Mar 05, 2018
Psoriasis is a persistent, chronic, still incurable skin disease. This is a common permanent skin disease, characterized by the appearance on the body of round sections of red or pink dry and flaky skin. They can arise anywhere, but mostly on the knees and elbows, and sometimes on the skin of the head and on the upper part of the forehead.
The name of this common disease comes from the Greek word psora, which means "skin disease, scabs".Skin manifestations with psoriasis are very characteristic: on the skin of the head, knee and elbow joints, in the lower back and in the skin folds, dense, inflamed, scaly, reddish foci are formed, causing itching. Dermatologists refer to these formations as "infiltrative papular elements, reddish scaly plaques, peeling, large-plate, silvery-shiny".Sometimes these phenomena are so small that patients do not notice them, but a significant part of the skin is often affected.
In biblical times, this disease was considered a form of leprosy. True, it is a disease of healthy people - it is not dangerous to life. Psoriasis does not leave scars and does not lead to baldness. And, except for the most severe cases, it does not weaken physical activity. And yet psoriasis is a source of great mental suffering for its victim. How to treat this ailment with folk remedies, look here.
Reinforced exfoliation of the skin on affected areas occurs continuously or intermittently. Usually new scales are constantly produced in deep layers of the skin. From there they rise to the surface layer - the epidermis, where the dead cells of the surface layer are replaced. This process usually takes about 28 days. However, in areas affected by psoriasis, new cells reach the skin surface in just four days, and the accumulation of an excess of these cells leads to the appearance of characteristic scales.
Damage can increase slowly, or psoriasis attacks can be separated by periods when the disease recedes. The first seizures usually begin at the age of 10 to 30 years. Sometimes psoriasis can cover the entire surface of the skin;in this case, you should immediately contact a dermatologist for treatment. Although most cases of psoriasis can be easily controlled with appropriate treatment and do not pose a serious threat to health, the disease can not be cured completely and itchy, and sometimes painful, the skin persists for life.
Psoriasis refers to skin diseases, as cutaneous manifestations come to the fore. However, this is a systemic disease. In psoriasis, not only the skin, but also the mucous membranes, the appendages of the skin( hair and nails), the musculoskeletal system are affected. Violated the functions of internal organs and systems.
Do not try to get rid of the dermal elements that bother you, do not try to "treat" them yourself. Seek professional help from dermatologists. Modern medicine allows you to select an adequate effective treatment, even in the most severe forms of the disease.
It is impossible to get infected from a patient with psoriasis: the disease is not transmitted by contact. But the hereditary factor should not be denied. It has long been noted that psoriasis often occurs in people whose relatives suffer from this disease.
Psoriasis is characterized by a chronic recurrent course. Relapses( exacerbations) of the disease usually manifest in the autumn-winter period, with a lack of sunlight and dry skin.
The disease, which marked the skin peeling, was known in ancient times. According to AA Piasecki( 1901), even in the Bible there were data on 10 cutaneous diseases( tuberosity, scales, spotting, hornfelscence, inflammation, etc.).In ancient Indian literature there is a mention of a disease similar to psoriasis. The ancient Greeks have a rich dermatological terminology in the age of Hippocrates, but psoriasis has been included in various groups of diseases due to the variety of clinical variants and has been designated as alphos, leichen, lepra and psora. The term alphos was used in cases when there were discolored spots of different origin: white spots with leprosy, scleroderma, psoriatic leukoderma. The term leichen( lichen) Hippocrates used in dermatoses with uneven skin and peeling, like parasitic vegetation, occurring in plants. The concept of lepra in ancient Greek medicine did not correspond to leprosy. This term was used to characterize diseases that were manifested by thickening of the skin, peeling, itching. The term psora is closest to the current name of the disease. Under this word, the ancient Greeks understood itching dermatoses.
The ancient Greeks did not have a clear description of the clinical picture of psoriasis. And later, terminological confusion existed among physicians for a long time. Celsus mentioned the alphos( psoriasis) of the nails. Wilson called psoriasis an alfosis, and the term "psoriasis" denoted scaling forms of eczema. But in the exposition of the clinic of psoriasis, the pioneer is the Roman Celsus.
The period of delusions, when psoriasis was mixed with leprosy and other skin diseases, continued until the XIX century. The classic description of the disease belongs to the Englishman R. Willan( 1801), the founder of the English dermatological school. He for the first time accurately described the symptoms of the disease, presenting psoriasis in the chapter on flaky dermatoses, conducted a differential diagnosis between leprosy and psoriasis, and also resurrected the term psoriasis, not used since the time of Galen. Willan distinguished two separate forms: discoid and figured psoriasis, described "old forms".Thanks to him, psoriasis took an independent place in the general classification of skin diseases. But he was partly captivated by the terminological confusion of the ancient authors. Many of his contemporaries continued to confuse psoriasis with leprosy, squamous eczema and other diseases.
Only in 1841, Ferdinand Hebra( Hebra) combined two forms of psoriasis into one and gave a clear clinical description of the disease, which has not lost its significance even today.
The most common form of the disease begins with small reddish rashes on the skin, which, growing and merging, are covered with scales. In the process of peeling, surface scales easily slough, remain denser, located in the depth. When removing deep scales, the exposed areas of the skin begin to bleed. These initially small rashes continue to spread, occupying at times a significant part of the skin.
Psoriasis most often affects the external surfaces of the elbow and knee joints, inguinal region and genitals, the scalp and nails. Foci of lesion are often located on the body symmetrically.
Nails affected by psoriasis have characteristic pinholes. Nail plates loosen, thin, begin to crumble and hard to treat.
Psoriatic rashes are often located in the skin folds of the inguinal and gluteal regions, underarms, on the genitals and under the mammary glands.
However, the disease has many forms. They differ in the severity of the flow, duration, appearance and in the form of rashes.
Thus, in children and young people often develop a drop-shaped psoriasis, when on the skin after colds there appear small numerous drops of a drop-shaped shape and a reddish color. Sometimes rashes spontaneously disappear within a few weeks or months.
Approximately 7% of patients develop psoriatic arthritis, which in most cases does not have a severe course. The severity of arthritis in some patients depends directly on the degree of skin damage, and its course improves with a decrease in skin manifestations.
Psoriasis affects 1.5-2% of the world's population. It occurs as often as diabetes. The number of registered cases of psoriasis in developed countries of Europe ranges from 1.4 to 2.8%.In dermatological clinics, the number of patients with this pathology is on the average 6-8% of the total number of patients. The prevalence of psoriasis is played by geographical and ethnic factors. In tropical and subtropical climatic zones, psoriasis is much less common than in northern latitudes. People of the white race are sicker than most, yellow race - less often, the black race is rare, and in people with red skin( Eskimos, South American Indians), psoriasis is almost never found. Probably, this different predisposition to the disease is caused genetically. The disease can begin at any age, although its manifestations in infants and in elderly people are rare. In adults, psoriasis occurs equally often in both men and women.
The so-called "cumulative" estimate of the incidence of psoriasis is calculated, that is, the risk of developing this disease throughout life. In Russia, the "cumulative" estimate was 2.25% for men and 2.15% for women.
In recent years, there has been a trend towards an increase in the number of young patients with common, complicated, often continuously-relapsing forms of psoriasis, requiring inpatient treatment up to 5-6 times a year for many years. Many cases of such psoriasis are resistant to conventional treatment regimens, and inter-recurrence periods are much shorter.
The true nature of the disease is still unknown. One of the possible causes may be a violation of the function of blood leukocytes and, as a consequence, inflammation of the skin. As a result, skin cells begin to be divided extremely quickly - every 3-4 days. But why - so far remains a question. Let's try to figure out what all the same matters for the onset of this disease.
The family occurrence of psoriasis clearly indicates that hereditary factors are essential in the manifestation of the disease. According to epidemiological studies, the total probability of psoriasis for children in parents without psoriasis is 12%.If one parent suffers from psoriasis, it rises to 20% if both parents are sick - up to 50%.If one of the identical twins develop psoriasis, the probability of a second disease is 90%.
In his book Journey to the Shore of Maclay, NN Miklouho-Maclay describes the most common skin diseases in the Papuans, including family psoriasis, which were quite common in those parts."Since this disease is transmitted by inheritance, it can be found sometimes even in newborns. .. over the years, it soon spreads throughout the body. Psoriasis is almost not considered a disease: men who suffer from psoriasis often choose their wives affected by the same disease, and it is therefore natural that most newborns have traces of the same disease. "
But in some ethnic groups in Nigeria and in the Eskimos, in the northern and southern American Indians, psoriasis is rare, which also seems to be due to genetic factors.
But since psoriasis does not necessarily appear in children with psoriasis of parents, it's not so simple with heredity. Physicians talk about the "multifactorial" or "polygenic" heredity of psoriasis. This means that the manifestation of the disease requires not only a combination of different genes, but also the influence of certain environmental factors.
