Psoriasis: causes, symptoms, diagnosis and treatment.
Psoriasis is a chronic non-communicable disease that can affect various organs: skin, joints, heart, kidneys.
Mild psoriasis most often appears on the skin as well-defined pinkish-red papules (nodules that rise above the surface of the skin), which merge into plaques with silvery-white scales.
In moderate and severe forms of the disease, the inflammatory process leads to damage to the musculoskeletal system and the cardiovascular system. Psoriasis has a recurrent course (recurrence of symptoms after complete or partial recovery) and a tendency to cause comorbidities that impair the quality of life of patients.
Causes of psoriasis
The disease can be based on several triggers. However, it is still not known exactly which of them are primary and which are secondary. Immune system dysfunction is considered to be the leading cause of psoriasis. Cells aimed at destroying the pathogens begin to attack their own cells (primarily the skin). As a result, an inflammatory process develops that causes accelerated division of epidermal cells (epidermal hyperplasia) and the formation of psoriatic papules and plaques.
Inadequate immune response is most often caused by genetic characteristics.
Psoriasis is very often inherited.
Currently, more than 40 chromosomal regions have been identified that are associated with the risk of developing psoriasis. The onset of the disease can be caused by a weakening of the immune system in the background of stress, infectious, endocrine diseases. Psoriasis is often accompanied by allergic and immunodeficiency conditions, which are based on a violation of the immune response. In addition, psoriasis can be caused by certain medications (antidepressants, beta-blockers, nonsteroidal anti-inflammatory drugs).
Classification of psoriasis
Depending on the localization of the pathological process, different types of psoriasis are distinguished. The most common is vulgar, orusually, psoriasiswhen well-defined pink papules appear on the skin that merge into plaques covered with silvery-white scales. In case of scalp damage (seborrheic psoriasis) a rash in the form of yellowish scales may descend on the forehead, forming a seborrheic "crown". In patients with metabolic disorders, plaques may show exudate, a fluid secreted during inflammatory processes (exudative psoriasis). In childhood and adolescence, especially after streptococcal infections, the disease can become acute, with many bright red teardrop-shaped papules appearing on the skin with mild peeling and infiltration (guttate psoriasis). Sometimes there is pustular psoriasis, which is characterized by the appearance of pustules on the background of redness of the skin, more often in the arch of the feet or palms.Psoriatic erythrodermamay occur in the background of exacerbation of ordinary psoriasis under the influence of provoking factors. Dry white scales cover the skin, it becomes bright red, swollen and hot to the touch. He runs very hardgeneralized Zumbusch psoriasis. It is characterized by the fact that small purulent vesicles appear on reddened skin, which merge to form "purulent lakes".Psoriatic arthritisaccompanied by joint damage and develops at the same time as the rash or precedes it.
Symptoms of psoriasis
The cutaneous form of psoriasis is accompanied by the appearance of light pink spotted papules, sometimes in the form of drops. When they merge, they form plaques covered with silvery-white scales.
The rash is found on the extensor surfaces of the wrists and knees, on the scalp, on the lower back, and on the sacrum.
The upper layer of plaques forms shells of dead epidermis that are easily removed. Initially, they occupy the center of the plate, and then fill the entire surface. When the shells are removed, a shiny bright red surface is revealed. Sometimes the plaque is surrounded by a pink edge - a zone of further growth, while the surrounding skin does not change. The rash is accompanied by intense itching. With psoriatic erythroderma, patients develop fever (chills with chills) and severe itching on the background of a rash all over the skin, and lymph nodes increase.
With a long course of the disease, hair and nails can fall out.
Generalized Zumbusch psoriasis is very severe. Purulent eruptions cover the entire skin and are accompanied by high fever and intoxication. Psoriatic joint damage is characterized by pain and redness of the skin over the joint surfaces. Every movement is difficult, inflammation of the ligaments and tendons develops. In psoriasis, the nail plates are very often affected, while precise indentations appear on the surface of the nail ("thimble" symptom).
