Psoriasis is an inflammatory skin disease. It occurs when the immune system malfunctions. The development of the disease is divided into clear stages - the appearance, progression, stabilization and regression. The different stages of psoriasis differ in the appearance of blemishes and rashes, itching and extensive skin inflammation.
Why is it necessary to distinguish between the stages of development of the disease and what are the characteristics of the psoriasis course at the beginning of development and in the recovery process?
Why you need to know the stages of psoriasis
The division of psoriasis into stages is used by doctors for the correct choice of therapeutic methods. A complex of drugs and external agents prescribed to treat inflammation depends on the stage of development of the disease. At the beginning of the manifestation of the disease, general therapy is required - vitamin complexes, diet, external aseptic treatment of the rash, for example, a course of UV procedures. He also prescribed drugs that encourage cleansing of the intestines, blood vessels, liver. Make sure to correct the psychoemotional state - by a neuropathologist or psychologist.
In the initial stage of the disease, they do not use potent drugs that extinguish the immune system, they do not prescribe hormonal ointments. These drugs have a long list of side effects, so they are prescribed only when it is impossible to do without them.
Psoriasis: treatment in acute phase and in remission
In the case of acute and progressive evolution of the disease, several drugs of various actions are prescribed. Immunosuppressants and glucocorticosteroids are often used to relieve inflammation and reduce itching. External treatments are complemented by photochemistry, ultrasound and laser therapy. In addition, agents are prescribed for the antiseptic treatment of damaged skin.
In a stabilized state, they continue to take hormonal anti-inflammatory drugs, gradually reducing their dose. To restore damaged skin, ointments with a regenerating effect are prescribed.
In remission - support the body. Correct nutrition, take vitamin and mineral complexes to restore immunity.
Treatment opportunity
The sooner treatment is started, the easier it will be to control psoriasis. Timely therapy limits the spread of skin inflammation, reduces its extension and prevents subsequent relapses of flaking. Since psoriasis is often mistaken for an allergic rash at an early stage, it is necessary to know its early signs so as not to miss the onset of a skin disease.
Note: Doctors are still investigating the causes of psoriasis. But it is definitely known that psoriatic skin inflammation is not contagious. It cannot be caught from a sick person or from an infection in the event of injury. This is our personal failure in the human body.
The cause of psoriasis is an immune failure, which can be caused by several factors. Severe stress, poisoning (including potent drugs, industrial emissions, alcohol), previous infection.
Psoriasis is difficult to treat. The disease is subject to recurrence, relapse. And the therapy itself is symptomatic. It consists of preventing the appearance of new spots and relieving the itching of the skin.
What stage of psoriasis is called initial? How to distinguish initial psoriasis from rash from diathesis? And how will the disease develop in the future?
Psoriasis: early stage
The first appearance of psoriasis on the skin looks like pimples. Most of the time, the rash appears in the folds of the elbows and knees or in places where the clothes are tightly pressed to the body (for example, under the belt at the waist). Rashes can also appear along the edge of the hair and under the hair, around the nails and on the nail plates. Sometimes psoriasis occurs on the feet and palms.
Psoriasis is almost always symmetrical - on the elbows of both hands, on both sides of the lower back or on two knees. The pimples themselves (in medical terminology - papules) at an early stage have a modest appearance. They have:
- Pink or red;
- Sharp and blurred border;
- Small size - the spine at the base does not exceed 2 mm;
- Flat shape - small pimples dotted at the beginning of the disease have almost no bulge, so they look like spots.
As the disease progresses, flaking skin flakes appear on the pimples. They are gray or silver, against the background of a red spine they look white.
The appearance of scales is accompanied by intense itching. If you can't resist and itch, the scales are removed, exposing the bright areas of young pink skin underneath. It is very thin, vulnerable, with prolonged scratches from itchy papules - it is hurt, it bleeds.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: progression stage
In the progressive stage, the individual spines merge into a common point, forming the so-called psoriatic plaques. They are raised above the surface of the skin and are almost completely covered with flaking. At the edges of the psoriatic plaques, there is a reddish-pink border that does not flake off.
The presence of an edge is a sign of a progressive stage of the disease. The border width is 1-2 mm. The skin is inflamed and resembles parchment paper in the structure.
The border represents the expansion area of the point. This is the skin that is already inflamed, but not yet peeled. After a while, it will also be covered with scales. And the patch will expand to cover new areas of the skin and form a new, wider border.
With the active development of the disease, adjacent points merge. At some point, a large inflamed red spot can form on the human body.
Psoriatic plaques itch a lot, causing unpleasant sensations in the person, interrupting their work, rest and sleep. They grow, occupy a large area and form a new rash on clean, healthy skin.
