Psoriasis is an inflammatory disease of the skin. Occurs when the immune system is malfunctioning. The development of the disease is divided into clear stages - the onset, progression, stabilization and regression. Different stages of psoriasis differ in the appearance of spots and rashes, painful itching, and extensive skin inflammation.
Why is it necessary to distinguish between the stages of development of the disease and what are the characteristics of the course of psoriasis in the early stages of development and during recovery?
Why you need to know the stages of psoriasis
The division of psoriasis into stages is used by doctors for the correct choice of therapeutic methods. A complex of drugs and external agents prescribed to treat inflammation depends on the stage of development of the disease. At the onset of the manifestation of the disease, general treatment is required - vitamin complexes, diet, external aseptic treatment of the rash, for example, a series of UV procedures. Also prescribed drugs that stimulate the cleansing of the intestines, blood vessels, liver. Be sure to proceed to the correction of the psycho-emotional state - by a neuropathologist or psychologist.
At the initial stage of the disease, they do not use strong drugs that turn off the immune system, do not prescribe hormonal ointments. These drugs have a long list of side effects, so they are prescribed only when it is impossible to do without them.
Psoriasis: treatment in acute stage and in remission
In the case of an acute progressive course of the disease, several drugs of various actions are prescribed. Immunosuppressants and glucocorticosteroids are often used to relieve inflammation and reduce itching. External treatments are supplemented by photochemical, ultrasound and laser therapy. In addition, agents are prescribed for the antiseptic treatment of damaged skin.
In a stabilized state, they continue to take hormonal anti-inflammatory drugs, gradually reducing their dose. To restore the damaged skin, ointments with a regenerating effect are prescribed.
In remission - support the body. Correct nutrition, take vitamin and mineral complexes to restore immunity.
Punctuality of treatment
The earlier treatment is started, the easier it is to control psoriasis. Timely treatment limits the spread of skin inflammation, reduces its extent and prevents subsequent relapses of the coat. Since psoriasis is often mistaken for an allergic rash at an early stage, it is necessary to know its first signs so as not to miss the onset of a skin disease.
Note: Doctors are always investigating the causes of psoriasis. But it is well known that psoriatic skin inflammation is not contagious. It cannot be taken from a sick person, nor from an infection in case of injury. It is our own personal failure in the human body.
The cause of psoriasis is immune failure, which can be caused by various factors. Severe stress, intoxication (including strong drugs, industrial emissions, alcohol), previous infection.
Psoriasis is difficult to treat. The disease is prone to relapses, relapses. And the therapy itself is symptomatic. It consists of preventing the appearance of new spots and relieving existing itchy skin.
Which stage of psoriasis is called initial? How to distinguish early psoriasis from diathetic rash? And how will the disease develop in the future?
Psoriasis: initial stage
The first appearance of psoriasis on the skin looks like pimples. Most often, the rash appears in the folds of the elbows and knees, or in places where clothes are tightly pressed against the body (for example, below the belt at the waist). Rashes can also appear along the edge of the hair and under the hair, around the nails and on the nail plates. Sometimes psoriasis occurs on the feet and palms.
Almost always, psoriasis manifests itself symmetrically - on the elbows of both hands, or on both sides of the lower back, or on two knees. The pimples themselves (in medical terminology - papules) at the initial stage have a modest appearance. They have:
- Pink or red;
- Sharp and fuzzy edge;
- Small size - the button at the base does not exceed 2 mm;
- Flat shape - the small punctuated pimples at the onset of the disease have almost no bulges, so they look like spots.
As the disease progresses, flakes of peeling skin appear on the pimples. They are gray or silvery, against a background of a red button, they appear white.
The appearance of scales is accompanied by severe itching. If you don't resist and scratch, the scales are removed, exposing the shiny areas of young, pink skin below. He is very thin, vulnerable, with prolonged scratching of itchy papules - he injures himself, bleeds.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: stage of progression
In the progressive stage, the individual pimples merge into a common point, forming the so-called psoriatic plaques. They are raised above the surface of the skin and are almost completely covered with coat. On the edges of psoriatic plaques there is an unscaled pink-red border.
The presence of a rim is a sign of a progressive stage of the disease. The rim width is 1 to 2 mm. The skin is inflamed and resembles parchment paper in structure.
The edge represents the area of expansion of the spot. It is the skin that is already inflamed, but not yet peeling. After a while, it will also be covered with scales. And the patch will expand to cover new areas of the skin and form a new wider edge.
With the active development of the disease, adjacent spots merge with each other. At some point, a large inflamed red spot can form on the human body.
Psoriatic plaques are very itchy, giving a person unpleasant sensations, interfering with work, rest and sleep. They grow, occupy a large area, and form a new rash on clean, healthy skin.
