Everything about psoriasis - how to treat, causes and symptoms, types

For more than two thousand years, humanity has been trying to solve all the mysteries of this severe dermatosis, but it still remains very unknown. According to statistics, this disease affects 4 to 7% of the population, women and men are equally susceptible to it. The first signs of psoriasis usually appear during puberty and accompany a person for the rest of his life, then disappear and disappear completely, after which they intensify.

Can psoriasis be cured?Modern medicine has achieved a lot in the treatment of this chronic dermatosis and is able to provide the patient with a decent level of quality of life.

Causes of psoriasis

Psoriasis is a chronic inflammatory process of the skin, which modern medicine calls autoimmune (associated with allergies to its own tissues). There are many causes of psoriasis and factors predisposing to the development of this dermatosis, in connection with which a number of theories about its origin are presented.

Autoimmune

This is the basic theory, as it is well established that the immune system responds actively to certain types of skin exposure. The skin of people suffering from psoriasis is very sensitive to mechanical, physical and chemical influences. Not only epithelial cells but also the entire immune system responds to such influences.

Cellular immunity is impaired: the ratio between the different subtypes of lymphocytes responsible for the formation of a normal immune response. Thus, in psoriasis, the number of helper T-lymphocytes increases, while the number of suppressor T-lymphocytes, which suppress an excessively strong immune response, decreases. Lymphocytes and some other cells produce cytokines - active substances that stimulate the immune response. Humoral immunity also suffers, an imbalance of antibodies (immunoglobulins) develops in the blood serum, antibodies appear to the tissues of the patient's body.

Inflammation begins against the background of activation of T-lymphocytes, but why it is not established. The question of how to suppress the autoimmune reaction without harming the patient is also in the process of research.

Exchange

Metabolic imbalances have a significant effect on the skin and immunity. In patients with psoriasis, there is an acceleration of metabolism, the appearance of large amounts of toxic free radicals and other toxins that support the inflammatory response. Metabolism is impaired:

• protein- the predisposition gene CDSN stimulates the synthesis of the protein corneodesmosin, which sensitizes (allergizes) the body; the content of albumin proteins in the blood decreases and the content of globulins increases; this condition is called dysproteinemia and further enhances sensitization;
• greasy- the content of lipids and cholesterol in the blood increases; the use of mainly plant foods and a general reduction in caloric content in the daily diet can reduce the activity of psoriatic inflammation;
• carbohydrates- almost always violated;
• metabolism of vitamins and minerals- the content of vitamin C in the skin increases, the content of vitamins C, A, B6, B12, iron, copper and zinc in the blood decreases.

Contagious

This theory was relevant at the beginning and in the middle of the last century. Certain bacteria (streptococci), fungi and viruses are considered to cause psoriasis. These theories have not been confirmed. But dermatologists note that any acute infectious process or the presence of a constant focus of infection can provoke relapses. Viral theory occupies a special place. Recent studies have revealed the effect of retroviruses (RNA-containing viruses - HIV, etc. ) on the genetic apparatus with the formation of genes for psoriatic predisposition.

Genetic

The predisposition to autoimmune reactions is inherited. If a person's relatives suffer from psoriasis, then the likelihood of developing this disease increases many times over. There are genes for susceptibility to psoriasis (local complexes PSORS1 - PSORS9, PSORS1 is particularly active, it contains the genes HLA-C, HLA-Cw6, CCHCR1 and CDSN, which are responsible for the development of the disease). Genes affect metabolism, immunity and the development of autoimmune processes. But the presence of such genes does not guarantee the development of the disease at all. The influence of provoking factors is of great importance.

Neurogenic

Prolonged stress, high neuropsychiatric stress, disorders of the autonomic nervous system (innervation of the walls of blood vessels and internal organs) can cause the development of psoriasis, causing an imbalance in the endocrine system, impaired metabolic and immunological processes.

