Psoriasis

Psoriasis (also known as squamous lichen) is a chronic, non-infectious and often recurring skin disease.

Psoriasis, the symptoms of which determine its tendency to damage periarticular tissue, manifests as scaly papules. In addition, it should be noted that this disease is one of the most common skin lesions that occurs at any age.

The etiology of this disease has not yet been fully investigated and proven, however, many dermatologists still agree that psoriasis is a disease directly related to inherited genetic pathologies.

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general description

Psoriasis is characterized by the duration and persistence of its course. Its remissions, which can last several months or several years, indicate its subsequent return and its lifespan. Spontaneous recovery from this disease is extremely rare.

If you try to determine a specific category of people predisposed to the onset of psoriasis, the solution will not be unambiguous. The fact is that psoriasis, acting as a systemic process, develops not only in people with actual immune disorders, but also in people with certain functional or morphological disorders associated with the functions of various systems and organs.

Belonging to the group of dermatoses, psoriasis is one of the most studied diseases. Meanwhile, none of the hypotheses that exist today can fully determine the essence of this disease. In view of this, the problems with its therapy and prevention are in the same uncertain and, at the same time, acute situation as before. Depending on the specific time period, various ideas have been proposed regarding the origin of psoriasis. This, in turn, led to the selection of a number of forms, each based on the results of certain laboratory studies and clinical observations.

• The hereditary nature of the disease. This implies the presence of psoriasis as part of the consideration of several generations, in which, accordingly, cases of this disease were noted. By the way, it is heredity that is considered practically the main and reliable cause of the development of psoriasis (in this case, psoriasis increases under the influence of various types of provoking factors).
• The metabolic nature of the disease. In this case, disorders of fat metabolism (i. e. cholesterol metabolism), reduced morbidity during periods of hunger, an increase in the amount of phosphorus in psoriatic dander, etc. are taken into account.
• The viral nature of the disease. In this case, the concept of the direct involvement of a viral infection in the etiology of the disease under consideration was formed on the basis of numerous long-term clinical observations. Accordingly, for the same reason, the infectious (and also viral) nature as a theory of the development of psoriasis is the oldest. So, the end of the XIX century was marked by cases of the formation of very extensive groups of psoriatic-type formations, formed against the background of patients with diseases such as scarlet fever and influenza. The systemic nature of the current lesion, its recurrent and prolonged course, the presence of a link with meteorological and heliophysical factors, as well as some features inherent in the course of rashes characteristic of psoriasis, also confirmed the infectious character ofdisease. sickness. As at present, research is underway for viral agents by which the psoriatic process could be triggered.
• Endocrine nature of the disease. The theory of a direct link between the onset of psoriasis and the endocrine (as well as metabolic) nature in the recent past has been supported by many. When examining patients with psoriasis, some disorders of the endocrine scale were quite often revealed, which served as a justification for the relevance of such a connection. In particular, disorders associated with the inherent functional state of the sex glands, the influence caused by the menstrual cycle, pregnancy, childbirth and lactation, the pronounced type of changes detected in the study of the pituitary system-adrenal glands in patients have been demonstrated.
• The neurogenic nature of the disease. It consists of the onset of the disease against a background of real nervous shock for the patient (more precisely after his transfer). In about 30% of cases, the exacerbation of the disease occurs precisely on the basis of stress. In this case, patients have a reduced ability to resist the impact of stress and the subsequent transfer of its consequences. At the same time, the disorders they present (asthenic, vegetative-vascular-visceral, vegetative-vascular-dystonic and asthenodepressive) associated with neurotic reactions provoke the formation or even exacerbate the characteristics of the dominant vicious circle.

Classification

As we have already noted, psoriasis acts as a chronic and relapsing disease. Each of its existing forms can be attributed to one of the variants of the relevant classification for psoriasis, in which there is a distribution for pustular or non-pustular psoriasis. In general, the classification is as follows:

• Pustular psoriasis
  • generalized psoriasis;
  • annular psoriasis (annular pustulosis);
  • palmoplantar psoriasis (extremity psoriasis, persistent palmoplantar pustulosis, pustular barbera psoriasis);
  • chronic form of persistent acrodermatitis (psoriasis of the soles of the feet and palms, palmoplantar psoriasis);
  • Psoriatic impetigo herpetiformis.
• Non-pustular psoriasis
  • vulgar psoriasis or vulgar psoriasis, simple psoriasis (plaque, stable psoriasis in chronic form);
  • Psoriatic erythroderma (erythrodermic psoriasis).

