Psoriasis

psoriasis on the skin

Psoriasis is a chronic skin disease characterized by the presence of monomorphic rashes in the form of pink-red nodules with a loose, silvery-white scaly surface. The disease lasts for years, with periods of relapse and remission alternating.

The severity of the disease can vary widely in different patients or even in one patient during exacerbation and remission - from local small lesions to complete coverage of the body with psoriatic plaques. Often, as the disease progresses over time (especially in the absence of treatment), the lesion area increases with the involvement of new skin areas, and exacerbations become more frequent and worsening. Some patients may have a continuous course of the disease without unexpected remissions.

Fingernails or toenails are also often affected. Seizures of the nails can occur in the absence of skin lesions and can be isolated.

Statistics

The prevalence of psoriasis in the world is about 1-3% of the population. According to the international organization Europso, in 2010 there were 125 million cases of psoriasis on the planet. It affects up to 5 million people in Europe, which is comparable to the incidence of coronary heart disease and diabetes.

Classification

In general, the classification is as follows:

  • Pustular psoriasis
    • generalized psoriasis;
    • annular psoriasis (annular pustulosis);
    • palmoplantar psoriasis (psoriasis of the extremities, palmolantaric persistent chronic pustulosis, Barbera pustular psoriasis);
    • chronic form of persistent acrodermatitis (psoriasis of the soles and palms, palmoplantar psoriasis);
    • herpetiform psoriatic impetigo.
  • Non-pustular psoriasis
    • psoriasis vulgaris or psoriasis vulgaris, simple psoriasis (chronic plaque-like, persistent psoriasis);
    • psoriatic erythroderma (psoriatic erythrodermatitis).

A number of authors consider it necessary to add this classification, so the types or forms of psoriasis can be added in the following versions:

  • seborrheic psoriasis (seborrheic psoriasis);
  • psoriasis napkin;
  • drug-induced psoriasis;
  • "reversible psoriasis" (psoriasis of the skin folds, curved surfaces).

Reasons

Doctors have not been able to compile a list of the exact causes of psoriasis. I suggest considering the reasons, depending on the nature.

  1. Immunity. A commonly known cause. The trigger mechanism is a gene process in which the immune connection is disrupted. An infectious disease, tonsillitis or sinusitis, can cause the appearance of psoriasis.
  2. Infectious. At first, scientists believed that spirochetes, streptococci, and even epidermophytes were to blame. The results of the study did not support this theory. New hypotheses suggest that the development of psoriasis is caused by infectious diseases, including tonsillitis and influenza.
  3. Genetic. We are talking about the inherited predisposition to the disease. Clinical experience shows that many suffer from paid lichen manifestations, but it is not always possible to trace the association with hereditary predisposition.

Predisposing and motivating factors

Key factors:

  1. Psychological - the effects of short-term severe stress, as well as unexpressed, but long-term or recurrent negative psychological effects, emotional dissatisfaction, sleep disorders, depressive states.
  2. Metabolic disorders in the body, dysfunction of the digestive organs, especially the liver and exocrine function of the pancreas.
  3. Disease or dysfunction of the endocrine glands (hypothalamus, thyroid, parathyroid and thymus glands, endocrine activity of the pancreas).
  4. Immune system disorders (allergic reactions and immune diseases).
psoriasis on the head

The course of the disease

Psoriasis is a chronic disease, usually characterized by a wavy course, with certain therapeutic effects of spontaneous or remission or improvement, and relapses or exacerbations from spontaneous or adverse external influences (alcohol consumption, intercurrent infections, stress).

What are the most common myths about the disease?

  • Psoriasis is contagious. No, psoriasis is a chronic, non-infectious, non-human skin disease that does not migrate from one part of the body to another. A patient suffering from psoriasis is free to visit public places - baths, saunas, swimming pools, use common household items, and receive treatment for non-dermatological diseases in public hospitals.
  • The climate is affected by the disease, and if you move to warmer countries, you will not have psoriasis. No, the climate does not affect the spread of psoriasis. At the same time, one of its treatments is heliobalne therapy - treatment with sun and sea water, but living in areas with a warm sea climate does not protect patients from exacerbation. Israel serves as a simple example: the Dead Sea resorts successfully treat psoriasis, but the incidence among the population is not below the world average.
  • Psoriasis can be prevented. Factors that cause exacerbation, either spontaneously or in various combinations, are the cause of the disease. Today, the initial impetus for the development of psoriasis is unknown, and therefore it is impossible to take preventive measures. There is no prescriptive drug that will stop the flow of emotions, though their effects can be curtailed. By avoiding the effects of factors that provoke or worsen the course of psoriasis, leading a healthy lifestyle and using supportive therapy, it is possible to increase the duration of remission in the absence of skin rashes.

