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. If the joints are damaged, their mobility is limited, which can lead to disability of the patient.
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 in the perimenopausal period);
- metabolic (fat metabolism disorder);
- infectious;
- viral (psoriasis antigens are isolated from individuals who are healthy but have a high probability of developing psoriasis in the future, while psoriasis is not an infectious disease);
- genetic.
Psoriasis can be traced in an entire generation of people with the same risk factors. However, the type of inheritance can be considered multifactorial. If one parent is sick, the child has a 25% chance of getting sick. If both parents are sick - 60-75%.
Viral and genetic theories continue to lead.
Factors contributing to exacerbation:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, tooth decay, hepatitis);
- tension;
- obesity;
- perimenopausal period;
- drugs (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin injuries; dryness, which leads to increased skin damage.
Clinical classification
There is no uniform classification. One of them:
- vulgar (ordinary);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis on the palms and soles;
- pustular psoriasis.
Characteristics of the flow:
- they get sick at any age, psoriasis is not rare in children;
- men and women are equally ill;
- its prevalence throughout the world;
- Exacerbations are summer, winter and mixed seasonality.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin, with the production of inadequately mature keratinocytes. Pink-red rashes appear, covered with silver-white scales.
A trio of symptoms is characteristic, thanks to which the diagnosis can be established:
- stearin stain symptom - when scraping, the number of scales increases;
- the phenomenon of psoriatic film - when all scales are scraped off, a smooth, shiny red surface appears;
- a symptom of accurate bleeding - when the film is scraped off, drops of blood appear. The reason for this is the uneven elongation of the papillae in the dermis, the expansion and swelling of the capillaries.
Signs of psoriasis
- Psoriasis on the body can start as a patch 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. This is an independent factor in increasing 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, "psoriasis crown".
- Psoriasis of the nails - leads to characteristic changes, precisely indentations, 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 junction of the ligaments to the bone, the ligaments themselves and the fingers.
Characteristics of psoriasis in children
The presence of one or more elements up to 1 cm is characteristic, and they rise above the surface of the skin. In children, itching is more pronounced than in adults. After scratching, the spot bleeds and wounds 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.
Psoriasis has three stages:
- Progressive - the elements of the rash increase in size and are uniformly white in color with a narrow red border at the edge;
- Stationary - the growth of the spot stops, a 2-5 mm wide strip of paler skin appears along the edge;
- Regressive stage - the scales gradually fall off, the spot shrinks 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), anamnesis (seasonality and frequency of exacerbations, genetic predisposition, effectiveness of previous treatments, accompanying diseases). During the examination, changes are found on the skin and joints.
Laboratory tests are performed:
- general blood test (including leukocyte count, ESR, platelet count);
- general urinalysis;
- 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 (sharply expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements);
- HIV, viral hepatitis B and C, and tuberculosis tests are performed before the biological treatment is prescribed;
- radiography of the affected joints;
- CT and MRI for axial lesions;
- EKG.
If necessary, a consultation will take place with an infectious disease specialist, phthisis doctor, 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 the BSA (Body Surface Area – the skin area affected by psoriasis), the PASI (Psoriasis Area and Severity Index – the incidence and severity index of psoriasis), and the DLQI (Dermatology Life Quality Index – dermatological). quality of life index).
The PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (ClASsification criteria for Psoriatic Arthritis) criteria are used to diagnose psoriatic arthritis.
Treatment of psoriasis
The treatment is complex and aims to eliminate inflammation and normalize the proliferation and differentiation of keratinocytes.
Local therapy:
- ointments and creams with vitamin D3 and analogues;
- calcineurin inhibitors;
- glucocorticoids for topical use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological drugs.
It can be used for psoriatic arthritis:
- non-steroidal anti-inflammatory drugs;
- disease modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
Psoriasis ointments are recommended for chronic cases, and psoriasis creams are used for exacerbations.
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 dosing of medications can be ineffective or cause side effects. The expected effect of the treatment appears after 1-2 weeks of use.
There are several ways of using creams and ointments containing glucocorticoids to treat psoriasis:
- continuous mode;
- tandem therapy mode;
- descending therapeutic regimen;
- step-by-step application method.
It is worth noting that mild and moderately severe forms of psoriasis are treated on an outpatient basis, using ointments and creams, directly on the affected area. In case of more severe forms, the treatment is carried out in hospitals using light therapy, systemic therapy and biological drugs.
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 affected;
- at least 2 nails are affected;
- There are some items that cannot be handled locally.
Systemic therapy is performed only in a hospital under strict medical supervision, as systemic treatment has many side effects, which can be reduced by choosing an individual treatment.
General recommendations for patients with psoriasis:
- minimizes skin trauma and dryness;
- after applying anti-psoriasis creams and ointments to your hands, use gloves to prevent the medicine from getting into your eyes;
- use a sunscreen 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 per day;
- use of lecithin;
- vegetables and fruits;
- porridge;
- lean meats and fish;
- dairy products.
Not recommended:
- citrus fruits;
- bread made from premium flour;
- fatty fish and meat;
- high-fat dairy products;
- coffee - up to 3 cups per day;
- yeast products;
- alcohol, sweet, sour, smoked, spicy.