Psoriasisis a systemic disease characterized by damage to the skin, musculoskeletal system, functional and morphological disorders of other organs and systems. The main symptoms of pathology: nodular rashes on the scalp, palms, feet, extensor surfaces of the elbows and knees, hyperemia, itching. The disease can be diagnosed visually, but to exclude the possibility of developing concomitant pathologies, laboratory tests and instrumental diagnostic methods are prescribed. Systemic treatment includes taking aromatic retinoids and cytostatic drugs, glucocorticosteroids.
Introduction
The name of the disease comes from the Greek "psora" - "skin disease", "scabies". In the Middle Ages, psoriasis was considered a form of leprosy (leprosy). The signs of psoriasis were first described professionally in 1808 by Robert Whelan in Great Britain. The term "psoriasis" was introduced by the Viennese dermatologist Ferdinand Gebra in 1841. The pathology is recorded in all latitudes of the globe with an uneven frequency of 0. 1 to 3%. Psoriasis develops equally in men and women, but in children it is more common in girls, and in adults - in men (60-65%).
Causes
There are various theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurogenic, endocrine, hereditary. Each of these theories is based on clinical observations and laboratory results.
Most scientists pay attention to the genetic nature of psoriasis. They claim that this disease is of polygenic origin. If one of the parents is sick, the risk of developing a pathology in the child is 8%, if both father and mother are 41%.
Factors that contribute to the development of psoriasis are divided into external and internal factors.
- External factors include mechanical and chemical damage to the skin, as well as dermatoses.
- Doctors include internal provoking factors: infections (streptococcus and human immunodeficiency virus), medications (corticosteroids, nonsteroidal anti-inflammatory drugs), nervous stress.
Pathogenesis
Today, doctors around the world recognize the involvement of the immune system in the pathogenesis of psoriasis. Cells of the immune system, which usually respond to antigens, begin to attack healthy cells, most often skin cells. As a result of this process, the cells of the epidermal layer divide more quickly than usual. They do not have time to mature, which is why strong bonds are not established between them. The cells, rising to the surface, form protruding plates with silvery scales.
Classification
According to the International Statistical Classification of Diseases and Related Health Problems, there are many types of psoriasis.
- Ordinary (vulgar). The most commonly recorded form of lichen planus, in which there are no complications. This group includes plaque and patch psoriasis.
- Generalized pustular psoriasis- a serious form of pathology, complicated by a secondary infection. This affects several areas at once. Includes Zumbusch syndrome and impetigo herpetiformis.
- Persistent acrodermatitis (Crocer's dermatitis, Setton's dermatitis)— the contents of the pustules are sterile, there is no secondary infection. The main areas affected are the fingers and nails.
- Palmar and plantar pustulosis (pustular bacterium)- develops on the feet and palms. It appears in the form of pustules with sterile contents, the surface area of which gradually increases.
- teardrop shaped- separately located papules that do not merge into plaques. The most commonly affected areas are the legs, thighs, back, forearms, chest and neck.
- Arthropathic- the clinical course resembles the rheumatic form of arthritis.
- Other psoriasis (reverse)- conglomerates are located in the armpits, inguinal folds and other natural folds. This type includes reverse flexor psoriasis.
- Psoriasis, unspecified- combines several types of pathologies, the clinical picture is quite broad.
Depending on the seasonality of the exacerbation, several types of psoriasis are distinguished:
- summer- the exacerbation occurs following exposure of the skin to the sun;
- winter- occurs due to extreme cold that affects the skin.
With non-seasonal psoriasis, there are no periods of remission, the disease occurs all year round.
By affected skin area:
- limited psoriasis- occupies less than 20% of the body's skin;
- common- more than 20%;
- generalized- all skin is affected.
Symptoms
The clinical manifestations of psoriasis directly depend on the stage of development of the disease. There are 3 steps.
- Progressive stage. It is characterized by the appearance of papules, itching, the appearance of peeling, peeling and deformation of the nails.
- Stationary scene. New papules do not appear, the old rash does not increase in size, and peeling is moderate.
- Regressive stage. The plaques heal and white depigmented spots form in their place, which no longer cause discomfort.
Rashes are only external signs of psoriasis. In fact, the disease affects many organs and systems, as well as tendons and joints. For this reason, patients complain of depression, a constant feeling of weakness and chronic fatigue.
Complications
Among the complications of psoriasis, psoriatic arthritis and psoriatic erythroderma are particularly important. In addition, in the absence of rapid diagnosis and effective treatment of psoriasis, the risk of developing serious chronic pathologies increases: diabetes mellitus, high blood pressure and metabolic syndrome.
Diagnostic
To identify pathology, laboratory and instrumental diagnostic methods are used.
The patient is referred for:
- general clinical analysis of blood and urine;
- blood biochemistry;
- blood test for C-reactive protein and rheumatic tests;
- coagulogram - assessment of blood clotting;
- blood test for human leukocyte antigen.
For complicated forms of psoriasis, associated with damage to the musculoskeletal system and internal organs, radiography of the joints, ultrasound of the kidneys and organs of the urinary system and echocardiography are prescribed.
There are diseases that have similar symptoms. A differential diagnosis is therefore necessary. To do this, use methods such as:
- biopsy (excision of a piece of skin with additional histological examination);
- laboratory tests - used to distinguish psoriasis from papular syphilis.
Treatment
Psoriasis responds well to symptomatic treatment. Knowing the pathogenesis, the doctor can individually select a treatment method. Some of them are aimed at reducing rashes, eliminating dryness and itching, others at preventing the immune system from "attacking" healthy cells.
Therapeutic tactics directly depend on the severity of the disease and the localization of lesions.
External therapy
Topical glucocorticosteroids are used for various forms of psoriasis as monotherapy or in combination with other medications. They exist in the form of dosage forms – ointments, creams or lotions.
Medicines containing vitamin D3 analogues. They are applied to affected skin areas if the prevalence of psoriasis does not exceed 30% of the body surface area.
Preparations containing activated zinc pyrithione are used in the form of an aerosol, cream, and also as a scalp shampoo.
Phototherapy
For treatment in this case, methods of medium-wave phototherapy and PUVA therapy are used. PUVA therapy is the combined use of long-wave ultraviolet (UVA) rays (320-400 nm) and a photosensitizer (8-methoxypsoralen). PUVA therapy is one of the most effective ways to cure the disease, it is most often prescribed for generalized vulgar and exudative psoriasis, persistent pathology and severe infiltration.
Combined therapy
Such treatment includes several therapeutic modalities, for example: phototherapy and topical corticosteroids; phototherapy and systemic retinoids.
Systemic therapy
Prescribed for moderate and severe forms of psoriasis. Systemic therapy drugs are prescribed mainly during disease progression.
Biological drugs
These drugs are created using genetic engineering methods. These are monoclonal antibodies used for therapeutic purposes.
Prognosis and prevention
With rapid diagnosis of the pathology and effective treatment, the prognosis is rather favorable. As a preventive measure, the following are often prescribed: a diet enriched with fish and vegetables, hydrotherapy, a course of herbal medicine, sanatorium treatment and emollients (mainly in the inter-relapse period - to restore the hydrolipidic layer).