Psoriasis - Causes, symptoms and treatment. MF.

Causes of
Symptoms of psoriasis
What tests to pass
Treatment of psoriasis
Possible complications
Psoriasis consultation

Psoriasis or squamous is a chronic, often recurring, noninfectious skin disorder prone to damage to the periarticular tissues.

The causes of psoriasis

The most reliable cause of the development of the process is the genetic predisposition, reinforced by the impact of various provoking factors.

It is known that psoriasis can manifest at any age and equally affects men and women. At the same time, various factors of the external and internal environment create favorable conditions for the development of psoriasis. It is noted that the peculiar psoriatic elements of the rash appear on the skin in the zone of its irritation by any mechanical factor, chemical or toxic substances contained in the agents for external use. This process is often preceded by various inflammatory processes on the skin as a result of the action of numerous pathogenic agents of a bacterial or fungal nature. A provoking factor that weakens the body from the inside is streptococcus. A clear pattern is established for the development of a certain form of psoriasis( drop-shaped) in the course of a prolonged course of infection of the upper respiratory tract, such as tonsillitis, bronchitis, and the like. The relationship of hormonal imbalances in the body and the manifestation of the psoriatic process in certain conditions of the body( pubertal period, pregnancy, menopause, aging) indicate the role of estrogens in the development of such skin lesions. The role of various medications, stress, smoking and alcohol( especially beer) as a trigger factor of the psoriatic process was noted.

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Symptoms of psoriasis

The following forms of psoriasis are distinguished:

Plaque is the most typical form, the red color of the papule, clearly bounded, flaky, merge and form foci of different size. Affected extensor surfaces( elbows and knees), scalp, lumbar region. Unprotected are the face, palms, soles. The scales fit tightly together and bleed when they try to remove them.
Guttate psoriasis is characterized by the sudden appearance of numerous specks. It often occurs in young people aged 8-16 years. Often the appearance of this form is preceded by streptococcal infection.
Pustular psoriasis is more often localized on the palms and soles. Appear small sterile pustules, often painful.
Intertriginous - there are eruptions on the folding surfaces and in the area of large folds( inguinal area, under the mammary glands).
Generalized pustular psoriasis is a severe form requiring immediate medical attention. It is accompanied by high fever and soreness.
Erythroderma - a severe form of psoriasis, requires immediate medical intervention. It is accompanied by chills, pain, redness of the whole body.

Usually the disease begins acutely, with the formation in the area of previously injured skin of flat itchy papules pink or red, with clear boundaries, the size of the pin head to the lenticular grain. Almost immediately, these papules are covered with silvery, easily detachable scales. The acute( progressive) period of the disease is characterized by the appearance of new elements of the rash and their rapid peripheral growth. Increasing papules merge, forming plaques of peculiar fanciful forms, covered with silvery scaly elements only in the center, leaving the edge free.

Photos of psoriasis symptoms: psoriasis inversion

Photo of psoriasis symptoms: teardrop psoriasis

Photo: progressive phase of psoriasis

Such elements of the rash can be localized on any part of the skin, most often they are located symmetrically, mainly around large joints( elbows,knees, sacral region), in the folds( inguinal, axillary) and on the scalp.

Photos: symptoms of psoriasis of the scalp

Photo: psoriatic corona

After a few months, there is a stationary period of psoriasis, which is characterized by the absence of peripheral plaque growth and the appearance of "fresh" elements. Peeling completely covers the plaque, around which a region of light and thin skin develops. In this state plaques can exist for a long time: months and years.

Photo: stationary stage of psoriasis

The resolution period is characterized by flattening of the elements of the rash and gradual cleaning of the plaque from peeling. In place of long-existing elements remain spots, most often of dark color.

With this classic form of psoriasis, the general condition of patients usually does not suffer.

Often the psoriatic process affects the nails and is characterized by typical changes of the nail plates, in the form of small-sized( thimble-like) depressions. Also for psoriasis is characterized by loosening and thickening of the free edge of the nail plate with a change in its color to a dull yellow color. Such a picture resembles a fungal nail lesion, in connection with which an analysis of nail scales for pathogenic fungi should be carried out. For a long time, the psoriatic process can be limited only to a barely noticeable specific change in the nail plates. It is necessary to know that such a lesion quite often combines with joint damage.

Photo: "thimble" in psoriasis

Psoriatic arthritis is a specific joint damage due to inflammation of the periarticular tissues, characterized by dystrophic changes and development of joint deformity followed by disability of the patient. In this process, interphalangeal joints of the fingers and feet are most often affected, which in the beginning is manifested by soreness and an increase in the volume of the joints, and then by changing their shape with limited mobility. In this case the joints are affected symmetrically. In the pathological process, larger joints can also be involved, as well as joints of the spine.

