Psoriasis is an inflammatory skin disease. Occurs when the immune system fails. The development of the disease is divided into clear stages - onset, progression, stabilization and regression. Different stages of psoriasis differ in the appearance of spots and rashes, itching, and widespread skin inflammation.
Why is it necessary to distinguish between the stages of development of the disease and the features of the course of psoriasis at the beginning of development and in the recovery process?
Why you need to know the stages of psoriasis
The division of psoriasis into stages is used by doctors for the correct choice of therapeutic methods. A complex of drugs and external agents that are prescribed to treat inflammation depends on the stage of development of the disease. At the beginning of the manifestation of the disease, general therapy is required - vitamin complexes, nutrition, external aseptic treatment of the rash, for example, a number of UV procedures. Also prescribed drugs that stimulate cleansing of the intestines, blood vessels, liver. Make sure you have a correction of the psychoemotional state - through a neuropathologist or psychologist.
In the initial stages of the disease, they do not use effective drugs that destroy the immune system and do not prescribe hormonal ointments. These drugs have a large list of side effects, so they are only prescribed when it is impossible to do without them.
Psoriasis: treatment in the acute stage and in remission
In the case of an acute progressive course of the disease, several drugs with different effects are prescribed. Immunosuppressants and glucocorticosteroids are commonly used to relieve inflammation and reduce itching. External treatments are complemented by photochemistry, ultrasound and laser therapy. Means for antiseptic treatment of damaged skin are also prescribed.
In a stabilized state, continue taking anti-inflammatory hormones and gradually reduce your dose. To restore damaged skin, ointments with a regenerating effect are prescribed.
In remission - support the body. Eating proper nutrition, vitamin complexes and minerals to restore immunity.
Actuality of the treatment
The earlier treatment is started, the easier it is to get psoriasis under control. Timely therapy limits the spread of skin inflammation, reduces its extent and prevents subsequent relapses of the peeling. Since psoriasis is often mistaken for an allergic rash at an early stage, it is necessary to know the first signs in order not to miss the appearance of a skin disease.
Note: Doctors are still investigating the causes of psoriasis. However, it is definitely known that psoriatic inflammation of the skin is not contagious. It cannot be absorbed by a sick person or an infection in the event of an injury. This is our own personal failure in the human body.
The cause of psoriasis is immune failure, which can be caused by various factors. Excessive stress, poisoning (including effective drugs, industrial emissions, alcohol), previous infections.
Psoriasis is difficult to treat. The disease is prone to relapses, relapses. And the therapy itself is symptomatic. It consists in preventing new spots from appearing and relieving existing itchy skin.
Which stage of psoriasis is referred to as initial? How to distinguish early psoriasis from diathesis rashAnd how will the disease develop in the future?
Psoriasis: initial stage
The first appearance of psoriasis on the skin looks like pimples. Most often, the rash occurs on the bends of the elbows and knees, or in places where clothing is pressed tightly against the body (for example, under the belt at the waist). Rashes can also appear along the edge of the hair and under the hair, around the nails and on the nail plates. Sometimes psoriasis occurs on the feet and palms.
Almost always psoriasis manifests itself symmetrically - on the elbows of both hands or on both sides of the lower back or on two knees. The pimples themselves (in medical terminology - papules) have a modest appearance in the initial stages. You have:
- pink or red;
- Sharp, blurred edge;
- Small size - pimples at the base do not exceed 2 mm;
- Flat shape - small point-like pimples at the onset of the disease have almost no bulge, so they look like spots.
As the disease progresses, flakes of skin appear on pimples. They are gray or silvery, appear white against the background of a red pimple.
The appearance of dandruff is accompanied by severe itching. Failure to resist and scratch will remove the scales, exposing the shiny areas of pink young skin underneath. It is very thin, vulnerable, with prolonged scratching of the itchy papules - it is injured, bleeding.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: stage of progression
In the progressive stage, individual pimples merge into a common place and form what are known as psoriasis plaques. They are raised above the surface of the skin and almost completely covered with peeling. At the edges of the psoriatic plaques there is a non-peeling pink border.
The presence of a border is a sign of a progressive stage of the disease. The rim width is 1-2 mm. The skin on it is inflamed and has a structure similar to parchment paper.
The border represents the expansion area of the spot. This is the skin that is already inflamed but not peeling off. After a while, it will also be covered with scales. The patch will widen to cover new areas of skin and create a new, wider edge.
With active development of the disease, adjacent spots merge with each other. At some point, a large, inflamed red spot can form on the human body.
Psoriasis plaques are very itchy, give a person unpleasant sensations, interfere with their work, rest and sleep. They grow, take up a large area, and form a new rash on clean, healthy skin.