The intensity of endogenous skin readiness for psoriatic reactions, the endogenous push to rash depends on time fluctuations. We can distinguish three different stages of development of vulgar psoriasis.
Genotypic or latent( hidden) psoriasis. The individual probably carries a polygenically related psoriatic reaction( psoriatic diathesis and predisposition), which, however, does not appear clinically. There is no possibility to make a diagnosis.
Genophenotypic or preclinical psoriasis. Special methods can establish changes in clinically normal skin that indicate preclinical disease, for example, epidermal post-wound hyperregeneration, increased glycolysis in the epidermis, alteration of perspiration, or accumulation of lipids on the skin surface, or an increase in macrophages in the dermis. There are no clinical manifestations of the disease.
Phenotypic or manifest psoriasis. In these cases, there is a manifest clinical psoriasis. And here modern methods allow to establish changes on clinically normal skin in comparison with the norm. The treatment of psoriasis can be aimed at transferring the disease from its phenotypic phase to genotypic psoriasis. The final recovery is impossible, so it is clear that even after the disappearance of skin manifestations, new psoriatic elements may continue to appear. The appearance and number of elements depends on the endogenous shock to the eruptions in a particular patient and on exogenous( or endogenous) provoking factors.
With the inheritance of psoriasis, age in the initial appearance of the disease and association with molecules of the major histocompatibility complex( HLA antigens) are of particular importance. Since the onset of the disease is possible at any age, the age of the disease shows a bimodal distribution with a maximum incidence in women from 16 to 60 years, in men from 22 to 58 years. Patients with psoriasis have a significantly increased presence of HLA antigens A2, B1 3, B27, Bw57, Cw2, Cw6, DR7.According to the correlation of the age of the disease and the type of HLA for non-pustular psoriasis, there are two types of psoriasis.
Psoriasis type I with early onset( up to 40 years) is associated with HLA antigens Cw6, B13, Bw57, DR7, and a reduced amount of Cw2 and A30.Psoriasis type I bleeds in 2/3 patients( 75%) and shows a family frequency: 10% of siblings or 15% of children are affected. If one parent has an A2, B13, Cw6 or HLA-A2, Bw57 and Cw6 HLA antigen, psoriasis affects even more than 30% of children. The course of the disease with type I psoriasis is more severe in most cases than in type II.
Psoriasis type II with late onset( older than 40 years).Here, the HLA association is weak( Cw2 - 27%, B27 - 26%, Bw6 - 31.8%).Family frequency of the disease is absent. Unlike the first type, there are nail and joint lesions in the bowl.
Primary manifestations of psoriasis after acute infectious diseases or after vaccination are described quite often. Infections of the upper respiratory tract( acute tonsillitis, bronchitis) with beta-hemolytic streptococci type A( and also groups C and G), very often are provoking factors of primary psoriasis in children. Already existing psoriasis can be aggravated by an infection of the upper respiratory tract.
Various medications( antimalarial, lithium, beta-blockers) and allergic reactions to medicines can provoke psoriasis, for this purpose even the use of beta-blockers in the form of eye drops is enough. Abolition of systemic glucocorticoid therapy can also lead to worsening of psoriasis.
The possibility of the influence of viral infec- tion on the genetic apparatus of a human cell is not ruled out, followed by a violation of the hereditary information code-the creation of new genomes of transformed cells with altered hereditary properties, which allows one to make an assumption about the viral genetic origin of the disease.
It can be assumed that the increased epidermopoiesis is caused by the influence of the virus on the genetic apparatus of the cell, as a result of which the genetic control of biochemical processes is disrupted, and there are enzymes that cause the latent( latent) course of the disease.
However, the change in the genetic apparatus of the cell does not yet entail the development of the process, but creates a predisposition to psoriatic disease. Under certain conditions, under the influence of provoking factors, the disease becomes manifest.
. Not only the cause, but also the sequence of development of pathological changes in the skin of the person with psoriasis and in his body has not yet been clarified. It is possible that under the name of "psoriasis" lies a whole group of diseases.
Currently, the following pattern of developments. For no apparent reason, the superficial epithelial cells of the skin begin to be divided at a tremendous rate. The cell cycle, that is, the process of maturation of the epithelial cell, decreases from 311 to 36 hours! As a result, keratinocytes form about 20-30 times more than normal. How can this be caused? The most likely trigger factor is the inflammatory skin reaction and the associated immune disorders( proof of this is a very rapid onset of remission with immunosuppressant treatment).
What's next? Due to hyperproliferation, the epidermal volume in a patient with psoriasis increases by a factor of 4-6, the mitotic activity and DNA synthesis in cells are significantly accelerated, the normal synthesis of proteins is disrupted.
This process is accompanied by a marked penetration of neutrophilic leukocytes into the epidermis and activated T-lymphocytes into the dermis, the immune regulation of the skin is disturbed, which leads to the release of activated keratinocytes, lymphocytes, macrophages and other dermal cells of various mediators of the immune response and inflammation, polyamines, proteases, which strengthen the proliferation of defective keratinocytes and stimulate the development of inflammatory changes in the skin.
The continuity of the pathological process in psoriasis is caused, apparently, by a chronic autoimmune reaction.
Why is it that even with the genetic predisposition and the action of the above-mentioned factors on each person, not everyone suffers from psoriasis? Hence, the nezabolevshie nevertheless formed protective mechanisms that protect them from the manifestation of even genetically inherent in them disease.
And this concerns not only psoriasis, but also many other diseases, with respect to the emergence and manifestation of which is still much unclear.
These mechanisms are specific and nonspecific immunity.
Each of us has a certain reserve of protective reactions from the moment of birth. They are very diverse and they are studied by many medical sciences. These include the protective functions of the skin and mucous membranes, which to a certain extent are able to resist external influences;immune reactions, which allow to detect and destroy any foreign material that has got into the body;numerous components of the homeostasis system that react to the slightest deviations in the functioning of all cells, tissues and organs, and to any deviations in the parameters of the internal environment of the organism.
How can we ensure that these mechanisms function smoothly? How to increase and strengthen their protective mechanisms in an environment of unfavorable ecology, the intense rhythm of modern life, the constant impact of endogenous and exogenous factors that provoke disease?
It turns out that not everything is so gloomy, and we can do a lot ourselves. After all, to preserve health means to preserve the entire reserve of protective mechanisms that we have put in place. To strengthen health means to strengthen protective mechanisms.
A healthy immune system protects us from potentially dangerous bacteria and viruses, from adverse environmental factors. This is a complex regulatory system, which includes the spleen, thymus gland, bone marrow, blood and lymph nodes. If it is weakened, the likelihood of disease is increased. Studies of recent years show that the state and activity of the immune system can be corrected by proper nutrition. At the same time, it is important not only to ensure that the ration contains products useful for the immune system, but also to exclude those nutritional factors that can weaken it.
To date, various immunostimulatory effects of vitamin C have been identified: the ability to increase the production of antibodies, to accelerate the maturation of immune cells. In high concentrations, vitamin C is present in citrus, kiwi, strawberry and green vegetables.
Foods that enhance immunity
Breakfast: live yoghurt, fresh fruit, muesli, oatmeal, freshly prepared orange juice.
Recipe: Flakes with yogurt and fruit.1 \ 2 cup of yogurt beat up with half a grapefruit juice and mix with a few tablespoons cornflakes or chopsticks, add any berries or fruits.
Lunch: stuffed baked vegetables, sandwiches with whole grain bread salad, vegetable soup, salads with the addition of sprouted wheat, baked potatoes with green or cabbage salad.
Recipe: Bean salad with brynza. To weld separately 1 glass of white beans and 500 g of string beans, cut into thin slices 1 onion and 2 tomatoes, cut into cubes 200 g of brynza. Gently mix and pour with a dressing from 3 tablespoons of wine vinegar, 5 tablespoons of olive oil, salt and pepper. To serve with white bread.
Dinner: baked or grilled fish - mackerel, flounder, salmon - with stewed vegetables, boiled potatoes and green salad;pasta with sauces;stewed liver;chicken, vegetable or fish risotto;casserole with vegetables.
Recipe: Vegetable stew with chicken breasts.100 g of pulp of chicken breasts cut into strips and fry in vegetable oil. Add 100 g of chopped mushrooms or other mushrooms, 1 boiled potato, 100 g of cabbage, 2 tablespoons of green peas and 1 carrot, season 3-4 tablespoons of soy sauce and put out 10 minutes. Recipe: Soup of spinach with yoghurt.450 grams of fresh or 250 grams of frozen spinach, 1 chopped onion, 3 young onions, 100 grams of washed rice, 1 liter of water, 450 ml of yogurt, 1 egg, 1 chopped garlic, 2 tablespoons of vegetable oil, salt and pepper to taste. Warm up the oil in the frying pan, fry it in a bowl until golden, add the chopped spinach and young onions and pass for a few minutes. Add rice, water, salt and pepper, bring to a boil and cook for 15-20 minutes over low heat. Stir yogurt with egg, add grated garlic. This dressing should be put in a ready-made soup, preheat it, but do not boil it. You can decorate with green onions and serve with chopped cubes and toasted white bread.
