Psoriasis or squamous lichenIt is a chronic disease that affects the skin and its attachments: nails and hair. It is characterized by periods of deterioration (relapses) and temporary well-being, when disease manifestations diminish. This disease is not contagious and the patient is not dangerous to others. Because the appearance of psoriasis is not associated with microorganisms.
Psoriasis most often occurs between the ages of 15 and 45 years. People with fair skin are more susceptible to this. In developed countries, the number of patients with psoriasis reaches 2 to 4% of the population. Every 25 inhabitants of the earth on all continents suffer from it.
A large number of medical institutions are dealing with this problem. Therefore, psoriasis has been recognized as the most studied disease. Even so, this disease is not fully understood. Officially, it is considered incurable and raises many questions.
Psoriasis is caused by the body's own immune cells. They ascend from the lower layers of the skin to the upper ones, causing inflammation, epidermal cell proliferation and the formation of small capillaries.
The manifestations of psoriasis on the skin are quite varied. Most of the time, the disease causes the appearance of red spots - psoriatic plaques. They are dry to the touch, rise above the surface of the skin and are covered in a white layer.
Types of Psoriasis
The disease is divided into two major groups: pustular and non-pustular psoriasis.
non-pustular psoriasis
- common (common) or simple (plaque psoriasis, chronic stable psoriasis) psoriasis
- psoriatic erythroderma or erythrodermic psoriasis
pustular psoriasis
- von Tsumbusch pustular psoriasis or generalized pustular psoriasis
- palmoplantar psoriasis (pustular psoriasis of the extremities, chronic persistent palmoplantar pustulosis)
- annular pustular psoriasis
- palmoplantar psoriasis
- herpetiform psoriatic impetigo
Furthermore, these types of psoriasis are differentiated.
- seborrheic psoriasis
- psoriasis of flexor surfaces and skinfolds
- napkin psoriasis
- drug-induced psoriasis
According to the severity, these forms of psoriasis are differentiated.
- Mild - Less than 3% of the skin is affected.
- Moderate - 3-10% of the skin is covered by psoriatic plaques.
- Severe - there are joint damage or more than 10% of the skin is involved.
Causes of psoriasis
So far, there is no unequivocal answer to the question: "why does psoriasis appear? "Scientists have come up with several theories.
- Psoriasis is an autoimmune disease. It is based on a malfunction of the immune system. The immune cells of T-killers and T-helpers, whose function is to protect the body from viruses, bacteria and tumor cells, for some reason, penetrate into the upper layers of the skin. Here, they produce inflammatory mediators - substances that "trigger" the inflammatory response. This results in increased skin cell division and multiplication (proliferation).
- Psoriasis is a disease caused by impaired growth, division and maturation of epithelial cells - keratinocytes. The result of these changes in the skin is an attack by the immune cells of T lymphocytes and macrophages on diseased skin cells.
Factors that contribute to the development of psoriasis
Doctors have looked at several factors that can cause the disease to develop. Obviously, psoriasis occurs more often if several of these illnesses act in the body at the same time.
- Hereditary predisposition.There is a version that genes responsible for the immune system and the function of T lymphocytes carry the disease. Therefore, parents suffering from psoriasis are more likely to have children with the same symptoms.
- Thin and dry skin. . . It was noted that people with such skin characteristics fall ill more often than those with oily, well-hydrated skin. This is likely due to the protective functions of sebum and the structural characteristics of the skin.
- external irritants. . . A high percentage of patients are among those people who are in constant contact with alcoholic solutions, solvents, household chemicals, cosmetics (lotions, hand creams).
- excessive hygiene- Excessive love of cleanliness also impairs the skin's protective properties. Soaps, shower gels and face towels clean the natural protective barrier and leave microscopic lesions behind.
- Bad habits- addiction to alcohol, tobacco and drugs is harmful to the skin. Your nutrition and blood supply are deteriorating.
- HIV- AIDS patients are more prone to psoriasis. Scientists cannot explain this phenomenon. The fact is that psoriasis is caused by increased lymphocyte activity and, with AIDS, their number decreases.
- Medicines- taking certain medications can cause illness. Among them: beta blockers, antidepressants, anticonvulsants and antimalarials, lithium carbonate.
- Infections (fungi and staphylococci). . . There have often been cases where psoriasis appeared immediately after fungal infections or streptococcal illnesses.
- In motion- a change in climate or even a season of the year, environmental degradation can be a trigger for this disease.
- Stress- severe emotional disturbances or physical stress (prolonged periods of hypothermia, overheating, accidents) precede the onset of the first symptoms of psoriasis.
- Trauma- constant effect on the skin: pressure, friction, scratches. This regular trauma can cause the first psoriatic plaques to appear at this location.