Seriousness

There are several scales to assess the severity of psoriasis. In general, the assessment of the severity of the disease is based on the assessment of the following factors: the area of the lesion (percentage of body surface area involved in the process), the degree of disease activity (redness, swelling, hyperemia of psoriatic plaques or pustules, skin itching, skin thickening, peeling, bleeding orpresence of exudation, secondary infection of the plaques, swelling and sensitivity of the joints), the presence of general symptoms of the activity of the process (eg, increased fatigue, increased ESR, increased uric acid levels in blood tests, etc. ), the patient's reaction to previous treatment attempts, the general condition of the diseaseabout the impact and daily life of the patient, his social activities.

plaque on the skin with psoriasis

Symptoms of psoriasis

In patients with psoriasis, dense areas of white, red, or silver color appear on the skin due to the intensive growth of skin cells. In a healthy person, the development of skin cells occurs gradually, their peeling occurs once a month. As a result, new cells gradually move to replace the old cells in the top layer of the skin.

In patients with psoriasis, the development of new cells occurs faster: they are formed in a few days, not a few weeks. Accordingly, during this period, the upper skin cells do not have time to die, and as a result, the main symptoms of psoriasis - stratification and the formation of plaques on the skin. In patients with psoriasis, the size of such plaques varies. Their manifestation is observed in different parts of the body - on the scalp, knees, hands, elbows, lower back. Symptoms of psoriasis often occur in adults, but the disease can manifest itself in children and adolescents.

The first signs of psoriasis can be observed at any age - both in a two-month-old child and in an older person. However, psoriasis most commonly occurs in people between the ages of twenty and forty.

Irritated psoriasis

It develops against the background of active exposure to the skin with progressive psoriasis, which already exists in certain irritants, especially those exposed to sunlight or specific ointments, as well as other types of irritants that affect the plaques. These plaques, in turn, become more convex, the color turns cherry red, and a hyperthermic zone is formed around them, as a result of which the sharp borders become slightly blurred. This belt acquires a wrinkled appearance after the solution of the board.

Exudative psoriasis

This form of psoriasis is characterized by excessive exudate during the inflammatory reaction, appearing in the advanced stages of the course of psoriasis. The exudate on the surface of the papule saturates the accumulation of scales, thus forming crust-like formations.

Guttate psoriasis

Sudden onset of symptoms of psoriasis is characterized by the formation of numerous spots on the skin. The disease is mainly diagnosed in patients aged 8 to 16 years. Streptococcal infection often acts as a precursor to gout psoriasis.

Spotted psoriasis

This form of the disease manifests itself in the form of slight infiltration of the rash elements (in the general definition, infiltration is the impregnation of tissues with this or that substance). They, in turn, look like spots (and not papules). Spotted psoriasis, as a rule, develops sharply, but is also characterized by similarity with toxidermia. The main method in the differentiation of the disease is to determine the compatibility of the course of the disease with the characteristic psoriatic triad.

Chronic psoriasis

This form of the disease, severe infiltration of plaques with a hyperkeratotic or warty surface, can be considered in terms of symptoms in the form of their general cyanosis. These types of foci are particularly difficult to treat, and it is possible that they may develop into malignant tumors in the future (this is rare, but unfortunately this option cannot be ruled out).

seborrheic psoriasis

This form of psoriasis, as the name implies, develops in patients with seborrhea, which already belongs to them. The disease manifests itself in the scalp, in the area behind the ears, in the chest, in the area of the nasolabial folds, in the lower back and lower back. Visible psoriatic scales are intensively impregnated with sebum, so they stick together and stick to the plaque surfaces, allowing the disease to simulate a scene typical of seborrheic eczema.

Palmar-plantar psoriasis

The disease can manifest itself either in the form of ordinary psoriatic plaques and papules, or in the form of hyperkeratotic compounds that simulate calluses and calluses. In some cases, the symptoms of psoriasis on the hands (or feet - respectively on the heel) are persistent in the hands, and this manifests itself in the form of increased thickening or keratinization. The boundaries of this type of lesion are characterized by clarity, more rarely this form of psoriasis is limited to the appearance of large ring-shaped peeling.

Diagnostics

The process of diagnosing psoriasis is not particularly difficult and is based on the study of the characteristic appearance of the patient's skin. Psoriasis usually does not require laboratory tests or special studies. However, in some cases with progressive severe psoriasis, a blood test is still needed to detect inflammatory, autoimmune, rheumatic processes.