A number of authors adhere to the need to supplement this classification, due to which types or forms of psoriasis can be added to it in the following variants:

• seborrhea-like psoriasis (seborrheic psoriasis);
• Napkin psoriasis;
• drug-induced psoriasis;
• "Reversible psoriasis" (psoriasis of the skin folds, flexor surfaces).

Psoriasis: symptoms

The first symptoms of psoriasis are the rash of miliary-type papules, which are characterized by a gradual increase along the periphery, while simultaneously turning them into nummular and lenticular papules and fusing with each other, due to whichplaques of different sizes appear. There are three main stages in the development of psoriasis within the skin.

First stage

This stage is defined as a progressive stage, it is caused by the formation of new formations on the skin (actually papules), as well as an increase in the size of the formations already present on the skin. This is also accompanied by the formation of an erythematous border around the lesions (such a border is defined as a zone of peripheral growth). The plaque along the edges is not sensitive to peeling, while the peeling, acting as the final stage of inflammation, does not follow the process of growth of psoriatic formations.

Second step

The second stage defines a stationary period in which new elements do not appear, however, the existing elements in the form of plaques and papules do not change in size. In general, the appearance of papules can be completed at any stage, so the stationary period may be accompanied by the simultaneous appearance of miliary, lenticular and nummular papules. Let's explain which are the three types of papules listed. So, nummular papules are elements of a rounded rash with a diameter of 15-20mm (for this reason, these papules are also called coin-shaped). Lenticular papules, in turn, are elements of a rash, flat or convex, oval or round in shape, resembling lenses. And, finally, miliary papules, which have a shape of conical elements and are therefore similar to hemp seed. Basically, these papules are small in size, the predominant area is near the hair follicles.

Third step

This stage is reversed (or regressive). Its main feature is that the rashes gradually disappear, and a whitish border of a pseudosclerotic type forms around the foci themselves (it is defined as the Voronov edge). During this period, some patients may experience mild itching. As for subjective sensations, they are mostly expressed in an insignificant way, or even completely absent.

The appearance of rashes can be noted in any area of the skin, however, they are mainly localized in the area of the surface of the folds of the limbs, especially the elbow and knee joints, the sacrum area, the scalp (here, in particular, the area along the edge of the hair growth is distinguished, which is defined as "Psoriatic crown"). Psoriasis on the head, the symptoms of which, although determined by the severity of their own manifestations, do not lead to a change in the structure of the hair, nor to their loss.

As for the concentration of plaques in the surface of the extensors of the knee and elbow joints, they often persist here for a long time from the time the rash usually resolves (this characteristic defines them as plaques "ofservice"). Some patients are faced with the fact that the skin folds of the inguino-femoral region or mammary glands, as well as axillary glands, are affected, and such a lesion can often be isolated.

Irritated psoriasis

It develops against the background of active exposure of the skin with already existing progressive psoriasis to certain irritants, in particular, sunlight or specific ointments, as well as other types of irritants that affect plaques. These plaques, in turn, become more convex in shape, the color changes to cherry red, a hyperthermic belt is formed in the surrounding area, due to which the sharp boundaries become somewhat blurred. This belt, depending on the resolution of the plate, takes on a crumpled appearance.

Spotted psoriasis

This form of the disease manifests itself in the form of a slight infiltration (in the general definition, infiltration is the impregnation of tissues with one or another substance) from the elements of the rash. In turn, they look like spots (not papules). As a rule, spotted psoriasis develops acutely and is also characterized by a similarity to drug eruption. As the main method of differentiating the disease, the definition of the correspondence of the course of the disease with its characteristic psoriatic triad is used.