The main sign of the progressive stage is the appearance of new eruptions. As soon as new pimples and blemishes stop appearing, the next stage of psoriasis begins - stationary. This is not yet a complete victory, but it is already a turning point for recovery.
In the progression stage, psoriasis is almost always accompanied by weakness, fatigue, weakness. Depression is common. Possible temperature.
The duration of the progressive stage of psoriasis can be long, several months.
Psoriasis: stationary stage
The main sign of the stationary stage is the cessation of the appearance of new spots and skin rashes. At the same time, itching also subsides and becomes more bearable. The rash loses its bright color, becomes discolored, becomes invisible. This is also one of the signs that the process is stabilizing.
The pink edges around the plaques disappear when the inflammation stops spreading. Active exfoliation and healing begin, regenerating healthy new skin.
It is noticeable to the naked eye that the flaking increases in the stationary phase. The scales completely cover the entire surface of the psoriatic stain, leaving no room for the edges. Psoriasis takes on the scaly appearance characteristic commonly recognized by the general public.
Extensive peeling in the stationary phase is not dangerous. When all the dead cells leave the surface of the psoriatic spot, healthy skin with a light shade will remain in place.
Other signs of progression or stabilization
In addition to the appearance of the rash, blemishes and flaking, there are several other signs that can be used to assess the development of the disease. This is the nature of the itchy feelings (strong or tolerable), general condition, depressed mood. And also the presence of temperature.
In the initial stage, the itch is changeable and the rash is incomprehensible. In addition, the itching intensifies every day. In the acute stage of psoriasis, it becomes unbearable. It disturbs sleep, rest, disrupts work. The person is irritated because the itchy sensations do not give him the opportunity to rest.
In the stationary stage, the itching decreases. Every day - a person feels better. The general state of the psyche changes, negativity and depressed mood weaken. The duration of the stationary stage is several weeks - from 2 to 5.
Psoriasis in attenuation stage
The fading stage of psoriasis is the almost complete disappearance of plaques, spots, redness, inflammation, itching. At this stage of the disease, psoriasis is just reminiscent of different skin pigments. At the site of the old psoriatic spots, it seems clearer. The surface of healthy skin has a darker shade.
In some cases, so-called hyperpigmentation is formed. The skin at the site of the psoriasis spots is not lighter, but darker. In any case, differences in skin pigmentation will be visible for another one to two months.
Psoriasis after recovery: the possibility of relapse
The possibility of recurrence of psoriasis is determined by the person's lifestyle, diet, allergic mood and the state of the body as a whole. It is also determined by the amount of toxins in your body, blood, liver. You can reduce the likelihood of repeated skin inflammation if you strengthen your immune system and cleanse your body of toxins from your liver, blood vessels and intestines.
Seasonal psoriasis relapses are often rare after cleansing. A person remains susceptible to the disease, but the likelihood of its occurrence is noticeably reduced.
Cleaning the body of toxins and taking vitamins and mineral complexes helps to boost immunity. This is especially important if immunosuppressants are used during treatment, in the progressive stage of psoriasis. His need was due to the work of inflammatory mediators. After suppressing autoimmune defense, it is necessary to restore the immune system.
Clinical manifestations
Psoriasis is characterized by monomorphic rashes in the form of papules (nodules) of various sizes, when they fuse, plaques form, which can spread through the skin.
In the beginning of the disease, in most cases, the rash is limited and is represented by single plaques in the locations of your preferred location (scalp, extensor surface of the elbow, knee joints, sacrum, etc. ).
The plaques are clearly demarcated from healthy skin, bright pink or deep red, covered with loose silvery-white scales, when shaved, you can get a triad of phenomena characteristic of psoriasis - "stearin stain", "terminal film", "blood dew". . .
There are 3 clinical stages of psoriasis: progressive, stationary and regressive.
Classification
Depending on the degree of the inflammatory process, the predominant location of the rash, the severity of the patient's condition and other clinical signs, plaque psoriasis, exudative, arthropathic, pustular, psoriatic erythroderma, pleat psoriasis, psoriasis are commonpalms and soles. It should be noted that different clinical variants can exist simultaneously in a patient.
Exudative psoriasis is characterized by a pronounced inflammatory reaction of the skin, which is manifested by the presence of lamellar scale crusts on the surface of the plaques, sometimes multilayered, looking like a puff cake in appearance (in such cases, this form ofpsoriasis is called rupioid). When the flaking crusts are removed, a watery surface is exposed.
In addition to the usual plaque eruptions, arthropathic psoriasis presents joint lesions, often small, distal, less often large.
