Psoriasis is an inflammatory skin disease. It occurs when the immune system is damaged. The development of the disease is divided into clear phases - onset, progression, stabilization and regression. The different stages of psoriasis differ in the appearance of spots and rashes, painful itching and extensive inflammation of the skin.
Why is it necessary to distinguish the stages of disease development and what are the characteristics of the course of psoriasis at the beginning of development and in the process of recovery?
Why you need to know the stages of psoriasis
Doctors use the division of psoriasis into stages for the correct choice of therapeutic methods. The complex of drugs and external means prescribed for the treatment of inflammation depends on the stage of development of the disease. At the beginning of the manifestation of the disease requires general therapy - vitamin complexes, diet, external aseptic treatment of the rash, for example, a course of UV procedures. Medicines that stimulate the cleansing of the intestines, blood vessels, and liver are also prescribed. Be sure to correct the psycho-emotional state - by a neuropathologist or psychologist.
In the initial stage of the disease do not use powerful drugs that quench the immune system, do not prescribe hormonal fats. These drugs have a large list of side effects, so they are prescribed only when it is impossible without them.
Psoriasis: treatment in the acute phase and in remission
In case of acute progressive course of the disease, several drugs of different action are prescribed. Immunosuppressants and glucocorticosteroids are often used to relieve inflammation and reduce itching. External treatments are complemented by photochemical, ultrasound and laser therapy. Also, means for antiseptic treatment of damaged skin are prescribed.
In a stabilized state, they continue to take anti-inflammatory hormonal drugs, gradually reducing the dose. Ointments with a regenerating effect are prescribed to repair damaged skin.
In remission - support the body. Proper nutrition, take vitamin and mineral complexes to restore immunity.
Timeliness of treatment
The earlier treatment is started, the easier it is to control psoriasis. Timely therapy limits the spread of skin inflammation, reduces its extent and prevents subsequent relapses of peeling. Since psoriasis at an early stage is often mistaken for an allergic rash, it is necessary to know its initial signs so as not to miss the appearance of skin disease.
Note: Doctors are still investigating the causes of psoriasis. But it is definitely known that psoriatic skin inflammation is not contagious. It cannot be picked up by a sick person or an infection in case of injury. This is our own, personal failure in the human body.
The cause of psoriasis is an immune failure that can be caused by various factors. Severe stress, poisoning (including powerful drugs, industrial waste, alcohol), previous infection.
Psoriasis is difficult to treat. The disease is prone to recurrence, relapse. And the therapy itself is symptomatic. It consists of preventing the appearance of new spots and alleviating the existing itching on the skin.
What stage of psoriasis is called initial? How to distinguish early psoriasis from diathesis rash? And how will the disease develop in the future?
Psoriasis: initial stage
The first appearance of psoriasis on the skin looks like acne. The rash most often appears on the bends of the elbows and knees or in places where the clothes are pressed tightly against the body (for example, below the waist). The rash 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.
Psoriasis almost always manifests symmetrically - on the elbows of both hands, on both sides of the lower back or on two knees. The pimples themselves (in medical terminology - papules) in the initial phase have a modest appearance. They have:
- Pink or red;
- Sharp, blurred edge;
- Small size - pimple at the base does not exceed 2 mm;
- Flat shape - small pimples at the beginning of the disease have almost no protrusions, so they look like spots.
As the disease progresses, flaky skin flakes appear on the pimples. They are gray or silvery, on the background of a red pimple they appear white.
The appearance of scales is accompanied by severe itching. If you do not resist and scratch, the scales are removed, revealing shiny areas of pink young skin underneath. She is very thin, vulnerable, with a long scratching of itchy papules - she is injured, bleeding.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: progression phase
In the progressive phase, individual pimples merge into a common place, forming so-called psoriatic plaques. They are raised above the surface of the skin and are almost completely covered with peeling. On the edges of the psoriatic plaques there is a pinkish-red edge that does not peel.
The presence of an edge is a sign of a progressive stage of the disease. The width of the rim is 1-2 mm. The skin on it is inflamed, reminiscent in structure of parchment paper.
The rim represents the area of spreading the stain. This is skin that has already become inflamed but is not yet peeling. After a while, it will be covered with scales. And the patch will expand to cover new areas of skin and form a new wider edge.
