Psoriasis is a chronic systemic multifactorial disease with a genetic predisposition that affects the skin and joints. Patients often complain of a pinkish-red rash with silvery-white scales. The rash is accompanied by itching, pain and peeling. If joints are damaged, their mobility is restricted, which can lead to disability for the patient.
Causes of Psoriasis
The cause of psoriasis remains unknown. There are only origin theories:
- neurogenic (the appearance of skin rashes after stress, burns, psychological trauma);
- endocrine (especially during perimenopause);
- metabolic (lipid metabolism disorder);
- contagious;
- viral (psoriasis antigens are isolated from people who are healthy but have a high probability of developing psoriasis in the future, while psoriasis is a non-communicable disease);
- genetically.
Psoriasis can be seen in an entire generation of people with the same risk factors. However, the mode of inheritance is believed to be multifactorial. If a parent is sick, the chance of the child becoming sick is 25%. If both parents are sick – 60-75%.
Viral and genetic theories remain leading.
Factors contributing to exacerbations:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, carious teeth, hepatitis);
- Stress;
- Obesity;
- perimenopausal period;
- Drugs (interferons, beta-receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin injuries; Dryness, leading to increased skin trauma.
Clinical classification
There is no uniform classification. One of them:
- vulgar (common);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis of the palms and soles;
- pustular psoriasis.
Characteristics of the river:
- They get sick at any age; Cases of psoriasis in children are not uncommon;
- Men and women get sick equally;
- worldwide distribution;
- There are summer, winter and mixed seasonality of exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of the keratinization of the skin with the production of insufficiently mature keratinocytes. Pinkish-red rashes appear, covered with silvery-white scales.
A triad of symptoms is characteristic, based on which a diagnosis can be made:
- Symptom of a stearin spot – when scratching, the number of scales increases;
- the psoriasis film phenomenon – when all the scales are scraped off, a smooth, shiny red surface appears;
- a symptom of pinpoint bleeding - drops of blood appear when the film is scraped off. This is due to uneven stretching of the papillae in the dermis, expansion of the capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start in spots and develop into large areas of damage.
- Psoriasis on the hands is most often localized on the extensor sides.
- Psoriasis on the face – the rash often appears behind the ears, on the forehead. It is an independent factor in improving treatment.
- Psoriasis on the scalp is an isolated form that does not affect the hair. The elements of the rash are located along the edge of the hair, the "psoriatic crown".
- Psoriasis of the nails – leads to characteristic changes, pinpoint depressions, the nail looks like a thimble. It may also happen that the nail becomes thicker, becomes dull, or yellow spots appear under the nail.
- Psoriatic arthritis – affects peripheral joints with or without pain, often with inflammation at the attachment of the ligaments to the bone, the ligaments themselves, and the fingers.
Features of psoriasis in children
They are characterized by the presence of one or more elements up to 1 cm and protrude above the surface of the skin. Itching is more severe in children than in adults. After scratching, the area bleeds and sores form. In children, psoriasis is often localized in the perineal area as a large red spot. In teenagers, spots appear on the palms of the hands and soles of the feet.
There are three stages of psoriasis:
- Progressive – the elements of the rash increase and have a uniform white color with a narrow red border along the edge;
- Stationary - the growth of the spot stops, a 2-5 mm wide strip of lighter skin appears at the edge;
- Regressive stage – the scales gradually fall off, the spot diminishes and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients turn to a general practitioner, dermatovenereologist or rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of skin rashes, itching, pain, swelling and tenderness of the joints), anamnesis (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). The examination reveals changes to the skin and joints.
Laboratory tests are carried out:
- general blood test (including white blood cell count, ESR, platelets);
- general urinalysis;
- biochemical analysis (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
- in difficult situations, a skin biopsy is performed with further pathohistological examination (severe acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of clusters of 4-6 or more elements);
- before prescribing biological treatment, an examination for HIV, viral hepatitis B and C, and tuberculosis is carried out;
- X-ray of the affected joints;
- CT and MRI for axial lesions;
- ECG.
If necessary, consultations are carried out with an infectious disease specialist, a doctor, an orthopedic traumatologist, a surgeon and other specialists.
When diagnosing psoriasis, it is worth excluding diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, Zhiber rosea and papular syphilid.
The severity of psoriasis is determined by BSA (Body Surface Area - the area of skin affected by psoriasis), PASI (Psoriasis Area and Severity Index - index of the prevalence and severity of psoriasis) and DLQI (Dermatology Life Quality Index - dermatological quality of life index).
The PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (ClASsification criteria for psoriatic arthritis) criteria are used to diagnose psoriatic arthritis.
Treatment of psoriasis
Treatment is complex and is aimed at eliminating inflammation and normalizing proliferation and differentiation of keratinocytes.
Local therapy:
- Ointments and creams with vitamin D3 and its analogues;
- calcineurin inhibitors;
- Glucocorticoids for local use;
- Phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological medicines.
For psoriatic arthritis use:
- Non-steroidal anti-inflammatory drugs;
- disease-modifying drugs;
- intra-articular injections of glucocorticoids;
- biological medicines.
In chronic cases, the use of anti-psoriasis ointments is recommended; in exacerbations, anti-psoriasis creams are used.
When applying ointment or cream, do not rub it into the skin or apply a bandage. This may increase the penetration of the drug into the skin and cause side effects.
It is not recommended to use hormonal ointments for more than 4 weeks. Incorrect dosage of medication can either be ineffective or cause side effects. The expected treatment effect occurs after 1-2 weeks of use.
There are different ways to use creams and ointments for psoriasis that contain glucocorticoids:
- continuous mode;
- tandem therapy mode;
- descending therapy regimen;
- Step application mode.
It is worth noting that treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis by applying ointments and creams directly to the affected area. For more severe forms, treatment is carried out in hospitals with phototherapy, systemic therapy and biological medications.
The course of the disease is considered moderate and systemic treatment can be started in the following cases:
- Areas of skin of aesthetic importance are affected;
- large areas of the head are affected;
- the external genitals are affected;
- Palms and soles are affected;
- at least 2 nails are affected;
- There are individual elements that cannot be handled locally.
Systemic therapy is carried out only in the hospital under strict medical guidance, as systemic treatment is associated with a large number of side effects that can be reduced by choosing an individual treatment.
General recommendations for patients with psoriasis:
- minimize skin trauma and drying;
- After applying psoriasis creams and ointments to your hands, wear gloves to prevent the medication from getting into your eyes.
- Use sunscreen with an SPF of 30;
- avoid stressful situations, if necessary consult a psychologist;
- Control your weight, eat sensibly.
Diet for psoriasis
Recommended:
- Alkaline drink 1200-1600 ml daily;
- use of lecithin;
- Vegetables and fruits;
- Porridge;
- lean meat and fish;
- Dairy products.
Not recommended:
- citrus fruits;
- Bread made from high quality flour;
- fatty fish and meat;
- high-fat dairy products;
- Coffee – no more than 3 cups per day;
- products containing yeast;
- Alcohol, sweets, pickling, smoked, spicy.