In their practical work, dermatologists use the classification of psoriasis, which takes into account the numerous clinical varieties and variants of the disease course.
The clinical picture of vulgar psoriasis is reduced to the skin manifestations described just above. If to use medical terminology, it is epidermal-dermal papules formed due to thickening of the Malpighian layer of the epidermis and cellular infiltration of the superficial blood network of the epidermis;they are clearly delineated from a healthy-looking skin, pinkish-red saturated color, covered with loose, large-plate scales of silvery-white color. Papules have a diameter of 1-2 mm, a regular shape with a tendency to peripheral growth, promoting the formation of plaques of rounded-irregular shape.
When scraping papules, a triad of disease-specific phenomena occurs successively:
Eruptions can be detected in any part of the skin, but prefer the extensor surfaces of the knee and elbow joints;lumbosacral region;the scalp in typical places( behind the ears, the forehead region at the border of hair growth - the so-called "psoriatic crown").
The itching in psoriasis, as a rule, is absent or it can be expressed to an insignificant degree, and even only in the progressing stage.
In the course of vulgar psoriasis, three stages are distinguished: progressive, stationary and regressive.
The progressive stage is characterized by the constant appearance of new bright red papules on the skin, a clear peripheral growth halo in the form of erythema around the primary element, itching, burning. It happens that in the place of injury( scratching, burns, toxic agents, contact allergic dermatitis, preventive vaccinations, drug toxicosis) after 10-14 days, repeating its outlines, there are psoriatic rashes.
The stationary stage is characterized by the absence of new primary elements;the cessation of the growth of "old" foci;lack of peripheral growth;the appearance of the so-called "Voronov's collar" around the foci - a rim in the form of a rosette 2-5 mm wide, normal or pale color resembling a cigarette paper;as well as a scaly covering the entire papule.
The regressing stage is characterized by the gradual disappearance of clinical symptoms, starting from the center of the elements towards the periphery.
This is the most common form of psoriasis. Small plaques usually do not itch. But they are bright red and covered with exfoliating silver-white scales. If you scrape scales, for example, with a fingernail, plaques can bleed( "blood dew").
Plaques have a distinct edge, unlike most forms of eczema, and are usually symmetrical( the right and left parts of the body are affected equally).The elbows, knees and scalp are most often affected, but plaques can also occur on the body. Fortunately, a person does not usually suffer, although the forehead may be affected if the entire head is covered with plaques to the limit of hair growth.
Appearance of plaques depends on their location on the body. In moist areas, for example, in the folds of the armpits and groin, between the buttocks and under the breast, the plaques are small or not flaky, red with a clear boundary. On the palms and soles of the plaques are most often shelled, but since the skin here is much thicker, the color of the spots is less bright. Most people have plaques large enough, a few centimeters or more in diameter. Sometimes they are much smaller, up to one centimeter.
This form can be considered a variation of ordinary psoriasis. The defeat of the head can be isolated, it can be combined with rashes in other areas of the body. It is characterized by intense itching. Hair usually does not fall out. On the scalp, the elements of the rash look like plaques covered with thick, hard-to-separate scales. Expressed wetness and cracks, especially behind the ears. Plaques can be located apart, but a diffuse lesion of the entire scalp may occur. The forecast is relatively favorable. Treatment usually leads to remission, which lasts from several months to several years.
Guttate psoriasis usually occurs in children or young people, and often follows severe tonsillitis( tonsillitis) caused by streptococcal infection. After 7-14 days, angina is accompanied by a sudden appearance of spots on the entire body, especially on the trunk and extremities. The spots are small, usually less than 1 cm in diameter. Itching is usually mild or absent. This type of psoriasis is easy to diagnose and minimize for several weeks or months by local treatment. Sometimes a short course of ultraviolet therapy helps. Do not try to treat yourself with ultraviolet without the doctor's advice! In psoriasis, small doses of ultraviolet are curative, and elevated - on the contrary, can only provoke an exacerbation of the disease, by the way, the same applies to solar baths.
This is also a form of ordinary psoriasis, but more rare. The rash is like a rash, which happens with infectious diseases: it appears just as rapidly and covers almost the entire body. Guttate psoriasis occurs mainly in young people, in many cases it occurs after a sore throat. Elements of the rash are presented in the form of pink "salmon" color drop-shaped papules with a diameter of 2 to 10 mm. The rashes are randomly scattered, mostly on the trunk, to a lesser extent on the face, the scalp, and the nails. Palms and soles, as a rule, are not amazed. Teardrop-shaped psoriasis sometimes passes independently for several weeks, but can take a chronic course.
differs in favor of localization on the seborrheal areas( the scalp, nasolabial, nososchechnye and zaushnye folds, the chest and inter-scapular area).The boundaries of the rashes can be indistinct, the peeling is not silvery white, but with a hint of yellow. On the scalp, a lot of dandruff, masking the underlying psoriatic rash, which in some cases can go from the scalp to the forehead in the form of a crown( "psoriatic crown").
Most often located on the front surfaces of the lower leg, ankle joints and the rear of the feet. A characteristic feature of this form is the variegation of morphological elements: erosive wet areas of bright red color, serous and serous-purulent scaly crusts, large strata of scales that are easily removed from the surface of the rash, and under them a moist surface of rosy-red color is exposed, covered with grayish-whitea blight with an easily evoked phenomenon of pinpoint bleeding. Rashes have clear boundaries and are often accompanied by itching.
Usually localized in the area of the ankles and wrist joints, the lower thirds of the shins and the rear of the feet. Papular elements are more often coin-like and, as a result of prolonged existence and mechanical irritation, gradually begin to hypertrophy. Perhaps malignant degeneration.
Psoriasis of nails of varying severity is found in 25% of patients with psoriasis, especially with psoriatic arthritis. The nails are affected both on the hands and on the legs. Psoriasis of the nails occurs in three forms. The most common changes in the surface of the nail as a thimble: on the nail plate, there are pinholes, often arranged in rows. The second form is spotted: under the nail plate appear small, several millimeters in diameter, reddish spots, most often located near the peri-oral grooves or holes. Psoriatic onychography - the third form of psoriasis of the nails: the nail plate thickens, becomes uneven, dotted with small scallops of grayish-yellow color. The affected nail exfoliates or takes the form of a claw raised above the bed as a result of subungual hyperkeratosis.
It often develops in patients with obesity, diabetes or hypothyroidism of the thyroid gland. Characteristic is the presence of psoriatic rashes of grayish-yellow crusts formed as a result of impregnation of scales exudate. In large folds, the surface of psoriatic elements is sharply hyperemic, and sometimes wetness is determined. The rash is often accompanied by itching and burning.
This form has a chronic recurrent character and is clinically manifested in the form of two varieties: palmar-plantar pustular psoriasis of Barber and generalized pustular psuniase Tsumbush. With pustular psoriasis Barbera on the palms and soles appears a lot of yellowish, deep in the epidermis pustules with sterile contents. Pustules are not opened, but dry up and turn into crusts. In the future, red-brown spots form in their place. The disease is often mistaken for a bacterial or viral infection. Women are sick 4 times more often than men. The disease lasts for years, with sudden exacerbations and remissions. Occasionally, ordinary psoriasis joins it.
Pustular psoriasis usually exists as a vast area of hyperemia( redness), covered with painful greenish pustules( pus-filled bubbles) 1-2 mm in diameter. Despite their color, these are abscesses of an infectious nature. Their color is caused by the masses of leukocytes, called polymorphic. These cells move to any part of the skin that is inflamed or damaged to fight infection and help recovery. After 7-10 days, the pustules dry up and become covered with brown crusts. These crusts spread, because in the new place there are the following pustules, and often this process goes on continuously.
With the most common form of pustular psoriasis, palms and soles are affected. In contrast to eczema, which affects these areas, psoriasis is characterized by soreness and itch equally. Pustular psoriasis is uncomfortable and ugly, can make it difficult to write or walk.
The less common form of pustular psoriasis is different in that ordinary plaque psoriasis begins to become covered with blisters. This can happen spontaneously, but is more likely to follow the prolonged use of potent local corticosteroid drugs.
The most severe - and, fortunately, the rarest - form is called generalized pustular psoriasis. The patient feels bad, becomes restless, and on the skin suddenly appear tiny pustules, usually starting from the upper part of the trunk, and then spreading throughout the body for hours or days. This condition requires hospitalization.
