Psoriasis. Types, causes, symptoms and signs, diagnosis and treatment of the disease

Psoriasis or scaly lichenIs a chronic disease that affects the skin and its appendages: nails and hair. It is characterized by periods of deterioration (relapses) and temporary well-being, when the manifestations of the disease become less. 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. People with fair skin are more susceptible to it. In developed countries, the number of patients with psoriasis reaches 2-4% of the population. Every 25th inhabitant of the earth on all continents suffers from it.

A huge number of medical institutions are dealing with this problem. Therefore, psoriasis has been recognized as the most studied disease. But still, 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 rise from the lower layers of the skin to the upper ones, causing inflammation, proliferation of epidermal cells and the formation of small capillaries.

The manifestations of psoriasis on the skin are quite varied. Most often, 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 with a white coating.

Types of psoriasis

The disease is divided into two large groups: pustular and non-pustular psoriasis.

Non-pustular psoriasis

  • ordinary (vulgar) or simple psoriasis (plaque psoriasis, chronic stable psoriasis)
  • psoriatic erythroderma or erythrodermic psoriasis

Pustular psoriasis

  • pustular psoriasis von Tsumbusch or generalized pustular psoriasis
  • palmoplantar psoriasis (pustular psoriasis of the extremities, chronic persistent palmoplantar pustulosis)
  • annular pustular psoriasis
  • palmoplantar psoriasis
  • herpetiformis psoriatic impetigo

Additionally, these types of psoriasis are distinguished.

  • seborrheic psoriasis
  • psoriasis of flexor surfaces and skin folds
  • Napkin's psoriasis
  • drug-induced psoriasis

According to the severity, such forms of psoriasis are distinguished.

  1. Mild - less than 3% of the skin is affected.
  2. Moderate - 3-10% of the skin is covered with psoriatic plaques.
  3. Severe - there are joint lesions or more than 10% of the skin is involved.

Causes of psoriasis

stress and fatigue lead to psoriasis

To date, there is no unambiguous answer to the question: "why does psoriasis appear? "Scientists have put forward several theories.

  1. Psoriasis is an autoimmune disease. It is based on a malfunction of the immune system. 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. It results in increased division of skin cells and their multiplication (proliferation).
  2. Psoriasis is a disease that is caused by impaired growth, division and maturation of epithelial cells - keratinocytes. The result of such changes in the skin is an attack by immune cells of T-lymphocytes and macrophages on diseased skin cells.

Factors that contribute to the development of psoriasis

Doctors have noted a number of factors that can cause the appearance of the disease. Of course, most often psoriasis occurs if several of these conditions act on the body at once.

  1. Hereditary predisposition.There is a version that genes that are responsible for the functioning of the immune system and for the function of T-lymphocytes are carriers of the disease. Therefore, parents who suffer from psoriasis are more likely to have children who develop the same symptoms.
  2. Thin dry skin. . . It was noted that people with such skin characteristics get sick more often than those with oily and well-hydrated skin. This is probably due to the protective functions of sebum and structural features of the skin.
  3. External irritants. . . A high percentage of patients among those people who are constantly in contact with alcohol solutions, solvents, household chemicals, cosmetics (lotions, hand creams).
  4. Excessive hygiene- an excessive love of cleanliness also undermines the protective properties of the skin. Soaps, shower gels and washcloths wash away the natural protective barrier and leave behind microscopic injuries.
  5. Bad habits- addiction to alcohol, smoking and drugs is bad for the skin. Her nutrition and blood supply are deteriorating.
  6. Hiv- AIDS patients are more prone to psoriasis. Scientists cannot explain this phenomenon. The fact is that psoriasis is caused by increased activity of lymphocytes, and with AIDS, their number decreases.
  7. Medications- taking certain medications can provoke illness. Among them: beta-blockers, antidepressants, anticonvulsants and antimalarial drugs, lithium carbonate.
  8. Infections (fungi and staphylococcus). . . Quite often, there were cases when psoriasis appeared immediately after fungal infections or diseases caused by streptococcus.
  9. Moving- a change in climate or even a season of the year, environmental degradation can be a trigger for this disease.
  10. Stress- strong emotional upheaval or physical stress (prolonged periods of hypothermia, overheating, accidents) precede the appearance of the first symptoms of psoriasis.
  11. Trauma- constant effect on the skin: pressure, friction, scratching. Such regular trauma can cause the first psoriatic plaques to appear in this place.
  12. Allergic conditions- Allergic skin rashes and the processes that occur in this case, in all layers of the skin, also increase the risk of disease.

