Psoriasis is an inflammatory skin disease. Occurs when the immune system malfunctions. The development of the disease is divided into clear stages - the appearance, progression, stabilization and regression. Different stages of psoriasis differ in the appearance of spots and rashes, soreness of itching and extensive skin inflammation.
Why is it necessary to distinguish between the stages of development of the disease, and what are the features of the course of psoriasis at the beginning of development and in the process of recovery?
Why you need to know the stages of psoriasis
Division of psoriasis into stages is used by physicians for the correct choice of therapeutic methods. The complex of drugs and external agents that are prescribed for the treatment of inflammation depends on the stage of development of the disease. At the beginning of the manifestation of the disease, general therapy is needed - vitamin complexes, diet, external aseptic treatment of the rash, for example, a course of UV procedures. Also prescribed drugs that stimulate the cleaning of the intestines, blood vessels, liver. Be sure to carry out a correction of 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, do not prescribe hormonal ointments. These drugs have a large list of side effects, so they are prescribed only when it is impossible to do without them.
Psoriasis: treatment in acute stage and in remission
In the case of an acute progressive course 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 photochemical, ultrasound and laser therapy. Also, agents are prescribed for antiseptic treatment of damaged skin.
In a stabilized state, they continue to take anti-inflammatory hormonal drugs, gradually reducing their dose. To restore damaged skin, ointments with a regenerating effect are prescribed.
In remission - support the body. Correct nutrition, take complexes of vitamins and minerals to restore immunity.
Timeliness of treatment
The earlier treatment is started, the easier it is to bring psoriasis under control. Timely therapy limits the spread of skin inflammation, reduces its extent, and prevents subsequent relapses of peeling. Since psoriasis is often mistaken for an allergic rash at an early stage, it is necessary to know its initial signs in order not to miss the appearance 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 picked up from a sick person, or an infection in case of injury. This is our own, personal failure in the human body.
The cause of psoriasis is an immune failure, which can be caused by various factors. Severe stress, poisoning (including potent medications, industrial emissions, alcohol), previous infection.
Psoriasis is difficult to treat. The disease is prone to recurrence, relapse. And the therapy itself is symptomatic. It consists in preventing the appearance of new spots and relieving existing skin itching.
What stage of psoriasis is called initial? How to distinguish early psoriasis from diathesis rash? And how will the disease develop in the future?
Psoriasis: initial stage
The first appearance of psoriasis on the skin looks like pimples. Most often, the rash appears at the bends of the elbows and knees, or in places where clothing is 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.
Almost always, psoriasis manifests itself symmetrically - on the elbows of both hands, or on both sides of the lower back, or on two knees. The pimples themselves (in medical terminology - papules) at the initial stage have a modest appearance. They have:
- Pink or red;
- Sharp, blurry edge;
- Small size - pimple at the base does not exceed 2 mm;
- Flat form - small punctate pimples at the beginning of the disease have almost no bulge, therefore they look like spots.
As the disease progresses, flakes of peeling skin appear on pimples. They are gray or silvery, against the background of a red pimple they appear white.
The appearance of scales is accompanied by severe itching. If you do not resist and scratch, then the scales are removed, exposing the shiny areas of pink young skin underneath. It is very thin, vulnerable, with prolonged scratching of the itchy papules - it gets injured, bleeds.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: stage of progression
In the progressive stage, individual pimples merge into a common spot, forming the so-called psoriatic plaques. They are raised above the surface of the skin and are almost completely covered with peeling. At the edges of the psoriatic plaques, there is a non-flaking pink-red rim.
The presence of a rim is a sign of a progressive stage of the disease. The rim width is 1-2 mm. The skin on it is inflamed and resembles parchment paper in structure.
The rim represents the expansion area of the spot. This is the skin that is already inflamed, but not peeling yet. 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 rim.
With active development of the disease, adjacent spots merge with each other. At some point, one large, inflamed red spot may form on the human body.
Psoriatic plaques are very itchy, giving a person unpleasant sensations, disrupting his work, rest and sleep. They grow, take up a large area, and form a new rash on clean, healthy skin.
The main sign of the progressive stage is the appearance of new rashes. As soon as new pimples and spots stop appearing, the next stage of psoriasis begins - stationary. This is not yet a complete victory, but it is already a turn towards recovery.
In the stage of progression, psoriasis is almost always accompanied by weakness, fatigue, weakness. Depression is common. Temperature possible.
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 rashes. At the same time, itching also decreases, it 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 rims around the plaques disappear as the inflammation stops spreading. Active exfoliation and healing begins, regeneration of new healthy skin.
It is noticeable to the naked eye that peeling increases in the stationary stage. The scales completely cover the entire surface of the psoriatic spot, leaving no space for the rims. Psoriasis takes on the characteristic flaky appearance that is commonly recognized by the general public.
