According to the WHO, currently 2-4% of the world's population suffers from psoriasis. This disease affects patients of all ages, but most often young people (aged 15-25 years). Unfortunately, today medicine is not able to completely cure psoriasis, but timely professional treatment significantly improves the quality of life. So in case of detection of the first symptoms it is better to consult a doctor immediately.
Psoriasis- This is a dermatosis that manifests itself in the form of scaly papules on the skin. Its distinctive feature is that in addition to the skin, it is able to affect the joints and nail plates. Hereditary factors are clearly traced in the pathogenesis of psoriasis, and other irritants are only secondary causes.
During the exacerbation of the disease, the natural processes of formation are disrupted - keratinocytes (cells of which human skin is mainly composed). There are also pronounced biochemical changes in the skin. In addition, doctors have recently been able to find that during the acute phase of the disease, the functioning of the nervous system also differs from the norm. In general, the main reason for the appearance of psoriasis is the presence of malfunctions in the immune system.
Spread of psoriasis
Psoriasis is common. Currently, the frequency statistics are approximately as follows:
- China - 0, 3%;
- USA - 1%;
- Denmark - 1-2, 3%;
- Northern Europe - 3%;
- Germany - 1-1, 3%.
Interestingly, the indigenous people of South America are not affected by the disease. No such case has been registered so far. If you look at the situation as a whole, then the proportion of psoriasis is approximately 6-8% of all skin diseases.
As already noted, psoriasis occurs at any age, but most often young people (up to 25 years) still suffer from both men and women with the same frequency.
Epidemiological situation
Based on the causes, psoriasis is a non-infectious disease with a pronounced genetic predisposition. The most at risk of the disease are those people whose relatives also suffer from this disease (in this case, only the closest relatives are considered). European researchers have found with certainty that if one parent is ill, he is 14-25% likely to pass it on to his child. If both parents are ill, this probability is already 41-60%.
According to the type of development of the disease, psoriasis is divided into two groups:
- early;
- late.
This is evidence that there are two main types of psoriasis (such as diabetes). The first occurs in people at an early age (average 16-22 years), is strictly hereditary and is directly related to the HLA phenotype (HLA-Cw6). The course of the disease is often severe and over time the disease only progresses.
The causes of type II psoriasis are quite random, so this disease is sporadic. It is most common in the elderly (about 60 years). It is generally quite easy, but in some cases it can be aggravated by damage to joints and nails.
Factors provoking the appearance of psoriasis
Although psoriasis tends to be inherited, it is usually multifactorial. Anything can cause a fatal immune system malfunction. So the provoking factors are divided into external and internal (or, scientifically, exogenous and endogenous).
Exogenous factors
They in turn are divided into physical and chemical. The former include common mechanical damage to the skin, such as domestic injuries, thermal burns, abrasions, scars, tattoos, scratches, insect bites and pets. Cases of psoriasis at injection sites have also been reported. X-rays and ultraviolet radiation also play a significant role. In about 5% of all cases, the disease occurs in the summer, and 40% of them are due to sunburn.
Chemical factors are the toxic effects of harmful chemicals or other irritants on the skin. In addition, psoriasis is provoked by other skin diseases, such as:
- dermatoses;
- fungal infections;
- contagious impetigo;
- acne;
- dyshidrosis;
- lichens;
- herpes;
- gangrenous pyoderma;
- allergic dermatitis of various natures.
Cases of the disease are known after performing basic diagnostic skin tests to determine the body's response to cosmetics, hygiene products, formalin, chromium, nickel and other chemicals.
Endogenous factors
Internal causes of psoriasis can be infectious diseases. Recent research in this area shows that streptococcal infections and HIV are most likely to be to blame. In addition, often the symptoms do not appear during the disease itself, or even after the usual vaccination. In these cases, psoriasis is often difficult to treat.
Lithium, beta-blockers, nonsteroidal anti-inflammatory drugs and ACE inhibitors are used to induce remission. In this case, corticosteroids are contraindicated.
Pregnancy and birth
Significant changes in hormonal levels caused by pregnancy can also become a provoking factor. A similar pattern is observed during puberty. It is also interesting that women who already have psoriasis can get an improvement in their condition during pregnancy (40%). Deterioration is much less common (only 14% of cases). It is true that after birth in most patients the condition worsens again (in 54% of cases)
Diet and nutrition
These factors often have no noticeable effect on the course of the disease. It is only known for sure that alcohol and cigarette abuse significantly increases the chances of psoriasis and worsens its course.
