Psoriasis is a chronic systemic multifactorial disease with a 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 disability of the patient.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only theories of origin:
- neurogenic (the appearance of rashes after stress, burns, mental trauma);
- endocrine (especially during the perimenopausal period);
- metabolic (fat metabolism disorder);
- infectious;
- viral (psoriatic antigens are isolated from individuals who are healthy, but with a high probability of developing psoriasis in the future, while psoriasis is a non-contagious disease);
- genetic.
Psoriasis can be traced in a whole generation of people with the same risk factors. But the type of inheritance is assumed to be multifactorial. If one of the parents is sick, then the child has a 25% chance of getting sick. If both parents are sick – 60-75%.
Viral and genetic theories remain the leaders.
Factors that contribute to exacerbations:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, carious teeth, hepatitis);
- stress;
- obesity;
- perimenopausal period;
- medications (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin injuries; dryness, leading to increased skin trauma.
Clinical classification
There is no single classification. One of them:
- vulgar (ordinary);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis of the palms and soles;
- pustular psoriasis.
Features of the flow:
- they get sick at any age; cases of psoriasis in children are not uncommon;
- men and women get sick equally;
- prevalence throughout the globe;
- There are summer, winter and mixed seasonality of exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin with the production of insufficiently mature keratinocytes. Pink-red rashes appear, covered with silver-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 pinpoint bleeding - when the film is scraped, droplets of blood appear. This is due to uneven elongation of the papillae in the dermis, expansion of the capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can begin with a spot and merge into large areas of damage.
- Psoriasis on the hands is most often localized on the extensor surfaces.
- Psoriasis on the face - the rash often appears behind the ears, on the forehead. It is an independent factor for enhancing treatment.
- Psoriasis on the scalp is an isolated form, does not affect the hair, the elements of the rash are located along the edge of the hair, "psoriatic crown".
- Psoriasis of the nails - leads to characteristic changes, pinpoint depressions, the nail looks like a thimble. It may also thicken, become dull, or yellow spots form under the nail.
- Psoriatic arthritis - affects peripheral joints with or without pain, often with inflammation at the attachment of ligaments to bone, the ligaments themselves and the fingers.
Features of psoriasis in children
Characterized by the presence of one or several elements 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 wounds form. In children, psoriasis is often localized in the perineal area as a large red spot. In teenagers, spots appear on the palms and soles.
There are three stages of psoriasis:
- Progressive - the elements of the rash increase, and are uniformly white in color, with a narrow red edging along the edge;
- Stationary – the growth of the spot stops, a strip of paler skin appears along the edge 2-5 mm wide;
- Regressive stage - the scales gradually fall off, the spot decreases and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients turn to a general practitioner, dermatovenerologist, or rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and tenderness of the joints), anamnesis (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). Upon examination, changes are found in the skin and joints.
Laboratory tests are carried out:
- general blood test (including leukocyte count, ESR, platelets);
- general urine analysis;
- biochemical analysis (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
- in difficult situations, a skin biopsy is performed with further pathohistological examination (sharply expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements);
- before prescribing biological treatment, an examination for HIV, viral hepatitis B and C, and tuberculosis is carried out;
- radiography of the affected joints;
- CT and MRI for axial lesions;
- 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 syphilide.
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 the prevalence and severity of psoriasis), DLQI (Dermatology Life Quality Index - dermatological quality of life index).
To diagnose psoriatic arthritis, the PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (ClASsification criteria for Psoriatic Arthritis) criteria are used.
Treatment of psoriasis
Treatment is complex, aimed at eliminating inflammation, normalizing 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:
- non-steroidal anti-inflammatory drugs;
- disease-modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
For chronic cases, it is recommended to use ointments for psoriasis; for exacerbations, creams for psoriasis 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 drug into the skin and cause side effects.
It is not recommended to use hormonal ointments for more than 4 weeks. Incorrect dosing of medications may either be ineffective or cause side effects. The expected effect of treatment occurs after 1-2 weeks of use.
There are several modes of use of creams and ointments for psoriasis containing glucocorticoids:
- continuous mode;
- tandem therapy mode;
- descending therapy regimen;
- step application mode.
It is worth noting that treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis using ointments and creams directly to the affected area. For more severe forms, treatment is carried out in hospitals using phototherapy, systemic therapy, and biological drugs.
The course of the disease is considered moderate, and systemic treatment can be started in the following cases:
- areas of 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 single elements that cannot be treated locally.
Systemic therapy is carried out only in a hospital, under the strict guidance of doctors, since systemic treatment is associated with a wide range of side effects, which can be reduced by selecting individual treatment.
General recommendations for patients with psoriasis:
- minimize skin trauma and drying out;
- after applying creams and ointments for psoriasis on your hands, use gloves to prevent the drug from getting into your eyes;
- use sunscreens with a protection factor of 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:
- citrus;
- bread made from premium flour;
- fatty fish and meats;
- high fat dairy products;
- coffee – no more than 3 cups per day;
- products with yeast;
- alcohol, sweets, pickling, smoked, spicy.