Generalized pustular psoriasis Tsumbusha - a serious, often life-threatening form of psoriasis. It starts suddenly. Within a few hours, a bright, fiery red erythema develops, which covers extensive areas of the skin. Small, grouped pustules appear on its background, they become more and more, they merge with the formation of "purulent lakes".Pustules sometimes appear as waves: as one "generation" of pustules dry up, another develops. The disease is always accompanied by fever, chills, malaise, increasing weakness and leukocytosis. It is believed that fever and leukocytosis are caused by massive infiltration of the dermis by neutrophils, which release cytokines and other inflammatory mediators. Inflammatory reaction ends with necrosis of keratinocytes and leukocytes. Patients with generalized pustular psoriasis often fall into the infectious departments of hospitals with suspected bacteraemia and sepsis. The negative result of blood culture removes this diagnosis. Exacerbations and remissions can follow one another for many years. The disease sometimes turns into ordinary psoriasis.
Generalized pustular psoriasis is more common in patients with psoriasis, but sometimes it also affects those who have not been sick before. Sometimes the disease is provoked by the abuse of strong local corticosteroid drugs.
It occurs more often as a result of an exacerbation of an already existing psoriasis under the influence of various irritating factors, but it can also begin primarily in a healthy person before this. Erythroderma extends to all or almost all of the skin. The skin becomes bright red, covered with a large number of large and small dry white scales that barely hold on to it and fall off even when the clothing is removed. The skin is edematous, hot to the touch, in places it is lichenificated. Patients are concerned about the itching and burning sensation of varying intensity, the feeling of tightening the skin. Erythroderma, especially at the initial stages, violates the general condition of the patient: body temperature rises to 38-39 ° C, lymph nodes increase. In the long course of this condition hair and nails can drop out.
Psoriatic erythroderma is a rare but serious form of the disease, and can even threaten the lives of older people. This condition can occur even in people who have not had psoriasis before. In patients with erythroderma, the skin becomes red, hot and continually flakes. At them the mechanism of heat exchange is broken, the organism loses heat, a liquid and fiber. Inpatient treatment and measures such as an intravenous drip to restore fluid loss in the body, use sedatives and weak steroid creams may be required. Full recovery is possible, but it depends on the stage of the disease, endurance of the patient's body and the time of the beginning of treatment.
Based on anamnestic data, clinical picture and histological changes, 2 types of psoriatic erythroderma are distinguished. The first type is a generic one, in which the entire skin is covered with one giant plaque, formed as a result of prolonged peripheral growth of individual psoriatic elements. The second type of erythrodermia is hyperergic or allergic, which occurs in a short time. In patients with this, there are signs of general intoxication: fever, headache, muscle pain, dyspeptic disorders. Acutely expressed inflammatory reactions predominate clinically and histologically.
This is one of the most severe forms of psoriasis, when skin manifestations are combined with joint damage.
For the diagnosis of psoriatic arthritis, it is necessary to take into account the diagnostic criteria of H. Mathies( 1974), which include:
Most often, psoriasis is symmetrical and widespread. But very rarely in the patient instead of psoriatic plaques appear only accumulations of red spots and white scales along a line along the limb, or, possibly, along the spine. This is a linear form of psoriasis, it must be distinguished from other linear eruptions, for example, nevi( birthmarks) or an unusual form of eczema. The study of a biopsy under a microscope usually shows typical changes for psoriasis. Treatment and prospects for recovery are the same as in plaque psoriasis.
The scalp is a frequent place of psoriasis, and you may find that it is the only affected area. Usually psoriasis on the head is a plaque with a clear border, red, covered with large scales of skin and often bumpy. The hair is usually not affected. Psoriasis of the scalp is very different from seborrhea, in which the peeling surface is much larger, there is no tuberosity and clear spots. In addition, psoriasis often extends beyond the hairline. But sometimes during the formation of plaques psoriasis is similar to seborrhea.
Treat psoriasis of the scalp with oil preparations with 3 percent salicylic acid, which reduce flaking( eg, Meted).Three times a week you rub these drugs into the scalp, then wash them with shampoo with tar( for example, Clinitar) after 4-6 hours. Perhaps you will even have a mixture of salicylic acid and tar, such as cocoas. Derivatives of vitamin D, for example, pre-Novex, can also help. Quickly good results can be obtained with the use of local steroid preparations for the scalp, for example, Betnoveit, but they are not so effective with prolonged use.
You may find that psoriasis occurs where your skin forms wrinkles, for example, in the armpits, under the chest, in the groin, between the buttocks and on the genitals. Because these are wet areas, plaques do not flake. They are bright red, with clear boundaries. You may notice that these psoriatic plaques often become inflamed, especially when these parts of the body are in motion.
Treatment is a combination of antifungal and steroid ointments, for example, Canesten-HC.The prospect of successful treatment is the same as in plaque psoriasis, although the wrinkling of the wrinkles may be particularly difficult to cure, since it is difficult to fix the ointment in place and not let it fade. In addition, the permanent diaper rash, characteristic of the folds of the skin( under a heavy chest, for example), may complicate treatment.
Palms and soles
When plaque psoriasis occurs on the palms and soles, the plaques are smaller and not so red, but are more flaky than in other areas of the body, where the peeling is smaller and flaking is easier. Sometimes cracks appear on the skin. There are painful sensations and in those cases when the tips of the toes are affected. This form is treated with moisturizers( E45, for example), creams containing steroids, or analogues of vitamin D topical application, but the healing process can slow down the same problems as with psoriasis in the folds of the skin.
Psoriasis rarely infects the mucous membrane of the mouth - if at all possible. However, in severe cases, psoriasis can strike the tongue, forming a characteristic structure called "geographical language".Usually, there are no other symptoms."Geographical language" is found in people without any skin disease, but it is also noted in generalized pustular psoriasis.
Sometimes psoriasis occurs on the injured skin, usually appearing as a line on the operating scar or abrasions. Sometimes it is formed on the elements of a rash with chicken pox. Some other skin diseases can also manifest themselves in a similar way, but this is especially typical of psoriasis. Once the appearance of the rash looks stable, remaining in the form of a line, although plaques can increase and look typical for plaque psoriasis, especially after chicken pox. The phenomenon of psoriasis of Kebner is similar to the typical psoriasis that occurs on the usual parts of the body for him.
The nails on the arms and legs are often affected by psoriasis. They can become bumpy or begin to separate from the nail bed( a process called onycholysis).With onycholysis, the nail usually has a whitish appearance. Perhaps you have another nail lesion or only onycholysis and not necessarily psoriasis, but if you have both diseases together, psoriasis is probably the reason. If the nail is badly hit, it will become brittle. But it is important to exclude the possibility of ringworm / herpes zoster as the cause of the disease, taking samples of the nail for examination.
If you have psoriasis of the nails, you will notice that the nails grow faster than normal. Although the treatment of this form of psoriasis is extremely difficult, a good job of a professional manicurist can help mask the damage to your nails.
Psoriasis in infants is rare. Most of the rashes that occur in the diaper area are caused by either eczema, Candida( thrush) or irritating urine. However, sometimes there is a red rash with a clear border, similar to psoriasis. In some infants, psoriasis-like spots can appear on both elbows and knees. The diaper rash is initially treated with antifungal creams( Kanesten) or a combination of antifungal and steroid preparations( Canesten-HC).And although there is a growing likelihood that the child will develop psoriasis later, it is not inevitable. In any case, it is necessary to consult a specialist.
The diagnosis can only be made by a dermatologist as a result of examination of the skin, nails and scalp.
During the examination, it may be necessary to take a skin sample for examination under a microscope( skin biopsy).
How does a dermatologist examine a patient?
Survey begins with a careful look at the skin, so that later, when asked the patient, compare what he saw with complaints. On examination, the doctor should determine: the localization of the rash;what elements it is represented;what is the shape and relative position of the elements of the rash. It is advisable, at the first examination, to examine all the skin and mucous to avoid missing anything important.
When questioning a patient, you need to get answers to the following questions:
Methods of research in dermatology Skin biopsy is a small surgical intervention. Its value is determined by the correctness of the skin site selection. Under local anesthesia( 1% lidocaine) with a scalpel or drill( special tubular knife 3-4 mm in diameter) grasp and cut off a piece of tissue. Depending on the location and size of the wound, sutures may be required.
Microscopy of a smear treated with hydroxyl potassium - the study is conducted when a fungal infection is suspected. From the edge of the affected area of the skin gently scraped with a scalpel, the obtained scales are placed on a slide and 1-2 drops of 10-20% potassium hydroxide are added. The silk dissolves the keratin and facilitates the detection of the pathogen. To accelerate the process, the preparation is heated slightly, and then examined under a microscope with a small increase in the shaded field. In the smear, you can find the mycelium of dermatophytes, budding cells and pseudomycellium yeast fungi.