Arthropathy can occur in the presence of skin lesions or precede them. Psoriatic arthritis is manifested by pain, swelling, limited mobility in the affected joints in varying degrees of intensity, from small arthralgias of individual joints to generalized injuries and inability of patients. The possibility of arthropathic psoriasis is greater in patients with severe skin manifestations (psoriatic erythroderma, pustular psoriasis), but a combination of severe joint damage with relatively limited skin rashes is possible.
Pustular psoriasis can be generalized (Tsumbusha) and limited, with involvement of the palms and soles (Barbera). Stressful situations, infections, general or local irrational therapy contribute to the onset of this severe form of psoriasis.
Generalized pustular psoriasis occurs with fever, leukocytosis, increased ESR and severe general condition. Suddenly, on the bottom of a shiny erythema, small superficial pustules appear, accompanied by burning, pain, they can be located in the area of common plaques and on the skin that was previously unchanged. New foci of pustulization appear paroxysmal, occupying large areas of the skin. The mixed pustules cause the epidermis to detach in the form of "purulent lakes", and erythroderma can occur.
Limited pustular psoriasis is more common, the rash is located mainly on the palms and soles of the feet in the form of pustules against the background of erythema and skin infiltration. The course, compared to the generalized, is milder, with a satisfactory general condition, but persistent, with frequent recurrences. Irritating local therapy is a provocative factor.
Psoriatic erythroderma is a severe form of psoriasis that develops with the gradual progression of the psoriatic process and fusion of the plaque elements until the defeat of the entire skin, characterized by acute hyperemia, edema, skin infiltration with large and small lamellar, less often pityriasis peeling. Subjective - severe itching is often observed. The disease can start with erythroderma. The general condition worsens (fever, weakness, lymph node reaction, heart failure, liver and kidney dysfunction, changes in blood tests, hair loss, etc. ).
Psoriasis of the folds is more common in children and the elderly, especially in patients with diabetes mellitus. The lesions are located in the armpits, under the mammary glands, in the perineum, inguinal-femoral folds, in the navel and are characterized by sharp edges, saturated red color and slight flaking.
Psoriasis of the palms and soles of the feet may exist in isolation or simultaneously with lesions in other areas of the skin; The characteristic psoriatic triad is difficult to evoke.
Three clinical stages of psoriasis
Progress stage. Under the influence of provocative factors (trauma, psycho-emotional stress, infectious diseases, inadequate treatment methods, etc. ), an exacerbation of the disease may develop with the appearance of small, abundant nodules with a tendency to peripheral growth and the formation of plaques of varioussizes and contours, which can be isolated or occupy large areas of the skin until universal skin lesions.
In the progressive phase, a symptom of an isomorphic reaction (Kebner phenomenon) is characteristic, which is characterized by the fact that typical psoriatic eruptions appear at the site of an injury, however small.
Stationary stage. In the stationary stage, the appearance of new elements ceases and the tendency for peripheral growth of existing plaques disappears.
Regressive stage. The regressive phase is characterized by a decrease in the color intensity of the plaques, their flattening, a reduction in flaking, infiltration, reabsorption of elements with subsequent formation of hypo foci or hyperpigmentation at the site of previous eruptions.
Treatment
The treatment of psoriasis aims to suppress the proliferation of epithelial cells and eliminate the inflammatory process and is prescribed taking into account the anamnestic data, the form, stage, prevalence of the process, concomitant diseases, age and sex. contraindications to a particular treatment method or medication.
For mild and limited manifestations of psoriasis, local external therapy in the form of salicylic ointment, naphthalan preparations, tar or emollient ointments is sufficient. Severe forms of the disease require complex systemic treatment with the use of detoxification, desensitization, anti-inflammatory drugs from different groups, physical therapy methods, external medications, etc.
This section will present the most modern and available effective methods and means of psoriasis therapy.
Systemic therapy
There are peculiarities in the treatment of patients at different stages of the psoriatic process. Advanced stage treatment requires special care. During this period, hemodia is prescribed by intravenous drip, 30 percent. sodium thiosulfate solution i. v. , 10% calcium gluconate solution, with concomitant hypertension, it is advisable to administer a magnesium sulfate solution; emollient creams or 1-2 percent are used externally. salicylic ointment.
Aromatic retinoids.Acitretin (neotigazone) - a representative of the second generation of monoaromatic retinoids is used to treat severe forms of psoriasis at a dose of 10 to 20-30 mg daily, depending on the severity of the skin process. The mechanism of action of acitretin is to inhibit the proliferation of epidermal cells, normalizing the keratinization processes. The drug is especially effective in combination with PUVA therapy. When prescribing acitretin, one should not forget its teratogenic effect.