Symptoms of arthropathic psoriasis:

edema in the joint region;
pain during palpation;
limited mobility, first of all, in the morning( "morning stiffness");
decreased functional activity of the joints and / or spine;
nail psoriasis;
psoriasis in blood relatives;
negative reactions to rheumatoid factor.

Photo: psoriatic nail

With irrational use of external treatment in the progressing period of psoriasis, the nonspecific toxic and allergic reaction of the body often develops. On the areas free from psoriatic plaque, redness appears, which merges, affects the entire skin. This process is accompanied by an increase in body temperature to 39 ° C and an increase in lymph nodes, as well as the appearance of a feeling of tightening the skin, itching and burning.

Often there is abundant peeling, increased hair loss and detachment of nail plates. This is a picture of the so-called psoriatic erythroderma , which can lead to a more severe form of psoriasis - pustuleznoy , when on the background of reddened skin there are pustules that increase in size and merge into "purulent lakes" and dry out in scaly crusts of yellow-brown color. In this case, the patient has general weakness and malaise. This condition is one of extremely severe, therefore, when the first symptoms of this form of psoriasis appear, urgent consultation of a specialist and hospitalization of the patient are needed.

Photo: symptoms of psoriatic erythroderma

In order to prevent the development of such psoriatic states, self-medication in the progressing phase is considered unacceptable.

Survey for suspicion of psoriasis

The first manifestation of psoriasis requires microscopic and mycological examination of scales of damaged skin for pathogenic fungi to exclude contagious dermatosis. With an isolated lesion of the joints, an x-ray picture and a blood test for rheumatological tests are needed. In complex cases, a diagnostic biopsy of the altered skin is used.

Diagnosis of psoriasis

Symptom of "stearin stain" - when grittazhe( scraping) of psoriatic eruptions, the surface of the vysypnyh elements becomes intensely white, the stearin scales are separated.
Symptom of "psoriatic film"( "terminal film") - when removing scales from psoriatic papules appears brilliantly red surface.
The symptom of Auspitz( the phenomenon of "bloody dew", the phenomenon of pinpoint bleeding) - when grittazhe( scraping) of psoriatic eruptions, after the phenomenon of "stearin stain" and "terminal film", there is a pinpoint bleeding.

Progressive stage of psoriasis:

Pilkov's symptom( Pilnov's rim) is a red rim of hyperemia on the periphery of psoriatic papules not covered with scales in these foci.
Symptom of Kebner - if skin is damaged or irritated, fresh rashes appear on the site of the injury.

The regression stage:

The Voronov symptom( pseudoatrophic bezel) - around psoriatic papules - a brilliant, light ring of slightly wrinkled skin.

Treatment of psoriasis

Since psoriasis is characterized by a chronically recurrent course( roughly speaking, psoriasis is not cure, but it can be achieved that the light periods will be years), the attending physician should face the task of achieving the longest possible remission. Selection of treatment is carried out, respectively, the phases and forms of psoriasis. It is necessary to normalize working and rest conditions, exclude provoking factors, namely skin irritation, stressful situations, smoking, drinking alcohol, timely treatment of streptococcal infections( tonsillitis, etc.).

In , the progressive period of psoriasis is assigned to general therapy and external drugs. Inside is applied vitamin therapy, the so-called "Hungarian scheme" , which includes a combination of vitamin C and folic acid in powders, taken 3 times a day for 30 days, as well as intramuscular injections of vitamin B12 at 400 mcg,15.

Additionally, hyposensitizing drugs are prescribed( 15 injections of 10% calcium gluconate per 10 ml intramuscularly, every other day, alternating with injections of vitamin B12).

Sedative therapy( preparations of bromine or valerian) have their positive effect for stabilizing the process.

Two experimental agents - brodalumab and ixsekizumab - promise to get rid of psoriasis and have shown excellent results of treatment, but studies of their toxicity are still ongoing and the means are not ready to enter the market.

Outwardly, only weak exfoliating agents are used in this phase of psoriasis: ointments, creams, lotions containing salicylic acid( 2%), sulfur( 2%), and to individual sections - Flucinar, Fluorocort, Lorinden-A, "Diprosalik" and other corticosteroid ointments. It is always necessary to use moisturizers that have a softening effect for 12 hours( Kold Cream, Trikzera, Unna cream).A good effect is rendered with dexpanthenol, zinc pyrithione in the composition of various external agents.