Punk test, developed by Russian dermatologist Arnold Wank, is used to diagnose infections caused by herpes simplex viruses. Make a scraping from the bottom of the opened vesicle, stop the material on a slide, dry and stain by Giemsa or Wright. With herpes, chicken pox and shingles reveal giant multi-nuclear cells. Ala identification of the pathogen is currently resorted to immunofluorescent staining or viral isolation in cell culture.
Diascopy is an examination of the elements of the rash when pressing them with a slide or lens. The method makes it possible to easily distinguish the hyperemic spot( erythema) from hemorrhagic( petechiae and ecchymosis): hemorrhagic rash does not change with color diascopy. For example, a hemangioma becomes dizzier with a diascopy, and palpable purpura for allergic vasculitis does not.
Inspection under the Wood lamp. Wood's lamp is a source of ultraviolet light with a wavelength of about 360 nm. Under its action, pigments( melanin) and some pathogenic microbes begin to glow.
Application Samples - they are used to confirm the allergic nature of the disease and search for an allergen. The test substances are applied to the skin of the back and covered with an occlusive dressing for 48 hours. In the place where the allergen was applied, there are signs of a delayed-type allergic reaction - erythema, edema or rash.
Traditional medicine in the treatment of psoriasis uses steroid drugs. However, sometimes their use leads to the opposite result: the skin becomes so dry that it becomes covered with cracks and becomes infected.
Although psoriasis is difficult to treat, aromatherapy oils help to get rid of it.
The main tasks of treating psoriasis are to remove inflammation and slow down the process of dividing skin cells. Moisturizing creams and lotions, softening scales, help reduce itching.
Patients are advised not to overdry the skin, use moisturizers and avoid contact with irritating factors.
Various diets offered for the treatment of psoriasis have proved ineffective. However, if you are used to eating foods rich in saturated fats and containing few fruits and vegetables, a radical change in the diet with the predominant use of healthy natural foods, unsaturated fats, a large number of vitamins and trace elements can play a decisive role in improving your body.
The choice of method of treatment depends on the patient's general health, age, lifestyle, type and severity of the disease. All treatment should be carried out under the constant supervision of a doctor who will select the optimal combination of different methods. The goal of most methods of treating psoriasis is to reduce the rate of passage of skin cells through their life cycle, which usually leads to relief of the symptoms of this disease.
Depending on your condition, the doctor may prescribe an external application of topical medications or, in more severe cases, ingestion of systemic drugs. In combination with drug treatment, light therapy - natural solar baths or special ultraviolet irradiation - is often used. Light therapy can be carried out both in a hospital and at home with the availability of appropriate equipment.
Treatment of psoriasis is a complex therapeutic problem. And because this disease is widespread, and any treatment regimen includes funds for local treatment( ointments, gels, liquids), in recent years there are many speculative proposals, usually widely advertised.
However, we want to warn people suffering from dermal manifestations of psoriasis, from an overly trusting attitude to advertising allegedly "patented" means. Any medical device, any conventional scheme of treatment, always serve only to the doctor for the treatment that he will assign to you. Each case is unique, because every patient has his own set of possible causes of the disease, his own set of symptoms, his "bouquet" of concomitant diseases. Therefore, only a competent doctor, after studying your clinical case, will prescribe you an adequate treatment.
In mild cases, treatment begins with local activities. As a rule, funds for external use do not have side effects, and the effectiveness of treatment is often not inferior to the effectiveness of general therapy. In the progressing stage of the disease usually apply 1-2% salicylic ointment. In the stationary and regressing stage, more active ointments containing tar, naphthalane, and corticosteroids are shown.
1. Corticosteroids. For local treatment of psoriasis, these drugs have been used since 1963 and are prescribed more often than other means. Corticosteroids are especially indicated when it is necessary to achieve -fast remission of the disease. They contribute to a temporary improvement in skin condition, having a pronounced anti-inflammatory effect. In most cases this is enough to eliminate skin manifestations of psoriasis. Corticosteroids are even classified according to the degree of anti-inflammatory action.
Produced in the form of creams, gels, ointments and lotions. The therapeutic effect of corticosteroids depends on the form of application: gels are usually more effective than ointments. Ointments are usually more active than some corticosteroids in creams, and creams are more effective than lotions. But this does not mean that you only need to use gels, and lotions are not needed at all. For each dosage form, there are indications. Less concentrated agents are usually used for particularly sensitive areas of the skin in the face, inguinal folds and genitals. Strongly-acting drugs are prescribed for the localization of psoriasis in the area of the elbows and knee joints, on the hands and feet, and also on the trunk. Their use may require the use of dressings and should be carried out under the supervision of a doctor. Ointments can be used for dense scaly patches, but they should not be applied to axillary and inguinal areas due to the risk of developing folliculitis. Creams are most effective in treating subacute processes. For the scalp and other skin surfaces covered with hair, gels, lotions and aerosols are preferred.
Local corticosteroids are usually prescribed 2 times a day, as more frequent applications, with the same efficacy, increase the risk of adverse reactions.
What is the danger of using corticosteroids?
Prolonged use of corticosteroids is harmful to the skin: it becomes thinner and discolored, slower healing of wounds, possible dilatation of the skin vessels and the appearance of telangiectasias, acne-like rashes, allergic and contact dermatitis. The frequency of these reactions increases with the use of strong drugs, when applied to areas with sensitive skin( face, scrotum, vulva), as well as in children and patients with kidney failure.
When using any corticosteroids, including local corticosteroids, it should be remembered that a sharp cessation of treatment can cause severe exacerbation of the disease. Long-term use of corticosteroids can lead to addiction and, consequently, to a decrease in the effectiveness of therapy. Do not forget that these are hormonal drugs. Therefore, the application of corticosteroids to large areas of the skin can cause systemic adverse reactions, including hyperglycemia and Cushing's syndrome, to induce glaucoma, cataracts or exacerbation of the eye infection. In addition, local corticosteroids can mask the clinical manifestations of skin infections.
All these issues need to be considered and all aspects of such treatment need to be discussed in detail with the doctor.
Modern corticosteroid ointments are devoid of many noted drawbacks. The most effective combinations are coal tar tar( lokokortentar), salicylic ointment( balsalik, diprosalik, vipsogal, lorinden A, localsen).When the process is localized on the scalp, lotions with corticosteroids( whitewash, diprosalic, lokoid, laticort, elocom) are convenient. To wash the head, there are therapeutic shampoos with tar( friderm-tar, T-Jel Nyutar), zinc( friederm-zinc).
2. Anthralin( dithranol) is an oil derivative. It has been used for the treatment of psoriasis for more than 80 years. This potent agent is rubbed into the affected areas of the skin. The drug may cause irritation of the eye mucosa, so it is applied to the face. The use of dithranol starts from small concentrations( from 0.05-0.1%), increasing depending on the tolerance by 0.1% every 7-10 days.
Patients, who have been suffering from psoriasis for years, hated anthralin, because it stained the clothes and had to stay on the skin all night. Now apply new, less polluting drugs of antraline, which is enough to keep on the skin for no more than half an hour. These drugs include zignoderm, dithrastic, psorax.
How does dithranol work?
This is a topical preparation that inhibits the mitochondrial synthesis of DNA and various cellular enzymes, leading to an antiproliferative effect that normalizes the epidermal architecture. Dithranol has a toxic and cytostatic effect, resulting in a decrease in the number of mitoses in the epidermis, as well as hyperkeratosis and parakeratosis. Antralin is part of the Lassar paste at a concentration of 5%.
DITRANOL is indicated for patients with chronic plaque psoriasis and those patients whose psoriasis can not be treated with vitamin D3 and corticosteroids. Ditranol is contraindicated in patients with pustular, erythrodermic and unstable relapsing psoriasis, as patients with these diseases can respond with severe irritation, which is very problematic to eliminate.
The clinical efficacy of dithranol is close to PUVA therapy and systemic treatment, provided that dithranol treatment is performed adequately and in a hospital setting. Application in the form of a cream as a short contact treatment and the use of a drug at home by patients is less effective.
3. Preparations of tar. These drugs reduce the size and redness of the plaques, but can cause irritation and surface staining of the skin, which disappears after the treatment. Most often used to treat plaque psoriasis, usually hard to treat. Treatment with tar can be very effective in the treatment of itchy, unstable psoriasis, with a pronounced antipruritic effect. In patients with pustular psoriasis and erythrodermic psoriasis, the concentration of untreated tar should be low to avoid irritation. Tar is a part of some medicinal products for baths, lotions and shampoos.