Endocrine

Endocrine disorders in psoriasis are common and mainly play the role of a provoking factor. A clear link between the two has not been proven. Dermatologists note that patients often have dysfunctions of the thyroid gland, adrenal glands and pituitary gland. There are menstrual disorders in women and sexual function in men.

Symptoms of psoriasis

The main symptoms of psoriasis are skin rashes. But there are other signs. The first manifestations usually appear in adolescence or childhood on the background of hormonal disorders, autonomic dystonia and prolonged stress.

The disease begins with a feeling of constant fatigue, mood swings. It is characterized by small, pink formations (papules) rising above the surface, powdered on top with whitish peeling. They are surrounded by a lighter, rising edge.

The elements of the rash grow and combine into large plaques with bizarre shapes. The base of the papule is an inflammatory infiltrate. By the nature of the rash, psoriasis is divided into:

• point- elements with a diameter of not more than 1 mm;
• tear- papules-droplets up to 2 mm;
• coin-shaped- round papules-coins up to 5 mm in size.

Characteristic features of the rash:

• stearin stain- if you scrape, the surface of the papules;
• terminal film- Thoroughly cleaning the surface of the papules from the scales, we will see a transparent film;
• blood dew (Auspitz phenomenon)- After scraping the film and breaking its integrity, we will see small blood droplets sticking out on the surface.

Stages of psoriasis

There are three stages of the disease:

1. progressive- the first elements of the rash appear, their number increases, all new areas are captured; rashes also occur when scratching itchy skin or exposure to some external irritants (Kebner's phenomenon); in the initial stage of psoriasis, the papules begin to merge into large plaques;
2. stationary- there are no new elements, and those that appeared earlier do not regress;
3. regressive- the rash pales, its base becomes less dense; the rash gradually regresses, the process often starting from the central part, so that the plaques may have the shape of rings; if the plaques in psoriasis dissolve from the periphery to the center, then they simply gradually decrease in size and around them a white ring is formed - a pseudo-atrophic edge of Voronov; where there was a rash, white, pigmented areas remain - psoriatic leukoderma.

Sometimes papules are present on the skin at the same time in all three stages of development. There are also summer and winter forms with a predominance of exacerbations in summer or winter.

Is psoriasis contagious?

Numerous studies confirm that this is not a contagious disease. If infectious pathogens are involved in its development, it is only through a general effect on metabolism, immunity and the genetic apparatus.

Patients often ask:

• How does psoriasis spread?

  Psoriasis is not transmitted from person to person.

• Is psoriasis inherited?

  The answer is again negative, but there is a hereditary predisposition in the form of metabolic characteristics and the functioning of the immune system, which is passed on to close relatives.

Types of psoriasis

The nature of the rash, their location, damage to other organs and systems in this chronic dermatosis may be different. According to these signs, several types of diseases are distinguished.

Usually (vulgar, plaque)

Most often. Its symptoms are papules with a characteristic bright pink color, covered with white scales. Downstream plaque psoriasis is divided into the following forms:

• easy- if the lesion covers no more than 3% of the skin; in the progressive phase the papules enlarge, but then they quickly reverse;
• moderate- the rash takes from 3 to 10%; the papules are large, merging into plaques;
• heavy- the defeat captures more than 10%; the rashes are numerous, merging to form a wide variety of shapes.

Vulgar psoriasis takes the form of relapses alternating with remissions, but there is also a continuous course.

Elbow psoriasis

This is one of the manifestations of a mild form of plaque inflammation. A distinctive feature of psoriasis of the elbows is the constant presence of one or more "duty" plaques on the extensor side of the elbow joints. If these elements are injured, exacerbation begins.

Guttate psoriasis

Bacterial (most often streptococcal) and viral infections are important in the development of guttate psoriasis. It occurs in childhood. Inflammation begins after infection. Streptococci secrete toxins (antigens - substances foreign to the human body) that bind to tissue proteins. They produce antibodies and develop autoimmune inflammation.

