- a high prevalence;
- unpredictability, Novitatis and variability of flow;
- the appearance of the first clinical signs predominantly at a young age;
- the increasing incidence in the last 10-15 years among young people;
- increase in percentage of severe forms of the disease, accompanied by serious psychological disturbances and sleep disorders;
- deterioration in the quality of life of patients;
- the difficulty of the treatment;
a significant increase in the number of patients with disability as sick leave and disability, especially among young men.
According to various sources, the disease was in 2-7% of the population. In the structure of skin diseases psoriasis is 3-5%, and among patients with dermatological hospitals — up to 25%.
This data is for some reason incomplete: the difficulty of identifying severe forms, such as, psoriatic arthritis, rare negotiability to medical institutions of patients with mild forms etc.
Causes of psoriasis and its pathogenesis
Despite the advantage of local cutaneous manifestations in most forms of the disease, its causes and the nature of the violations in the body the disease is of a systemic nature.
In the course of the disease involved joints, blood vessels, kidneys, liver. There is also a high risk of diabetes, obesity and hypertension in persons with psoriasis, especially in women.
In 20-30% of patients subsequently developing a syndrome of metabolic disorders with a high content of triglycerides in blood, obesity predominantly in the abdomen, psoriatic arthritis.
Also in recent years revealed a number of biological markers, indicating a direct connection of psoriasis with Crohn's disease, rheumatoid arthritis, cardiovascular diseases, angina, and increased mortality due to myocardial infarction.
For these and other reasons an increasing number of researchers are inclined to the system definition Dermatosis as "psoriatic disease" and not just "psoriasis."</1_img>
If passed, the psoriasis hereditary?
Despite the large number of hypotheses and research conducted to the present time remains difficult, the response to the question of whether psoriasis is transmitted by inheritance. However, it is generally accepted that the disease is genetically determined. In the absence of the disease in both parents it is found only in 4.7% of children. When the disease one of the parents, the child's risk of Contracting is increased to 15-17%, both parents — to 41%.
The beginning of psoriatic disease can be at any age, but in most cases, the peak observed in the age of 16-25 years (type I psoriasis) and 50-60 years (type II psoriasis). Psoriasis of the I-th type can be traced hereditary disease, joint lesions and prevalence of lesions varius. With type II disease have a more favorable course.
The mechanism of development (pathogenesis)
The main link in the pathogenesis (mechanism of development) disease that causes lesions on the skin, is the increase in mitotic (cell division) activity and the accelerated proliferation (growth) epidermalibus cells. The result — cells of the epidermis, without having orogovet, ejected by the cells of the underlying layers of the skin. This phenomenon is accompanied by excessive flaking and is called Hyperkeratose.
Possible free communication and contact with patients, i.e. can you get? All the studies related to this disease, refute this assumption. The disease does not spread to other people by droplets or by direct contact.
Implementation of a genetic predisposition to the disease (according to the genetic theory of psoriasis) are possible in the case of disorders of regulatory mechanisms of the following systems:
mentis.Mental instability contributes to disorders of the function of the autonomic nervous system. The latter is one of reflex units in the implementation of certain emotional factors effect through alpha - and beta-receptors on the vascular system of the skin, and hence, on its General condition.
Mental trauma plays a significant (if not primary) role in the mechanism of the disease, and the frequency and duration of relapses. At the same time, the dermatosis causes a disruption of the functional state of the psyche. Endocrine.
psoriatic diseaseis a manifestation of the violation of adaptive mechanisms, the main role in which play of the endocrine glands (hypothalamus, pituitary, adrenal glands), the regulation of which is carried out not only declinare, way (through the blood), but also with the participation of the nervous system. /For the purposes of adaptation of the hypothalamic-pituitary-adrenal system first turns on (in response to the impact of environmental changes, extreme and accentus factors) by increasing or decreasing the secretion of hormones, resulting in altered cellular metabolism. </2_img>
Immune. The mechanism of realization of genetic predisposition to PSORIASIS with involvement of the immune system occurs through genes controlling the cellular immune response and immune cell interaction with each other (HLA system). Immune system in psoriasis is also altered either genetically or under the influence of internal or external factors, as evidenced by a violation of all parts of the cutaneous immune regulation.
Genetically determined disorders of cell metabolism lead to the accelerated growth and proliferation of immature cells of the epidermis, which leads to the release of biologically active substances (BAS) lymphocytes, immature skin cells, activated keratinocytes and macrophages. The latter are mediatores, inflammation and immune response.
These substances include protease, protein informational molecules called cytokines (tumor necrosis factor, interleukins, interferons, and various subtypes of lymphocytes), polyamines (hydrocarbon radicals). Mediators, in turn, stimulate the growth of defective cells of the epidermis, changes in the walls of small vessels and the appearance of the inflammation.