With the active development of the disease, the neighboring places merge with each other. At some point, a large, inflamed red spot can form on the human body.
Psoriatic deposits are very itchy, giving a person unpleasant sensations, interfering with his work, rest and sleep. They grow, occupy a large area and create a new rash on clean, healthy skin.
The main sign of a progressive phase is the appearance of new rashes. As soon as new pimples and blemishes stop appearing, the next stage of psoriasis begins - stationary. This is not yet a complete victory, but it is already a turnaround towards recovery.
In the progression phase, psoriasis is almost always accompanied by weakness, fatigue, weakness. Depression is common. Possible temperature.
The duration of the progressive phase of psoriasis can be long, several months.
Psoriasis: stationary stage
The main sign of a stationary stage is the cessation of the appearance of new spots and rashes. At the same time, the itching also weakens, it becomes more bearable. The rash loses its bright color, becomes colorless, becomes invisible. This is also one of the signs that the process is stabilizing.
The pink streaks around the perimeter of the plaque disappear as the inflammation stops spreading. Active peeling and healing begins, regeneration of new healthy skin.
It is noticeable to the naked eye that peeling increases in the stationary stage. The scale completely covers the entire surface of the psoriatic site, leaving no room for edges. Psoriasis takes on a characteristic scaly appearance that is generally recognized by the general public.
Extensive peeling in the stationary stage is not dangerous. When all the dead cells leave the surface of the psoriatic site, healthy skin with a slight light shade will remain in their place.
Other signs of progress or stabilization
In addition to the appearance of rashes, spots and peeling, there are a number of other signs that can be used to judge the development of the disease. This is the nature of the feeling of itching (strong or bearable), general condition, depressed mood. And also the presence of temperature.
In the initial stage, the itching is variable and the rash is incomprehensible. Furthermore, the itching intensifies every day. In the acute phase, psoriasis becomes unbearable. It interferes with sleep, rest, interferes with work. The person becomes irritable because the feelings of itching do not give him a chance to rest.
In the stationary phase, the itching subsides. Every day - the person feels better. The general state of the psyche changes, negativity and depressed moods weaken. The duration of the stationary phase lasts several weeks - from 2 to 5.
Psoriasis in the weakening phase
The fading phase of psoriasis is the almost complete disappearance of deposits, spots, redness, inflammation, itching. At this stage of the disease psoriasis only resembles different skin pigmentation. Instead of the former psoriatic spots, it looks brighter. The surface of healthy skin has a darker shade.
In some cases, so-called hyperpigmentation occurs. The skin at the site of psoriasis spots does not become lighter, but darker. In any case, the differences in skin pigmentation will be visible for another one to two months.
Post-recovery psoriasis: the possibility of recurrence
The possibility of psoriasis recurrence is determined by lifestyle, diet, allergic mood and the condition of the body as a whole. It is also determined by the amount of toxins in his body, blood, liver. You can reduce the likelihood of recurrent skin inflammation if you strengthen the immune system and cleanse the body of toxins in the liver, blood vessels and intestines.
Seasonal relapses of psoriasis are often rare after cleansing. The person remains susceptible to the disease, but the probability of its occurrence is noticeably reduced.
Cleansing the body of toxins and taking vitamin-mineral complexes help boost immunity. This is especially important if immunosuppressants are used during treatment, in the progressive phase of psoriasis. Their need was the result of the work of inflammation mediators. After suppressing the autoimmune defense, it is necessary to renew the immune system.
Clinical manifestations
Psoriasis is characterized by monomorphic eruptions in the form of papules (nodules) of various sizes, when combined, they form plaques and can spread across the skin.
At the onset of the disease, in most cases the rash is limited and is represented by individual plaques at the sites of its favorite localization (scalp, extensor surface of the elbow, knee joints, sacral region, etc. ).
Plaques are clearly demarcated from healthy skin, bright pink or dark red, covered with loose silvery-white scales, when scraped you can get a triad of phenomena characteristic of psoriasis - "stearin stain", "terminal 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 rash, the severity of the patient's condition and other clinical signs, there are frequent plaque psoriasis, exudative, arthropathic, pustular, psoriatic erythroderma, wrinkle psoriasis, psoriasis of the palms and soles. It should be noted that different clinical variants may co-exist in a single patient.