What are the symptoms and signs of psoriasis?

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.

But still, the main manifestations of the disease occur on the skin. The name squamous lichen quite accurately conveys the symptoms of psoriasis. The first manifestations are often pink or bright red papules of the correct rounded shape, covered with scales - psoriatic plaques. They are located symmetrically, mainly on the extensor surfaces, lower back and scalp. But they can affect any part of the skin and genital mucosa. Their size is from a few millimeters, at the initial stages, to ten centimeters or more.

Depending on the characteristics of the rash, suchforms of psoriasis:

  1. Pitting psoriasis - the size of the elements is less than the head of a pin.
  2. Guttate psoriasis - papules are tear-shaped and reach the size of a lentil grain.
  3. Coin psoriasis - plaques grow up to 3-5 mm and have rounded edges.

They also distinguish the forms of the rash, when its elements are in the form of rings, arcs and garlands, geographical maps with uneven edges.

The papules are covered with a scaly coating that can be easily removed. It consists of keratinized cells of the epidermis. Psoriatic plaques begin to become covered with scales from the center, then the plaque spreads to the edges. Its loose and light appearance is due to the fact that keratinized cells are permeated with spaces filled with air. A pink ring may form around the elements - this is an area of inflammation, a zone of plaque growth. The skin around the elements of the rash is not changed.

Scalp psoriasisrepresents psoriatic plaques that rise significantly above the surrounding skin. They are densely covered with dandruff-like scales. In this case, the hair remains unaffected. Rashes can occur not only under the hair, but also on smooth skin, on the neck and behind the ears. Such changes are explained by the active division of keratinocytes in the affected areas.

Psoriasis of 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 intensive cell division, which multiply 8 times faster than usual, but are not removed in time from the surface of the skin.

Psoriasis of nailsdiffers in a variety of symptoms. But the most important are two main types of damage to the nail plates:

  1. By the type of "thimble". Small pits form on the nail plate, similar to needle stick marks.
  2. By the type of onychomycosis. Lesions resemble nail fungus. Nails thicken, change color, flake off. A psoriatic papule surrounded by a red rim is visible through the nail plate. It looks like an oil stain that shines through the nail.

Symptoms and signs of psoriasis depend on the stage of the disease, which replace each other cyclically throughout the year. So 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 in the sun has a therapeutic effect. But some patients suffer from the "summer" type.

There are such stages of the course of psoriasis:

  • progressive - the appearance of new elements, the active growth of existing plaques, the implicitness of the pink growth zone around them, intense peeling and itching.
  • stationary - stopping the growth of papules, the absence of new rashes, fine folding of the upper layer of the skin around psoriatic plaques.
  • regressing - the absence of peeling, the disappearance of plaques and the appearance in their place of areas of pigmentation, indicate the attenuation of the process.

What do skin rashes look like with psoriasis?

what does psoriasis look like on the skin

Each organism is individual and reacts differently to illness. Therefore, the nature of the rash 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 spots - psoriatic plaques, rising 1-3 mm above the level of healthy skin. Their appearance is caused by the fact that the cells of the surface layer of the skin - keratinocytes, divide very actively, not having time to mature and turn into full-fledged epithelial cells. As a result of this increased pathological growth, certain areas of the skin thicken. This is due to the fact that immune cells release chemicals that cause inflammation in the skin.