Previously produced drugs had a strong odor, stained skin, clothing and bedding. The new formulations available today are more convenient to use and are usually quite effective, although in severe forms, more effective methods of treatment may be required. During pregnancy and lactation unrefined tar should be avoided.
4. Carbon resin in combination with ultraviolet rays .This combination is used for severe psoriasis. The coal tar is applied to psoriatic plaques, then it is removed and the affected areas of the skin are irradiated with UFO.The course of daily treatment lasts from 2 to 6 weeks. Treatment can be done at home using a portable device or natural sunlight. The method is characterized by high efficiency and is widely used since its creator - physician William Gokerman - first reported in 1925 about the successful use of such treatment in the clinic of the city of Mayo.
5. Coal resin, anthralin and ultraviolet rays .Such a complex combination is called the Ingram method. The method is very effective, but it takes more time and attention to detail, so it is not suitable for many busy people.
6. Keratolytic preparations. In case of severe hyperkeratosis, keratolytic treatment is indicated. Effective keratolytic agents are both a 10% salicylic ointment and an aqueous 50% solution of propylene glycol used under the occlusive dressing.
7. Synthetic analogues of vitamin D3. Preparations of this group contribute to the slowing down and normalization of skin cell division processes in patients with localized psoriasis. Some doctors believe that in the future they will play an important role in treatment. They can be taken in tablets or used as a cream.
The usual vitamin D, which is part of the vitamin complexes, is not suitable for the treatment of psoriasis.
The first of the drugs in this group in 1992 began to use calcipotriol. The drug was very effective and non-toxic.
Calcipotriol is a synthetic analogue of the most active metabolite of natural vitamin D. It causes a dose-dependent inhibition of the proliferation of keratinocytes( significantly increased in patients with psoriasis) and accelerates their morphological differentiation. Has an insignificant effect on the metabolism of calcium in the body.
Cream or ointment calcipotriol( psorkutan) are first-line drugs in the treatment of psoriasis. It is recommended to apply them, as a rule, twice a day, since this is the most effective mode. Do not use more than 100 g of calcipotriol cream or ointment per week. A greater risk of hypercalcemia in the treatment with calcipotriol exists in patients with kidney disease and in children.
Ointment can be used in combination with both light therapy and various medications. To avoid skin reactions, ointment should not be applied to sensitive areas of the skin of the face and genitals, and also exceed the prescribed dose.
A synthetic preparation of the active metabolite of vitamin D, is calcitriol( divenex, rocalaltrol), a regulator of calcium and phosphorus metabolism. The medicine used the ability of the drug to increase the absorption of calcium and phosphorus in the intestine, increase their reabsorption in the kidneys, normalize the processes of bone mineralization in a number of diseases: renal osteodystrophy in chronic renal failure, osteoporosis in the climacteric period, vitamin D-dependent rickets. Use the drug and with psoriasis. The usual dose is 0.00025 mg 2 times a day.
How does calcipotriol work?
Calcipotriol has a normalizing effect on all the main pathogenetic factors of psoriasis: it removes hyperproliferation and normalizes the differentiation of epidermal keratinocytes, has a pronounced positive effect on the main factors of the immune system of the skin that regulate normal cell proliferation and has anti-inflammatory properties. Ointment should not be applied to the face, hands and scalp.
You may have also met with even more new drugs, of which there is no information in the pharmacological reference books: ointment taccalcitol, silicone. When using new, unfamiliar drugs, be guided only by the instructions of the attending physician.
8. Retinoids. Vitamin A derivatives, known as retinoids, can also be used to treat psoriasis. However, they have undesirable consequences: congenital defects of the fetus in women taking medications of this type. Therefore, women who plan to have a baby are advised to wait 2 years before conception, since the body accumulates retinoids for a long time.
The first retinoid, which found a clear antipsoriatic effect after topical use, was tazarotene. In concentrations of up to 0.1% in the form of a gel, the drug was effective, and its tolerability was acceptable in the treatment of chronic plaque psoriasis with a lesion of up to 10% of the body surface. In a comparative study of the treatment with tazarotene once a day in the form of 0.1% gel, its effectiveness was comparable to the efficacy of flucononide cream relative to compaction and flaking. However, flucinonide caused a greater reduction in erythema compared with tazarotene. Further comparative studies are needed to find the position of tazarotene in the spectrum of antipsoriatic treatment.
9. Ultraviolet rays. UV irradiation, phototherapy or light therapy has an important therapeutic effect in psoriasis. Natural sunlight and ultraviolet irradiation can inhibit the process of abnormally rapid division of skin cells. However, with inept use, light therapy can lead to premature aging of the skin, subsequently - to the development of skin cancer, as well as to eye damage. But its use under the supervision of a doctor is not only effective, but also fully safe. For patients with significant lesion area, special booths for full-body irradiation have been developed. Patients living in regions with a hot climate, as one of the methods of therapy, a doctor can recommend careful use of sunbathing. However, it is also necessary to seek help from a doctor and not to engage in self-medication.
Phototherapy is indicated for advanced chronic plaque psoriasis and teardrop psoriasis. With generalized pustular psoriasis and erythrodermic psoriasis, it is recommended to use any physical therapy, including phototherapy, with limited and cautious. Contraindications for phototherapy - photodermatosis, taking phototoxic medicines, the presence of cutaneous cancer in the anamnesis and actinic keratosis, as well as treatment with x-rays or ingestion of arsenic. The presence of melanoma in a family history is also considered a contraindication for phototherapy.
Ultraviolet irradiation can be done daily or several times a week( usually about 40 sessions), controlling the effect. Taking sunbathing, you need to remember that UV irradiation, regardless of origin - artificial or natural - increases the risk of cancer and other skin diseases. Therefore, with a therapeutic purpose, one should irradiate your skin exactly as much as is required to achieve a beneficial effect, but no more. Specific recommendations in this regard will give you a doctor.
How does UFD work?
UV-B radiation( 290-320 nm) has a significant photodynamic effect, since irradiation penetrates the dermo-epidermal transition zone. The therapeutic efficacy of UV-B phototherapy for psoriasis is satisfactory in most patients. Conversely, the therapeutic effect of UV-A( 320-400 nm) is limited. Although radiation penetrates deeper layers of the skin, the UV-A radiation energy quantum is too low for a significant antipsoriatic effect. In combination with ultraviolet A and systemic or topical application of psoralen, a significant photodynamic and antipsoriatic effect can be achieved. Both phototherapy with UV-B, and photochemotherapy require dose selection in order to minimize the irritating effect of the treatment on the skin.
10. PUVA - therapy. PUVA- or photochemotherapy has a significantly higher antipsoriatic potential compared to UV-B phototherapy. It is effective in 85-90% of cases of psoriasis, when a significant area of skin is affected or when other methods of treatment do not work. The purpose of this method is to extend the life cycle of the affected cells. The name of the method reflects the basic principle of treatment. Patients are prescribed practically harmless medications called psoralens( lat. R) and after 2 hours they undergo an irradiation session with special ultraviolet light of spectrum A( Latin UVA).A noticeable improvement occurs approximately after 25 sessions, held within 2-3 months. To ensure confident control of the disease, 30-40 sessions of PUVA therapy are usually sufficient for a year.
Since psoralens have the ability to linger in the lens of the eye, patients with PUVA therapy must use sunglasses with a UVA filter from the moment the session begins throughout the current day before sunset. Uncontrolled use of PUVA therapy can promote skin pigmentation, increase the risk of premature aging and even skin cancer. Therefore PUVA-therapy should be conducted exclusively under the guidance of a doctor or specially trained personnel. The method proved to be very effective, and it was actively used for extensive psoriasis. But the period of general enthusiasm has passed, and now there are indications that PUVA therapy can lead to extremely harmful to the skin consequences that will affect in a few years.
Side effects of photochemotherapy - erythema, blisters, burning, nausea, itching, pigmentation, PUVA-lentigines( spotted rashes after PUVA therapy), hypertrichosis and pain. After long-term treatment with PUVA, multiple squamous cell carcinomas were recorded. Contraindications for PUVA are the same as for UV-B, although PUVA's side effects are more severe than with UV-B.Chronic side effects of PUVA therapy are cataract and hepatotoxicity.
PUVA therapy is indicated for advanced psoriasis, including generalized pustular psoriasis, pustular palmar-plantar and erythro-dermal psoriasis. For several years in the Scandinavian countries, balneo-PUVA therapy has been applied. Psoralfen is applied through a bath, and then patients are treated with UVA.The advantage of balneo-PUVA therapy is a reduction in the manifestations of nausea. Long-term risk for the development of skin cancer( squamous cell carcinoma) in balneo-PUVA therapy is lower than with systemic PUVA therapy. It is of practical importance that patients taking systemic drugs with phototoxic potential should abstain from PUVA therapy or stop taking a phototoxic drug. Patients taking immunosuppressive drugs should refrain from photochemotherapy, since this combination has a carcinogenic effect. Recently, it was shown that patients who received 250 PUVA or more have an increased risk of malignant melanoma. Therefore, the cumulative carcinogenic risk of PUVA therapy should not be underestimated.