The whole process is accompanied by the accumulation in the epidermis and the papillary layer of the dermis of one - and multi-celled leukocyte. Predisposing and trigger factors Key pathological manifestation of psoriasis is the excessive growth of defective cells of the epidermis. Therefore, fundamental to the elucidation of the mechanism of the disease and deciding how to treat psoriasis, is the establishment starting factors. The main ones:
Psychological— the influence of short-term severe stress, and unexpressed, but time-consuming or repetitive negative psychological impacts, moral dissatisfaction, sleep disturbances, depressive States.
Metabolic disorders in the body, dysfunction of the digestive organs, especially the liver and exocrine function of the pancreas. Disease or dysfunction of the endocrine glands (hypothalamus, thyroid, parathyroid tissue and glands, the endocrine activity of the pancreas). Immune system (allergichekie reactions and immune diseases).
The presence in the body of chronic foci of infection (tonsillitis, rhinosinusitis, inflammationibus profuere, etc.). Pathogenic and conditionally pathogenic microorganisms, especially Staphylococcus aureus, streptococci and fermentum fungi, their toxins, the skin cells damaged by these microorganisms, are powerful antigens, can trigger the immune system to aggression against them, modified, and healthy cells of the body.
Mechanical and chemical damage to the skin, the prolonged use of antibiotics or glucocorticoids about any disease, giperinsolyatsiya, Smoking and alcohol abuse, acute infectious diseases (respiratoriorum viral infection, influenza, angina, etc.).
Symptoms and types of psoriasisAccepted clinical classification of psoriatic disease does not exist, but traditionally there are the most frequently encountered clinical form. They are in some cases so different from each other that they are regarded as separate diseases.
In the development of the disease there are three stages:
The progression of the process in which precipitation of up to 1-2 mm appear in large numbers in new areas. They transformirovalsya in a typical psoriatic plaque.
Stationary phase— the lack of the appearance of "fresh" elements, keeping the size and appearance of existing plaques, completely covered with exfoliating epidermis.
Stage regression— reduction and flattening of the plaques, reducing the severity of the peeling and disappearance of elements, the resorption that begins in the center. After their complete disappearance usually remain foci of depigmentation.
Psoriasis vulgaris(normal, normal) It appears monographia (homogeneous) eruptionibus in the form of plaques or papules — nodules of red or pink which rise above the surface of the skin. Papules are clearly demarcated from the healthy areas and covered statera dolosa is a silvery-white color. The size of their diameter can be from 1-3 mm to 20 mm and more. For them, the three characteristic phenomenon that occurs after their poskablivanii surface: </3_img>
the symptom of "stearin spot" — strengthening peeling after a light poskablivanii, causing the surface of the papules becomes similar to the drop oppressi stearin; this is due to parakeratosis (thickening of the epithelium), Hyperkeratose (thickening of the stratum corneum, T. Zn. stratification scales), the accumulation of fat and sicut crassus, components in the outer layers of the epidermis; a symptom of the "terminal film" under remote scales is a mucilaginous epidermal layer in the form of a thin, velvety, shiny, wet surfaces; the symptom of "blood dew", or the phenomenon Auspittsa-Polotebnova — not merging together of the droplets of blood in the form of dew, which act on the shiny surface after a light poskablivanii it is due to an injury plenus sanguinis, dermal papillae.
Favorite places localization rash pellis are part of the head, symmetrical arrangement on extensoris indicis surfaces in the area of large joints — elbow, knee. Localization of plaques can be a long time to be restricted to these areas. Therefore they are called "guardians", or "officium". Rarely affects the nails, skin in the area of other joints, genitals, face, soles and palms, large folds.
Another characteristic symptom is the appearance of psoriatic lesions in areas of mechanical or chemical damage to the skin (the phenomenon Kebnera). Such injuries can be scalpendi, cuts, chemical irritation by acids or alkalis.Depending on the localization of the elements and clinical course, psoriasis vulgaris is divided into several varieties:
- Hand-quadratus plantae.
- The nail psoriasis.
Seborrheic psoriasis.It occurs in areas of skin with lots of sebaceous glands on the forehead, scalp, BTE region, in areas of facial folds (nasolabial and nososchechnyh), between the shoulder blades and in the upper part of the anterior surface of the chest.
If on the face, back and chest rash has the character of red papules, which are covered squamea convolvens large plates of silver-white color, the ears it is similar to the rash of seborrheic dermatitis, complicated by acceding infection.
The surface of the seborrheic spots and papules of the ear sinks more bright and edematous, compared with other areas. It is covered with statera dolosa yellowish-white or grayish-white color and serosum vehentem-purulent crust (due to macerari), which fits tightly to the skin. Almost always rash accompanied by severe itching.