Old psoriasis

This form of the disease can be seen in terms of symptoms in the form of severe infiltration on the side of the plaques, their general cyanosis, with a hyperkeratotic or warty surface. This type of foci is especially difficult to cure, and their future transformation into a malignant tumor formation is not excluded (this rarely happens, but, unfortunately, it is not necessary to exclude this option).

Seborrheic psoriasis

This form of psoriasis, as the name suggests, develops in patients with seborrhea that already affects them. The disease manifests itself from the scalp, in the area behind the atria, on the chest, in the area of the nasolabial folds, in the subscapular and scapular parts of the back. Emerging psoriatic scales are subjected to intense sebum saturation, due to which they stick together and remain on the surface of the plaque, thus allowing the disease to simulate a characteristic image of seborrheic eczema.

Palmoplantar psoriasis

The disease can manifest itself either as ordinary psoriatic plaques and papules, or as hyperkeratotic formations that mimic calluses and calluses. In some cases, psoriasis on the hands, the symptoms of which are noted in this case on the palms (or on the legs - according to the definition, on the soles of the feet) is continuous, which manifests itself in the form of aincreased thickening or keratinization. The boundaries of this type of lesion are characterized by clarity; in rarer cases, this form of psoriasis is limited to the appearance of a wide-ring peel.

Exudative psoriasis

This form of psoriasis is characterized by excessive severity of the exudate during an inflammatory reaction; it appears during the progressive period of the evolution of psoriasis. Rising to the surface of the papule, the exudate helps to saturate the accumulation of scales, thus forming from them formations that resemble crusts. These elements are secondary, define them as crusts of flakes, the color of these elements is yellowish. After their removal, a slightly bleeding and oozing surface is subjected to exposure. Scaled crusts, when dried and layered, often form a massive type of conglomerate, resembling an oyster shell (which is already defined as rupioid psoriasis).

Guttate psoriasis

Guttate psoriasis, the symptoms of which appear suddenly, is characterized by the formation of multiple spots on the skin. Most of the time, the disease is diagnosed in patients between the ages of 8 and 16. Often, strep infection acts as a precursor to teardrop-shaped psoriasis.

Psoriasis of the nails

Psoriasis of the nails, whose symptoms make it possible to isolate this type of psoriasis in three main forms, depending on the degree of damage to the nails, it can be atrophic, punctual or hypertrophic.

A punctate lesion is considered to be the formation of punctate depressions on the nail plates, which can also be compared to the surface of a thimble. The manifestation of this form of psoriasis is possible in a slightly different version, which in its specificity is similar to onychomycosis. In this case, inside the free edge, the nail plate changes color, becomes dull, prone to crumbling without much effort. As a sign to differentiate psoriasis, an inflammatory border formed along the periphery of the affected area of the nail plaque is determined. It presents as the edge of a papule in the nail bed, visible through the nail plate.

Psoriatic arthritis (psoriasis)

Psoriatic arthritis, the symptoms of which are manifested by infiltration, which involves periarticular tissues with simultaneous damage to the joints, mainly affects the interphalangeal joints. At the same time, the possibility of the involvement of large joints in the pathological process is not excluded; joints and joints of the sacroiliac spine are extremely rarely at risk in this regard.

It is important to take into account that psoriatic arthritis, unlike other types of arthritis (which in the general definition means inflammation of the joints), forms against the background of a psoriatic rash that already exists inthe patient, often associated with nail damage. . In addition, an important point can be distinguished that the appearance of this type of arthritis is associated with an exacerbation of psoriasis within the skin, which in most cases acquires an exudative character.

Irrational treatment of the disease during the period of its progression is often accompanied by the appearance of a non-specific reaction of the body. It is toxic-allergic in nature and consists in the appearance of redness in the area of areas not affected by psoriatic plaques, this redness, merging, completely affects the skin. This process is combined with a high temperature (within a range of not more than 39 degrees), as well as an increase in lymph nodes, a feeling of tightness of the skin, burning and itching. In frequent cases, there is also profuse peeling, thickening and exfoliation of the nail plates, hair loss. This image already indicates the relevance of psoriatic erythroderma. Erythroderma ends with the restoration of the traditional version of the course of psoriasis.