From above, plaques can be covered with a gray, silvery or yellowish bloom, which looks like paraffin. Therefore, they got the name - "paraffin lakes". These are keratinized epithelial cells, the rejection of which is impaired and they accumulate on the surface of the affected skin area.

psoriasis vulgaris on the skin

The spots are flaky, hotter than the rest of the skin, and can grow to a large size. Often the patient feels severe itching in this place. This is due to the fact that, against the background of the inflammatory process, a cascade of neuro-reflex reactions and an allergic reaction occur.

Another type of element is papules. These are small elements of a rash that resemble a tubercle. The size is about 1 mm. In the middle there is no cavity filled with content. They are often located on the knee and elbow joints. They remain even during periods when the disease recedes.

During exacerbations, the elements of the rash gradually grow in width and merge with neighboring plaques. During periods of improvement (remission), the spots begin to lighten from the middle. They gradually take on the form of a ring and can completely dissolve. After plaques, a trace remains on 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.

What do nail lesions look like in psoriasis?

psoriasis on the nails

Nail psoriasis is similar to a fungal infection of the nail plate. For a correct diagnosis, it is necessary to conduct a laboratory analysis. Changes can affect only one nail or all at once and are very diverse. They occur in 10-15% of patients. Damage to the nails is often accompanied by joint pain caused by psoriasis. In this case, there may be no skin rashes.

Psoriasis of the nail has several stages:

  • depressed points - thimble nail
  • longitudinal depressed grooves
  • transverse compression in the center of the nail, these first signs are associated with damage to the nail root - the nail matrix
  • "Oil spots" pink spots of irregular shape that show through the nail - this is the accumulation of serous fluid under the nail
  • the nail becomes dull, cloudy, yellow and thickened due to circulatory disorders
  • the nail plate takes on the appearance of a bird's claw, which is accompanied by pain. This is due to the fact that the process captures the nerve endings.

Nail lesions start from the edge and gradually move towards the root, covering the entire surface. Microcirculation disorders 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 the patient's acquaintances. Scientists give an unequivocal answer to it. 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 own immune cells, for unknown reasons, attack the skin cells, causing skin inflammation. The result of this process is rashes and thickening of the skin in some places (psoriatic plaques).

How is psoriasis treated?

hospital psoriasis treatment

Treatment for psoriasis depends on the form and stage of the disease and on the sensitivity to drugs. Traditional medicine focuses on the use of drugs. Treatment is started with local preparations that act on the affected skin. Thus, they try to avoid the side effects that occur when taking medications by mouth. More details about the use of local remedies will be described below. Now let's dwell on pills and capsules.

There is a technique when, first, the patient is offered more gentle drugs with the least number of side effects. If they are not effective, they are replaced with more potent ones, and so on. Even in the case when 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 decreases.

Oral systemic drugs are very effective. They are prescribed for moderate and severe stages of the disease. They help even those patients for whom treatment with other means has not yielded a positive result. However, they have significant disadvantages: they can cause serious side effects, and after the abolition of these funds, the condition deteriorates again.

Group of medicines Dosage form and effect of the drug on the body
Retinoids - derivatives of vitamin A Influences the maturation of the surface layer of the skin and eliminates the disturbances in this process caused by psoriasis. Release form - capsules. Dosage according to the scheme, depending on the stage, 30-75 mg / day.
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 Reduces the activity of T-lymphocytes, which cause increased division of skin cells. 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 (Cytostatics) Inhibits excess growth and reproduction of atypical cells of the epidermis. Available in tablets. Assign 2. 5-5. 0 mg orally, 2-3 times a day, 1 time per week.

Physiotherapy treatments for psoriasis are very effective. They bring significant relief to patients, stop the progression of the disease and, in some cases, serve as a safe substitute for drugs.