- Allergic conditions- Allergic rashes and the processes that occur in all layers of the skin also increase the risk of disease.
What are the symptoms and signs of psoriasis?
Psoriasis is a systemic disease that affects more than just the skin and nails. It affects joints, tendons and spine, immune, nervous and endocrine systems.
Even so, the main manifestations of the disease occur in the skin. The name squamous lichen very accurately conveys the symptoms of psoriasis. The first manifestations are often pink or bright red papules with the correct rounded shape, covered by scales - psoriatic plaques. They are located symmetrically, mainly on the extensor surfaces, the lumbar region and the scalp. But they can affect any part of the skin and genital mucosa. Its size ranges from a few millimeters in the early stages to ten centimeters or more.
Depending on the characteristics of the eruption, suchforms of psoriasis:
- Pitting psoriasis - the size of the elements is smaller than the head of a pin.
- Guttate psoriasis - the papules are teardrop-shaped and grow to the size of a lentil seed.
- Coin psoriasis - plaques grow to 3-5 mm and have rounded edges.
They also distinguish the forms of the eruption, when its elements are in the form of rings, arcs and garlands, geographic maps with jagged edges.
The papules are covered with a scaly coating that can be easily removed. It consists of keratinized cells from the epidermis. Psoriatic plaques start to become covered with scales from the center, then plaque spreads to the edges. Its loose and light appearance is due to the fact that the keratinized cells are permeated by spaces filled with air. A pink ring can form around the elements - this is an area of inflammation, a zone of plaque growth. The skin around the elements of the rash is unchanged.
scalp psoriasisrepresents psoriatic plaques that rise significantly above the surrounding skin. They are densely covered with dandruff-like scales. In that case, the hair is not affected. Rashes can occur not just under the hair, but also on smooth skin, on the neck and behind the ears. These changes are explained by the active division of keratinocytes in the affected areas.
Psoriasis of the feet and palmscauses a strong thickening of the stratum corneum of the skin in these areas of the body. The skin becomes thick, rough. Cracks often penetrate it. This is caused by intense cell division, which multiplies 8 times faster than normal, but is not removed in time from the skin's surface.
nail psoriasisdiffers in a variety of symptoms. But more importantly, there are two main types of damage to nail plates:
- By the type of "thimble". Small lumps form on the nail plate, similar to needle prick marks.
- By the type of onychomycosis. Lesions resemble nail fungus. The nails thicken, change color, peel. A psoriatic papule surrounded by a red border is visible through the nail plate. Looks like an oil slick that shines through the nail.
The symptoms and signs of psoriasis depend on the stage of the disease, which are replaced cyclically throughout the year. Therefore, most patients have a "winter" type of disease when the exacerbation occurs in the autumn-winter period. An improvement in the condition in summer is due to the fact that ultraviolet light from the sun has a therapeutic effect. But some patients suffer from the "summer" type.
There are stages in the course of psoriasis:
- progressive - the appearance of new elements, the active growth of existing plaques, the implication of the pink growth zone around them, intense scaling and itching.
- stationary - preventing the growth of papules, the absence of new rashes, thin folds of the upper layer of skin around the psoriatic plaques.
- regressing - the absence of desquamation, the disappearance of plaques and the appearance in their place of areas of pigmentation, indicate the attenuation of the process.
What do rashes look like in psoriasis?
Each organism is individual and reacts differently to illnesses. Therefore, the nature of the eruption can be very varied. This explains the variety of forms and types of psoriasis.
However, for most people, the symptoms of psoriasis are similar. These are red patches - psoriatic plaques, which rise 1-3 mm above the level of healthy skin. Its appearance is caused by the fact that the cells of the skin's superficial layer - keratinocytes, divide very actively, having no time to mature and transform into grown epithelial cells. As a result of this increased pathological growth, certain areas of the skin thicken. This is because the cells of the immune system release chemicals that cause inflammation in the skin.
From above, the plates can be covered with a gray, silver or yellowish flower, which looks like paraffin. Therefore, they were given the name - "paraffin lakes". They are keratinized epithelial cells whose rejection is impaired and accumulate on the surface of the affected skin.
The patches are scaly, warmer than the rest of the skin, and can grow to a large size. Often, the patient experiences intense itching at this location. This is due to the fact that, in the context of the inflammatory process, a cascade of neuro-reflex reactions and an allergic reaction occurs.
Another type of element are papules. These are small elements of a rash that resemble a tubercle. Size is about 1mm. In the middle there is no cavity filled with content. They are usually located at the knee and elbow joints. They remain even during periods when the disease subsides.