What psoriasis looks like: a photograph of the initial stage

The main element of psoriasis is a single pink or red papule covered with numerous loose silver-white scales. An important diagnostic sign is the triad of psoriasis: stearin stain when the scales are removed, the phenomenon of terminal film and stain bleeding.

early stages of psoriasis

Quality of life in patients with psoriasis

Psoriatic plaques on exposed areas of the arms or legs can prevent a patient from working out, engaging in certain sports, or caring for family members, pets, or the home. Psoriatic plaques on the scalp often create a special psychological problem for patients and cause significant stress and even social phobia, as pale plaques on the scalp can be mistaken for dandruff or lice. A larger psychological problem is associated with psoriatic rashes on the skin of the face and ears. Treatment of psoriasis can be expensive and requires a lot of time and effort from the patient, interfering with work, education, socialization and personal life.

Treatment of psoriasis at home

Psoriasis is a chronic disease. Its treatment initially involves the use of milder drugs and methods, and in the future it is possible to change the appointment, based on observations of the development of the disease in the patient. The goal of treatment is to achieve positive results so that skin rashes disappear and do not appear for as long as possible. In some cases, psoriasis does not require any treatment.

The question of how to treat psoriasis at home should be divided into 3 main categories: internal use of drugs, mainly drugs, external use (ointments, etc. ) and physiotherapy. Minors are more often used in addition to the treatment of psoriasis.

Regardless of which dermatologist chooses to treat psoriasis, the maximum effect is provided by an integrated approach to solving this problem, which includes:

  • use of external means;
  • use of medicines, vitamins, dietary supplements;
  • combination of physiotherapy procedures;
  • treatment in sanatoriums with mineral waters, mud, leech;
  • determination of diet, therapeutic starvation.

When prescribing treatment, the doctor should take into account a lot of information about the patient:

  • complexity of the disease,
  • digestive function
  • metabolic disorders
  • accompanying diseases,
  • functions of the nervous and endocrine systems are studied,
  • environmental effects,
  • heredity and so on.

Medications

Take orally:

  • antihistamines;
  • hepatoprotectors;
  • enzymes;
  • energy sorbents;
  • antibiotics;
  • non-steroidal anti-inflammatory drugs;
  • immunosuppressive substances;
  • biological products.

Hormonal drugs are used in complex stages of the disease. Use only as directed by your doctor. In other cases, they are recommended to do without. Although they have a quick effect because they are addictive, they do not last long. In addition, hormonal medications have many side effects.

psoriasis picture on the skin

Ointments for psoriasis

In the case of a mild form of this pathology, it is sometimes possible to get rid of its symptoms only by external means. The pharmaceutical market is simply full of such drugs. Here are some of them:

  1. Naphthalene ointment is used in both inpatient and regression stages of this pathology.
  2. Glucocorticosteroids can reduce the inflammatory process, although they can not be used for a long time.
  3. Salicylic ointment helps to soften the corneal scales of the skin, as well as quickly removes them.
  4. Five and ten percent sulfur tar ointment helps to reduce the inflammatory process of the skin, although it should never be used by patients with exudative forms of this pathology.
  5. Ointments for psoriasis with vitamin D have a fairly strong anti-inflammatory effect and help to make the treatment of this pathology more effective.

Phytochemotherapy

Phytochemotherapy is one of the treatments for psoriasis using ultraviolet rays.

PUVA therapy

This is the therapeutic effect of long-wave ultraviolet radiation in combination with special drugs used in the most severe forms of psoriasis, which are difficult to respond to other treatments.

Set up to an average of 25 exposures in gentle mode. This regime includes summer vacation, up to two courses in the first year on the recommendation of a doctor, etc. Relapses can occur after the flu, SARS or tonsillitis, and in rare cases - after nerve shocks.

Innovative treatments - new in the treatment of psoriasis

Surgical treatment of psoriasis

It has long been proven that treatment with external drugs alone does not give the desired result with the diagnosis of psoriasis of the skin. For several years now, surgeons have been performing a unique operation to surgically repair the small bowel cap, which protects this part of the gut from pathogenic bacteria. After the operation, the protective capacity of the immune system is strengthened, the skin heals and long-term remission is observed.

Use of narrow-band UVB therapy with a wavelength of 311 nm

Recently, this method is used as monotherapy. Compared to other UV effects, this method has minimal side effects, is well tolerated and is a short-acting technique - a few minutes in 1 procedure, the course of treatment is 2. 5 months. There is a visible clinical improvement in such a short period of time and a long-term remission of up to 2 years.

Diet for psoriasis

List of alkaline products in the body:

  • Any vegetable except rhubarb, pumpkin and Brussels sprouts. It should be remembered that potatoes, peppers, eggplants and tomatoes are strictly forbidden.
  • Do not exclude fruits. The main thing is not to use plums, cranberries, currants and blueberries. It should be noted that bananas, melons and apples should not be consumed at the same time as other products.
  • Be sure to drink fresh vegetable juices from carrots, beets, parsley, celery and spinach.
  • You can consume daily fruit juices from grapes, pineapples, pears, oranges, papaya and grapefruit, mango, lemon and apricot. It is important to add lecithin and lemon juice to meals.

