Psoriasis

psoriasis on a man's body

Psoriasis is a non-communicable skin disease characterized by the formation of a large number of epithelial cells and local inflammatory erosions.

Also known as a disease

  • Common psoriasis;
  • acrodermatitis;
  • psoriatic erythroderma.

Reasons

Psoriasis is a disease with many causes. An inherited factor is of great importance in development - the presence of PSORS1-PSORS9 genes that cause the development of the disease. HLACw6 and HLADR7 antigens are more commonly found in psoriasis patients. Triggers include psycho-emotional overload, alcohol abuse, medications (lithium salts, beta-blockers, chloroquine / hydroxychloroquine, oral contraceptives, interferon and its inducers, etc. ).

In children, unlike adults, a predisposing factor for psoriasis is infections caused by β-hemolytic streptococci. The toxins of this bacterium are a powerful stimulator of T-lymphocytes - key cells in the development of psoriasis.

The autoimmune component of the development of psoriasis is discussed - when the immune cells infect the skin cells for no apparent reason.

Smoking not only increases the risk of developing psoriasis, but also affects the severity of the condition.

In recent years, the link between psoriasis and obesity, metabolic syndrome, diabetes mellitus, hyperlipidemia, arterial hypertension has been shown.

Who is at risk

  • Patients with close relatives suffering from psoriasis;
  • Carriers of the PSORS1-PSORS9 genes, especially PSORS1;
  • chronic bacterial and viral infections, HIV;
  • patients with frequent skin trauma, sunburn;
  • fat;
  • taking certain medications (lithium, beta-blockers, chloroquine / hydroxychloroquine, ACE inhibitors, etc. );
  • smokers, alcoholics;
  • children during adolescence.

How much happens

It is the most common skin disease, occurring in 1-2% of the population of developed countries.

Psoriasis can develop at any age, at most 20-30 and 50-60 years. About 10-15% of new cases occur between the ages of 10. The age peaks in the development of psoriasis are 6-7 years and 14-17 years, which coincides with the periods of physiological elongation of the child's body, hormonal instability, social and psycho-emotional overload. The average age of psoriasis is 28 years.

Women suffer from psoriasis more than men. It occurs equally often in childhood, in both sexes.

Symptoms

The manifestations of psoriasis depend on the form.

Common symptoms include:

  • various localized rashes;
  • itching and peeling of the skin in the area of the rash;
  • psoriatic triad - the symptoms that appear successively when shaving rashes (increased peeling, the appearance of a moist, thin surface of the elements, to accurately determine the bleeding);
  • damage to the nails - a change in the shape of a dot on the surface of the nails, similar to the surface of a thickness ("height" symptom); small red and yellow-brown spots are often found under the nail plate (a symptom of a "fat spot").

Adi (psoriasis vulgaris)

  • Spills- papules up to 5 mm in diameter, without cavities. The rash is pinkish-red with clear borders, prone to coalescence and the formation of various plaques. The plates are covered with silver and white scales.
  • Place the plaque- mainly on the scalp, extensor surface of the elbow, knee joints, lumbar region, sacrum.
  • It is characteristicpsoriatic triad. . .

Exudative psoriasis

Obesity, diabetes, an increase in patients with thyroid disease in the rash area - sweating of the fluid part of the blood in the rash area. Tight-fitting gray-yellow crusts are formed, which are difficult to separate from the spill element. Accompanied by unbearable itching.

Seborrheic psoriasis

A form in which the rash is localized only in the seborrheic areas of the skin - where the concentration of sebaceous glands. These are the scalp, nasolabial and ear folds, chest and intercapular region. It is characterized by a "psoriatic crown" - a clear pattern of rash with a clear peeling on the head as the rash passes from the scalp to the forehead.

Guttate psoriasis

Acute form of the disease. At the same time, a large number of bright red papules appear with slight desquamation. It often occurs in children (acute tonsillitis and others) after streptococcal infections.

Pustular psoriasis

The debris is localized in the form of pustular elements in the area of the palms and soles. Development is facilitated by the use of drugs for infections, severe stressful situations, hormonal disorders and immunosuppression.

Psoriatic erythroderma

As a result of the exacerbation of common psoriasis under the influence of irrational treatment or irritants (taking a bath in a progressive stage, prolonged exposure to the sun or an overdose of ultraviolet rays). Erythroderma spreads to more than 90% of the skin. The skin is red, swollen, warm to the touch, covered with numerous large and small scales. The scales fall when the clothes are removed. Patients are concerned about itching, burning and tightening of the skin. The general condition is worrying: weakness, weakness, loss of appetite, fever up to 38-39 ° C.

Psoriatic arthritis

Joint damage can be isolated without joint damage. Joints are swollen, painful, with limited mobility, morning stiffness. With a long walk, deformities of the joints develop, inflammation of the tendons in the area of attachment to the bones.

Diagnosis of the disease

Interrogation and inspection

The patient's general condition is assessed. The doctor examines the skin, determines the location, size, color, shape and depth of the rash. The psoriasis trio and the Kebner phenomenon are identified - psoriasis foci form here with trauma to previously unaffected skin.