The main sign of the progressive phase is the appearance of new rashes. As soon as there are no more new pimples and spots, the next stage of psoriasis begins - stationary. This is not yet a complete victory, but it is already a turning point towards recovery.
In the stage of progression, psoriasis is almost always accompanied by weakness, fatigue and weakness. Depression is common. Temperature possible.
The progressive stage of psoriasis can last for several months.
Psoriasis: stationary stage
The main sign of the stationary stage is the cessation of the appearance of new spots and rashes. At the same time, the itching weakens and becomes more bearable. The rash loses its light color, discolor, becomes invisible. This is also one of the signs that the process is stabilizing.
The pink bands around the perimeter of the plaques will disappear when the inflammation stops spreading. Active peeling and healing begin, regeneration of new healthy skin.
With the naked eye it is noticeable that the peeling increases in the stationary stage. The scales completely cover the entire surface of the psoriasis patch, leaving no room for the rims. Psoriasis takes on the characteristic scaly appearance that is widely recognized by the public.
Extensive peeling in the stationary stage is not dangerous. When all of the dead cells break away from the surface of the psoriatic patch, healthy skin with a slight shade of light will remain in place.
Other signs of progression or stabilization
In addition to the appearance of a rash, spots, and scales, there are a number of other signs that can be used to assess the development of the disease. This is the nature of itching (severe or tolerable), general condition, depressed mood. And also the presence of temperature.
In the initial stage, the itching is variable and the rash is incomprehensible. In addition, the itching increases every day. In the acute stage of psoriasis, it becomes unbearable. Disturbs sleep, rests, disrupts work. The person becomes irritable because the sensations of itching are not giving them an opportunity to rest.
In the stationary stage, the itching subsides. Every day - a person feels better. The general state of the psyche changes, negativity and depressive moods weaken. The duration of the stationary phase is several weeks - from 2 to 5.
Psoriasis in the weakening stage
The fading stage of psoriasis is the almost complete disappearance of plaques, spots, redness, inflammation, and itching. At this stage of the disease, psoriasis is only reminiscent of different skin pigmentations. Instead of the earlier psoriasis patches, it looks lighter. The surface of healthy skin is darker in color.
In some cases, so-called hyperpigmentation occurs. The skin at the site of the psoriasis patch does not get lighter, but darker. In either case, differences in skin pigmentation will be visible for one to two months.
Post-recovery psoriasis: the possibility of relapse
The possibility of psoriasis recurrence is determined by the person's lifestyle, diet, allergic mood, and the condition of the entire body. It is also determined by the amount of toxins in his body, blood, liver. Strengthening the immune system and clearing the body of toxins in the liver, blood vessels and intestines can reduce the chances of recurring skin inflammation.
Seasonal relapses of psoriasis are often rare after cleansing. A person remains susceptible to disease, but the likelihood of their occurrence is noticeably reduced.
Cleansing the body of toxins and taking vitamin and mineral complexes help strengthen immunity. This is especially important if immunosuppressants were used during treatment in the progressive stage of psoriasis. Their need stemmed from the work of inflammation mediators. After suppressing the autoimmune defense, the immune system must be restored.
Clinical manifestations
Psoriasis is characterized by monomorphic eruptions in the form of papules (nodules) of various sizes when they fuse, plaques form, and spread to the skin.
At the onset of the disease, the rash is limited in most cases and is represented by individual plaques in the places of its preferred localization (scalp, extensor surface of the elbow, knee joints, sacrum region, etc. ).
Plaques are clearly delineated from healthy skin, light pink or deep red, covered with loose silver-white scales. If you are scraped off, you can get a triad of phenomena characteristic of psoriasis - "stearin stain", "final film", "blood dew". . .
There are 3 clinical stages of psoriasis: progressive, stationary and regressive.
Classification
Depending on the degree of the inflammatory process, the predominant localization of the rashes, the severity of the patient's condition and other clinical symptoms, plaque psoriasis, exudative, arthropathic, pustular, psoriatic erythroderma, wrinkle psoriasis, psoriasis of the palms of the hands and soles of the feet often appear. It should be noted that different clinical variants can exist in one patient at the same time.
Exudative psoriasis is characterized by a pronounced inflammatory reaction of the skin, which is manifested by the presence of lamellar scaly crusts on the surface of plaques, sometimes multilayered and resembling a puff cake in appearance (in such cases, this form of psoriasis is called rupioid). When the flake crusts are removed, a weeping surface is exposed.
Arthropathic psoriasis in the clinical picture shows, in addition to the usual plaque eruptions, lesions of the joints, often small, distal, more rarely large.