Extensive peeling in the stationary stage is not dangerous. When all the dead cells come off the surface of the psoriatic spot, healthy skin with a slight light shade will remain in their place.
Other signs of progression or stabilization
In addition to the appearance of the rash, spots and scaling, there are a number of other signs that can be used to judge the development of the disease. This is the nature of itching sensations (strong or tolerable), general condition, depressed mood. And also the presence of temperature.
In the initial stage, itching is changeable, and the rash is incomprehensible. Further, the itching intensifies every day. In the acute stage of psoriasis, it becomes intolerable. Disrupts sleep, rest, interferes with work. The person becomes irritable because the itching sensations do not give him the opportunity to rest.
In the stationary stage, itching subsides. Every day - a person feels better. The general state of the psyche changes, negativity and depressive moods 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 only reminiscent of different skin pigmentation. In place of the former psoriatic spots, it looks lighter. The surface of healthy skin has a darker shade.
In some cases, the so-called hyperpigmentation is formed. The skin at the site of psoriasis spots does not become 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 psoriasis recurrence 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 his body, blood, liver. You can reduce the likelihood of repeated skin inflammation if you strengthen the immune system and cleanse the body of toxins in the liver, blood vessels, and intestines.
Seasonal relapses of psoriasis are often rare after cleansing. A person remains susceptible to illness, but the likelihood of its occurrence is noticeably reduced.
Cleansing the body of toxins and taking vitamin and mineral complexes help to boost immunity. This is especially important if immunosuppressants were used during the treatment, in the progressive stage of psoriasis. Their need was due to the work of inflammatory mediators. After suppressing the autoimmune defense, it is necessary to restore the immune system.
Clinical manifestations
Psoriasis is characterized by monomorphic eruptions in the form of papules (nodules) of various sizes, when they merge, plaques form, and they can spread throughout the skin.
At the onset of the disease, in most cases, the rash is limited and is represented by single plaques in the places of its favorite localization (scalp, extensor surface of the elbow, knee joints, sacrum region, etc. ).
Plaques are clearly demarcated from healthy skin, bright pink or deep red, covered with loose silvery-white scales, when scraped, you can get a triad of phenomena characteristic of psoriasis - "stearin spot", "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 localization of the rash, the severity of the patient's condition, and other clinical signs, there are common plaque psoriasis, exudative, arthropathic, pustular, psoriatic erythroderma, fold psoriasis, psoriasis of the palms and soles. It should be noted that different clinical variants can exist simultaneously in one 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 plaques, sometimes multilayer, resembling a puff cake in appearance (in such cases, this form of psoriasis is called rupioid). When flake-crusts are removed, a weeping surface is exposed.
Arthropathic psoriasis in the clinical picture has, in addition to the usual plaque eruptions, lesions of the joints, 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 of varying degrees of intensity, from minor arthralgias of individual joints to generalized lesions and disability of patients. The possibility of arthropathic psoriasis is higher 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, irrational general or local therapy contribute to the emergence of this severe form of psoriasis.
Generalized pustular psoriasis occurs with fever, leukocytosis, increased ESR, and a general serious condition. Suddenly, against the background of bright erythema, small superficial pustules appear, accompanied by a burning sensation, soreness, they can be located in the area of ordinary plaques and on previously unchanged skin. New foci of pustulization appear paroxysmal, occupying large areas of the skin. Merged pustules cause detachment of the epidermis in the form of "purulent lakes", erythroderma may develop.
Limited pustular psoriasis is more common, the rash is mainly localized on the palms and soles in the form of pustules against the background of erythema and skin infiltration. The course, in comparison with generalized, is milder, with a satisfactory general condition, but persistent, with frequent relapses. An irritating local therapy is a provoking factor.
Psoriatic erythroderma is a severe form of psoriasis that develops with a gradual progression of the psoriatic process and fusion of plaque elements to the defeat of the entire skin, characterized by sharp hyperemia, edema, skin infiltration with abundant large and small lamellar, less often pityriasis peeling. Subjective - severe itching is often noted. The disease can begin with erythroderma. The general condition worsens (fever, weakness, lymph node reaction, heart failure, impaired liver and kidney function, changes in blood tests, hair loss, etc. ).
Psoriasis of 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 borders, saturated red color and slight peeling.
Psoriasis of the palms and soles can exist in isolation or simultaneously with damage to other areas of the skin; The characteristic psoriatic triad is difficult to evoke.
Three clinical stages of psoriasis
Progressing stage. Under the influence of provoking factors (trauma, psycho-emotional stress, infectious diseases, inadequate treatment methods, etc. ), an exacerbation of the disease may develop with the appearance of abundant small nodules prone to peripheral growth, and the formation of plaques of various sizes and shapes, which can be isolated oroccupy large areas of the skin up to universal skin lesions.
In the progressive stage, a symptom of an isomorphic reaction (Kebner's phenomenon) is characteristic, which is characterized by the fact that typical psoriatic eruptions appear at the site of an injury, even a minor one.