Laboratory examination

  • General blood test- ESR may be increased (in some forms of psoriasis).
  • Blood chemistry- Uric acid levels may rise, which makes it difficult to rule out gout.
  • Blood test for rheumatoid factor- These are IgM class antibodies produced for inflammatory and autoimmune processes. In psoriasis, the test is usually negative. Research is needed to rule out other diseases (rheumatoid arthritis, Sjogren's disease).
  • Microscopic examination of the composition of pustules- sterile composition with a large number of neutrophils.
  • Molecular genetic researchidentify frequent mutations in psoriasis. Fragments of the CARD14 and IL36RN genes were examined to identify combinations of polymorphic regions in certain chromosome regions.

Functional, radiation and instrumental diagnostics

  • Histological examination- Thickening of the epidermis is determined by the growth of thorny cells in the seed layer (acanthosis), the formation and accumulation of keratin in the horn cells (parakeratosis). Groups of neutrophils (Munro microabscesses) were found. Accumulation of inflammatory cells around full-blood capillaries - lymphocytes, histiocytes, single neutrophils.
  • Radiography of the affected jointsto exclude rheumatoid, reactive arthritis, gout.

Treatment

Treatment goals

These are the reduction of clinical manifestations and the frequency of exacerbations, the improvement of quality of life.

Lifestyle and help

  • Bathe daily.Daily bathing can clean the scales and soothe skin pain. You can add bath oil, Dead Sea salts to the water. Hot water and soaps that can cause aggravation should be avoided. Use warm water and mild soap with added oils and greases.
  • Moisturizers are used.After the water treatment, a thick, moisturizing cream is applied while the skin is still wet. Oils are used for very dry skin - more durable than creams or lotions. Moisturize your skin several times a day in cold and dry weather.
  • Limit sun exposure.Short exposure to the sun improves the condition of the skin. Prolonged sun exposure aggravates psoriasis.
  • Avoid provocative factors.It is important to determine exactly what is causing the symptoms to worsen.
  • Quit smoking and alcoholFactors that worsen the course of psoriasis are known.

Medications

External therapy

  • Local glucocorticosteroids- local hormonal agents used in any form in combination or as monotherapy. There are special rules for the use of these drugs: course administration, starting with glucocorticosteroids of low or moderate activity, especially in children.
  • Preparations that are analogues of vitamin D3,- The area of application of these drugs should not exceed 30% of the body surface. Courses - 4-8 weeks, depending on the area of application.
  • Drugs containing zinc pyrite have been activated, Is used in the form of aerosols, creams and shampoos in courses up to 2-3 months.

Systemic therapy

Shown in moderate and severe forms.

  • Cytostatic drugs (methotrexate)- appointment and admission includes regular medical supervision and monitoring of laboratory parameters. Side effects are possible. Methotrexate should be combined with folic acid.
  • Retinoic acid preparationsUsed to treat severe forms. Differentiation and keratinization of skin cells normalizes the renewal process.
  • Biological preparations- monoclonal antibody preparations created using genetic engineering methods. Antibodies bind specifically to specific antigens of inflammatory proteins that play a key role in the development of psoriasis.

Procedures

PUVA therapy(photochemotherapy) - a combination therapy - a combination of retinoic acid preparations and phototherapy. The effectiveness of the method is that the combined use of therapeutic components increases their effectiveness, allows to reduce the dose and frequency of application. This in turn reduces the risk of side effects.

Surgical operations

No surgery is required to treat psoriasis.

Restoration and improvement of quality of life

Special scales and questionnaires are used to determine the quality of life. There is a decrease in quality of life in both mental and physical components. The rate of change in vital signs depends on the age of the patient, the duration of the disease, the frequency of exacerbations and the presence of co-morbidities.

Possible complications

  • Secondary skin infection- Traumatized skin with impaired local immunity becomes a breeding ground for various bacteria. To prevent these conditions, anti-inflammatory ointments include antibiotics and antifungal components.
  • Inflammatory eye diseases:conjunctivitis, blepharitis (inflammation of the eyelids), uveitis (inflammation of the choroid). Sometimes this is the first sign of the onset of psoriasis.
  • Psoriatic arthritis- Inflammation of the joints may be a manifestation of psoriasis, especially in the absence of other symptoms, or a complication of the disease.
  • Development of autoimmune diseases- Psoriasis patients suffer more from celiac disease (gluten intolerance), Crohn's disease.
  • Disorders of the psycho-emotional sphere- Severe itching, discomfort associated with aesthetic and physical disorders, causes neurotization of the patient.

Prophylaxis

There is no method that prevents the development of psoriasis. It is not possible to determine whether the correction of reversible risk factors affects the development of the disease.

Forecast

Although psoriasis is benign, it is a lifelong disease with remission and exacerbation. In rare cases, psoriasis does not respond to treatment.

Studies show that psoriasis is associated with a higher risk of cardiovascular disease, diabetes, kidney and joint disease. Patients with severe, poorly controlled psoriasis die 3-4 years earlier than people without psoriasis.