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. When the joints are damaged, their mobility is limited, which can lead to disability of the patient.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only theories about the origin:
- neurogenic (appearance of rash after stress, burns, mental trauma);
- endocrine (especially during perimenopause);
- metabolic (fat metabolism disorder);
- contagious;
- viral (psoriatic antigens are isolated from healthy people, but with a high probability of developing psoriasis in the future, while psoriasis is a non-infectious disease);
- genetic.
Psoriasis can be traced to an entire generation of people with the same risk factors. But the type of inheritance is assumed to be multifactorial. If one of the parents is sick, then the child has a 25% chance of getting sick. If both parents are sick - 60-75%.
Viral and genetic theories remain leading.
Factors that contribute to the worsening of the condition:
- infectious and parasitic diseases, including transmission (HIV, tonsillitis, tooth decay, hepatitis);
- stress;
- obesity;
- perimenopause period;
- drugs (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin injuries; dryness, which leads to increased skin trauma.
Clinical classification
There is no single classification. One of them:
- vulgar (ordinary);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis of the palms and soles;
- pustular psoriasis.
Flow characteristics:
- they get sick at any age, cases of psoriasis in children are not rare;
- men and women are affected equally;
- worldwide distribution;
- There are summer, winter and mixed seasonal exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of 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, thanks to which a diagnosis can be made:
- stearic stain symptom - when scraped, the number of scales increases;
- psoriatic film phenomenon - when all the scales are scraped off, a smooth shiny red surface appears;
- a symptom of precise bleeding - when the film is scraped, drops of blood appear. This is due to the uneven elongation of papillae in the dermis, expansion of capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start as a spot and merge into large areas of damage.
- Psoriasis on the hands is most often localized on the extensor surfaces.
- Psoriasis on the face - the rash often appears behind the ears, on the forehead. It is an independent factor for improving treatment.
- Psoriasis on the scalp is an isolated form, it does not affect the hair, elements of the rash are located along the edge of the hair, "psoriasis crown".
- Nail psoriasis - leads to characteristic changes, precise depressions, the nail looks like a thimble. It can also thicken, become dull, or yellow spots form under the nail.
- Psoriatic arthritis - affects peripheral joints with or without pain, often with inflammation at the point of attachment of the ligaments to the bone, the ligaments themselves and the fingers.
Characteristics of psoriasis in children
They are characterized by the presence of one or more elements up to 1 cm, rising above the surface of the skin. Itching in children is more pronounced than in adults. After scratching, the site bleeds and sores form. In children, psoriasis is often localized in the perineal area as a large red patch. In teenagers, the spots appear on the palms and soles.
There are three stages of psoriasis:
- Progressive - the elements of the rash increase, they are uniform white in color, with a narrow red border along the edge;
- Stationary - the growth of the spot stops, a strip of paler skin 2-5 mm wide appears along the edge;
- Regressive stage - the scales gradually fall off, the spot shrinks and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients turn to a general practitioner, dermatovenerologist or rheumatologist (due to psoriatic arthritis). The doctor collects complaints (presence of rash, itching, pain, swelling and tenderness of joints), history (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, accompanying diseases). Examination reveals changes in the skin and joints.
Laboratory tests are carried out:
- general blood test (including number of leukocytes, ESR, platelets);
- general urinalysis;
- biochemical analyzes (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total proteins, CRP, rheumatoid factor);
- in severe situations, a skin biopsy is performed with further pathohistological examination (sharply expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements);
- before prescribing biological treatment, an examination is performed for HIV, viral hepatitis B and C, and tuberculosis;
- radiography of the affected joints;
- CT and MRI for axial lesions;
- EKG.
If necessary, consultations are held with an infectious disease specialist, a phtisiatrist, 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 syphilis.
The severity of psoriasis is determined according to BSA (body surface area - skin area affected by psoriasis), PASI (psoriasis area and severity index - psoriasis prevalence and severity index), DLQI (dermatological quality of life index - dermatological quality of life index).
PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (Classification Criteria for Psoriatic Arthritis) criteria are used to diagnose psoriatic arthritis.
Treatment of psoriasis
The treatment is complex, aimed at removing inflammation, normalizing the 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 drugs.
For psoriatic arthritis use:
- non-steroidal anti-inflammatory drugs;
- disease modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
For chronic cases, the use of psoriasis ointment is recommended, and for exacerbations, psoriasis creams are used.
When applying the ointment or cream, do not rub it into the skin or apply a bandage. This can 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. Improper dosing of medications can be ineffective or cause side effects. The expected effect of the treatment appears after 1-2 weeks of use.
There are several ways to use psoriasis creams and ointments that contain glucocorticoids:
- continuous mode of operation;
- method of tandem therapy;
- descending therapeutic regimen;
- gradual way of application.
It is worth noting that the treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis with the help of ointments and creams directly on the affected area. In more severe cases, treatment is carried out in hospitals with phototherapy, systemic therapy and biological drugs.
The course of the disease is considered moderate, and systemic treatment can be started in the following cases:
- skin areas of aesthetic importance are affected;
- large areas of the head are affected;
- the external genitalia are affected;
- palms and soles are affected;
- at least 2 nails are affected;
- There are individual elements that cannot be treated locally.
Systemic therapy is carried out only in a hospital, under the strict supervision of a doctor, because systemic treatment is associated with a wide range of side effects, which can be reduced by choosing individual treatment.
General recommendations for patients with psoriasis:
- reduce trauma and drying of the skin;
- after applying psoriasis creams and ointments to your hands, use gloves to prevent the medicine from getting into your eyes;
- use sun creams with protection factor 30;
- avoid stressful situations, consult a psychologist if necessary;
- control your weight, eat rationally.
Diet for psoriasis
Recommended:
- alkaline drink 1200-1600 ml per day;
- use of lecithin;
- vegetables and fruits;
- porridge;
- lean meat and fish;
- milk products.
Not recommended:
- citrus fruits;
- bread made from premium flour;
- fatty fish and meat;
- high-fat dairy products;
- coffee - no more than 3 cups a day;
- yeast products;
- alcohol, sweets, pickling, smoked, spicy.