Symptoms of psoriasis - Causes, symptoms and treatment. MF.

Psoriasis( squamous lichen) - one of the most common skin diseases, refers to chronic diseases, which occurs over the years, accompanied by alternating exacerbations and external health. According to statistical data cited by various authors, this disease affects about 2% of the world population.

The main symptoms of psoriasis

Psoriasis is characterized by the presence of a monomorphic rash in the form of nodules( papules) with a diameter from 1-3 mm to 2-3 cm or more, pink and red, covered with loose silver-white scales. When the papules are scraped, the symptoms characteristic of psoriasis are revealed: "stearin stain", "terminal film", "bloody dew".

The disease begins in different patients in different ways. More often at the beginning of the disease there are not many rashes, they can persist for a long time in the same places, especially on the scalp and in the area of ​​large joints, gradually increasing in area, usually under the influence of any provoking factors( traumatism, violation of diet,pregnancy or childbirth, etc.).After infectious diseases( influenza, tonsillitis, etc.), severe nervous shock, drug intolerance can immediately develop a plentiful psoriatic rash with a multitude of elements, usually small, swollen, lying on the entire skin.

Psoriasis on the elbow of

In the course of the development of the disease, the increase in the number of elements, their peripheral growth, the papules merge and form plaques of various sizes and shapes.

A characteristic of psoriasis is the phenomenon of Kebner ( a symptom of an isomorphic reaction) when psoriatic papules that are characteristic of the disease appear at the site of the injury or scratch.

Psoriasis is most often localized on the extensor surfaces of the extremities, especially in the area of ​​the elbow and knee joints. Rashes can affect the skin of the trunk. Often the scalp is affected.

During psoriasis, progressive, inpatient and regressive stages are distinguished. For , the progressive stage of is characterized by the appearance on the new skin areas of a large number of small, pinhole-sized nodular rashes, a tendency toward peripheral growth of the elements and the development of psoriatic papules.

Vulgar psoriasis

In the stationary stage , new elements do not appear. The papules existing on the skin cease to increase.
The regressing stage of psoriasis is characterized by the flattening of psoriatic plaques, reduced peeling and resorption of elements, which most often starts from the central part. In place of regressed rashes, as a rule, depigmented spots remain.

Symptoms of psoriasis depending on the classification of

The following clinical varieties of psoriasis are distinguished: common, exudative, arthropathic, psoriatic erythroderma and pustular psoriasis.

Exudative psoriasis differs from the symptoms of ordinary psoriasis by significant exudation( wetting), as a result of which lamellar scaly yellowish crusts form on the surface of the papules. When removing the papules from such crusts, a wetting and bleeding surface is exposed.

Exudative psoriasis

Pustular psoriasis can manifest itself as a generalized or palmar-plantar form. Generalized pustular psoriasis is severe, with fever, malaise, leukocytosis, an increase in ESR.Paroxysmal against the background of bright erythema appear small superficial pustules, accompanied by burning and soreness, located both in the zone of plaques and on previously unchanged skin. Pustular psoriasis of the palms and soles occurs more often than the generalized form. Eruptions, as a rule, are symmetrical and represent intraepidermal pustules against a background of severe hyperemia, infiltration and lichenization.

Arthropathic psoriasis is characterized by the presence of typical skin rashes accompanied by joint damage, mostly small( brushes and feet), rarely large ones. The range of symptoms may vary from minor arthralgias, especially at the beginning, to a disabling condition. The distal joints are most often affected. At the beginning of the disease, mono- or oligoarthritis, usually asymmetric, is observed, with a progressing course, generalized joint damage can develop. Swelling, soreness, restriction of mobility of joints as a result of infiltration and compaction of pararticular tissue are noted. In the further course of the process, dislocations, subluxations, ankyloses, leading to deformation of the joints, and often disability of the patient may occur.

