According to the WHO, currently 2-4% of the world's population suffers from psoriasis. This disease affects patients of all ages, however, most often young people (15-25 years). Unfortunately, today medicine is not able to cure psoriasis completely, but timely professional treatment significantly improves the quality of life. Therefore, in case of detection of the first symptoms, it is better to consult a doctor immediately.
Psoriasis- This is a dermatosis that manifests itself in the form of scaly papules on the skin. Its recognizable characteristic is that, in addition to the skin, it is capable of affecting the joints and nail plates. Hereditary factors are clearly followed in the pathogenesis of psoriasis, and other irritants are only secondary causes of its occurrence.
During the worsening of the disease, the natural processes of creation are disturbed - keratinocytes (cells that mainly make up human skin). There are also pronounced biochemical changes in the skin. In addition, doctors have recently been able to determine that during the acute phase of the disease, the functioning of the nervous system also differs from the norm. In general, the main reason for the appearance of psoriasis is the presence of malfunctions in the work of the immune system.
Prevalence of psoriasis
Psoriasis is common. Currently, the incidence statistics are approximately as follows:
- China - 0, 3%;
- USA - 1%;
- Denmark - 1-2, 3%;
- Northern Europe - 3%;
- Germany - 1-1, 3%.
Interestingly, the indigenous population of South America is not affected by the disease. No such case has been reported so far. If you look at the situation as a whole, then the proportion of psoriasis is approximately 6-8% of all skin diseases.
As already mentioned, psoriasis manifests itself at any age, but most often young people (up to 25 years old) still suffer, and it occurs with the same frequency in both men and women.
Epidemiological situation
Based on the cause, psoriasis is a non-infectious disease with a pronounced genetic predisposition. The most dangerous are people who suffer from this disease (in this case, it refers only to the closest relatives). European researchers have determined with certainty that if one of the parents is ill, then he has a 14-25% probability that he will pass it on to his child. If both parents are ill, this probability is already 41-60%.
According to the type of disease development, psoriasis is divided into two groups:
- early;
- late.
This is evidence that there are two main types of psoriasis (like diabetes mellitus). The first occurs in people at an early age (average 16-22 years), is strictly hereditary in nature and is directly related to the HLA phenotype (HLA-Cw6). The course of the disease is often difficult and over time the disease only progresses.
The causes of type II psoriasis are quite random, so this disease is sporadic. It most often occurs in older people (around 60 years of age). It is generally quite easy, but in some cases it can be aggravated by damage to the joints and nails.
Factors that cause psoriasis
Although psoriasis has a tendency to be inherited, it is mostly multifactorial. Anything that can trigger that fatal breakdown of the immune system. Thus provoking factors are divided into external and internal (or, in a scientific sense, exogenous and endogenous).
Exogenous factors
They in turn are divided into physical and chemical. The former include common mechanical damage to the skin, such as domestic injuries, heat burns, scratches, scars, tattoos, scratches, insect bites, and pets. Cases of psoriasis at injection sites have also been reported. X-rays and ultraviolet radiation also play a significant role. In about 5% of all cases, the disease occurs in the summer, and 40% is due to burns.
Chemical factors are expressed in the toxic effects of harmful chemicals or other irritating ingredients on the skin. In addition, psoriasis is caused by other skin diseases, such as:
- dermatosis;
- fungal infections;
- contagious impetigo;
- acne;
- dyshidrosis;
- lichens;
- herpes zoster;
- gangrenous pyoderma;
- allergic dermatitis of various natures.
Cases of the disease are known after conducting basic diagnostic skin tests to determine the body's reaction to cosmetics, hygiene products, formalin, chromium, nickel and other chemicals.
Endogenous factors
Internal causes of psoriasis can be infectious diseases. Recent research in this area suggests that streptococcal infections and HIV are most likely to be to blame. Moreover, the symptoms often do not appear during the disease itself, but even after the usual vaccination. In these cases, psoriasis is often difficult to treat.
To induce remission, lithium preparations, beta blockers, nonsteroidal anti-inflammatory drugs, and ACE inhibitors are used. Corticosteroids are contraindicated in this case.
Pregnancy and childbirth
Significant changes in hormonal levels caused by pregnancy can also become a provoking factor. A similar pattern is observed during puberty. It is also interesting that women who already have psoriasis can experience an improvement during pregnancy (40%). Worsening is much less common (only in 14% of cases). True, after childbirth in most patients the condition worsens again (in 54% of cases)
Diet and nutrition
These factors often have no noticeable effect on the course of the disease. It is only certain that the abuse of alcohol and cigarettes significantly increases the chance of getting psoriasis and worsens its course.
