A medical condition characterized by scaly, nodular changes in the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of disease.
Psoriasis is a chronic skin and nail disease in which a rash of pink nodules and silvery scales appear on the skin. Usually the nodules merge into large plaques, around which the skin is quickly covered with scales. With the prolonged development of the disease, joint damage is possible, accompanied by reduced mobility and constant pain. Different forms of psoriasis differ in the degree of skin damage: the patient may have only subtle patches on the scalp or large patches in different parts of the body. The likelihood of developing psoriasis complications also depends on many factors. This disease is especially dangerous for pregnant women, since the pustular form of the disease can cause miscarriage.
About the disease
Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually occur between the ages of 18 and 35. Psoriasis often occurs in the context of cardiovascular disorders, Crohn's disease and depression. About 30% of patients develop joint damage (arthritis). It is impossible to eliminate the root cause of psoriasis, however, symptomatic treatment can significantly alleviate the course of the disease.
Types of Psoriasis
According to the predominant symptoms, several types of psoriasis can be distinguished:
- plate: characterized by the appearance of classic plates covered with silvery scales; preferential location: elbows, knees, torso, scalp;
- teardrop-shaped: the main manifestation consists of orange-pink nodules whose size varies from 1 to 10 mm;
- nail psoriasis: the nail plates are mainly affected;
- large fold psoriasis: rashes occur in the armpits, in the folds of the neck, on the genitals and other places with excessive friction; this form is more common in obese people;
- psoriasis of the head: the scalp is affected;
- arthropathic psoriasis (psoriatic arthritis): the joints are affected;
- pustular psoriasis: multiple small blisters containing pus appear on the patient's skin;
- psoriatic erythroderma: in addition to the rash, there is a pronounced redness of the skin in the area of the rash.
Psoriasis symptoms
Most often, plaques appear in the forearm, lower leg, navel and scalp. The pustular form of psoriasis is characterized by the formation of pus-filled blisters on the skin. At certain times, many patients experience a change in the color and structure of the nails. Damage to the scales of the skin leads to the appearance of spot bleeding. Patients also complain of itchy skin. The skin changes disappear and reappear periodically.
Other symptoms and signs:
- the appearance of red spots in the skin folds;
- profuse rashes occur after infectious diseases and stress;
- slight increase in body temperature;
- the appearance of new rashes during the winter months;
- articular pain;
- reduced mobility in the affected joint area;
- dryness and hypersensitivity of the skin.
Resorption of plaques usually begins from the central part, as a result of which psoriatic elements acquire a ring or garland shape. Temporary depigmentation (pseudo leucoderma) remains at the sites of resolved rashes. During periods of incomplete remissions, individual "service" plaques may remain in certain areas of the skin (more often at the elbow and knee joints).
The most serious types of psoriasis are psoriatic erythroderma and arthropathic psoriasis.
In psoriatic erythroderma, all of the skin (or almost) is involved in the pathological process. The skin becomes tense, rough, infiltrated, red in color, with abundant desquamation of large and small lamellar on the surface. Peripheral lymph nodes increase, subfebrile temperature appears, the general condition of patients is disturbed, changes in blood (leukocytosis, elevated ESR) and urine (proteinuria) are observed. The development of erythroderma is promoted by irrational and irritating therapy in the progressive stage of psoriasis.
Arthropathic psoriasis is characterized by predominantly lesions of the small joints of the hands and feet, less often of the wrist, ankle, intervertebrals, etc. , accompanied by severe pain and swelling of the joints, limitation of their mobility and deformities. X-ray reveals lysis of the distal phalanges of the fingers and joint changes, similar to rheumatoid arthritis. The Waaler-Rose test and the latex test are usually negative. In the blood, leukocytosis, elevated ESR, hypergammaglobulinemia. Joint damage may be associated with skin lesions or be isolated over several years.
With all these forms of psoriasis, it is possible to damage the nails in the form of pierced nail plates ("thimble phenomenon"), their opacification or thickening which can go as far as onychogryphosis. The course of the disease is chronic and undulating. The seasonality of the process is usually expressed - deterioration in winter with a significant improvement in summer (winter type), less often - vice versa (summer type).
Causes of Psoriasis
The exact mechanisms of psoriasis formation are still not understood. It is believed to be an autoimmune disease in which the body's defense system mistakenly attacks healthy tissue. T cells and neutrophils needed to fight off pathogens can start attacking skin cells and joint structures. In this case, characteristic skin changes occur, including the formation of bubbles with inflammatory fluid. The expansion of blood vessels in the area of inflammation is accompanied by reddening of the skin. Autoimmune diseases can be caused by hereditary factors.
Additional risk factors:
- skin infections. First, they are bacterial infections caused by streptococci;
- skin lesions caused by cuts and burns;
- prolonged stress and psychotraumatic factors;
- alcoholism and smoking;
- vitamin D deficiency in the body;
- taking certain medications, including lithium and beta-blockers;
- unfavorable family history. The discovery of psoriasis in a close relative of the patient indicates the possibility of a genetic predisposition to this disease;
- acquired or congenital impairment of immunity. It may be HIV infection, AIDS or another disease.
Despite the discovery of the alleged immunopathological causes of psoriasis, the disease remains poorly understood. There are a huge number of diseases and lifestyle features that provoke the manifestation of hidden predisposing factors for this disease.