Physiotherapy method Effects on the body
PUVA therapy or photochemotherapy Combination of long-wave ultraviolet irradiation and an internal photosensitizer. The course is 20-30 procedures. The method is based on the fact that UV rays penetrate deeply into the skin. The photosensitizer inhibits the synthesis of DNA of skin cells and the rate of their division. For treatment, special installations or cabins are used.
Selective phototherapy (S. F. T) Irradiation of the skin with ultraviolet rays with a wavelength of 280-320 nm. The course is 15-35 procedures. A special booth is required for the therapy.
Monochromatic UV treatment Exposure to each focus separately with a laser or lamp source of UV radiation. It makes it possible to irradiate foci 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 rashes, laser radiation with different wavelengths is used. The laser promotes the speedy 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 carried out on a device that is 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, the activity of the nervous system 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. Itching and inflammation of the skin, swelling and pain in the joints decreases, the psychoemotional state improves. The Betatron apparatus is used for treatment. The duration of the procedure is 20 minutes. Number per course 10-15.
Ultrasound therapy It is used as a pain reliever, antipruritic and decongestant. Promotes the resorption of scars. The procedure can be combined with drug administration (phonophoresis). The duration of exposure to one area is 15 minutes. To obtain a therapeutic effect, 7-14 sessions are required.
Hyperthermia Heating fabrics to a temperature of 40 degrees using special pillows with a thermal mixture. This effect on the body normalizes the functioning of the immune system, and it reduces the attack on the skin. The duration of the procedure is about 2 hours. Their number is determined by the doctor.
Bee venom treatment The substance is introduced into the body using an electrophoresis or ultrasound apparatus. An anti-inflammatory, absorbable, antipruritic effect is achieved. The metabolism is normalized. The minimum number of procedures is 10.

It is very important for people with lichen scaly to follow a diet. Eating disorders can exacerbate the disease. 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 allergize the body.

Allowed Products Prohibited foods
Vegetables (pumpkin, watermelon, beets, carrots, potatoes, radish) Animal fats
Fruits (apricots, peaches, apples), juices Alcohol
Berries (except red berries: strawberries, raspberries, red currants) Fatty 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 Carbonated drinks and coffee
Nuts Eggs
Low-fat varieties of fish Ice cream and milkshakes
Seaweed Minimal amount of confectionery and sugar
Whole wheat bread Butter and puff pastry

To cleanse the body of toxins and metabolic products, fasting days must be carried out twice a week. They recommend kefir, apple, vegetable.

What ointments are effective in treating psoriasis?

The use of ointments for psoriasis brings the greatest effect in comparison with other external preparations. The components of the ointment do not remain on the surface of the plaque, but soften the scales and get inside the skin.

There are a large number of ointments available to treat psoriasis. At the first stages, appointnon-hormonal ointments.

In the event that the treatment did not give the expected effect, then prescribehormonal ointments. . . Treatment begins with lighter drugs that have minimal side effects. If improvement has not been achieved, then stronger ointments with glucocorticosteroids are prescribed.

Name of the ointment Drug action Side effects
Weak ointments Suppresses the increased activity of leukocytes, prevents their movement into the skin, eliminates the feeling of tightness and itching. Swelling of the skin, itching, redness.
Moderate ointments It has anti-inflammatory, anti-allergic, anti-edematous, antipruritic effects. Suitable for patients with exudative forms of psoriasis, reduces bleeding. Apply in a thin layer to limited areas 2-3 times a day. The treatment lasts 10-14 days. Steroid acne, skin atrophy and stretching, burning, itching, hypopigmentation.
Strong ointments Local anti-inflammatory, antipruritic and anti-allergic agent. Reduces skin wetness. Apply to the 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 antipruritic and anti-allergic effect. Slows down the processes of cell division and keratinization. Apply 1-2 times a day for no longer than two weeks per course. Acne, hair loss, skin atrophy. Do not use for pustular and widespread plaque psoriasis.

Pharmaceutical companies produce many medicines in the form of ointments. The doctor individually selects the drug for the patient and, if necessary, changes it to a stronger one.

Do not forget that in no case with psoriasis should you ignore visits to the doctor. After all, this disease may hide the initial stage of skin cancer.

Choosing a treatment regimen for psoriasis is a lengthy process that involves a lot of trial and error. Do not despair if you do not find "your" medicine right away. Remember that many people achieve lasting improvement when the disease does not return for years. You can do it too!