The beginning is sharp. Small red tear papules with scaly surfaces appear on the skin of the limbs (rarely the body and face). Injuries in the area of the rash form small erosions and wounds, the risk of infection increases.

Psoriasis quickly takes a subacute and chronic course. Recurrences are replaced by remissions, independent recovery or transition to the adult form of the disease is possible.

Palmar-plantar psoriasis

It develops in those who engage in physical labor, is accompanied by severe itching and almost always gives a complication of the nails. There are subspecies:

• plaque-fan-shaped- with large elements on the palmar and plantar surfaces, covered with white scales, merging into fan-shaped plates; such psoriasis of the hands is more common;
• circular- annular scaly elements on the palmar and plantar surfaces;
• excited- characterized by an increase in coarse epithelium with the formation of calluses;

A separate subspecies is pustular psoriasis on Barber's palms and soles. The areas under the thumbs of the limbs are covered with vesicles and pustules (with purulent contents), severe itching occurs. The abscesses merge and then dry out, forming crusts. Elsewhere in the body, characteristic psoriatic elements develop. The disease often spreads to the nails.

Psoriasis of the legs is maintained and aggravated by varicose veins, in which case the rash will be mainly in the lower leg.

Nail psoriasis

Nail damage can be independent or a complication. Typical symptoms:

• small dimples of different depths appear on the nail plate; similar nail lesions are found in other dermatitis, but in psoriatic lesions they are deeper and slightly painful when pressed;
• spontaneous slow painless separation of the nail (onycholysis);
• subungual hemorrhages on the toenails, especially if the patient wears tight shoes;
• trachyonychia - turbidity and irregularities on the nail plate; a depression forms in the middle of the nail and the nail becomes like a spoon (koilonihiya).

Sometimes the fungal roller is affected by the transition of inflammation to other tissues (psoriatic paronychia).

Scalp psoriasis

Here the disease proceeds alone or as part of a general pathological process. It is characterized by leakage, crusting in parts or on the entire surface of the head. Hair growth is not affected simultaneously: psoriasis of the scalp does not impair the function of the hair roots. But the leak poses a threat of infection with subsequent damage to the hair follicles.

It flows in waves, then subsides with the disappearance of the crusts, then becomes aggravated again and is accompanied by severe itching, often leading patients to neurosis.

Seborrheic psoriasis

Seborrhea is a condition caused by the malfunction of the skin glands that produce sebum. Viscous oil is produced, which irritates the skin and contributes to the development of inflammation - dermatitis.

Seborrheic psoriasis spreads rapidly throughout the head, covering it in the form of a cap and accompanied by severe itching. In the areas behind the ear, crying sometimes develops and an infection joins. The head, covered with dandruff and hard crusts, sometimes resembles a psoriatic crown.

Psoriasis on the face

Usually psoriasis on the face is localized in the area of the nasolabial triangle, eyelids, above the eyebrows, in the areas behind the ear. The fused elements of the rash form large areas of redness and swelling. If there is dysfunction of the sebaceous glands, the process is often accompanied by crying, crusting and an increased risk of infection.

Psoriasis of the genitals

This is not an isolated process. Simultaneously with the defeat of the genitals, there are characteristic psoriatic rashes all over the body, so it is not difficult to identify the disease.

Psoriasis of the penis in men and large labia in women, as well as in adjacent skin areas, manifests itself in the form of oval, pink scaly papules, rising slightly above the skin. There is practically no itching. Sometimes the process spreads to the mucous membranes and looks like vulvovaginitis in women and balanoposthitis in men.

Atypical psoriatic rashes can be observed in obese people in folds located next to the genitals (inguinal, intergluteal). Here, areas of intense red color with a mirror surface are formed, with no signs of flaking due to constant wetting.

What is the danger of psoriasis and whether it should be treated

The danger is that psoriasis can become widespread severe, the rash will occupy more than 10% of the skin. This stage of the disease is difficult, relapses, the elements of the rash are injured and wet, often accompanied by infection. Only timely treatment of psoriasis can stop the process of its spread.