During exacerbations, elements of the eruption gradually increase in width and merge with neighboring plaques. During periods of improvement (remission), the spots begin to lighten in the middle. They gradually take the shape of a ring and can completely dissolve. After the plaques, a trace remains in the body - pigmentation. It can be significantly lighter or darker than the surrounding skin. After a person is tanned, the skin tone is usually evened out.
How are nail lesions in psoriasis?
Nail psoriasis is similar to a fungal infection of the nail plate. For a correct diagnosis, it is necessary to carry out a laboratory analysis. Changes can affect just one nail or all at once and are very diverse. They occur in 10-15% of patients. Nail damage is often accompanied by joint pain caused by psoriasis. In that case, there may not be a rash.
Nail psoriasis has several stages:
- depressed stitches - nail thimble
- longitudinal depressed grooves
- transverse compression at the center of the nail, these early signs are associated with damage to the nail root - the nail matrix
- "Oil spots" irregularly shaped pink spots that appear through the nail - this is the accumulation of serous fluid under the nail
- the nail becomes opaque, cloudy, yellow and thick due to circulatory disturbances.
- the nail blade takes on the appearance of a bird's claw, which is accompanied by pain. This is because the process captures nerve endings.
Nail lesions start at the edge and gradually progress towards the root, covering the entire surface. Disorders of the microcirculation cause clouding of the nail and a change in its color from yellow to bluish.
If you find similar symptoms in yourself, do not diagnose yourself. Similar changes can be caused by other reasons: fungi, trauma, and impaired blood supply.
Is psoriasis contagious?
This question is often asked by those who have just been diagnosed with the disease and by those who are known to the patient. Scientists give an unequivocal answer to this. Psoriasis is not contagious and a sick person is absolutely safe for others. This is because psoriasis is not caused by a virus or bacteria, but by aggressive white blood cells. These immune system cells themselves, for unknown reasons, attack the skin cells, causing inflammation of the skin. The result of this process is a rash and thickening of the skin in some places (psoriatic plaques).
How is psoriasis treated?
Treatment of psoriasis depends on the form and stage of the disease and drug sensitivity. Traditional medicine focuses on drug use. Treatment starts with local preparations that work on the affected skin. Thus, they try to avoid the side effects that occur when taking medications orally. More details on using local resources will be described below. Now let's talk about pills and capsules.
There is a technique where, first, the patient is given milder medications and with the fewest side effects. If they are not effective, they will be replaced by more powerful ones, and so on. Even in the case where the treatment is suitable for the patient, after a while it is changed. The fact is that the body gradually gets used to the drug and its effect diminishes.
Systemic oral medications are very effective. They are prescribed for moderate and severe stages of the disease. They help even those patients for whom treatment by other means has not produced a positive result. However, they have significant drawbacks: they can cause serious side effects, and once these funds are abolished, the situation gets worse again.
| drug group | Dosage form and effect of the drug on the body |
| Retinoids - Vitamin A Derivatives | It influences the maturation of the skin's surface layer and eliminates disturbances in this process caused by psoriasis. Release form - capsules. Dosage according to schedule, depending on stage, 30-75 mg / day. It reduces the rate of division of keratinocytes, promotes normal maturation and differentiation of cells. Available in capsules. The daily dose is 25-50 mg. |
| Immunosuppressants - drugs that reduce the activity of the immune system | It reduces the activity of T lymphocytes, which cause increased skin cell division. Sterile solution in ampoules. The initial dose when administered into a vein is 3-5 mg / kg per day, for oral administration - 10-15 mg / kg per day. |
| Medicines for the treatment of malignant neoplasms (cytostatic) | It inhibits the overgrowth and reproduction of atypical epidermal cells. Available on tablets. Assign 2, 5-5, 0 mg orally, 2-3 times a day, 1 time a week. |
Physical therapy treatments for psoriasis are very effective. They bring significant relief to patients, halt disease progression, and, in some cases, act as a safe replacement for medications.