Menu for the week with psoriasis

For a week, review the recommended sample menu to prevent flares, relapses, and dangerous periods.

1st day

  • Breakfast: fresh cabbage salad, a slice of whole grain bread, green tea.
  • Second breakfast: 2 boiled eggs, toast, dried fruit compote.
  • Dinner: cauliflower soup, whole grain bread, for the second - buckwheat porridge with mushrooms or vegetables, green tea.
  • Dinner: sour cream, a little unsweetened cottage cheese with kefir.

2 nd day

  • Breakfast: cucumber and tomato salad, apples, green tea.
  • Second breakfast: a slice of black bread with butter, 1
  • hard boiled eggs, green tea.
  • Dinner: meatless cabbage soup, a slice of black bread, green tea. Dinner: an apple, a glass of fermented baked milk.

3rd day

  • Breakfast: fruit salad with yogurt, corn compote.
  • Second breakfast: vegetable salad, a slice of whole grain bread, green tea.
  • Dinner: boiled fish with a minimum of salt (perch, catfish), a slice of whole grain bread, corn compote.
  • Dinner: yesterday's bread, corn compote.

4th day

  • Breakfast: cucumber and egg salad with sour cream, whole grain toast, apple juice.
  • Second breakfast: 2 bananas, 1 glass of fermented baked milk or kefir.
  • Dinner: a cup of broth, a piece of boiled meat, cucumber and tomato salad.
  • Dinner: a slice of whole grain bread with butter, a glass of kefir.

5th day

  • Breakfast: carrot salad, whole grain toast, green tea.
  • Second breakfast: boiled fish (not red).
  • Lunch: tea fish soup, a slice of whole grain bread, green tea.
  • Dinner: yesterday's bread, a glass of yogurt.

6th day

  • Breakfast: oatmeal in water, a slice of wholemeal bread, green tea.
  • Second breakfast: cottage cheese (banana, apple, apricot), kefir.
  • Lunch: meatless pea soup, a slice of bread (any), an apple.
  • Dinner: a glass of kefir.

7th day

  • Breakfast: buckwheat porridge with milk, kefir. Second breakfast: sandwich with butter and a piece of boiled meat, apple juice.
  • Lunch: soup with meatballs, green tea. Dinner: 2 apples.

Proper nutrition will often help prevent relapses. You should contact a dietitian to choose an individual diet.

psoriasis on the knees

Folk methods of treatment of the disease

All treatments can be conventionally divided into drugs for internal use, as well as agents for external use.

Prescription drugs for oral use

The following recipes are recommended to cleanse the skin and eliminate the main symptoms of psoriasis:

  1. Use of flax seeds. To prepare the product, a tablespoon of seeds is poured into a glass of boiling water and mixed thoroughly. The remedy should be infused for at least 12 hours. It is better to leave the drug overnight. Take the infusion on an empty stomach in the morning.
  2. Dill seeds. Vegetable seeds in the amount of 2 tbsp. l. Pour a glass of boiling water and insist 2-3 hours. After taking the drug, it is necessary to filter 2-3 times a day and take half a glass.

Products for external use

The following recipes are used to get rid of plaque and cleanse the skin:

  1. Treatment of lesions with flaxseed oil. You can apply oil 5-6 times a day.
  2. Ointment based on tar and propolis. You need to take 50 g of tar and 30 g of propolis to eat. The products should be heated in a water bath and mixed thoroughly. After cooling, apply the ointment on the boards 3-4 times a day.

Treatment of psoriasis: spa therapy

Balneotherapy is prescribed in the later stages of psoriasis.

  1. Climatotherapy is the use of climatic factors, natural biostimulants of the body for medicinal purposes.
  2. Aerotherapy is a stay prescribed and regulated by a doctor, sleeping in the fresh air, air baths.
  3. Heat therapy is a spa therapy method that includes mud, paraffin, ozokerite and clay therapy, psammo and naphthalene therapy and other methods.

Prevention

There is no specific prevention for psoriasis, but after the onset of the disease it is necessary to take sedatives, take courses of vitamin therapy and correct the diseases that cause relapses.

What is the forecast?

The prognosis is conditionally unfavorable, because psoriasis is a chronic disease that cannot be completely cured. It progresses slowly, timely and adequate treatment not only improves the quality of life, but does not eliminate the disease itself.

Loss of ability to work occurs during periods of exacerbation. In the absence of adequate medical care, it can lead to disability.