The best effect of PUVA therapy is observed in young people, with a small prescription of the disease, in brunettes and persons prone to sunburn.
Psoralen - from the group of photosensitizing and photoprotective preparations, contains two isomeric furocumarins - psoralen and isopsoralen, found in the fruits and roots of the plant psoralen of the otonaceous from the legume family. Application in medical practice is based on the property of furocoumarins to sensitize the skin to the action of light and to stimulate melanocyte formation of the endogenous skin pigment of melanin upon irradiation of its UVA.When used in conjunction with UFO, the drug can help restore skin pigmentation in vitiligo. When depigmentation of the skin associated with the destruction of melanocytes, the effect is not observed. It is used as a component of photochemotherapy of psoriasis, fungal mycosis, vitiligo, etc. In this method, photosensitizing preparations are combined with irradiation with long-wave ultraviolet rays( 320-390 nm).As photosensitizers, in addition to psoralen, use beroxane( puvalene, meladine, meloxin, methoxin, xanthine, etc.), ammifurin, psoberann.
Elokom lotion - 0.1% mometasone solution, is available in 20 ml vials. The lotion is gently rubbed into the affected areas of the skin of the scalp until completely absorbed. Elokom can be used to treat children older than 2 years.
T-Jel Shampoo Shampoos
Effective Shampoo Ti-Jel Newtar contains tar extract, it is recommended for conditions of severe dandruff, psoriasis, seborrheic dermatitis. Eliminates itching, flaking and redness. Makes hair soft, shiny and beautiful.
Frequency of application: daily until the condition of the scalp;twice a week to consolidate the results.
The choice of method of treatment depends on the severity of the condition, hair length and lifestyle of the patient. Most of the recommended products, produced in the form of shampoos, oils, aerosols, solutions, are either tar preparations or contain corticosteroids. When using them, massage the scalp gently, avoiding coarse rubbing of the skin.
With persistent current of chronic plaque psoriasis and generalized pustular psoriasis, systemic treatment can be used.
Brief description of preparations for systemic therapy of psoriasis
1. Retinoid - synthetic analogues of vitamin A - effectively normalize the process of ripening of the surface layer of the skin that is disturbed by psoriasis. According to dermatologists, none of the groups of drugs since the appearance of glucocorticoids had such an effect on dermatoses, like retinoids.
For a long time all over the world, in the treatment of severe forms of psoriasis, including pustular and psoriatic erythroderma, resistant to other therapies, etretinate has been successfully used. Several years ago, a more advanced retinoid appeared - acitretin( neotigazone).
How do I dose a neotigazone?
Doses of the drug are selected individually for each patient, depending on the diagnosis, the severity of clinical manifestations, the effectiveness of treatment and tolerability.
In the first 2-4 weeks, the drug is prescribed in a dose that has the maximum therapeutic effect. A maintenance dose is then established, which should be based on the results of treatment and tolerability.
After the cancellation of the neotigazone, the duration of remission may be different. Sometimes remission can be prolonged with the help of long-term therapy in small doses.
Given the possible side effects( especially on bone tissue), long-term treatment should use all possible ways to reduce the dose of the drug, for example, use a combination treatment, prescribe the drug every other day, increase the intervals between treatment courses.
Side effects and therapeutic measures
How to apply neotigazone in various forms of psoriasis?
With vulgar psoriasis, monotherapy is recommended: the initial dose of the drug is 30-50 mg / day, maintaining a dose of 10-50 mg / day. The withdrawal syndrome is not observed. Combination therapy with this form has its advantages: a greater percentage of positive results, a reduction in the doses of the drugs used, better tolerability. Neotigazone can be combined with cignoline( initial dose 30-50 mg / day of neotigazone and ointment of cignoline, maintenance therapy - neotigazone: 10-50 mg / day + cignoline), PUVA / UV( initial dose 30-50 mg / day14 days prior to irradiation, maintaining a dose of 25 mg / day during irradiation).
In psoriatic erythroderma, the initial dose of neotigazone is 10-30 mg / day, maintaining a dose of 10-50 mg / day. When prescribing treatment, care must be taken: excess initial doses lead to exacerbation, and after initial stabilization the dose can be gradually increased.
Pustular psoriasis requires the appointment of neotigazone at an initial dose of 50-75 mg / day, maintaining a dose of 30-50 mg / day. Pustules usually disappear after 3-10 days. After the disappearance of the pustule, you should slowly switch to a minimal maintenance dose to prolong remission.
Before the treatment and after a month of treatment, and then every 3 months, the following laboratory parameters should be determined: a clinical blood and urine test, biochemical blood counts( ACT, ALT, alkaline phosphatase, triglycerides and total cholesterol).With long-term treatment( more than 4 months), periodic X-ray control is needed - X-ray of the spine, tubular bones, wrist and ankle joints.
The undesirable effects that most often occur against the background of the use of all retinoids - dryness of the mucous membrane of the lips and eyes - correspond to the signs of hypervitaminosis A and in most cases completely disappear after the withdrawal of treatment. Retinoids are teratogenic, that is, they can have a negative effect on the development of the fetus in the mother's body, and therefore their appointment to pregnant women is categorically contraindicated.
Contraindications for the treatment of acitretinum - liver disease, hyperlipidemia, pregnancy and the desire to become pregnant, breast-feeding, severe diabetes mellitus, simultaneous intake of vitamin A or other retinoids, simultaneous administration of tetracyclines or methotrexate, contact lens wear, hypersensitivity to acitretin.
The use of neotigazone in men. Acitretin does not adversely affect the sperm volume, motility or morphology of spermatozoa. Ots does not have a mutagenic effect.
Application of neotigazone in women. Neotigazone is contraindicated in women of childbearing age. It can be used only in severe forms of the disease, resistant to other methods of treatment. The patient needs to clarify in detail the issue of teratogenicity of neotigazone. During treatment, and also within 2 years after its termination, pregnancy should be excluded and reliable contraception should be provided.
Neotigazone in children. Children are particularly careful to establish indications for use. If possible, avoid prolonged therapy for children younger than 7 years of age. Regularly monitor the parameters of growth( growth rate, condition of the musculoskeletal system), regularly conduct an X-ray examination prior to treatment and at annual intervals( eg, spine, knee, elbow joints and joints of brushes).The initial dose is 0.5-1.0 mg / kg body weight. The maintenance dose is 0.1-0.2 mg / kg body weight. The maximum dose is 35 mg / day.
What if. ..
If the patient is abusing alcohol, you need to firmly set the indications for neotigazone treatment;often carry out laboratory monitoring, monitor the liver.
If a patient has diabetes mellitus, the level of metabolism should be monitored as often as possible( there may be an improvement or deterioration in carbohydrate tolerance).
If there are pains in the bones, it is necessary to perform an X-ray examination of the affected areas;if necessary, reduce the dose of neotigazone to a minimum effective dose;avoid excessive physical activity;if necessary, prescribe non-steroidal anti-inflammatory drugs.
If the activity of liver enzymes increases, alcohol should be avoided;limit the intake of fats and carbohydrates;take lipid-lowering drugs;if possible - reduce the dose of neotigazone to the minimum effective;stop treatment when persisting pathological indicators( more than 2 times higher than the norm).
If hyperlipidemia develops, alcohol should be avoided;limit the intake of fats and carbohydrates;take lipid-lowering drugs;if possible, reduce the dose of neotigazone to a minimum effective dose;stop treatment with preservation of pathological indicators( more than 2 times higher than the norm).
If the treatment is not effective enough, you need to check the correctness of the reception: the capsule should be taken in 2 divided doses, during meals, preferably with whole milk - to increase absorption. If the drug is taken correctly, you need to increase the dose to the recommended maximum or prescribe a combination therapy.
If the drug is poorly tolerated, you should divide the dose into 2 divided doses with the basic methods of writing;if possible, reduce the dose to a minimum effective.
2. Cytostatics - a group of antitumor drugs that suppress cell division - are used only in severe forms of psoriasis, when other methods of treatment have proved ineffective. To avoid the development of side effects, in particular liver damage, in the treatment of cytostatics, regular blood testing, chest X-ray, and if necessary, a liver biopsy. Of the drugs in this group: methotrexate is used.
It is effective in almost all forms of psoriasis. To reduce the toxic potential of this medication, intermittent treatment is used.
Usually, the treatment is carried out according to the Weinstein scheme( 3 doses per week with a 12-hour interval).A maximum dose of 15 mg of methotrexate per week is recommended. According to the medical literature, doses up to 30 mg are acceptable.