Under the nail plate in the base, small, reddish and yellowish-brown spots appear (symptom of "oil stain"). Dystrophic changes in nails and hair often develop.
In children, especially infants, the symptoms of psoriasis have their own specifics.
In the area of redness that occurs in the skin folds, there may be effusion and mild peeling of the upper layer of the epidermis. This picture is reminiscent of diaper rash or candidiasis. Sometimes rashes appear on the skin of the face or in the genital area.
Diagnosis of psoriasis
The disease can be recognized on the basis of the symptoms of the psoriatic triad (white stearin surface of the papule; reddish glossy film after peeling of the scales and precise protrusion of the blood after its removal).
An additional feature is the Koebner phenomenon. It lies in the fact that in the area of skin irritation after 7-12 days erythematous-scaly rash appears (areas of redness and peeling in the area of scratches, scratches). Histological examination of the affected skin is sometimes performed to confirm the diagnosis. In addition, clinical and laboratory examination is necessary: clinical blood test, biochemical blood test (total proteins, protein fractions, C-reactive protein, ALT, AST, LDH, creatinine, electrolytes: potassium, sodium, chlorine, calcium).
Which doctors to contact
If rashes appear, which often occur in the background of infectious diseases, skin injuries, stress, you should consult a therapist or dermatologist. In case of systemic damage to the patient's body, they can be referred to an ophthalmologist, endocrinologist, gynecologist or other specialists.
Treatment
Psoriasis affects both the skin and the musculoskeletal system, as well as the internal organs. When the rash appears only on the skin, local glucocorticosteroid preparations, ointments containing synthetic analogs of vitamin D3, activated zinc, salicylic acid and other components are recommended. Hormonal creams should be used with caution on skin prone to atrophy.
It is necessary to take into account the possibility of hormonal disorders with prolonged use of steroid creams.
The effectiveness of hormonal creams increases in combination with salicylic acid, vitamin D analogues. For the treatment of severe forms of psoriasis, second-generation aromatic retinoids, which are based on acitretin, are used. The drug slows down the proliferation of epidermal cells, normalizes the keratinization process and has an immunomodulatory effect. Phototherapy (medium wave UV and PUVA therapy) in combination with retinoids is also recommended. As a systemic therapy, your doctor may prescribe immunosuppressants. If necessary, prescribe detoxification and desensitization therapy, plasmapheresis.
Complications of psoriasis
10% of patients develop psoriatic arthritis involving the spine, wrists and legs. Patients suffer from joint pain and morning stiffness. Characteristics of psoriatic arthritis include asymmetry of the site of its manifestation, which can be combined with nail damage. Psoriasis is often accompanied by concomitant or comorbid diseases.
Inflammatory vascular lesions increase the risk of coronary heart disease and stroke.
It is also possible to develop diabetes and Crohn's disease. In some cases, complications of psoriasis can lead to disability.
Prevention of psoriasis
Measures to prevent psoriasis are primarily aimed at strengthening the immune system. Skin care should include hydration and nutrition. In case of predisposition to allergies, it is necessary to control the diet, avoid fatty and spicy foods, excessive consumption of carbohydrates and potatoes. A mandatory component of psoriasis prevention should be vitamin therapy.
In addition, the functioning of the immune system largely depends on the state of the nervous system. People who are hyper-responsible, have a busy work schedule and constantly experience negative psycho-emotional impact are more prone to autoimmune diseases, including psoriasis. Therefore, the prevention of psoriasis, in addition to measures of physical healing (renunciation of bad habits, physical activity), should ensure the achievement of psycho-emotional comfort.
BITAN!
The information in this section should not be used for self-diagnosis or self-medication. In case of pain or other worsening of the disease, diagnostic tests should be prescribed only by a doctor. For diagnosis and proper treatment it is necessary to consult your doctor.