Exudative psoriasis is characterized by a pronounced inflammatory reaction of the skin, which is manifested by the presence of lamellar scales on the surface of plaques, sometimes multilayered, which look like a puff pastry (in such cases this form of psoriasis is called rupioid). When the flakes are removed from the flakes, a weeping surface is revealed.
Arthropathic psoriasis in the clinical picture has, in addition to the usual plaque eruptions, also joints, often small, distal, rarely large.
Arthropathy may occur in the presence of skin lesions or precede them. Psoriatic arthritis is manifested by pain, swelling, limited mobility of the affected joints of varying intensity, from minor arthralgias of individual joints to generalized lesions and disability 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 damage with relatively limited skin rash is possible.
Pustular psoriasis can be generalized (Tsumbusha) and limited, involving the palms and soles (Barbera). Stressful situations, infections, irrational general or local therapy contribute to the development of this severe form of psoriasis.
Generalized pustular psoriasis occurs with fever, leukocytosis, increased ESR, and general seriousness. Suddenly, on the background of bright erythema appear small superficial pustules, accompanied by a feeling of burning, soreness, can be found in the area of ordinary plaques and on previously unaltered skin. The new foci of pustulation look paroxysmal and occupy large areas of the skin. Merged pustules cause separation of the epidermis in the form of "purulent lakes", erythroderma can develop.
Limited pustular psoriasis is more common, the rash is mainly localized on the palms and soles in the form of pustules in the background of erythema and skin infiltration. The course is, in comparison with the generalized, milder, with a satisfactory general condition, but persistent, with frequent relapses. Irritant local therapy is a provoking factor.
Psoriatic erythroderma is a severe form of psoriasis that develops with the gradual progression of the psoriatic process and the fusion of plaque elements to the defeat of the whole skin, characterized by severe hyperemia, edema, skin infiltration with abundant large and small lamellar, rarely pityriasis peeling. Subjective - severe itching is often noticed. 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. ).
Wrinkle psoriasis is more common in children and the elderly, especially in patients with diabetes mellitus. The lesions are located in the armpit, under the mammary glands, in the perineum, inguinal-femoral folds, in the navel and are characterized by sharp borders, saturated red color and mild peeling.
Psoriasis of the palms and soles may exist in isolation or simultaneously with lesions of other areas of the skin, characterized by the formation of hyperkeratotic foci with clear borders, covered with scales that are difficult to scrape and the presence of painful cracks. The characteristic psoriatic triad is hard to conjure up.
Three clinical stages of psoriasis
Progress phase. Under the influence of provoking factors (trauma, psycho-emotional stress, infectious diseases, inadequate treatment methods, etc. ), exacerbation of the disease may develop by the appearance of abundant small nodules prone to peripheral growth, and the formation of plaques of various sizes and shapes, which can be isolated or occupy large areasskin to universal skin lesions.
The progressive phase is characterized by the symptom of an isomorphic reaction (Kebner phenomenon), which is characterized by the fact that typical psoriatic eruptions occur at the site of injury, even more easily.
Stationary stage. In the stationary phase, the appearance of new elements stops and the tendency of peripheral growth of existing plaques disappears.
Regression phase. The regressive stage is characterized by a decrease in the intensity of plaque color, their smoothing, reduction of desquamation, infiltration, resorption of elements with subsequent formation of foci of hypo- or hyperpigmentation at the site of previous rashes.
Treatment
Treatment of psoriasis is aimed at suppressing the proliferation of epithelial cells and removing the inflammatory process and is prescribed taking into account anamnestic data, shape, stage, prevalence of the process, comorbidities, age and sex of the patient, contraindications for a particular method of treatment or drug.
For mild, limited manifestations of psoriasis, topical 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 using detoxification, desensitization, anti-inflammatory drugs of different groups, physiotherapeutic methods of therapy, external drugs, etc.
This section will present the most up-to-date and effective methods and means for the treatment of psoriasis.