Side effects include anorexia( loss of appetite) and a decrease in the number of all blood cells. Methotrexate can cause fibrosis and cirrhosis of the liver. There are also unpleasant sensations in the stomach, nausea and dizziness. Women and men who want to have children soon after taking the drug should take into account its mutagenic effect. They should be protected, at least, within 6 months after the end of the drug intake. Contraindications to treatment with methotrexate - serious liver and kidney disease, pregnancy, desire to conceive a child in the near future, active infections, interaction with other medicines, bone marrow hypoplasia, peptic ulcer, ulcerative colitis and lack of cooperation from the patient. During the course of treatment, patients should abstain from alcohol on the days of taking methotrexate. Patients should visit the clinic at intervals of 4-6 weeks. Before treatment and after taking a total dose of 1.5 mg of the drug, a liver biopsy is shown to assess its histological state.
3. Immunosuppressants - have a pronounced effect on the immune system, and they are traditionally prescribed to patients who underwent a transplant of internal organs. Preparations of this group inhibit the process of division of skin cells, providing a fairly rapid relief. However, their action is terminated upon completion of the drug.
The use of immunosuppressants is indicated in patients with severe forms of psoriasis in cases when another therapy is ineffective or impossible, for example, in case of individual intolerance. In connection with a significant risk of hypertension and renal dysfunction, as well as the need for systematic blood and urine tests, patients receiving immunosuppressants need special medical attention. Preparations of this group are not recommended for pregnant women, nursing mothers, people with low immunity and who have undergone a course of ultraviolet irradiation or PUVA therapy. Immunosuppressants for the treatment of psoriasis uses cyclosporine( sandimmun-neoral).
Cyclosporine is effective in almost all forms of psoriasis;the recommended dose is between 3 and 5 mg / kg / day.Side effects - nephrotoxicity, hypertension, gingival hyperplasia, tremor, hypertrichosis, headache, diarrhea, general feeling of discomfort and nausea.
Contraindications - reception of immunosuppressive medications, exposure to X-rays, simultaneous photochemotherapy, malignant formations, active infections, immunodeficiency, organ defects, drug addiction, epilepsy, pregnancy, renal and hepatic dysfunction, uncontrolled hypertension. The patient should be monitored every 4-6 weeks. Kidney function, blood pressure, liver function and hematological parameters should be checked during each visit to the doctor.
Sandimun-neoral, unlike sandimmun, has several advantages: it does not inhibit bone marrow hematopoiesis, does not suppress nonspecific defense factors, immunosuppression depends on the dose, the concentration of the drug in the blood also strictly depends on the dose, the side effects are controlled and reversible. Neural can achieve improvement in 90% of patients with severe forms of psoriasis, when another therapy was ineffective.
Contraindications to its use are renal dysfunction;uncontrolled arterial hypertension;infectious diseases in the absence of adequate therapy;malignant neoplasms( with the exception of skin lesions).
Precautions: patients receiving neoral should not simultaneously prescribe ultraviolet B-irradiation or PUVA therapy. In addition, avoid direct sunlight on the skin.
4. Sulfasalazine .It was found that this drug, used in the treatment of irritable bowel syndrome and colitis, is effective in the treatment of psoriasis. It should be taken under the supervision of a doctor, to regularly examine blood and urine to make sure that there are no harmful effects( changes in the number of blood elements and impaired liver and kidney functions that may occur after the administration of sulfasalazine).
5. Itraconazole( orungal). This is an antifungal agent from the group of triazoles. There are reports of the effectiveness of oregal in the treatment of patients with seborrhoeic psoriasis. Recommended dosage: 1 capsule 2 times a day for 2-4 weeks. The drug is nontoxic, well tolerated by patients. Sometimes there are disorders of the gastrointestinal tract.
To achieve therapeutic effect and long-term remission in the treatment of psoriasis, a combination of different treatment methods is recommended. So, it is recommended to use hyposensitizing agents, sedatives( for example, bromide, novocaid) - their use is caused by the presence of functional disorders in the central nervous system. Bromine is used in neurasthenia. Aminazine reduces the permeability of capillaries, has anti-inflammatory and anti-histamine action.
Vitaminotherapy is used as a component of nutrition that promotes treatment, as well as for the successful elimination of metabolic disorders that are characteristic of psoriasis patients.
In the case of psoriasis, vitamins B, A, D2, C, P, E are used in combination with others, there are data on the use of subtoxic doses of vitamin A. B, - patients with disorders of the central nervous system( hypotension, fatigue, insomnia, irritability).B2 - in case of mucous membranes and in generalized forms with pronounced desquamation. B12 - in large doses, sometimes in combination with A. Some believe that B12 is indicated in patients with increased sensitivity to UV( summer type).
The use of folic acid in psoriatic arthritis has contributed to a reduction in pain in the joints. Since the exchange of folic acid is associated with the metabolism of vitamin B12, a combination is shown. It is recommended to use ascorbic acid, which promotes more effective action of other means of general and external therapy.
Hormones, cytostatics, immunomodulators are used as essential medicines to eliminate symptoms of psoriasis.
Enzymes, hepatoprotectors, preparations for sorption detoxification protect the liver and gastrointestinal tract from the toxic effects of certain drugs and contribute to the full correction of metabolic disorders.
Therapeutic nourishment is an obligatory component of complex therapy of psoriasis.
Phytotherapy uses preparations made on the basis of plant material.
Physiotherapy methods for psoriasis use PUVA therapy, REPUA therapy, selective PUVA therapy, UFO, laser therapy, magnetic therapy, EHF therapy, acupuncture.
Finally, with psoriasis apply and sanatorium treatment.
Patients with generalized rashes are treated in specialized dermatological clinics or at centers for the treatment of psoriasis. The most effective treatment methods for patients with generalized psoriasis are: 1) light treatment( UV-B) in combination with emollients;2) PUVA therapy;3) methotrexate( once a week);4) combination of PUVA therapy with methotrexate or retinoids( etretinate, acitretin, isotretinoin) - today it is the most effective method of treatment of psoriasis;5) cyclosporin.
Most patients benefit from UVB in combination with emollients. If less than 40% of the surface of the body is affected, calcipotriol( vitamin D3) is very effective. The dose should not exceed 100 g / week. If phototherapy is ineffective, PUVA therapy is shown, or, even better, PUVA therapy in combination with retinoids( Re-PUVA therapy).Men of Re-PUVA therapy are treated with etretinate, women - with isotretinoin. During and after treatment, women need contraception. Methotrexate is prescribed for elderly patients( over 50 years of age), and also when light therapy( UV-B + emollients + retinoids) and Re-PUVA therapy have been unsuccessful. Highly effective drug is cyclosporin A, which is prescribed internally at a dose of 4-5 mg / kg / day.
You may have psoriasis that develops, then disappears for many months or years. You may even have only one attack during a lifetime. The disease can start slowly, with only a few spots, or much more intensively, especially after strep throat caused by strep.
It is usually easy for doctors to diagnose psoriasis. However, sometimes it can be mistaken for other skin diseases. In the elderly, for example, psoriasis is often confused with eczema. Eczema and psoriasis are similar disorders, and you can even suffer from two diseases at the same time.
Eczema is also known as dermatitis, and is usually caused by dry, irritated skin. The disease exists in a variety of forms, including atopic eczema-a hereditary predisposition to various types of allergies-for example, eczema, asthma, hay fever-and, after applying certain chemicals, to skin irritation( contact dermatitis).
The word "eczema" literally means "boiling."In the initial stages of the disease, your skin can look as if it was scalded, with redness and tiny blisters. Usually it is accompanied by dry skin - because of this at an early stage, you can take eczema for psoriasis.
Elderly people are especially prone to dry skin and eczema, and it is often impossible to decide whether the rash is the result of eczema or psoriasis, or both, even a biopsy is possible to make a diagnosis. It is important to discover the cause of the rash, because some of the local preparations for psoriasis can irritate the skin affected by eczema.
Young people sometimes find it difficult to distinguish between psoriasis and seborrhea.
Seborrhea is a form of eczema, leading to peeling and a characteristic rash on the face and trunk. It is caused, at least in part, by the pathogenic yeast Pityrosporum. Seborrhea usually affects the scalp, eyebrows, the outer part of the ears, the wings of the nose, folds around the mouth, armpits, chest and groin. It also causes eye irritation.
Psoriasis can be confused with seborrhea because in the initial stages it affects the same areas of the body.
The treatment of diseases is different, and therefore it is necessary to accurately determine the disease, although sometimes only time brings clarity. In the treatment of seborrhea, antifungal creams and shampoos( Nizoral) are used, and also containing sulfur and salicylic acid creams that help reduce inflammation. Seborrhea, like psoriasis, can not be cured, but it can significantly reduce its manifestations.