Arthropathy can occur or precede skin lesions. Psoriatic arthritis manifests itself in pain, swelling and limited mobility of the affected joints of varying intensity, from minor arthralgias of individual joints to generalized lesions and disabilities of patients. The possibility of arthropathic psoriasis is higher in patients with severe skin manifestations (psoriatic erythroderma, pustular psoriasis), but a combination of severe joint lesions with relatively limited rashes is possible.
Pustular psoriasis can be generalized (tsumbusha) and limited, affecting the palms and soles of the feet (barbera). Stressful situations, infections, irrational general or local therapy all contribute to the development of this severe form of psoriasis.
Generalized pustular psoriasis occurs with fever, leukocytosis, increased ESR and a generally serious illness. Suddenly, against the background of bright erythema, small superficial pustules appear, accompanied by burning and pain. They can be in the area of common plaques and on previously unchanged skin. New foci of pustulation appear paroxysmal and occupy large areas of the skin. Merged pustules cause the epidermis to become detached in the form of "purulent lakes"; erythroderma can develop.
Limited pustular psoriasis is more common, the rash is localized mainly on the palms and soles of the feet in the form of pustules against the background of erythema and skin infiltration. The course is milder in comparison to generalized, with a satisfactory general condition, but persistent, with frequent relapses. Irritating local therapy is a provoking factor.
Psoriatic erythroderma is a severe form of psoriasis that develops with the gradual progression of the psoriasis process and the merging of plaque elements to the defeat of the entire skin. Subjective - severe itching is often noted. The disease can begin with erythroderma. The general condition worsens (fever, weakness, lymph node reaction, heart failure, impaired liver and kidney function, changes in blood tests, hair loss, etc. ).
Psoriasis of the wrinkles is more common in children and the elderly, especially in those with diabetes mellitus. The lesions are located in the armpits, under the mammary glands, in the perineum, in the inguinal femur folds, in the navel, and are characterized by sharp borders, saturated red color and easy peeling.
Psoriasis of the palms of the hands and soles of the feet can occur in isolation or at the same time as lesions in other areas of the skin. The characteristic psoriatic triad is difficult to evoke.
Three clinical stages of psoriasis
Progressive phase. Under the influence of provocative factors (trauma, psycho-emotional stress, infectious diseases, inadequate methods of treatment, etc. ), exacerbation of the disease may develop with the appearance of abundant small nodules, prone to peripheral growth, and the formation of plaques of various sizesand shapes that can be isolated or occupy large areas of the skin up to universal skin lesions.
In the progressive stage, a symptom of an isomorphic reaction (Kebner phenomenon) is characteristic, which is characterized by the fact that typical psoriatic eruptions appear at the site of an injury, even if it is a minor one.
Stationary stage. In the stationary stage, the appearance of new elements ceases and the tendency for peripheral growth of existing plaques disappears.
Regressive phase. The regressive stage is characterized by a decrease in the intensity of the color of plaques, their flattening, a decrease in peeling, infiltration, absorption of elements with the subsequent formation of foci of hypo- or hyperpigmentation on the site of previous rashes.
Treatment
Treatment of psoriasis is aimed at suppressing the proliferation of epithelial cells and eliminating the inflammatory process. It is prescribed taking into account the anamnestic data, the form, stage, prevalence of the process, concomitant diseases, age and sex of the patient, contraindications to a particular method of treatment or drug.
For mild, limited manifestations of psoriasis, local external therapy in the form of salicylic ointment, naphthalene preparations, tar or emollient ointments is sufficient. Severe forms of the disease require complex systemic treatment with the use of detoxification, desensitization, anti-inflammatory drugs of different groups, physiotherapy methods of therapy, external drugs, etc.
In this section the available and most modern effective methods and means for psoriasis therapy are presented.
Systemic therapy
There are peculiarities in the treatment of patients at different stages of the psoriasis process. Treatment of the advanced stage requires special care. During this time, Hemodez is prescribed a 30 percent intravenous drip infection. Sodium thiosulfate solution i. v. , 10% calcium gluconate solution with simultaneous hypertension, it is advisable to introduce a solution of magnesium sulfate; emollient creams or 1-2 percent are used topically. Salicylic ointment.