Stationary stage. In the stationary stage, the emergence of new elements ceases and the tendency for peripheral growth of existing plaques disappears.
Regressive stage. The regressive stage is characterized by a decrease in the intensity of the color of plaques, their flattening, a decrease in desquamation, infiltration, resorption of elements with the subsequent formation of foci of hypo- or hyperpigmentation at the site of previous rashes.
Treatment
Treatment of psoriasis is aimed at suppressing the proliferation of epithelial cells and eliminating the inflammatory process and is prescribed taking into account the anamnestic data, the form, stage, prevalence of the process, concomitant diseases, the age and sex of the patient, contraindications to a certain method of treatment or drug.
For mild, limited manifestations of psoriasis, local external therapy in the form of salicylic ointment, naftalan preparations, tar or emollient ointments is sufficient. Severe forms of the disease require complex systemic treatment with the use of detoxification, desensitizing, anti-inflammatory drugs of different groups, physiotherapeutic methods of therapy, external drugs, etc.
This section will present the available and most modern effective methods and means of psoriasis therapy.
Systemic therapy
There are peculiarities of managing patients at different stages of the psoriatic process. Treatment of the advanced stage requires special care. During this period, hemodez is prescribed intravenously drip, 30 percent. solution of sodium thiosulfate i / v, 10%calcium gluconate solution, with concomitant hypertension, it is advisable to introduce a solution of magnesium sulfate; 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 per day, depending on the severity of the skin process. The mechanism of action of acitretin is to inhibit the proliferation of epidermal cells, normalize the processes of keratinization. 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 the presence of contraindications to other methods of treatment, being a folic acid antagonist, it acts mainly on actively proliferating cells. Very toxic. There are many methods of application, preferably intramuscular administration once a week under strict laboratory control.
Immunosuppressants.Cyclosporin-A is prescribed in cases of severe, widespread psoriasis resistant to other types of therapy. This drug has an immunosuppressive action, has an inhibitory effect on the processes of cell growth, suppresses the secretion of activated lymphocytes of cytokines and the expression of receptors for interleukin-1 on immunocompetent cells. With psoriasis, it is prescribed at the rate of 5 mg per 1 kg of body weight per day.
Non-steroidal 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 drugs and the duration of treatment depend on the intensity of the pain syndrome, the degree of inflammation and individual tolerance.
The use of systemic corticosteroid drugs in the treatment of psoriasis is considered inappropriate, it leads to the development of torpid forms of the disease resistant to various 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 from 320 to 420 nm) and photosensitizing furocoumarin drugs. The use of photosensitizers is due to their ability to increase the sensitivity of the skin to ultraviolet rays and stimulate the formation of melanin. PUVA therapy leads to 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 taking 8-methoxypsoralen. The dose of the drug is selected taking into account the patient's weight. The procedures are released 3-4 times a week, for a course of 20-25 sessions.
Local PCT is also used with the use of external photosensitizers.
The combined use of PUVA therapy and retinoids is called Re-PUVA therapy. It has the highest clinical effect in cases of severe psoriasis.
Selective phototherapy (SFT) - ultraviolet irradiation in the medium-wave spectrum (wavelength 280-320 nm) without taking photosensitizers. SFT is used for less pronounced manifestations of the disease, the presence of contraindications to the appointment of PUVA therapy.
How to recognize psoriasis at an early stage
Treatment of psoriasis is most effective at the earliest stage. Therefore, it is so important to make a diagnosis on time. Only a dermatologist can tell you whether you have psoriasis or some other skin disease. However, you yourself can recognize this disease in yourself by several characteristic signs:
- Most often, psoriasis first manifests itself on the folds of the arms and legs, at the hairline or where clothing is in close contact with the body or rubs - under the belt of trousers, various elastic bands or straps.
- At the onset of the disease, a very itchy rash appears, covered with gray or silvery skin scales that are very easily removed.
- Removing the scale reveals thin, shiny and slightly damp skin.
- If you scrape the plaque with something like a spatula, removing the scales, then blood will appear on the spot in the form of tiny droplets. However, it is better not to use the latter method for self-determination of psoriasis - it is very easy to get an infection.
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 unsuitable drugs for treatment.
What to do if you find symptoms of the initial stage of psoriasis?
Psoriasis cannot be cured once and for all, so the main goal of therapy is to achieve stable and longest possible remission. You should know that without proper treatment, psoriasis quickly becomes chronic: exacerbations can occur up to 9 times a year, with a duration of 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. Usually, patients explain such a step by the fact that they allegedly heard from friends that such funds help quickly. This is a big mistake!
What is the danger of such self-medication? Hormonal ointments for psoriasis have a lot of side effects and contraindications. It is highly undesirable to use them without a strict doctor's recommendation on 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 scaling and psoriatic plaque formation;
- relieves itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the protective functions of the skin.