Psoriasis is a chronic systemic multifactorial disease with genetic predisposition that affects the skin and joints. Patients often complain of a pinkish-red rash with silvery-white scales. The rash is accompanied by itching, pain and peeling. When joints are damaged, their mobility is limited, which can lead to the patient's disability.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only origin theories:
- neurogenic (appearance of skin rashes after stress, burns, mental trauma);
- endocrine (especially during perimenopause);
- metabolic (fat metabolism disorder);
- infectious;
- viral (psoriatic antigens are isolated from healthy individuals, but with a high probability of developing psoriasis in the future, while psoriasis is a non-contagious disease);
- genetic.
Psoriasis can be detected in an entire generation of people with the same risk factors. But the type of inheritance is considered multifactorial. If one of the parents is sick, the child has a 25% chance of getting sick. If both parents are sick – 60-75%.
Viral and genetic theories continue to be the leaders.
Factors contributing to exacerbations:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, tooth decay, hepatitis);
- stress;
- obesity;
- perimenopausal period;
- medications (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin lesions; dryness, leading to increased trauma to the skin.
Clinical classification
There is no single classification. One of them:
- vulgar (common);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis on the palms and soles;
- pustular psoriasis.
Flow characteristics:
- they get sick at any age, cases of psoriasis in children are not uncommon;
- men and women get sick equally;
- prevalence worldwide;
- There are summer, winter and mixed seasonality of exacerbations.
Psoriasis symptoms
The disease itself is characterized by a violation of skin keratinization with the production of insufficiently mature keratinocytes. Reddish-pink rashes appear, covered with silvery-white scales.
A triad of symptoms is characteristic, thanks to which a diagnosis can be made:
- symptom of stearin stain - when scraped, the number of scales increases;
- the phenomenon of psoriatic film - when all the scales are scraped off, a smooth, shiny red surface appears;
- a symptom of point bleeding - when the film is scraped off, drops of blood appear. This is due to the uneven stretching of the papillae in the dermis, the expansion of capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start with a spot and turn into large areas of damage.
- Psoriasis on the hands is usually located on the extensor surfaces.
- Psoriasis on the face - the rash often appears behind the ears, on the forehead. It is an independent factor to enhance treatment.
- Psoriasis on the scalp is an isolated form, it does not affect the hair, the elements of the rash are located along the edge of the hair, "psoriatic crown".
- Nail psoriasis - leads to characteristic changes, pinpoint depressions, the nail looks like a thimble. It may also thicken, become opaque, or form yellow spots under the nail.
- Psoriatic arthritis - affects peripheral joints with or without pain, often with inflammation in the connection of the ligaments to the bone, in the ligaments themselves and in the fingers.
Features of psoriasis in children
Characterized by the presence of one or more elements measuring up to 1 cm, they rise above the surface of the skin. Itching in children is more pronounced than in adults. After scratching, the spot bleeds and sores form. In children, psoriasis is usually located in the perineal region as a large red spot. In adolescents, spots appear on the palms of the hands and soles of the feet.
There are three stages of psoriasis:
- Progressive - elements of the rash enlarge and are uniformly white in color, with a narrow red border along the edge;
- Stationary – the growth of the spot stops, a strip of lighter skin appears along the edge 2 to 5 mm wide;
- Regressive stage - the scales gradually fall off, the spot decreases and disappears. A depigmented patch remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients turn to a general practitioner, dermatovenereologist or rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and tenderness in the joints), anamnesis (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). On examination, changes in the skin and joints are found.
Laboratory tests are carried out:
- general blood test (including leukocyte count, ESR, platelets);
- general urine analysis;
- biochemical analyzes (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
- in difficult situations, a skin biopsy is performed with subsequent anatomopathological examination (pronounced acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of stacks of 4-6 or more elements);
- before prescribing biological treatment, an HIV, viral hepatitis B and C and tuberculosis test is carried out;
- x-ray of the affected joints;
- CT and MRI for axial injuries;
- ECG.
If necessary, consultations are held with an infectious disease specialist, phthisiatrician, orthopedic traumatologist, surgeon and other specialists.
When diagnosing psoriasis, it is worth excluding diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, Zhiber rosea and papular syphilis.
The severity of psoriasis is determined by BSA (Body Surface Area - the area of skin affected by psoriasis), PASI (Psoriasis Area and Severity Index - index of prevalence and severity of psoriasis), DLQI (Index Quality of Life Index). Dermatology - dermatological quality of life index).
To diagnose psoriatic arthritis, the PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (ClASsification for Psoriatic Arthritis criteria) criteria are used.
Psoriasis treatment
The treatment is complex, aimed at eliminating inflammation, normalizing the proliferation and differentiation of keratinocytes.
Local therapy:
- ointments and creams with vitamin D3 and its analogues;
- calcineurin inhibitors;
- glucocorticoids for local use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological drugs.
For psoriatic arthritis use:
- nonsteroidal anti-inflammatory drugs;
- disease-modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
For chronic cases, the use of psoriasis ointments is recommended; for exacerbations, psoriasis creams are used.
When applying ointment or cream, do not rub it into the skin or apply a bandage. This may increase the penetration of the medicine into the skin and cause side effects.
It is not recommended to use hormonal ointments for more than 4 weeks. Incorrect medication dosage may be ineffective or cause side effects. The expected effect of the treatment occurs after 1-2 weeks of use.
There are several ways to use creams and ointments for psoriasis containing glucocorticoids:
- continuous mode;
- tandem therapy mode;
- descending therapy regimen;
- step-by-step application mode.
It is worth mentioning that the treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis, with ointments and creams directly on the affected area. In the most severe forms, treatment is carried out in hospitals with phototherapy, systemic therapy and biological medications.
The course of the disease is considered moderate and systemic treatment can be initiated in the following cases:
- areas of the skin of aesthetic importance are affected;
- large areas of the head are affected;
- the external genitalia are affected;
- palms and soles are affected;
- at least 2 nails are affected;
- There are unique elements that cannot be handled locally.
Systemic therapy is carried out only in a hospital setting under the strict guidance of doctors, as systemic treatment is associated with a wide range of side effects, which can be reduced by selecting an individual treatment.
General recommendations for patients with psoriasis:
- minimize trauma and dryness of the skin;
- after applying psoriasis creams and ointments to your hands, wear gloves to prevent the medicine from getting into your eyes;
- use sunscreens with protection factor 30;
- avoid stressful situations, consult a psychologist if necessary;
- control your weight, eat rationally.
Diet for psoriasis
Recommended:
- alkaline drink 1200-1600 ml daily;
- use of lecithin;
- vegetables and fruits;
- porridge;
- lean meats and fish;
- dairy products.
Not recommended:
- citrine;
- bread made with premium flour;
- fish and fatty meats;
- high-fat dairy products;
- coffee – no more than 3 cups per day;
- yeast products;
- alcohol, sweets, pickling, smoked, spicy.