Aromatic retinoids.Acitretin (Neotigazon) - a representative of the second generation of monoaromatic retinoids is used to treat severe forms of psoriasis at a dose of 10-20-30 mg per day, depending on the severity of the skin process. The mechanism of action of acitretin is to inhibit the proliferation of epidermal cells and normalize the processes of keratinization. The drug is particularly effective in combination with PUVA therapy. When prescribing acitretin, the teratogenic effect should not be forgotten.
cytostatics. Methotrexate is used for persistent psoriasis and contraindications to other treatments. As a folic acid antagonist, it mainly acts on actively proliferating cells. Very poisonus. There are many methods of administration, preferably once a week intramuscular administration under strict laboratory control.
immunosuppressants.Cyclosporin-A is prescribed for severe, widespread, and resistant psoriasis to other therapies. This drug has an immunosuppressive effect, has an inhibitory effect on the processes of cell growth, suppresses the secretion of activated lymphocytes of cytokines and the expression of receptors for interleukin-1 on immunocompetent cells. For psoriasis, it is prescribed in the amount of 5 mg per 1 kg of body weight per day.
Non-steroidal anti-inflammatory drugsare prescribed to treat arthropathic psoriasis and to reduce acute inflammation in exudative psoriasis and erythroderma. The daily dose of medication and the duration of treatment depend on the intensity of the pain syndrome, the degree of inflammation and individual tolerance.
The use of systemic corticosteroid drugs in the treatment of psoriasis is considered inappropriate and leads to the development of torpid forms of the disease that are resistant to various types of therapy. In severe arthropathic psoriasis, intra-articular administration of extended corticosteroids is possible. The dose and duration of treatment will depend on the size of the affected joint and the degree of inflammation.
Physiotherapy treatments.One of the most effective treatment methods is PUVA therapy or photochemotherapy (PCT). PCT is a combined application of long-wave ultraviolet radiation (wavelength from 320 to 420 nm) and photosensitizing furocoumarin drugs. The use of photosensitizers is based on their ability to increase the skin's sensitivity to ultraviolet rays and stimulate the formation of melanin. The PUVA therapy leads to the inhibition of cell proliferation, to the suppression of pathological cornification, influences the metabolism of prostaglandins and the permeability of cell membranes. The peak of the photosensitizing effect occurs 1-3 hours after taking 8-methoxypsoralen. The dose of the drug is selected taking into account the weight of the patient. The procedures are published 3-4 times a week for a course of 20-25 sessions.
Local PCT is also used with external photosensitizers.
The combined application of PUVA therapy and retinoids is called Re-PUVA therapy. It has the highest clinical effect in severe psoriasis.
Selective phototherapy (SFT) - ultraviolet radiation in the medium wave spectrum (wavelength 280-320 nm) without the inclusion of photosensitizers. SFT is used for less pronounced manifestations of the disease, the presence of contraindications to the appointment of PUVA therapy.
How to recognize psoriasis early
Treatment of psoriasis is most effective at the earliest stage. That is why it is so important to make a diagnosis on time. Only a dermatologist can tell you if you have psoriasis or some other skin condition. However, you yourself can recognize this disease by several characteristic signs:
- Most often, psoriasis manifests itself first on the folds of the arms and legs, at the hairline or where the clothing is in close contact with the body or rubs under the belt of a pair of pants, various elastic bands or straps.
- At the onset of the disease, a very itchy rash appears, covered with gray or silver flakes of skin that can be removed very easily.
- By removing the scale, a thin, shiny and slightly damp skin becomes visible.
- If you scrape off the plaque with a spatula and remove the scales, blood will appear on the spot in the form of tiny droplets. However, it is better not to use the latter method for psoriasis self-determination - it is very easy to get an infection.
To have full confidence, you need to see a doctor, as often patients themselves confuse psoriasis with different types of lichen or allergic dermatitis and use inappropriate drugs to treat it.
What to do if you find symptoms in the early stages of psoriasis?
Psoriasis cannot be cured once and for all, so the main goal of therapy is to achieve a stable and maximally long-term remission. You should know that psoriasis quickly becomes chronic without proper treatment: exacerbations can occur up to 9 times a year with a duration of up to 15 days.
What to do if you suspect you have psoriasis? Often times, people who have discovered signs of the disease themselves make a big mistake and resort to "heavy artillery" - hormonal ointments (called topical glucocorticosteroids, or THCS), without consulting a doctor. Usually, patients explain such a step by saying that they have supposedly heard from friends that such drugs help quickly. This is a big mistake!
What is the danger of such self-medication? Hormonal ointments for psoriasis have many side effects and contraindications. It is highly undesirable to use them without the strict recommendation of a doctor as to duration, frequency, area of application on the body, as well as without taking into account the individual characteristics of your body.
Non-hormonal agents such as zinc pyrithione should be used to effectively treat early psoriasis. Zinc pyrithione or active zinc is a very effective remedy for psoriasis treatment that has a complex effect:
- suppresses excessive proliferation and inflammation of skin cells and reduces flaking and plaque formation.
- relieves itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the protective functions of the skin.