Cytostatics.Methotrexate is used in cases of persistent psoriasis and in the presence of contraindications to other treatment methods, being an antagonist of folic acid, it acts mainly on cells in active proliferation. Very toxic. There are many methods of application, preferably intramuscular administration once a week under strict laboratory control.
Immunosuppressants.Cyclosporine-A is prescribed in cases of severe generalized psoriasis resistant to other therapies. This drug has an immunosuppressive action, has an inhibitory effect on cell growth processes, suppresses the secretion of activated cytokine lymphocytes and the expression of interleukin-1 receptors in immunocompetent cells. With psoriasis, it is prescribed at the rate of 5 mg per 1 kg of body weight per day.
Nonsteroidal anti-inflammatory drugsare prescribed for arthropathic psoriasis, as well as for the reduction of acute inflammation in exudative psoriasis and erythroderma. The daily doses of medication and the duration of treatment depend on the intensity of the pain syndrome, the degree of inflammation and individual tolerance.
The use of systemic corticosteroids in the treatment of psoriasis is considered inappropriate, as it leads to the development of numb forms of the disease that are resistant to different types of therapy. In cases of severe arthropathic psoriasis, intra-articular administration of prolonged corticosteroids is possible, the dose and duration of treatment depend on the size of the affected joint and the degree of inflammation.
Physiotherapy treatments.One of the most effective methods of treatment is PUVA therapy or photochemotherapy (PCT). PCT is a combined application of long-wave ultraviolet radiation (wavelength 320 to 420 nm) and photosensitizing drugs furocoumarin. The use of photosensitizers is due to its ability to increase the sensitivity of the skin to ultraviolet rays and to stimulate the formation of melanin. PUVA therapy leads to the inhibition of cell proliferation, suppression of pathological keratinization, affects the metabolism of prostaglandins, the permeability of cell membranes. The peak of the photosensitizing effect occurs 1-3 hours after the ingestion of 8-methoxypsoralen. The dose of the medication is selected taking into account the patient's weight. Procedures are released 3-4 times a week, over a course of 20 to 25 sessions.
Local PCT with external photosensitizers is also used.
The combined use of PUVA and retinoid therapy is called Re-PUVA therapy. It has the greatest clinical effect in cases of severe psoriasis.
Selective phototherapy (SFT) - ultraviolet irradiation in the medium wave spectrum (wavelength 280-320 nm) without taking photosensitizers. The FTS is used for less pronounced manifestations of the disease, the presence of contraindications for indicating PUVA therapy.
How to recognize psoriasis at an early stage
Psoriasis treatment is most effective in the early stages. Therefore, it is so important to make a diagnosis at the right time. Only a dermatologist can tell if you have psoriasis or some other skin condition. However, you can recognize this disease yourself by several characteristic signs:
- In most cases, psoriasis manifests itself first in the folds of the arms and legs, in the hairline or where the clothes are in close contact with the body or rub - under the belt of the trousers, several elastic bandsor strips.
- At the beginning of the disease, a very itchy rash appears, covered with gray or silver skin scales that are easily removed.
- If you remove the scale, you will see thin, shiny and slightly damp skin underneath.
- If you scrape the plate with something like a spatula, removing the scales, the blood will appear on the stain in the form of small drops. However, it is better not to use the latter method for self-determination of psoriasis - it is very easy to infect it.
For complete confidence, you need to see a doctor, as patients themselves often confuse psoriasis with various types of lichen or allergic dermatitis and use inappropriate drugs for treatment.
What to do if you encounter symptoms in the early stage of psoriasis?
Psoriasis cannot be cured once and for all, so the main goal of therapy is to achieve a stable and longest possible remission. You should be aware that without proper treatment, psoriasis quickly becomes chronic: exacerbations can occur up to 9 times a year, lasting up to 15 days.
What to do if you suspect you have psoriasis? Often people, having discovered signs of this disease in themselves, make a big mistake, resorting to "heavy artillery" - hormonal ointments (so-called topical glucocorticosteroids, or THCS), without consulting a doctor. Typically, patients explain such a step because they are supposed to have heard from friends that such funds help quickly. This is a big mistake!
What is the danger of this self-medication? Hormonal ointments for psoriasis have many side effects and contraindications. It is highly undesirable to use them without a strict recommendation from the doctor about the duration of use, frequency, area of application on the body and also without taking into account the individual characteristics of your body.
Non-hormonal agents, such as zinc pyrithione, should be used to effectively treat early psoriasis. Zinc pyrithione, or active zinc, is a very effective remedy for the treatment of psoriasis, which has a complex effect:
- suppresses excess skin cell proliferation and inflammation, reducing flaking and psoriatic plaque formation;
- relieves itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the skin's protective functions.