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 cause the patient's disability.
Causes of psoriasis
The cause of psoriasis is still unknown. There is only the original theory:
- neurogenic (appearance of rashes after stress, burns, mental trauma);
- endocrine (especially during perimenopause);
- metabolic (disorders of fat metabolism);
- contagious;
- viruses (psoriatic antigens isolated from healthy individuals, but with a high probability of developing psoriasis in the future, while psoriasis is a non-infectious disease);
- genetics.
Psoriasis can be detected in entire generations of people with the same risk factors. But the type of inheritance is assumed to be multifactorial. If one of the parents is sick, then the child has a 25% chance of getting sick. If both parents are sick - 60-75%.
Viral and genetic theories remain the leaders.
Factors that contribute to the severity:
- infectious and parasitic diseases, including transportation (HIV, tonsillitis, dental caries, hepatitis);
- pressure;
- obesity;
- perimenopause period;
- drugs (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin injury; dryness, leading to increased skin trauma.
Clinical classification
There is no single classification. One of them:
- abusive (common);
- exudative;
- psoriatic erythroderma;
- arthropathy;
- psoriasis of the palms and soles;
- pustular psoriasis.
Stream features:
- they get sick at any age, cases of psoriasis in children are not uncommon;
- men and women alike are ill;
- worldwide prevalence;
- There are summer, winter and mixed seasonal exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin with the production of insufficiently mature keratinocytes. A pinkish-red rash appears, covered with silvery-white scales.
Three sets of symptoms are characteristic, which allow the diagnosis to be made:
- symptoms of stearin stains - when scraped, the number of scales increases;
- psoriatic film phenomenon - when all the scales are scraped off, a smooth shiny red surface appears;
- exact symptoms of bleeding - when the film is scraped, drops of blood appear. This is due to the uneven elongation of the papillae in the dermis, the expansion of capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start in spots and merge into large areas of damage.
- Psoriasis on the hands is most often localized on the extensor surface.
- Psoriasis on the face - rashes often appear behind the ears, on the forehead. It is an independent factor to improve treatment.
- Psoriasis on the scalp is an isolated form, does not affect the hair, elements of the rash are located along the edge of the hair, "psoriatic crown".
- Nail psoriasis - leads to characteristic changes, precise depression, the nail looks like a thimble. It may also thicken, become dull, or yellow spots form under the nail.
- Psoriatic arthritis - affects peripheral joints with or without pain, often with inflammation of the attachment of ligaments to bones, the ligaments themselves and the fingers.
Characteristics of psoriasis in children
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, bleeding spots and wounds are formed. In children, psoriasis is often localized in the perineal area as a large red spot. In adolescents, spots appear on the palms and soles of the feet.
There are three stages of psoriasis:
- Progressive - the elements of the rash increase, and are uniformly white, with narrow red edges along the edges;
- Stationary - spot growth stops, pale skin strips appear along the edges 2-5 mm wide;
- Regressive stage - the scales gradually fall, the spot decreases and disappears. Spots of depigmentation remain at the site of the rash.
Diagnosis of psoriasis
Often, patients turn to general practitioners, dermatovenerologists, or rheumatologists (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and joint tenderness), anamnesis (seasonal exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). After examination, changes were found in the skin and joints.
Laboratory tests are carried out:
- general blood tests (including leukocyte count, ESR, platelets);
- general urine analysis;
- 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 (acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of stacks of 4-6 or more clear elements);
- before prescribing biological treatment, screening for HIV, hepatitis B and C viruses, and tuberculosis is carried out;
- radiography of the affected joint;
- CT and MRI for axial lesions;
- ECG.
If necessary, consultations are held with infectious disease specialists, phthisiatricians, orthopedic traumatologists, surgeons and other specialists.
When diagnosing psoriasis, it is desirable to exclude diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, Zhiber rosea, and papular syphilis.
The severity of psoriasis is determined by BSA (Body Surface Area - skin area affected by psoriasis), PASI (Psoriasis Area and Severity Index - psoriasis prevalence and severity index), DLQI (Dermatology Life Quality Index - dermatology. quality of life index).
To diagnose psoriatic arthritis, the PEST (Psoriasis Epidemiological Screening Tool) and CASPAR (Classification criteria for Psoriatic Arthritis) criteria are used.
Treatment of psoriasis
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 local use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatic;
- immunosuppressants;
- biological drugs.
For psoriatic arthritis use:
- non-steroidal anti-inflammatory drugs;
- disease modifying drugs;
- intra-articular injection of glucocorticoids;
- biological drugs.
For chronic cases, it is recommended to use ointment for psoriasis; for severity, creams for psoriasis are used.
When using an ointment or cream, do not rub it into the skin or use a bandage. This can increase drug penetration into the skin and cause side effects.
It is not recommended to use hormonal ointment for more than 4 weeks. The wrong dose of medicine may either be ineffective or cause side effects. The expected effect of treatment occurs after 1-2 weeks of use.
There are several ways of using creams and ointments for psoriasis that contain glucocorticoids:
- continuous mode;
- tandem therapy mode;
- decreased therapy regimen;
- step application mode.
Keep in mind 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. For more severe forms, treatment is carried out in hospitals using phototherapy, systemic therapy and biological drugs.
The course of the disease is considered moderate, and systemic treatment can be started in the following cases:
- affected skin areas of aesthetic importance;
- a large area of the head is affected;
- affected external genitalia;
- affected palms and soles;
- 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 a doctor, because systemic treatment is associated with various side effects, which can be reduced by choosing individual treatment.
General recommendations for psoriasis patients:
- minimize skin trauma and dryness;
- after using creams and ointments for psoriasis on your hands, use gloves to prevent the drug from getting into your eyes;
- use sunscreen with a protection factor of 30;
- avoid stressful situations, consult a psychologist if necessary;
- control weight, eat rationally.
Diet for psoriasis
Recommended:
- alkaline drinks 1200-1600 ml daily;
- use of lecithin;
- vegetables and fruits;
- porridge;
- lean meat and fish;
- dairy product.
Not encouraged:
- citrus;
- bread made from premium flour;
- fatty fish and meat;
- high-fat dairy products;
- coffee - no more than 3 cups a day;
- products with yeast;
- alcohol, sweets, pickles, smoked, spicy.