The main sign of the progressive stage is the appearance of new rashes. As soon as new pimples and spots stop appearing, the next stage of psoriasis begins - stationary. It is not yet a complete victory, but it is already a turn towards recovery.
In the progression stage, psoriasis is almost always accompanied by weakness, fatigue, weakness. Depression is common. Temperature possible.
The duration of the progressive stage of psoriasis can be long, several months.
Psoriasis: stationary stage
The main sign of the stationary phase is the cessation of the appearance of new spots and rashes. At the same time, the itching also weakens, it becomes more bearable. The rash loses its bright color, becomes discolored, becomes invisible. It is also one of the signs that the process is stabilizing.
The pink edges around the plaques disappear when the inflammation stops spreading. Active exfoliation and healing begins, regeneration of new, healthy skin.
We notice with the naked eye that the coat increases at the stationary stage. The scales completely cover the entire surface of the psoriatic spot, leaving no space for the rims. Psoriasis takes on the characteristic flaky appearance that is commonly recognized by the general public.
Extensive coat in the stationary stage is not dangerous. When all the dead cells peel off the surface of the psoriatic spot, healthy skin with a slight light tint will remain in their place.
Other signs of progression or stabilization
In addition to the appearance of the rash, spots, and peeling, there are a number of other signs that can be used to judge the development of the disease. It is the nature of the itching sensations (strong or tolerable), the general condition, the depressed mood. And also the presence of temperature.
At the initial stage, the itching is variable and the rash is incomprehensible. In addition, the itching intensifies every day. In the acute stage of psoriasis, it becomes intolerant. Disrupts sleep, rest, interferes with work. The person becomes irritable because the itching sensations do not give him the opportunity to rest.
At the stationary stage, the itching goes away. Every day a person feels better. The general state of the psyche changes, negativity and depressive moods weaken. The duration of the stationary stage is several weeks - from 2 to 5.
Decaying psoriasis
The discoloration stage of psoriasis is the almost complete disappearance of plaques, spots, redness, inflammation, itching. At this stage of the disease, only a different pigmentation of the skin is reminiscent of psoriasis. In place of the old psoriatic spots, it looks lighter. The surface of healthy skin has a darker shade.
In some cases, the so-called hyperpigmentation is formed. The skin at the site of the psoriasis spots does not become lighter, but darker. In any case, the differences in skin pigmentation will be visible for another one to two months.
Psoriasis after recovery: possibility of relapse
The possibility of psoriasis relapse is determined by lifestyle, diet, allergic mood, and the condition of the body as a whole. It is also determined by the amount of toxins in his body, blood, liver. You can reduce the risk of repeated skin inflammation if you strengthen the immune system and cleanse the body of toxins in the liver, blood vessels, and intestines.
Seasonal relapses of psoriasis are often rare after cleansing. A person remains susceptible to the disease, but the likelihood of its occurrence is significantly reduced.
Cleansing the body of toxins and taking vitamin and mineral complexes help to strengthen immunity. This is especially important if immunosuppressants have been used during treatment, in the progressive stage of psoriasis. Their need was due to the work of inflammatory mediators. After suppressing the autoimmune defense, it is necessary to restore the immune system.
Clinical manifestations
Psoriasis is characterized by monomorphic rashes in the form of papules (nodules) of various sizes, when they coalesce, plaques form and can spread all over the skin.
At the onset of the disease, in most cases, the rash is limited and is represented by single plaques in the places of its preferred location (scalp, elbow extensor surface, knee joints, sacral region, etc. )
The plaques are clearly distinct from healthy skin, bright pink or dark red, covered with loose silvery-white scales, the scratching of which can produce a triad of characteristic phenomena of psoriasis - "stearin stain", "terminal film", "dew of blood". . .
There are 3 clinical stages of psoriasis: progressive, stationary and regressive.
Classification
Depending on the degree of the inflammatory process, the predominant localization of the rash, the severity of the patient's condition and other clinical signs, there is a common, exudative, arthropathic, pustular, psoriatic erythrodermic plaque psoriasis, fold psoriasis, psoriasis of the palms and soles of the feet. It should be noted that different clinical variants can exist simultaneously in the same patient.
Exudative psoriasis is characterized by a pronounced inflammatory reaction of the skin, manifested by the presence of lamellar crusts on the surface of plaques, sometimes multi-layered, resembling a puff cake (in this case, this form of psoriasis iscalled rupioid). When the flake crusts are removed, a weeping surface is exposed.
Arthropathic psoriasis in the clinical picture presents, in addition to the usual eruptions of plaques, lesions of the joints, often small, distal, less often large.