| physiotherapy method | Effects on the body |
| PUVA therapy or photochemotherapy | Combination of longwave ultraviolet irradiation and an internal photosensitizer. The course is 20 to 30 procedures. The method is based on the fact that ultraviolet rays penetrate deeply into the skin. The photosensitizer inhibits skin cell DNA synthesis and the rate of their division. For the treatment, special facilities or cabins are used. |
| Selective phototherapy (S. F. T) | Skin irradiation with ultraviolet rays with a wavelength of 280-320 nm. The course is from 15 to 35 procedures. A special cabin for therapy is required. |
| Monochromatic UV treatment | Exposure to each spot separately with a laser or UV radiation lamp source. Allows you to radiate spots even in hard-to-reach places, without affecting healthy skin. It is prescribed in cases where less than 10% of the skin is affected. The course of treatment is 15-30 procedures. |
| laser therapy | For the treatment of skin rashes, laser radiation with different wavelengths is used. The laser promotes rapid resorption of psoriatic plaques, protects against the appearance of scars in their place. The doctor determines the number of procedures individually for each patient. |
| electrosleep | The procedure is performed in a device based on a mild effect on the brain with weak electrical impulses. Duration 20-60 minutes. The number of procedures is 10-12. Electrosleep has a calming effect. As a result, nervous system activity is normalized, plaques begin to dissolve, and a period of well-being begins faster. |
| Magnetotherapy | Treatment with magnetic fields has a beneficial effect on the general condition. The itching and inflammation of the skin, swelling and pain in the joints decrease, the psycho-emotional state improves. The Betatron device is used for treatment. The procedure takes 20 minutes. Number per course 10-15. |
| ultrasound therapy | It is used as an analgesic, antipruritic and decongestant. Promotes scar resorption. The procedure can be combined with the administration of medications (phonophoresis). The duration of exposure to an area is 15 minutes. To obtain a therapeutic effect, 7 to 14 sessions are needed. |
| hyperthermia | Heating fabrics to a temperature of 40 degrees using special thermally blended pads. This effect on the body normalizes the functioning of the immune system and reduces the attack on the skin. The procedure takes about 2 hours. Its number is determined by the doctor. |
| bee venom treatment | The substance is introduced into the body using an electrophoresis or ultrasound device. An anti-inflammatory, absorbable and antipruritic effect is obtained. Metabolism is normalized. The minimum number of procedures is 10. |
It is very important that people with scaly lichen follow a diet. Eating disorders can make the disease worse. The menu should be rich in vitamins and at the same time simple. It should give rest to the intestines and liver, and also not allergic to the body.
| Allowed Products | prohibited food |
| Vegetables (pumpkin, watermelon, beetroot, carrot, potato, radish) | animal fats |
| Fruits (apricots, peaches, apples), juices | Alcohol |
| Berries (except berries: strawberries, raspberries, gooseberries) | Fat meat (pork, duck) |
| fresh herbs | smoked meats |
| Lean meat (veal, beef, rabbit, turkey) no more than 200 g per day | Red fish |
| Cheese, cottage cheese, dairy products | soft drinks and coffee |
| Nuts | Eggs |
| Low-fat fish varieties | ice cream and milkshakes |
| Seaweed | Minimum amount of confectionery and sugar |
| whole wheat bread | Butter and puff pastry |
To cleanse the body of toxins and metabolic products, fasting days twice a week are necessary. They recommend kefir, apples, vegetables.
What ointments are effective in treating psoriasis?
The use of ointments for psoriasis has the greatest effect compared to other external preparations. The components of the ointment do not remain on the surface of the plaque, but soften the scales and penetrate the skin.
There are a large number of ointments available to treat psoriasis. In the early stages, namenon-hormonal ointments.
In case the treatment does not have the expected effect, prescribehormonal ointments. . . Treatment starts with milder medications with minimal side effects. If improvement is not achieved, then stronger glucocorticosteroid ointments are prescribed.
| name of ointment | drug action | Side effects |
| weak ointments | Suppresses increased activity of leukocytes, prevents their movement in the skin, eliminates tightness and itchiness. | Swelling of the skin, itching, redness. |
| moderate ointments | It has anti-inflammatory, anti-allergic, anti-edematous and antipruritic effects. Suitable for patients with exuding forms of psoriasis, reduces bleeding. Apply in a thin layer to limited areas 2-3 times a day. Treatment lasts from 10 to 14 days. | Steroid acne, skin atrophy and stretching, burning, itching, hypopigmentation. |
| strong ointments | Local anti-inflammatory, antipruritic and anti-allergic agent. Reduces skin moisture. Apply to affected area 2-3 times a day for up to two weeks. Used during an exacerbation. | Skin atrophy. |
| very strong ointments | It has a strong anti-pruritic and anti-allergic effect. It slows down cell division and keratinization processes. Sign up 1-2 times a day for no more than two weeks per course. | Acne, hair loss, skin atrophy. Do not use for psoriasis in pustular and disseminated plaques. |
Pharmaceutical companies produce many drugs in the form of ointments. The doctor individually selects the medication for the patient and, if necessary, switches to a stronger one.
Don't forget that in any case with psoriasis you should skip doctor visits. After all, this disease can hide the early stage of skin cancer.
Choosing a treatment regimen for psoriasis is a time-consuming process that involves a lot of trial and error. Don't despair if you don't find "your" remedy right away. Remember that many people achieve lasting improvement when the disease has not returned for years. You can do this too!