Psoriasis is a chronic multifactorial systemic disease with a genetic predisposition that affects the skin and joints. Patients often complain of a pinkish-red rash with silvery-white scales. The rash is accompanied by itching, pain and peeling. When joints are damaged, their mobility is limited, which can lead to disability for the patient.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only theories of origin:
- neurogenic (appearance of rashes after stress, burns, mental trauma);
- endocrine (especially during the perimenopausal period);
- metabolic (fat metabolism disorder);
- infectious;
- viral (psoriasis antigens are isolated from individuals who are healthy but have a high probability of developing psoriasis in the future, while psoriasis is a non-contagious disease);
- genetic.
Psoriasis can be found in an entire generation of people with the same risk factors. But the type of inheritance is assumed to be multifactorial. If one parent is sick, the child has a 25% chance of getting sick. If both parents are sick – 60 to 75%.
Viral and genetic theories remain the leaders.
Factors that contribute to exacerbations:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, decayed teeth, hepatitis);
- stress;
- obesity;
- perimenopausal period;
- medications (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, tobacco, household chemicals);
- skin injuries; dryness, leading to increased skin trauma.
Clinical classification
There is no single classification. One of them:
- vulgar (ordinary);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis of the palms and soles;
- pustular psoriasis.
Flow characteristics:
- they get sick at any age, cases of psoriasis in children are not rare;
- men and women get sick equally;
- prevalence worldwide;
- There is a summer, winter and mixed seasonality of exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin with the production of insufficiently mature keratinocytes. Pink-red rashes appear, covered with silvery-white scales.
A triad of symptoms is characteristic, thanks to which a diagnosis can be made:
- symptom of stearin stain - when scratching, the number of scales increases;
- the phenomenon of psoriatic film - when all the scales are scraped off, a smooth, shiny red surface appears;
- a symptom of spot bleeding - when the film is scratched, droplets of blood appear. This is due to uneven elongation of the papillae in the dermis, expansion of capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start as a spot and grow into large areas of damage.
- Hand psoriasis is most often located on the extensor surfaces.
- Psoriasis on the face - the rash often appears behind the ears, on the forehead. It is an independent factor in improving treatment.
- Scalp psoriasis is an isolated form, does not affect the hair, the elements of the rash are located along the edge of the hair, "psoriatic crown".
- Nail psoriasis - leads to characteristic changes, point depressions, the nail resembles a thimble. It may also thicken, become dull, or yellow spots form under the nail.
- Psoriatic arthritis – affects peripheral joints with or without pain, often accompanied by inflammation where the ligaments attach to bones, the ligaments themselves, and the fingers.
Features of psoriasis in children
Characterized by the presence of one or more elements up to 1 cm, they rise above the surface of the skin. Itching in children is more pronounced than in adults. After scratching, the stain bleeds and wounds form. In children, psoriasis is often located in the perineal region in the form of a large red spot. In adolescents, spots appear on the palms and soles.
There are three stages of psoriasis:
- Progressive - the elements of the rash increase and are uniformly white in color, with a narrow red border along the edge;
- Stationary – the growth of the spot stops, a strip of paler skin appears along the edge 2-5 mm wide;
- Regressive stage - the scales gradually fall off, the spot diminishes and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients turn to a general practitioner, a dermatovenerologist or a rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and tenderness of joints), anamnesis (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). On examination, changes are noted in the skin and joints.
Laboratory tests are carried out:
- general blood test (including WBC count, ESR, platelets);
- general urine analysis;
- biochemical analysis (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
- in difficult situations, a skin biopsy is performed with a more thorough pathohistological examination (strongly expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of clusters of 4-6 or more elements);
- before prescribing biological treatment, an examination for HIV, viral hepatitis B and C and tuberculosis is carried out;
- x-ray of affected joints;
- CT and MRI for axial lesions;
- ECG.
If necessary, consultations are held with an infectious disease specialist, phthisiatrician, orthopedic traumatologist, surgeon and other specialists.
When diagnosing psoriasis, diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, Zhiber rosea and papular syphilis should be excluded.
The severity of psoriasis is determined by the BSA (Body Surface Area - the area of skin affected by psoriasis), the PASI (Psoriasis Area and Severity Index - index of prevalence and severity of psoriasis), the DLQI (Dermatology Life Quality Index- dermatological). quality of life index).
To diagnose psoriatic arthritis, the PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (Psoriatic Arthritis Classification Criteria) criteria are used.
Treatment of psoriasis
The treatment is complex and aims to eliminate inflammation, normalize the proliferation and differentiation of keratinocytes.
Local therapy:
- ointments and creams with vitamin D3 and its analogues;
- calcineurin inhibitors;
- glucocorticoids for local use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological medicines.
For psoriatic arthritis:
- non-steroidal anti-inflammatory drugs;
- disease-modifying drugs;
- intra-articular injections of glucocorticoids;
- biological medicines.
For chronic cases, it is recommended to use psoriasis ointments; for exacerbations, psoriasis creams are used.
When applying ointment or cream, do not rub it into the skin or apply a bandage. This may increase the penetration of the medicine into the skin and cause side effects.
It is not recommended to use hormonal ointments for more than 4 weeks. Incorrect dosage of medications may be ineffective or cause side effects. The expected effect of the treatment occurs after 1-2 weeks of use.
There are several ways to use psoriasis creams and ointments containing glucocorticoids:
- continuous mode;
- tandem therapy mode;
- top-down treatment regimen;
- step-by-step application mode.
It should be noted that the treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis using ointments and creams directly on the affected area. For more serious forms, treatment is carried out in a hospital setting using phototherapy, systemic therapy and biological drugs.
The course of the disease is considered moderate and systemic treatment can be initiated in the following cases:
- areas of skin of aesthetic importance are affected;
- large areas of the head are affected;
- the external genitalia are affected;
- palms and soles are affected;
- at least 2 nails are affected;
- Some items cannot be processed locally.
Systemic treatment is carried out only in a hospital, under the strict guidance of doctors, since systemic treatment is associated with a wide range of side effects, which can be reduced by selecting individual treatment.
General recommendations for patients with psoriasis:
- minimize skin trauma and drying;
- after applying psoriasis creams and ointments to your hands, use gloves to prevent the medicine from getting into your eyes;
- use sunscreens with a protection factor of 30;
- avoid stressful situations, consult a psychologist if necessary;
- control your weight, eat rationally.
Diet for psoriasis
Recommended:
- alkaline drink 1200-1600 ml per day;
- use of lecithin;
- vegetables and fruits;
- porridge;
- lean meats and fish;
- dairy products.
Not recommended:
- citrus;
- bread made from premium flour;
- fatty fish and meats;
- high-fat dairy products;
- coffee – no more than 3 cups per day;
- yeast products;
- alcohol, sweets, marinades, smoked, spicy.