Arthropathy can occur in the presence of or precede skin lesions. Psoriatic arthritis is manifested by pain, swelling, limited mobility in the affected joints of varying degrees of intensity, from minor arthralgias of individual joints to generalized lesions and disability in patients. The possibility of arthropathic psoriasis is higher in patients with severe skin manifestations (psoriatic erythroderma, pustular psoriasis), but a combination of severe joint damage with relatively limited rash is possible.
Pustular psoriasis can be generalized (Tsumbusha) and limited, involving the palms and soles of the feet (Barbera). Stressful situations, infections, irrational general or local therapies contribute to the emergence of this severe form of psoriasis.
Generalized pustular psoriasis occurs with fever, leukocytosis, increased ESR and general serious condition. Suddenly, against the background of bright erythema, small superficial pustules appear, accompanied by burning, pain, they can be localized in the area of ordinary plaques and on previously unchanged skin. New foci of pustulization appear paroxysmal, occupying large areas of the skin. The fused pustules cause the epidermis to detach in the form of "purulent lakes", erythroderma can develop.
Limited pustular psoriasis is more common, the rash is mainly localized on the palms and soles of the feet as pustules on the background of erythema and skin infiltration. The evolution, in comparison with generalized, is milder, with a satisfactory general state, but persistent, with frequent relapses. Irritating local therapy is a provoking factor.
Psoriatic erythroderma is a severe form of psoriasis that develops with a gradual progression of the psoriatic process and the fusion of the elements of the plaque until the defeat of the whole skin, characterized by acute hyperemia, edema, skin infiltration with abundant large and small lamellar skin, less often pityriasis. Subjective - severe itching is often noted. The disease can start with erythroderma. The general condition worsens (fever, weakness, lymph node reaction, heart failure, liver and kidney failure, changes in blood tests, hair loss, etc. ).
Fold psoriasis is more common in children and the elderly, especially in patients with diabetes mellitus. Lesions are located in the armpits, under the mammary glands, in the perineum, inguinal-femoral folds, in the navel and are characterized by sharp edges, saturated red and slight scaling.
Psoriasis of the palms and soles of the feet can exist singly or simultaneously with lesions of other areas of the skin, it is characterized by the formation of hyperkeratotic foci with clear borders, covered with scales that are difficult to scratch andby the presence of painful cracks. The characteristic psoriatic triad is difficult to describe.
Three clinical stages of psoriasis
Progress step. Under the influence of provoking factors (trauma, psycho-emotional stress, infectious diseases, inadequate methods of treatment, etc. ), an exacerbation of the disease may develop with the appearance of abundant small nodules subject to peripheral growth, and the formation of plaques of different sizes and contours, which can be isolated or occupy large areas of the skin up to universal skin lesions.
In the progressive stage, a symptom of isomorphic reaction (Kebner's phenomenon) is characteristic, which is characterized by the fact that typical psoriatic rashes appear at the site of even a minor injury.
Stationary stage. At the stationary stage, the appearance of new elements ceases, and the tendency to peripheral growth of existing plaques disappears.
Regressive stage. The regressive stage is characterized by a decrease in the intensity of the color of the plaques, their flattening, a decrease in peeling, infiltration, resorption of elements with the subsequent formation of foci of hypo- or hyperpigmentationat the site of previous eruptions.
Care
The treatment of psoriasis is aimed at suppressing the proliferation of epithelial cells and eliminating the inflammatory process and is prescribed taking into account the anamnestic data, form, stage, prevalence of the process, concomitant diseases, lage and sex of the patient, contraindications to a certain method of treatment or drug.
For mild and limited manifestations of psoriasis, local external treatment in the form of salicylic ointment, naphthalan preparations, tar or emollient ointments is sufficient. Severe forms of the disease require complex systemic treatment with the use of drugs for detoxification, desensitization, anti-inflammatory drugs of different groups, therapeutic methods of physiotherapy, external drugs, etc.
This section presents the most modern and effective methods and means available for the treatment of psoriasis.
Systemic therapy
There are peculiarities in the management of patients at different stages of the psoriatic process. Treatment of the advanced stage requires special care. During this period, hemodez is prescribed intravenously drip, 30 percent. sodium thiosulfate solution i / v, 10% calcium gluconate solution, in case of concomitant hypertension, it is advisable to introduce a solution of magnesium sulfate; emollient creams used externally or 1-2 percent. salicylic ointment.
Aromatic retinoids.Acitretin (neotigazone) - a representative of the second generation of monoaromatic retinoids is used to treat severe forms of psoriasis at a dose of 10-20-30 mg per day, depending on the severity of the skin process. The mechanism of action of acitretin is to inhibit the proliferation of epidermal cells, to normalize the processes of keratinization. The drug is particularly effective in combination with PUVA treatment. When prescribing acitretin, one should not forget about its teratogenic effect.