Systemic therapy
There are special features of patient management in different phases of the psoriatic process. Treatment of the advanced stage requires special attention. During this period, hemodesis is prescribed intravenous drip, 30 percent. sodium thiosulfate solution and / v, 10% calcium gluconate solution, with concomitant hypertension, it is desirable to apply a solution of magnesium sulfate; emollient creams or 1-2 percent are used externally. 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 to 20-30 mg per day, depending on the severity of the skin process. The mechanism of action of acitretin is inhibition of epidermal cell proliferation, normalization of keratinization process. The drug is particularly effective in combination with PUVA therapy. When prescribing acitretin, its teratogenic effect should not be forgotten.
Cytostatics.Methotrexate is used in cases of persistent psoriasis and the presence of contraindications for other methods of treatment, since it is a folic acid antagonist, it acts mainly on actively proliferating cells. Very toxic. There are many routes of administration, preferably intramuscular injection once a week under strict laboratory control.
Immunosuppressants.Cyclosporine-A is prescribed in cases of severe psoriasis resistant to other therapies. This drug has an immunosuppressive effect, inhibits cell growth processes, suppresses the secretion of activated cytokine lymphocytes and the expression of interleukin-1 receptors on immunocompetent cells. In psoriasis, it is prescribed at a rate of 5 mg per 1 kg of body weight per day.
Nonsteroidal anti-inflammatory drugsare prescribed for arthropathic psoriasis, as well as to reduce acute inflammation in exudative psoriasis and erythroderma. Daily doses of medication and 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, leading to the development of torpid forms of the disease, resistant to various types of therapy. In cases of severe arthropathic psoriasis, intra-articular administration of prolonged corticosteroids is possible, and the dose and duration of treatment 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 drugs furocoumarin. The use of photosensitizers is the result of their ability to increase the skin's sensitivity to ultraviolet rays and stimulate the production of melanin. PUVA therapy leads to inhibition of cell proliferation, suppression of pathological keratinization, affects prostaglandin metabolism, permeability of cell membranes. The peak of the photosensitization effect occurs 1-3 hours after taking 8-methoxypsoralene. The dose of the drug is selected taking into account the weight of the patient. Procedures are issued 3-4 times a week, during 20-25 sessions.
Local PCT is also used using external photosensitizers.
The combined use of PUVA therapy and retinoids is called Re-PUVA therapy. It has the greatest clinical effect in cases of severe psoriasis.
Selective phototherapy (SFT) - ultraviolet radiation in the medium wave spectrum (wavelength 280-320 nm) without taking photosensitizers. SFT is used for less pronounced manifestations of the disease, the presence of contraindications for the appointment of PUVA therapy.
How to recognize psoriasis at an early stage
Psoriasis treatment 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 can recognize this disease in yourself by several characteristic signs:
- Psoriasis most often manifests itself on the folds of the arms and legs, on the hairline or where the clothes are in close contact with the body or rubbed - under the waist of pants, various elastic bands or straps.
- At the beginning of the disease there is a very itchy rash covered with gray or silvery scales of the skin that are very easy to remove.
- Removing the scales reveals thin, shiny and slightly moist skin.
- If you scrape the tile with something like a spatula, removing 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 self-determination of psoriasis - it is very easy to infect it.
For complete confidence, you must visit a doctor because patients themselves often confuse psoriasis with various types of lichen or allergic dermatitis and use inappropriate medications for treatment.
What to do if you discover the symptoms of the initial stage of psoriasis?
Psoriasis cannot be cured once and for all, so the main goal of therapy is to achieve stable and longest possible remission. You should be aware that without proper treatment, psoriasis quickly becomes chronic: exacerbations can occur up to 9 times a year, lasting up to 15 days.
What to do if you suspect you have psoriasis? Often people, discovering the signs of this disease in themselves, make a big mistake by resorting to "heavy artillery" - hormonal fats (so-called local glucocorticosteroids or THCS), without consulting a doctor. Usually, patients explain such a step by the fact that they allegedly heard from a friend that such means help quickly. This is a big mistake!
What is the danger of such self-medication? Hormonal ointments for psoriasis have a lot of side effects and contraindications. It is highly undesirable to use them without a strict doctor's recommendation on the duration of use, 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 drug for the treatment of psoriasis, which has a complex effect:
- suppresses excessive proliferation and inflammation of skin cells, reducing peeling and the formation of psoriatic plaque;
- relieves itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the protective functions of the skin.