Sometimes the disease is complicated by inflammation in the joints with the formation of psoriatic arthritis, against which the function of the joints can be significantly impaired.

Against the background of a systemic autoimmune process, which has a significant effect on the patient's condition, often develop other autoimmune diseases (rheumatoid arthritis, some types of osteoarthritis, Crohn's disease, etc. ), as well as severe cardiovascular pathology, diseases of the digestive system, neurological reactions.

If you do not start treatment for psoriasis in time, the patient's condition will deteriorate dramatically and lead to damage.

There is also such a complication as psoriatic erythroderma, which develops with improper or insufficient treatment of psoriasis, as well as when various inflammatory factors are exposed to the inflamed skin. The skin acquires a bright pink color with a clear distinction of the affected areas from healthy, small and large lamellar peels. Such a patient requires urgent medical attention.

Is psoriasis treatable?

Yes, and quite successfully, but a full recovery cannot be guaranteed.

Methods of treatment

Autoimmune inflammation requires individually selected complex therapy, lifestyle changes, nutrition and elimination of all bad habits. Modern medicine has proposed three basic principles for the successful treatment of psoriasis:

• strict adherence to the algorithms for prescribed therapy;
• regular monitoring of the effectiveness of the therapy;
• timely correction of the prescribed therapy with its insufficient effectiveness.

Nutrition in psoriasis

There is no special diet for psoriasis, but nutrition is very important. Therefore, when prescribing complex treatment, it is mandatory to give recommendations on nutrition:

• identify hypersensitivity of the body to certain foods and exclude them from the diet;
• give preference to fresh vegetables, non-sour fruits and berries, cooked and roasted lean meat, drink more;
• what not to eat with psoriasis:
  1. products containing essential oils - onion, garlic, radish;
  2. beverages containing caffeine (concentrated tea, coffee), alcohol;
  3. everything is more salty, sour and sweet, rich;
  4. products that promote sensitization (allergy) of the body - orange fruit, honey, nuts, cocoa, eggs;
  5. do not eat fatty animal products.

Pegano diet for psoriasis

This diet was developed by the American doctor John Pegano, but has not found official medical recognition. The principle of building a pegan diet in psoriasis is associated with alkalizing the body by choosing the right diet. According to this principle, all products are divided into:

• alkali-forming (two thirds of the daily diet) - non-acidic fruit and forest mixtures and juices, vegetables (except those causing increased gas formation);
• acid-forming (one-third of the diet) - meat, fish, dairy products, beans, peas, potatoes, cereals, pastries and pastries.

Patients are recommended to drink mineral water without gas, drinking water up to 1, 5 liters per day, as well as other drinking fluids (compotes, juices, etc. )

Drug therapy

Mild psoriasis is treated with topical medications. Severe and rapidly progressive forms of the disease are treated mainly in hospital with the appointment of drugs with general (systemic) action.

External treatment of psoriasis

The drug is selected by a dermatologist. For psoriasis vulgaris with dry shrinking plaques are suitable ointments, if a leak develops (with seborrheic), then creams and healing solutions are used. To avoid the body's resistance to a particular drug, it changes over time.

In the acute (progressive) stage, the following external therapy is performed:

• agents that have a emollient effect - boron vaseline, 2% salicylic ointment;
• effective non-hormonal ointments for psoriasis containing activated zinc pyrithionate; they suppress the infection and have a cytostatic (suppress tissue proliferation) effect;
• external agents containing glucocorticosteroid (GCS) hormones;
• combined agent with calcipotriol (vitamin D3 analogue) and betamethasone corticosteroids; perfectly suppresses the inflammatory process.

External treatment of inpatient psoriasis:

• ointments that dissolve the scales (keratolytic) and have anti-inflammatory effect - 5% naphthalene, boron-naphthalene, tar-naphthalene;
• corticosteroid drugs.