Usually, the recurrence of the disease occurs in the autumn-winter, as well as in the spring-summer period, which is an important factor to take into account, including when prescribing the necessary treatment.

Psoriasis treatment

Before the appointment of treatment, a thorough examination of the patient is carried out, and already to determine specific measures, they are based on the stage of the course of the disease, on its clinical variety, the general condition of the patient, on thepresence of concomitant diseases, the conformity of the manifestations of the disease to seasonality, etc. the fastest, and, at the same time, a favorable result of treatment is obtained in the case of simple forms of psoriasis with their short course, as well as with limited manifestations. In general, the treatment of psoriasis is quite a laborious process, and in most cases it is not possible to cure completely - the disease simply regresses (that is, a period of its existence withoutsymptoms begins), which, however, is also a positive result for her.

The main goal of treatment was determined to be the maximum possible suppression of symptoms in combination with the addition of preventive measures.

First of all, with psoriasis, a diet is prescribed, in which foods that provoke an exacerbation of the disease (spicy foods, chocolate, alcoholic beverages) are excluded from the diet. The restriction also applies to the consumption of smoked meats, honey, fried and fatty foods, etc. During the period of exacerbation of the course of the disease, it is recommended to eat more fruits and vegetables (except red ones: apples, tomatoes, cherries, etc. ), fish and lean meats (boiled).

The course of psoriasis has a beneficial effect on its treatment in the conditions of sanitary facilities at seaside resorts. Considering the particular sensitivity of the skin in patients with psoriasis, it is recommended to avoid sun exposure for the period of 11 to 16 hours.

As for the drug treatment of psoriasis, it is based on the use of several methods. First of all, these are external agents (creams, ointments, etc. ), drugs for systemic treatment (injections, pills, etc. ) and such methods as phytochemotherapy (herbal medicine), physiotherapy, etc. . external treatment methods. In particular, the following drugs were most commonly used among them:

• Salicylic ointment. With its help, softening of the formed scales is ensured, which, in turn, offers the possibility of their early removal, as well as better absorption of another type of drugs. This ointment (0, 5% or 5%) is applied to the affected areas of the skin in a thin layer, once or twice a day. An important feature of the application is the use of a smaller amount of ointment with a significant nature of inflammation (that is, the more pronounced the inflammation in the nature of its manifestation, the lessthe amount of ointment is used for this, respectively). Salicylic acid, which acts as the basis of the drug, is also found in a number of other ointments used in the treatment of psoriasis.
• Sulfur tar ointment (5 or 10%). The use of this ointment helps to reduce inflammatory processes relevant to the skin. The contraindication to use is exudative psoriasis (i. e. psoriasis, accompanied by scabs and oozing scales). You cannot apply this ointment on the skin of the face. Tar shampoos are used to treat scalp psoriasis.
• Naphthalene ointment. It is used to treat the regressive and stationary stages of the disease. Exacerbation or progression of psoriasis determines the inadmissibility of the use of this remedy. With the help of this ointment, severe itching and inflammation is reduced. A 5% or 10% ointment is used.
• Glucocorticoid drugs. Their use allows a decrease in the intensity of inflammation. They are used only in short courses, with the mandatory supervision of a specialist.
• Ointments containing vitamin D. Such ointments have an anti-inflammatory effect, while improving the course of the disease.

As for systemic treatment, it is selected strictly individually and only by the attending physician. As already stated, this means the use of various pills, injections, etc.

Herbal chemotherapy as a method of treating psoriasis involves exposure to ultraviolet light of the affected skin areas. For this, a special type of installation is used, which irradiates these areas without affecting the healthy skin.

In general, the treatment of psoriasis can mean many different regimens implemented in practice, but none of these regimens are generally accepted due to the difference in their course and specificity. Therefore, the effectiveness of one regimen cannot be determined equally for all patients. Let us repeat that the treatment of the disease is carried out on a strictly individual basis under the constant supervision of the attending physician.

If symptoms indicating psoriasis appear, it is necessary to contact a dermatologist and a specialist in infectious diseases.