Psoriatic erythroderma is an acutely developing, generalized process characterized by the following symptoms at its peak: abrupt hyperemia( redness), swelling, infiltration and lichenation, with a large number of scales on the surface. The patient raises the temperature, there are pains in the joints, worsens overall health. Erythroderma can develop due to the gradual progression of the psoriatic process, the fusion of plaques, and also under the influence of provoking factors, among which the most unfavorable are excessive insolation, overdose of ultraviolet rays or their application( as well as irritating external agents) in the progressing stage.

In psoriasis, nail lesions of can occur, which is manifested by pinpoint depressions on the surface of the nail plate( symptom of a "thimble"), cloudiness or the appearance of longitudinal and transverse grooves. Sometimes the nail plates are thickened, deformed, their surface is uneven. In other cases, the nails crumble, break and tear away.

Psoriasis of nails

Histopathology of psoriasis

The pathognomonic sign of psoriasis is a significant acanthosis with the presence of elongated epidermal outgrowths, somewhat thickened in their lower part.

Over the tops of the papillae of the dermis, the epidermis is sometimes thinned, parakeratosis is characteristic, and in the old foci - hyperkeratosis. The granular layer is unevenly expressed, and there is no under parakeratosis. In the progressing stage, interstitial and intracellular edema, exocytosis with formation of focal aggregations of neutrophilic granulocytes, which migrate to the stratum corneum or parakeratotic regions, form the Munro microabscesses in the spinous layer. Mitosis is often found in the basal and lower rows of the spinous layer. Accordingly, the lengthening of the epidermal outgrowths of the papilla of the dermis is elongated and enlarged, sometimes bulbous, edematous, the vessels in them are sinuous, full of blood. In the podsochev layer, a perivascular infiltrate from lymphocytes and neutrophilic granulocytes is noted.

Symptoms depending on the causes of

Psoriasis is a multifactorial disease. There are two types of psoriasis. Psoriasis type I is associated with the system of HLA antigens( HLA Cw6, HLA B13, HLA B 17).This type of psoriasis affects 65% of patients, the debut of the disease falls on a young age( 18-25 years).Psoriasis type II is not associated with the HLA system of antigens and occurs at an older age.

Undoubtedly, an important role in the pathogenesis of psoriasis is played by changes in the immune system, caused either genetically or acquired under the influence of external and internal factors. Provocative moments may include skin trauma, stress, the use of certain medications, alcohol abuse, infectious diseases( especially those caused by streptococcus, viral diseases), etc.

Immune system disorders are detected both at the cellular and humoral levels and consist of changes in the content of immunoglobulins of the main classes, circulating immune complexes, pool of lymphocytes in peripheral blood, B- and T-populations and subpopulations of lymphocytes, killer cells, phagocytic activity segmentoocyte leukocytes.

It is believed that the primary changes in psoriasis occur both at the level of the cells of the dermal layer and the epidermis. Dysregulation in the dermis cells causes excessive proliferation of mostly normal epidermis.

Hyperproliferation of keratinocytes leads to the secretion of cytokines and eicosanoids, which exacerbate skin inflammation. In the lesions of the epidermis, cells presenting an antigen produce interleukin-1.Probably, interleukin-1 is identical to the activation factor of epidermal T-lymphocytes( ETAF), which is produced by keratinocytes and activates lymphocytes of the thymus. Interleukin-1 determines the chemotaxis of T-lymphocytes and, by stimulating their migration into the epidermis, may be responsible for the infiltration of the epidermis by these cells.

Psoriasis of the palms

Psoriasis of the feet

Interleukins and interferons produced by T lymphocytes themselves can be mediators in the processes of hyperproliferation of keratinocytes, as well as mediators of inflammation and thus contribute to maintaining a vicious circle that determines the chronic nature of psoriasis.

Just these factors and cause the development of complications of the disease and the patient's propensity to the diseases of other organs and systems.

Psoriatic arthritis as a complication of psoriasis

To see a doctor if psoriasis is suspected

This disease is handled by a dermatologist.