External treatment of psoriasis at the stage of resolution:

• the same keratolytic ointments, but in a higher concentration: 10% tar-naphthalene ointments;
• ointments based on vitamin D3 analogues - within 6 - 8 weeks; suppresses the inflammatory process and peeling of the rash.

For the treatment of psoriasis of the nails are used special varnishes that inhibit the development of the pathological process. Treatment of fungal phalanges with moisturizing gels is recommended.

Systemic treatment of psoriasis

• drugs that relieve inflammation and intoxication - calcium chloride, sodium thiosulfate, unithiol in the form of injections;
• tablets for psoriasis, which suppress the processes of proliferation (proliferation of epithelial cells) - cytostatics, suppressing the activity of the immune system, vitamin A analogues, corticosteroid hormones;
• biological agents containing human monoclonal antibodies of the IgG class, acting on certain links of inflammation by inhibiting the synthesis of cytokines; it is a very effective modern medicine that is given by injection;
• vitamins for psoriasis help to restore the metabolism and keratinization of epithelial cells; doctors prescribe vitamins A, E, D3, group B.

Folk remedies for psoriasis

Any treatment for psoriasis, including the use of folk remedies, can be prescribed only by a doctor. Self-medication can have the opposite effect: the spread of the disease.

The following methods can be used as part of the complex therapy:

• grease- product for processing of industrial oils; to prepare the ointment, you need to buy medical solid oil at a pharmacy; recipe: in 0, 5 kg of solid butter add 50 g of honey and half a pack of baby cream; the procedures are performed daily; in the pharmacy you can buy ready-made preparations based on solidol.
• baking soda- folk remedy for psoriasis, which helps to clean the skin, relieves itching; recipe for applications with soda: take 60 g of soda, dissolve in 0, 5 liters of water, soak a gauze cloth in the solution, fold it in several layers and apply on the lesion for 20 minutes; after the procedure, soak the skin and apply emollient ointment; treatment of psoriasis with soda is carried out once a day;
• mummy- has a pronounced anti-inflammatory effect, well relieves itching; can be taken orally once a day, 0, 2 g for two weeks; external therapy is performed with a solution of mummy; applied to dry itchy plaques twice a day; treatment of psoriasis of the head is carried out by rinsing the scalp with a solution of mummy after washing;
• sea salt- relieves inflammation, itching well; baths with sea salt: take 1 kg of salt, dilute in two liters of water and add to the bath; take a bath for 15 minutes, then rinse the solution in a warm shower, soak the body with a towel and apply emollient ointment; treat psoriasis with baths no more than twice a week;
• clay- has a pronounced cleansing effect, adsorbing on its surface toxins formed as a result of inflammation and improper metabolism; helps dry, remove crusts and itch; you can take any clay, but it is better to buy blue clay at the pharmacy; pieces of clay should be well dried, broken with a hammer, diluted with water and left to stand for several hours; place the resulting plate as clay on a napkin (up to 3 cm thick) and apply to the foci of inflammation for three hours; for the treatment of psoriasis with clay every other day.

Important: the treatment of psoriasis at home with folk remedies should be carried out with caution and strictly according to the doctor's prescription. Such treatment will help one patient, while in another it may cause exacerbation and rapid spread of inflammation. Therefore, if the patient's condition has worsened during therapy, it is necessary to stop him immediately and consult a doctor.

Home treatment for psoriasis

When treating psoriasis at home, it is important to follow dietary recommendations, lead a healthy lifestyle, rule out bad habits and strictly follow all the prescriptions of a dermatologist.

How to treat psoriasis at home? Some patients try to cleanse themselves of toxins and toxins using any non-traditional methods (enemas, etc. ). This can give the exact opposite result: the work of the digestive tract will be disrupted and will begin to exacerbate. Modern medicine recognizes the cleansing of the body in the form of proper nutrition and getting rid of bad habits.

It is important to follow all the doctor's prescriptions and pay attention to how the prescribed therapy works. If it is not effective enough, the doctor will replace the treatment, achieving the maximum therapeutic effect.