When the process is stabilized, permissive external agents are prescribed in gradually increasing concentrations and longer fixation on the plaque. These are numerous keratoplastic ointments: 5-10% ichthyol, 2-5% sulfur-tar, 10-20% naphthalan with addition of corticosteroids, and also hydroxyantrons. Tar 2-5-10% and anthralin are used in the form of compresses and baths, leaving a free face, wrinkled area, scalp and genitalia. These drugs have also proven themselves in the treatment of psoriasis when combined with topical steroids and ultraviolet irradiation in suberythmic doses( only patients with "winter" form of psoriasis).Re-PUVA therapy and photochemotherapy, autohemotherapy, pyrogenal, injections of staphylococcal anatoxin( in the presence of chronic foci of infection), hemosorption and plasmapheresis proved to be well established. For the treatment of psoriatic arthritis, paraffin applications and therapeutic exercises are used.

The exacerbation of psoriasis , flowing with severe and torpid current, is stopped by cytotoxic immunosuppressants( methotrexate) administered inside.

Of the modern means successfully used in recent times in the world for the treatment of psoriasis, attracts attention calcipotriol-synthetic analogue of the active metabolite of vitamin D. Its effectiveness is explained by the ability to inhibit the proliferation of keratinocytes and accelerate their morphological differentiation. The use of this component alone and in combination with betamethasone promotes the formation of long-term remission. It is necessary to know and remember that external means containing these substances should be used only under the supervision of a doctor.

And once again we want to draw your attention to the involvement of staphylococcus in autoimmune diseases, including psoriasis. At the slightest suspicion of its activity, there is a need for antibiotic treatment.

Patients with psoriaticheskim process are under constant dispensary supervision of a dermatologist and receive appropriate supportive treatment.

Folk remedies for the treatment of psoriasis

Among folk remedies used to treat psoriasis, a good effect is observed when birch tar is applied with honey and egg whites based on various oils. It must be remembered that such procedures are safe and effective in the stationary and regressive phases of the disease. When using these funds in an acute period, there is a danger of progression of the process.

In order to maintain a longer remission, patients with psoriasis without exacerbation are shown various sanatorium procedures, such as sunbathing and sea bathing, mud cure( for joints), hydrogen sulfide and radon sources( Matsesta, Tskhaltubo, etc.), heliotherapy.

Diet for psoriasis treatment

When exacerbating psoriasis in a diet, it is recommended to limit foods high in animal fats and carbohydrates, exclude spicy foods and alcohol. Abundant drink while helping to remove from the body of various toxic substances, which speeds up the stabilization of the process.

Complications of psoriasis

If you ignore the psoriasis patients treatment of this disease, you may develop such severe complications, such as:

psoriatic arthritis;
psoriatic erythroderma;
generalized pustular psoriasis.

And all these complications can result in profound disability and death.

In addition, people with this skin disease often develop diabetes, cardiovascular abnormalities, including hypertension and heart attack, peptic ulcer, kidney disease, liver, rheumatoid diseases and peripheral vascular lesions.

Consultation of a dermatologist on psoriasis:

1. Can a mosquito bite cause psoriasis?
In this case, the bite acts as an irritating trigger factor for the formation of psoriatic elements. This is the so-called isomorphic reaction of stimulation or Kebner's symptom, which are characterized by the appearance of new elements in the places of mechanical traumatization of the skin after 1-2 weeks. These are scratches, and injections, and bites of insects, and friction of clothes and much more.

2. What is a "psoriatic triad"?
The psoriatic triad includes 3 classic psoriasis symptoms, detected by a dermatologist when examining a patient. When scraping psoriatic plaque with a scalpel, a silvery peeling enhancement( a symptom of the stearin stain) is first noted, a shiny surface( symptom of the "terminal film") and then a drop of blood( a symptom of "bloody dew") is found under the scales.

3. I recently had dandruff in white, my head began to itch and hair fell out very badly. Can this be psoriasis?
For psoriasis of the scalp, a "psoriatic crown" is characteristic - a plaque that extends beyond the growth of the hair and the patient is primarily concerned with a cosmetic defect. Hair loss in psoriasis is not typical at all.

4. What is the "winter" and "summer" form of psoriasis?
Exacerbations of psoriasis are most often observed in the autumn-winter period, this is the so-called winter form. In the summer form of this disease, exacerbations are associated with increased ultraviolet irradiation and occur in the spring-summer period. Differentiate these forms of psoriasis is necessary to determine the tactics of treatment.

5. What kind of examination is needed for psoriatic arthritis?
It is necessary to evaluate the standard indices of inflammatory activity( ESR and CRP) and rheumatoid factor in the blood, as well as to evaluate radiographic pictures of brushes and feet, cervical and lumbar spine, ileosacral articulations.

Doctor dermatologist Tatiana Kuklina