Hypocalcaemia and hypokalaemia
These factors can provoke the appearance of generalized pustular psoriasis. The chances of a favorable outcome in this case are very small.
Pustular psoriasis.
Psychogenic factors
Today, their role is considered quite controversial. Some researchers claim that the presence of traumatic psychogenic factors provokes psoriasis in 60% of all cases. However, it is only known for sure that they can only worsen the course of the disease and reduce the effectiveness of therapy.
Classification
Several separate types of psoriasis have now been identified. They differ significantly in the clinical picture and the degree of impact on the body, so to have an idea of what it is, it is better to look at the world wide web and carefully study the pictures of psoriasis of different etiologies, as well as to get acquainted withthe description.
Vulgar psoriasis
Vulgar or common psoriasis occurs in most cases. This disease manifests itself as an abundant rash of small, bright red papules (from a matchstick to a pea). After germination, they grow rapidly and silvery-white scales appear on their surface. In the future, the papules transform into plaques that merge into one large lesion. Very often they have clear boundaries that separate them from healthy skin.
When you try to comb or remove the papule, the peeling first increases. This phenomenon is known as the "stearin stain symptom" and once all the scales have been removed, a shiny, smooth surface can be found, a "terminal film symptom". If you continue to scrape, the capillaries are injured and blood droplets are released. This symptom is known as "blood dew".
The development of psoriasis is divided into three main periods:
- progressive (acute);
- stationary;
- resolution period.
The success of the treatment here depends mainly on how correctly the methods of therapy are chosen, because depending on the period their effectiveness varies considerably.
Period of progress. A characteristic feature of this stage is the abundant appearance of a specific rash. In the exacerbation phase, certain parts of the patient's body are covered with small papules that actively peel off. The peeling in this case is strictly localized and does not affect healthy skin. It is easy to identify acute psoriasis along the characteristic red or pink border that limits the papule.
The most characteristic symptoms at this stage are itching and the presence of the so-called Koebner's symptom. The latter is expressed in the fact that psoriatic papules appear at the site of any skin damage (minor burns, scratches, injections, scratches, etc. ). This phenomenon occurs on average two weeks after the injury and occurs in 38-76% of all patients.
It is also extremely interesting that (much less often) the opposite effect is observed. Scientists believe that this is caused by the presence in the blood serum of some patients of special factors that inhibit Koebner's syndrome.
Stationary period. On average, 2-3 months after the appearance of the first rash, the formation of new papules stops. Plaque growth also stops. At this stage, their entire surface is already covered with scales. This period can last months or even years. The latter, however, is relatively rare.
Resolution period. This period is also called the regression period, because during it a gradual reduction of the plaque is observed. At first they stop peeling, and then gradually smooth out until they disappear completely. If the disease is mild, this phenomenon occurs spontaneously. The treatment only accelerates its onset. Often, the place where the plaques were located stands out against the background of healthy skin areas by depigmentation or, which happens a little less often, by hyperpigmentation. In psoriasis vulgaris, the rash can appear almost anywhere and is usually localized symmetrically (stretching surfaces of the elbows and knees). It can also appear on the head, sacrum, hands, palms, feet, groin and armpits. In addition, in many cases, the nail plates are also affected (the appearance of punctate pits, loosening, thickening). These symptoms are very similar to those that occur with fungal infections, so the final diagnosis is made only after receiving a negative reaction to fungal spores in a special laboratory study. Psoriasis vulgaris generally has no general adverse effects on the patient's body and is chronic. Periods of exacerbation occur in autumn or winter, while in summer exacerbations, on the contrary, are much less common. The main incentive for active treatment lies in the fact that without proper therapy psoriatic plaques can cover the body for years, while adequate treatment leads to improvement after a few months.
Psoriatic erythroderma
Psoriatic erythroderma is one of the most unpleasant forms of this disease. On average, such a reaction occurs in about 2% of patients and occurs both spontaneously and as a result of improperly selected treatment. Although, of course, if the drugs used irritate the skin or it is exposed to ultraviolet radiation, the risk of psoriatic erythroderma is much higher. Most often, psoriatic erythroderma occurs suddenly during the first stage of psoriasis. It can be combined with arthritis and generalized pustular psoriasis, and exposure to factors such as streptococcal infections or hypocalcemia significantly increases the likelihood of such a complication. Abrupt withdrawal of corticosteroids can also worsen the condition. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by diffuse reddening of the skin, severe itching and lamellar peeling.