Hypocalcaemia and hypokalaemia
These factors can cause generalized pustular psoriasis. The chances of a favorable outcome in this case are very small.
Pustular psoriasis.
Psychogenic factors
Their role today is considered quite controversial. Some researchers claim that the presence of traumatic psychogenic factors causes psoriasis in 60% of all cases. However, it is only reliably known that they can only worsen the course of the disease and reduce the effectiveness of therapy.
Classification
Currently, several separate types of psoriasis have been identified. They differ significantly in the clinical picture and the degree of effect on the body, so in order to have an idea of what it is, it is better to look at the World Wide Web and carefully study photos of psoriasis of various etiologies, as well as read the description.
Vulgar psoriasis
Vulgar or frequent psoriasis occurs in most cases. This disease manifests as an abundant rash of small, bright red papules (from the head of a match to a pea). After germination, they grow rapidly, and silvery-white scales appear on their surface. In the future, the papules turn into plaques that merge into one large lesion. Very often they have clear boundaries that separate them from healthy skin.
When you try to comb or remove a papule, peeling first increases. This phenomenon is known as the "symptom of a stearin stain", and after removing all the scales, a shiny, smooth surface can be found, a "symptom of the terminal film". If you continue to scrape, the capillaries are injured and drops of blood are released. This symptom is known as "dew in the blood".
The development of psoriasis is divided into three main periods:
- progressive (acute);
- stationary;
- resolution period.
The success of treatment here mostly depends on how correctly the methods of therapy are chosen, because, depending on the period, their effectiveness varies significantly.
Period of progress. The characteristic of this phase is the abundant appearance of a certain rash. In the exacerbation phase, certain parts of the patient's body are covered with small papules that are actively peeling. Peeling in this case is strictly localized and does not affect healthy skin. It is easy to recognize acute psoriasis by the characteristic red or pink border that borders the papule.
The most characteristic symptoms at this stage are itching and the presence of the so-called Koebner symptom. The latter is expressed in the fact that psoriatic papules appear at the site of any skin injury (minor burns, scratches, injections, scratches, etc. ). This phenomenon occurs on average two weeks after the injury itself and occurs in 38-76% of all patients.
It is also extremely curious that (much less often) the opposite effect is observed. Scientists believe that this is caused by the presence in the blood serum of some patients of special factors that inhibit Koebner syndrome.
Stationary period. On average, 2-3 months after the appearance of the first rash, the formation of new papules stops. Plaque growth also stops. At this stage, their entire surface is already covered with scales. This period can last for months or even years. However, the latter is relatively rare.
Resolution period. This period is also called regressive, because a gradual reduction of plaque is noticed during it. At first they stop peeling, and then they are gradually smoothed out until they disappear completely. If the disease is mild, this phenomenon occurs spontaneously. The treatment only accelerates its onset. Often, the place where the plaques were located stands out against the background of healthy areas of the skin by depigmentation or, which is somewhat less common, by hyperpigmentation. In psoriasis vulgaris, the rash can appear almost anywhere and is usually localized symmetrically (extensor surfaces of the elbows and knees). It can also appear on the head, lower back, arms, palms, soles, groin and armpits. In addition, in many cases, the nail plates are also affected (appearance of dotted pits, relaxation, thickening). These symptoms are very similar to those that occur with a fungal infection, so the final diagnosis is made only after a special laboratory study has a negative reaction to the fungal spores. Psoriasis vulgaris as a whole does not have a generally negative effect on the patient's body, and its course is chronic. Periods of deterioration occur in autumn or winter, while in summer exacerbations, on the contrary, are much rarer. The main impetus for active treatment lies in the fact that without proper therapy psoriatic plaques can cover the body for years, while adequate treatment causes improvement after a few months.
Psoriatic erythroderma
Psoriatic erythroderma is one of the most unpleasant forms of this disease. On average, a similar reaction is observed in about 2% of patients and occurs spontaneously and as a result of improperly selected treatment. Although, of course, if the medications used irritate the skin or it is exposed to ultraviolet radiation, the risk of psoriatic erythroderma is much higher. Most often, psoriatic erythroderma appears suddenly during the first phase of psoriasis. It can be combined with arthritis and generalized pustular psoriasis, and exposure to factors such as streptococcal infections or hypocalcemia significantly increases the likelihood of such a complication. Abrupt withdrawal of corticosteroids may also worsen the condition. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by diffuse redness of the skin, severe itching and lamellar peeling.
