation of melanin. PUVA therapy leads to inhibition of cell proliferation, suppression of pathological keratinization, affects the metabolism of prostaglandins, the permeability of cell membranes. The peak of the photosensitizing effect occurs 1-3 hours after taking 8-methoxypsoral. The dose of the drug is chosen taking into account the patient's weight. The procedures are started 3-4 times a week, for a course of 20-25 sessions.
Local PCT is also used with the use of external photosensitizers.
The combined use of PUVA therapy and retinoids is called Re-PUVA therapy. It has the highest clinical effect in cases of severe psoriasis.
Selective phototherapy (SFT) - ultraviolet radiation in the mid-wave spectrum (wavelength 280-320 nm) without taking photosensitizers. SFT is used for less pronounced manifestations of the disease, the presence of contraindications to the appointment of PUVA therapy.
How to recognize psoriasis at an early stage
Psoriasis treatment is most effective at the earliest stage. That is why it is so important to make the diagnosis on time. Only a dermatologist can tell you if you have psoriasis or some other skin condition. However, you can recognize this disease in yourself by several characteristic features:
- Most often, psoriasis occurs first on the folds of the arms and legs, on the hairline or where the clothes are in close contact with the body or rubbing - under the belt of pants, various elastics or straps.
- At the beginning of the disease, a very itchy rash appears, covered with gray or silvery skin scales, which are very easy to remove.
- Removing the scale reveals thin, shiny and slightly moist skin.
- If you scrape the poster with something like a spatula, removing the scales, then blood will appear on the stain in the form of small droplets. However, it is better not to use the latest method for self-diagnosis of psoriasis - it is very easy to infect it.
You should see a doctor for complete confidence, as patients themselves often confuse psoriasis with various types of lichen or allergic dermatitis and use inappropriate medications for treatment.
What to do if you find symptoms of the initial stage of psoriasis?
Psoriasis cannot be cured once and for all, so the main goal of therapy is to achieve stable and longest possible remission. You should be aware that without proper treatment, psoriasis quickly turns into a chronic form: exacerbations can occur up to 9 times a year, lasting up to 15 days.
What to do if you suspect you have psoriasis? Often people, after finding signs of this disease in themselves, make a big mistake by resorting to "heavy artillery" - hormonal ointments (so-called topical glucocorticosteroids or THCS), without consulting a doctor. Patients usually explain such a step by the fact that they have heard from friends that such tools 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 the strict recommendation of a doctor about the duration of use, frequency, area of application on the body, and also without taking into account the individual characteristics of your body.
Non-hormonal agents such as zinc pyrithione should be used to effectively treat early psoriasis. Zinc pyrithione or active zinc is a very effective treatment for psoriasis, which has a complex effect:
- suppresses excess proliferation and inflammation of skin cells, reducing flaking and the formation of psoriatic plaque;
- relieves itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the protective functions of the skin.