Pustular psoriasis
Also a severe form of psoriasis. It is characterized by the appearance of abscesses, which often remain the only symptom. Much less often they are combined with the classic symptoms of psoriasis vulgaris. Pustular psoriasis is generalized and localized. The second differs only in that the abscesses in this case are concentrated only in the palms or soles.
Psoriatic arthritis
Psoriatic arthritis is currently classified as an autoimmune disease. It results in bone and muscle damage in patients who already have psoriasis or are at high risk for a family history of the disease. Very often psoriatic arthritis is combined with classic psoriasis, as well as psoriatic nail lesions. This disease is diagnosed by the appearance of back pain accompanied by the following conditions:
- lack of a clearly stated cause of occurrence;
- the patient's age is over 40;
- unexplained deep pain in the lower back or buttocks;
- unclear location of pain;
- reduction of post-workout pain;
- pain or stiffness is felt early in the morning or at night;
- the presence of pain with excellent general condition of the musculoskeletal system.
Nail plate psoriasis
Very often psoriasis vulgaris is accompanied by nail damage. In this case, there is a pronounced dystrophy, as well as symptoms characteristic of fungal infections. It is a common companion of psoriatic arthritis. Given that about 4% of the world's population suffers from ordinary psoriasis, then 30-50% of them also have nail psoriasis.
Treatment of psoriasis
Unfortunately, at present medicine is not yet able to cure psoriasis, as it requires much more in-depth knowledge of the peculiarities of the work of the basic mechanisms of the human immune system. As this type of research is progressing quite slowly and the disease itself is not particularly life-threatening, symptomatic therapy is currently a priority. Before starting treatment, the patient needs a thorough examination, as each organism contains an individual set of factors that affect the course of the disease. Gender, age, occupation, general health, type of psoriasis - all this should be taken into account when prescribing therapeutic therapy. An important role is played by establishing the nature of the course of the disease, individual sensitivity to drugs and the current stage of the disease.
General activities
First of all, the doctor must determine the mental and physical condition of the patient, assess the general condition of his body and understand how tolerant he is to the disease. The best prerequisites for effective treatment are good rest, stay in a calm environment, transition to a less intensive mode of work or short-term hospitalization. Various methods of psychotherapy (rehabilitation in seaside resorts using cognitive-behavioral therapy, etc. ) have also proven quite well. It is also very important for the patient to know that the healing process is going well, because without a quick effect, about 40% of patients lose faith in the effectiveness of the therapy and begin to ignore it. It is important to remember that psoriasis is a chronic disease, so the safety of therapy must be taken into account. Many drugs are toxic and can accumulate in the body, turning into a time bomb. An addictive effect is also possible, so it is better to save the most powerful drugs until the really dangerous symptoms appear.
Course of the disease and long-term prognosis
Psoriasis is often unpredictable. Modern doctors have practically failed in this, therefore, as before, psoriasis remains an unpleasant and uncontrollable disease. In each case, it is completely individual, so any attempt to make a prognosis regarding the course of the disease, as well as the duration of the phases of exacerbation and remission, is doomed to failure. There is only one thing that is pleasing - despite the difficulty of treatment, it rarely poses a real threat to the patient's life. As for psoriatic arthritis, this disease is much easier than rheumatoid arthritis and the reduction in the quality of life of patients compared to the latter is very insignificant. Statistics show that with proper treatment, most patients with psoriatic arthritis remain functional and can lead a full life. If the necessary therapy is absent or the disease progresses with complications, joint deformities may develop with the further development of severe pathologies. However, such complications are found only in a very small number of patients with psoriasis. Most patients can count on a gradual stabilization of the condition and the appearance of long-term remissions (more than two years). In very rare cases, the disease occurs mainly in the active phase, but in this case it can be effectively localized. Effective treatment for psoriasis today can be obtained in any major city. And although, as you know, the final recovery cannot be achieved, diet, special medications and procedures will do the job quickly. In addition, you will not need long-term hospital treatment. The doctor's task is only to quickly bypass the first two stages of psoriasis and bring the person into remission. Then the patient can only take care of himself, follow the instructions and forget about the disease for a long time.