Psoriasis: causes, symptoms, diagnosis and treatment.
Psoriasis is a chronic non-communicable disease that can affect various organs: skin, joints, heart, kidneys.
Most often, mild psoriasis manifests itself on the skin as well-defined pinkish-red papules (nodules that rise above the surface of the skin), which merge into plaques with silvery-white scales.
In moderate and severe forms of the disease, the inflammatory process leads to damage to the musculoskeletal system and the cardiovascular system. Psoriasis has a recurrent course (recurrence of symptoms after full or partial recovery) and a tendency to cause comorbidities that worsen the quality of life of patients.
Causes of psoriasis
The disease can be based on several triggers. However, it is not yet known exactly which of them are primary and which are secondary. Immune system dysfunction is considered to be the leading cause of psoriasis. Cells aimed at destroying pathogens begin to attack their own cells (mostly the skin). As a result, an inflammatory process develops, which causes accelerated cell division of the epidermis (epidermal hyperplasia) and the formation of psoriatic papules and plaques.
Inadequate immune response is most often due to genetic characteristics.
Psoriasis is often inherited.
Currently, more than 40 chromosomal regions have been identified that are associated with the risk of developing psoriasis. The onset of the disease can be caused by weakening of the immune system against the background of stress, infectious, endocrine diseases. Psoriasis is often accompanied by allergic and immunodeficiency conditions, which are based on a violation of the immune response. In addition, psoriasis can be caused by certain medications (antidepressants, beta-blockers, nonsteroidal anti-inflammatory drugs).
Classification of psoriasis
Depending on the location of the pathological process, different types of psoriasis are distinguished. The most common is vulgar, orcommon, psoriasiswhen well-defined pink papules appear on the skin, which merge into plaques covered with silvery-white scales. In case of scalp damage (seborrheic psoriasis) rashes in the form of yellowish scales may descend on the forehead, forming a seborrheic "crown". In patients with metabolic disorders, plaques may show exudate, fluid secreted during inflammatory processes (exudative psoriasis). In childhood and adolescence, especially after streptococcal infections, the disease can be exacerbated by the appearance on the skin of many bright red teardrop-shaped papules with slight scaling and infiltration (guttate psoriasis). Sometimes there is pustular psoriasis, which is characterized by the appearance of pustules on the background of reddened skin, more often in the arch of the feet or palms.Psoriatic erythrodermamay occur against the background of exacerbation of ordinary psoriasis under the influence of provoking factors. Dry white scales cover the skin, it becomes bright red, swollen and hot to the touch. He runs very hardgeneralized psoriasis of Zumbusch. It is characterized by the appearance of small purulent vesicles on the reddened skin, which, merging, form "purulent lakes".Psoriatic arthritisaccompanied by joint damage and develops simultaneously with the rash or precedes them.
Symptoms of psoriasis
The cutaneous form of psoriasis is accompanied by the appearance of bright pink dotted papules, sometimes in the form of droplets. As they merge, they form plaques covered with silvery-white scales.
The rash is found on the extensor surfaces of the arms and knees, the scalp, the lower back and the sacrum.
The top layer of plaque is formed by easily removable scales of dead epidermis. Initially, they occupy the center of the poster, and then fill the entire area. When the scales are removed, a shiny bright red surface is revealed. Sometimes the plaque is surrounded by a pink edge - an area of further growth, while the surrounding skin does not change. The rash is accompanied by severe itching. In psoriatic erythroderma, patients develop fever (chills with chills) and severe itching on the background of rashes all over the skin and swollen lymph nodes.
With a long course of the disease, hair and nails can turn out.
Zumbusch's generalized psoriasis is very difficult. Purulent rashes cover the entire skin and are accompanied by severe fever and intoxication. Psoriatic joint damage is characterized by pain and redness of the skin above the joint surfaces. Every movement is difficult, inflammation of the ligaments and tendons develops. In psoriasis, nail plates are very often affected, while punctate depressions ("thimble" symptom) appear on the surface of the nail.
Under the nail plate at the base appear small, reddish and yellowish-brown spots (symptom of "oil stain"). Dystrophic changes in nails and hair often develop.
In children, especially infants, the symptoms of psoriasis have their own specifics.
In the area of redness that appears in the skin folds, there may be effusion and slight scaling of the upper layer of the epidermis. This picture looks like a diaper rash or candidiasis. Occasionally there is a rash on the skin of the face or genitals.
Diagnosis of psoriasis
It is possible to identify the disease based on the symptoms of the psoriatic triad (white stearin surface of the papule; reddish glossy film after peeling and precise protrusion of the blood after removal).
An additional feature is the Koebner phenomenon. It lies in the fact that in the area of skin irritation after 7-12 days appear erythematous-scaly rashes (areas of redness and flaking in the area of scratches, scratches). Occasionally, a histological biopsy of the affected area of skin is performed to confirm the diagnosis. In addition, a clinical and laboratory examination is required: clinical blood test, biochemical blood test (total protein, protein fractions, C-reactive protein, ALT, AST, LDH, creatinine, electrolytes: potassium, sodium, chlorine, calcium).
Which doctors to turn to
If you experience rashes, which often occur against the background of infectious diseases, skin injuries, stress, you should consult a therapist or dermatologist. In case of systemic damage to the patient's body, they can be referred to an ophthalmologist, endocrinologist, gynecologist or other specialists.
Treatment
Psoriasis affects both the skin and the musculoskeletal system, as well as internal organs. When the rash appears only on the skin, topical glucocorticosteroids, ointments containing synthetic analogues of vitamin D3, activated zinc, salicylic acid and other components are recommended. Hormonal creams should be used with caution in skin prone to atrophy.
It is necessary to take into account the possibility of hormonal disorders with prolonged use of steroid creams.
The effectiveness of hormonal creams is increased in combination with salicylic acid, an analogue of vitamin D. For the treatment of severe forms of psoriasis are used second-generation aromatic retinoids, which are based on acitretin. The drug slows down the proliferation of epidermal cells, normalizes the process of keratinization and has an immunomodulatory effect. Phototherapy (medium-wave UV and PUVA therapy) in combination with retinoids is also recommended. As a systemic therapy, your doctor may prescribe immunosuppressants. If necessary, prescribe detoxifying and desensitizing therapy, plasmapheresis.
Complications of psoriasis
10% of patients develop psoriatic arthritis affecting the spine, joints and legs. Patients suffer from joint pain and morning stiffness. Characteristics of psoriatic arthritis include asymmetry at the sites of its manifestation, which can be combined with nail damage. Psoriasis is often accompanied by concomitant or concomitant diseases.
Due to inflammatory vascular lesions, the risk of coronary heart disease and stroke increases.
It is also possible to develop diabetes and Crohn's disease. In some cases, complications of psoriasis can lead to disability.
Prevention of psoriasis
Measures to prevent psoriasis are mainly aimed at strengthening the immune system. Skin care should include hydration and nutrition. In case of predisposition to allergies, it is necessary to control the diet, avoiding fatty and spicy foods, excessive consumption of carbohydrates, potatoes. Vitamin therapy should be a mandatory component of psoriasis prevention.
In addition, the functioning of the immune system largely depends on the state of the nervous system. People who are over-responsible, have a busy work schedule and experience constant negative psycho-emotional impact are more susceptible to autoimmune diseases, including psoriasis. Therefore, the prevention of psoriasis, along with physical treatment measures (rejection of bad habits, physical activity), must ensure the achievement of psycho-emotional comfort.
IMPORTANT!
The information in this section should not be used for self-diagnosis or self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. You should contact your doctor for diagnosis and proper treatment.