Pustular psoriasis
Also a severe form of psoriasis. It is characterized by the appearance of abscesses, which often remain the only symptom. They are much less often combined with the classic symptoms of psoriasis vulgaris. Pustular psoriasis is generalized and localized. The second differs only in that the abscesses in this case are concentrated only in the area of the palms or soles.
Psoriatic arthritis
Currently, psoriatic arthritis is itself classified as an autoimmune disease. It is expressed in damage to bones and muscles in patients who already suffer from psoriasis or have a family history and have a high risk of the disease. Very often psoriatic arthritis is combined with classic psoriasis as well as psoriatic nail lesions. This disease is diagnosed by the appearance of back pain, accompanied by the following conditions:
- lack of a clearly stated reason for performance;
- the patient's age is older than 40 years;
- unexplained deep pain in the lower back or buttocks;
- unclear localization of pain;
- reduction of pain after exercise;
- pain or stiffness is felt early in the morning or at night;
- the presence of pain with an excellent general condition of the musculoskeletal system.
Nail plate psoriasis
Very often, psoriasis vulgaris is accompanied by nail damage. In this case, their pronounced dystrophy is observed, as well as the symptoms characteristic of fungal infections. It is a common companion of psoriatic arthritis. Given that about 4% of the world's population suffers from ordinary psoriasis, then 30-50% of them also have nail psoriasis.
Treatment of psoriasis
Unfortunately, medicine is still not able to cure psoriasis, because it requires much deeper knowledge about the peculiarities of the basic mechanisms of the human immune system. Because this type of research is progressing rather slowly, and the disease itself does not pose a particular threat to life, symptomatic therapy is currently a priority. Before starting treatment, the patient needs a thorough examination, because each organism contains an individual set of factors that affect the course of the disease. Gender, age, profession, general health, type of psoriasis - all this must be taken into account when prescribing therapeutic therapy. An important role is played by determining the nature of the course of the disease, individual sensitivity to drugs and the current stages of the disease.
General activities
First of all, the doctor should determine the mental and physical condition of the patient, assess the general condition of his body and find out how tolerant he is to the disease. The best prerequisites for effective treatment are a good rest, a stay in a quiet environment, a transition to a less intense way of working or short-term hospitalization. Various methods of psychotherapy (rehabilitation in marine resorts with the use of cognitive-behavioral therapy, etc. ) have also proven to be quite good. It is also very important that the patient knows that the healing process is going as it should, because without a quick effect about 40% of patients lose faith in the effectiveness of the therapy and begin to ignore it. It is important to remember that psoriasis is a chronic disease, so the safety of therapy must be taken into account. Many drugs are poisonous and can accumulate in the body, turning into a time bomb. The addictive effect is also possible, so it is best to save the strongest medications until really dangerous symptoms appear.
Disease course and long-term prognosis
The course of psoriasis is often unpredictable. Modern doctors have practically failed in that, therefore, as before, psoriasis remains an unpleasant and uncontrolled disease. In any case, it takes place completely individually, so that any attempt to give a prognosis regarding the course of the disease, as well as the duration of the phases of worsening and remission, is doomed to failure in advance. There is only one thing that makes me happy - despite the difficulties in treatment, it rarely poses a real threat to the patient's life. As for psoriatic arthritis, this disease is much milder than rheumatoid arthritis, and the reduction in the quality of life of patients compared to the latter is very insignificant. Statistics show that with proper treatment, most patients with psoriatic arthritis remain functional and can lead a fulfilled life. If the necessary therapy is absent or the disease progresses with complications, joint deformities may develop with further development of severe pathologies. However, such complications are found only in a very small number of patients with psoriasis. Most patients can count on the gradual stabilization of the condition and the appearance of long-term remissions (more than two years). In very rare cases, the disease usually passes in the active phase, however in this case it can be effectively localized. An effective treatment for psoriasis today can be obtained in any major city. And, although, as you know, a final recovery is not possible, diet, special medications and procedures will do the job quickly. You will also not need long-term hospital treatment. The doctor's task is only to quickly bypass the first two stages of psoriasis and bring the person to remission. After that, the patient can only take care of himself, follow the instructions and forget about the disease for a long time.