Diagnosis of psoriasis
If skin changes appear, you should consult a dermatologist. The doctor at our clinic first performs a general skin examination to assess the nature of the rash. Gentle scratching allows you to detect peeling papules and a thin film under the nodules. Under the film, there is a moist surface of the skin, prone to small hemorrhages. At the same time, there are atypical signs of psoriasis that resemble other diseases, so the doctor should perform instrumental and laboratory diagnostics.
- Blood test. The dermatologist prescribes a venous blood test to exclude other diseases and detect signs of psoriasis. In the treatment room, the nurse treats the skin of the patient's cubital fossa with an antiseptic, applies a tourniquet and draws blood with a syringe. In our laboratory, specialists first exclude the presence of rheumatoid factors. In pustular psoriasis, an increase in the sedimentation rate of erythrocytes is often found. High levels of uric acid are detected;
- Examination of the liquid from the pustules. The doctor collects the liquid in a sterile container and sends the material to the laboratory. Microbiological examination does not reveal a bacterial culture, but there is an increase in the number of neutrophils characteristic of psoriasis;
- Skin biopsy. The dermatologist prescribes this study to make an accurate diagnosis of atypical rashes. During the procedure, the doctor treats the skin with an antiseptic, anesthetizes and removes a small area of skin with a scalpel. Tissue material is studied in the laboratory of our clinic using microscopy. The results make it possible to specify the cellular composition of the nodules;
- X-ray of the affected joint. The doctor prescribes this study to determine the type of arthritis. Also, in severe complications of arthropathic psoriasis, radiographic diagnosis of the bones is required;
- Scraping of the skin to eliminate fungi. The doctor cleans the surface of the skin and, using a special spatula, collects several scales for microbiological examination. This analysis is mainly necessary if the rashes occur only in the area of the foot and nails.
If necessary, a consultation with a rheumatologist is carried out.
Expert opinion
Psoriasis is a disease with multiple manifestations. It can be almost invisible or cause serious health problems. The most dangerous complications of psoriasis are joint damage, which can lead to disability in the patient. Also, the disease can lead to autoimmune disorders, in particular, Crohn's disease and ulcerative colitis, metabolic pathology, erectile dysfunction in men. Women with psoriasis can be infertile and miscarry. In order to prevent these complications, it is necessary to consult a doctor immediately after the appearance of suspicious signs and, with an already diagnosed diagnosis, carefully follow all the recommendations of a specialist.
Psoriasis treatment
The main goal of psoriasis treatment is symptomatic treatment. Patients need medications that reduce inflammation and prevent the formation of rashes. In addition to drug therapy, the dermatologist in our clinic necessarily prescribes a special diet for the patient. Normalizing lifestyle and eliminating stressors can reduce the severity of psoriasis symptoms.
Depending on the situation, a dermatologist can use different methods to treat the condition.
- Administration of corticosteroids. The dermatologist prescribes ointments containing these drugs. The beneficial effects of corticosteroids include reducing inflammation in tissues and eliminating itching;
- Vitamin D supplements. Synthetic forms of this vitamin slow the growth of skin cells, preventing the formation of scales and nodules;
- Therapy with drugs containing derivatives of vitamin A. A dermatologist prescribes ointments based on retinoids to reduce inflammation and itching. These drugs increase the skin's sensitivity to light, so sunscreen should be used;
- Use of calcineurin inhibitors. They are immunosuppressants that reduce inflammation. The dermatologist prescribes topical agents like tacrolimus. These drugs are used in a short course to prevent the development of side effects and complications;
- Treatment of the skin with salicylic acid to remove dead cells. A dermatologist prescribes this drug together with corticosteroids for the complex treatment of the skin;
- Use a moisturizer to eliminate dry and itchy skin;
- Irradiation of the skin with ultraviolet light. This safe physiotherapeutic treatment method improves the functioning of local immunity. The doctor selects an individual dose of radiation for the patient;
- Phototherapy. This method involves skin irradiation using special devices. Phototherapy combines the technologies of laser therapy and photochemotherapy;
- Joint puncture in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, anesthetizes the tissues and inserts a needle. Using a syringe, drugs are injected into the joint cavity to reduce the inflammatory process.
The dermatologist controls all stages of the treatment to obtain the best result and prevent complications. Corticosteroids, retinoids and calcineurin inhibitors are used strictly under the supervision of a specialist.
Prevention of psoriasis
The recommendations of the dermatologist of our clinic will help reduce the severity of rashes and smooth the course of the disease.
Prevention of exacerbations of psoriasis:
- relieve anxiety and stress by improving sleep, avoiding coffee, and taking prescription sedatives;
- exclusion from the diet of foods containing allergens;
- timely treatment of infectious diseases of the skin.
Rehabilitation
Psoriasis is a chronic disease that cannot be cured. Rehabilitation measures aim to prevent relapses. Depending on the form of the disease, physiotherapy, spa treatment, mud therapy, therapeutic baths and other procedures may be prescribed.
Questions and answers
Is it possible to treat psoriasis with folk remedies?
There are no methods whose effectiveness has been proven. It is important not to trust dubious types of treatment, but to follow the recommendations of the attending physician.
Does stress affect the course of psoriasis?
Yes, stressful situations can aggravate the course of the disease.