Cytostatics.Methotrexate is used in case of persistent psoriasis and in the presence of contraindications to other methods of treatment, being an antagonist of folic acid, it acts mainly on actively proliferating cells. Very toxic. There are many methods of application, preferably intramuscular administration once a week under strict laboratory control.
Immunosuppressants.Cyclosporine-A is prescribed for severe generalized psoriasis resistant to other therapies. This drug has immunosuppressive action, has an inhibitory effect on cell growth processes, suppresses the secretion of activated lymphocytes of cytokines and the expression of interleukin-1 receptors on immunocompetent cells. In psoriasis, it is prescribed at the rate of 5 mg per 1 kg of body weight per day.
nonsteroidal anti-inflammatory drugsare prescribed for arthropathic psoriasis, as well as for the reduction of acute inflammation of exudative psoriasis and erythroderma. Daily doses of drugs and duration of treatment depend on the intensity of the pain syndrome, the degree of inflammation and individual tolerance.
The use of systemic corticosteroids in the treatment of psoriasis is considered inappropriate, it leads to the development of torpid forms of the disease resistant to various types of therapy. In severe arthropathic psoriasis, intra-articular administration of prolonged corticosteroids is possible, the dose and duration of treatment depend on the size of the affected joint and the degree of inflammation.
Physiotherapy treatments.One of the most effective treatment methods is PUVA therapy or photochemotherapy (PCT). PCT is a combined use of long-wave ultraviolet radiation (wavelength 320-420nm) and photosensitizing drugs based on furocoumarin. The use of photosensitizers is due to their ability to increase the sensitivity of the skin to ultraviolet rays and stimulate the formation of melanin. PUVA therapy leads to the inhibition of cell proliferation, the suppression of pathological keratinization, affects the metabolism of prostaglandins, the permeability of cell membranes. The peak of the photosensitizing effect occurs 1 to 3 hours after taking 8-methoxypsoralen. The dose of the drug is selected taking into account the weight of the patient. Procedures are published 3-4 times a week, for a course of 20-25 sessions.
Local PCT is also used with the help of external photosensitizers.
The combined use of PUVA therapy and retinoids is called Re-PUVA therapy. It has the highest clinical effect in severe psoriasis.
Selective phototherapy (SFT) - ultraviolet irradiation in the medium wave spectrum (wavelength 280-320 nm) without taking photosensitizers. SFT is used for less pronounced manifestations of the disease, the presence of contraindications to the appointment of PUVA therapy.
How to recognize early stage psoriasis
Treatment of psoriasis is most effective at the earliest stage. Therefore, it is so important to make a diagnosis in time. Only a dermatologist can tell you if you have psoriasis or another skin condition. However, you yourself can recognize this disease in yourself by several characteristic signs:
- Most often, psoriasis first manifests itself in the folds of the arms and legs, at the hairline or where clothing is in close contact with the body or rubbing together - below the waistbandpants, various elastic bands or straps.
- At the onset of the illness, a very itchy rash appears, covered with gray or silvery scales of skin that come off very easily.
- If you remove the tartar, you will see thin, shiny and slightly moist skin underneath.
- If you scrape the plaque with something like a spatula, removing the scales, blood will appear on the spot as tiny droplets. However, it is better not to use the latter method for psoriasis self-determination - so it is very easy to infect an infection.
For complete confidence, you need to consult a doctor, as patients themselves often confuse psoriasis with various types of lichen or allergic dermatitis, and use inappropriate drugs for treatment.
What to do if you find symptoms of the initial stage of psoriasis?
Psoriasis cannot be cured once and for all, so the main goal of therapy is to achieve stable and longest remission. It should be noted that without adequate treatment, psoriasis quickly becomes chronic: exacerbations can occur up to 9 times a year, lasting up to 15 days.
What to do if you think you have psoriasis? Often people, having discovered signs of this disease in themselves, make a big mistake by resorting to “heavy artillery” - hormonal ointments (so-called topical glucocorticosteroids, or THCS), without consulting a doctor. Usually, patients explain such a move by the fact that they have heard from friends that such funds help quickly. This is a big mistake!
What is the danger of such self-medication? Hormonal ointments for psoriasis have many side effects and contraindications. It is strongly not recommended to use them without a strict recommendation from the doctor on the duration of use, frequency, area of application on the body, and also without taking into account the individual characteristics of your body.
Non-hormonal agents such as zinc pyrithione should be used to effectively treat early psoriasis. Zinc pyrithione, or active zinc, is a very effective remedy for the treatment of psoriasis, which has a complex effect:
- suppresses the excessive proliferation of skin cells and inflammation, reducing the formation of desquamation and psoriatic plaque;
- relieves itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the protective functions of the skin.