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 appears on the skin as well-defined pinkish-red papules (nodules that rise above the skin's surface) that give way to plaques of silvery-white scales.
In moderate and severe forms of the disease, the inflammatory process leads to damage to the musculoskeletal and cardiovascular systems. Psoriasis has a relapsing course (recurrence of symptoms after full or partial recovery) and tends to cause comorbidities that affect patients' quality of life.
Causes of Psoriasis
The disease can be due to several triggers. However, it is still not known exactly which of them are primary and which are secondary. A dysfunction of the immune system is considered to be the main cause for the occurrence of psoriasis. Cells aiming to destroy pathogens begin attacking their own cells (mainly skin). As a result, an inflammatory process develops, causing accelerated cell division of the epidermis (epidermal hyperplasia) and the formation of psoriatic papules and plaques.
An inadequate immune response is mostly genetic.
Psoriasis is very often inherited.
Currently, more than 40 chromosomal regions associated with the risk of developing psoriasis have been identified. The onset of the disease can be caused by a weakening of the immune system against the background of stress, infectious, endocrine diseases. Psoriasis is often accompanied by allergic and immunodeficiency states, which are based on a violation of the immune response. Psoriasis can also be triggered by certain medications (antidepressants, beta-blockers, non-steroidal anti-inflammatory drugs).
Classification of psoriasis
Depending on the localization 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, merging into plaques covered with silvery-white scales. For damage to the scalp (seborrheic psoriasis) Rashes in the form of yellowish scales can descend on the forehead, forming a seborrheic "crown". In patients with metabolic disorders, plaques may contain exudate, a fluid secreted during inflammatory processes (exudative psoriasis). In childhood and adolescence, especially after streptococcal infections, the disease can become acute, with many bright red, teardrop-shaped papules with slight detachment and infiltration appearing on the skin (guttate psoriasis). Sometimes there is pustular psoriasis, which is characterized by the appearance of pustules against the background of reddened skin, more often on the arches of the feet or on the palms of the hands.Psoriatic erythrodermacan occur against the background of exacerbation of ordinary psoriasis under the influence of provoking factors. Dry white scales cover the skin, which becomes bright red, swollen, and hot to the touch. Runs very hardgeneralized Zumbusch psoriasis. It is characterized by the fact that small purulent vesicles appear on the reddened skin, which, when they merge, form "purulent lakes".psoriatic arthritisaccompanied by damage to the joints and develops simultaneously with rashes or precedes them.
Symptoms of Psoriasis
The skin form of psoriasis is accompanied by the appearance of bright pink dotted papules, sometimes in the form of droplets. When merging, they form plaques covered with silvery-white scales.
Rashes are found on the extensor sides of the arms and knees, on the scalp, lower back, and sacrum.
The top layer of plaques is formed by easily removable scales of dead epidermis. Initially, they occupy the center of the plaque, and then fill up its entire area. When the scales are removed, a glossy bright red surface is revealed. Sometimes the plaque is surrounded by a pink border - a zone of further growth, while the surrounding skin does not change. The rash is accompanied by severe itching. With psoriatic erythroderma, patients develop fever (fever with chills) and severe itching against the background of rashes all over the skin, and the lymph nodes increase.
If the disease progresses for a long time, hair and nails may fall out.
Generalized Zumbusch psoriasis is very difficult. Purulent eruptions cover the entire skin and are accompanied by severe fever and intoxication. Psoriasis joint damage is characterized by pain and redness of the skin over the joint surfaces. Any movement is difficult, inflammation of the ligaments and tendons develops. In psoriasis, the nail plates are very commonly affected, while pinpoint indentations appear on the nail surface (a "thimble" symptom).
Small, reddish and yellowish-brown spots appear under the nail plate at the base ("oil stain" symptom). Dystrophic changes in nails and hair often develop.
In children, especially infants, the symptoms of psoriasis have their own peculiarities.
In the area of \u200b\u200bredness that appears in the folds of the skin, there may be effusions and slight detachments of the upper layer of the epidermis. This picture resembles diaper rash or candidiasis. Sometimes rashes appear on the skin of the face or in the genital area.
diagnosis of psoriasis
The disease can be identified on the basis of the symptoms of the psoriasis triad (white stearic surface of the papule; reddish shiny film after peeling off the scales and punctiform protrusion of blood after their removal).
Another feature is the Koebner phenomenon. It lies in the fact that in the area of \u200b\u200bskin irritation, after 7-12 days, erythematous-scaly rashes appear (redness and peeling in the area of \u200b\u200bscratches, scratches). Sometimes a histological examination of a biopsy of the affected area of skin is done to confirm the diagnosis. In addition, a clinical and laboratory examination is necessary: a clinical blood test, a biochemical blood test (total protein, protein fractions, C-reactive protein, ALT, AST, LDH, creatinine, electrolytes: potassium, sodium, chlorine, calcium).
Which doctors to contact
When rashes appear, which often appear 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, he can be referred to an ophthalmologist, endocrinologist, gynecologist or other specialists.
treatment
Psoriasis affects the skin and the musculoskeletal system as well as internal organs. If rashes appear only on the skin, local glucocorticosteroid preparations, ointments with synthetic analogues of vitamin D3, activated zinc, salicylic acid and other components are recommended. Hormonal creams should be used with caution on skin prone to atrophy.
With prolonged use of steroid creams, the possibility of hormonal disorders should be taken into account.
The effectiveness of hormonal creams is increased in combination with salicylic acid, analogues of vitamin D. Second-generation aromatic retinoids based on acitretin are used to treat severe forms of psoriasis. 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, the doctor may prescribe immunosuppressants. If necessary, prescribe detoxification and desensitization therapy, plasmapheresis.
Complications of Psoriasis
In 10% of patients, psoriatic arthritis develops, affecting the spine, joints of the arms and legs. Patients suffer from joint pain and morning stiffness. Among the features of psoriatic arthritis is the asymmetry of the places of its manifestation, which can be combined with damage to the nails. Psoriasis is often accompanied by concomitant or concomitant diseases.
Inflammatory vascular lesions increase the risk of coronary heart disease and stroke.
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 primarily aimed at strengthening the immune system. Skin care should include hydration and nutrition. With a predisposition to allergies, it is necessary to control the diet, avoid fatty and spicy foods, excessive consumption of carbohydrates, potatoes. A mandatory component of psoriasis prevention should be vitamin therapy.
In addition, the functioning of the immune system largely depends on the state of the nervous system. People who are overly responsible, have busy work schedules, and constantly experience negative psycho-emotional effects are more prone to autoimmune diseases, including psoriasis. Therefore, in addition to physical healing measures (giving up bad habits, physical activity), the prevention of psoriasis should also ensure the achievement of psycho-emotional well-being.
IMPORTANT!
The information in this section should not be used for self-diagnosis or self-treatment. With pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should consult your doctor.