Psoriasis (psoriasis) – chronic non-contagious disease that affects the skin, nails and joints. Characterized by the appearance on the skin monomorphic rash nodules are bright pink, covered with silvery scales. Elements of the rash may merge in various configuration resembling a geographic map. Accompanied by moderate pruritus. Psoriasis affects the appearance of the skin, delivers psychological discomfort to the patient. When joint damage develops psoriatic arthritis. Threat of generalized pustular psoriasis pregnant, leading to foetal damage and miscarriage.
Psoriasis is a common chronic skin disease that is characterized by a monomorphic rash of flat papules, which tend to merge into large plaques that are very quickly covered with loose silvery-white scales. Psoriasis has a fluctuating course, the incidence is 2% of the total population, is diagnosed equally in men and women.
The causes and pathogenesis of psoriasis
The etiology and pathogenesis of psoriasis are not fully understood, but research results suggest that genetic, infectious or neurogenic nature most likely. Hereditary nature of psoriasis confirmed by the facts that the incidence is higher in those families in which psoriasis have already been diagnosed, except in monozygotic twins, the concentration of morbidity is also higher than in other groups. Infectious etiology of psoriasis limited to the presence of the modified complexes and inclusions, such as during viral infection, but to identify the virus is not yet possible.
And, to date, psoriasis is considered a disease with a large number of factors of infection with a share genetic and infectious components. The risk of incidence of psoriasis are the people with constant trauma to the skin, with the presence of chronic streptococcal infections of the skin, disorders of the autonomic and Central nervous system, endocrine disorders, additionally, alcohol abuse increases the risk of psoriasis.
The clinical manifestations of psoriasis
The primary element in psoriasis is a single papule is pink or red in color that is covered with lots of loose silvery-white scales. An important diagnostic feature is the triad of psoriasis: the phenomenon of a stearin stain, a terminal film and the point of bleeding while attempting to remove the scales.
In the stage of development of psoriasis rash a little, gradually over months and even years their number increases. Psoriasis very rarely will debut an intense and generalized rash, such a beginning can be observed after acute infectious diseases, severe neuropsychiatric overloads and, after a massive drug therapy. If psoriasis is the beginning, the rash is swollen, have a bright red color and quickly spread throughout the body, psoriatic plaques hyperemic, swollen, and often itch. The papules are localized on the flexor surfaces, particularly in the area of the knee and elbow joints, torso and scalp.
For the next stage of psoriasis characterized by the appearance of new, small elements in areas of scratching, injuries and abrasions, this clinical feature is called the phenomenon of Kebner. In the result of peripheral growth, the newly emerging elements blend with the existing and form a symmetrical plaques or are in the form of lines.
In the third stage of psoriasis the intensity of the peripheral growth of plaques is reduced, and their boundaries become more clear, the color of the affected skin acquires a bluish tint, there is intense peeling on the entire surface of the elements. After the final stop the growth of plaques of psoriasis at their periphery formed pseudoatrophic bezel - bezel Voronova. In the absence of treatment of psoriasis plaques of thicken, sometimes you can see the papillomatous and warty growths.
In the stage of regression of the symptoms of psoriasis starts to fade, while normalizing the skin goes from the center of the affected surface to the periphery, first disappears peeling, normal colour of the skin and at last disappears infiltration of tissues. With deep lesions of psoriasis and when the lesions are thin and loose skin can sometimes be a temporary hypopigmentation after cleansing the skin from rashes.
Exudative psoriasis differs from the usual presence of crusts scales and plaques, which are formed due to absorb the exudate, in the folds of the body may be oozing. Risk factors for the incidence of exudative psoriasis get with diabetes, people with hypofunctions of the thyroid gland (hypothyroidism) and having excess body weight. Patients with this form of psoriasis have noted itching and burning in the affected areas.
Psoriasis, occurring in the seborrheic type, is localized in areas prone to seborrhea. A large amount of dandruff does not allow to diagnose psoriasis, because it masks the rash. Over time, the patches of skin affected by psoriasis, grow and move on to the skin of the forehead in the form of "psoriatic crown".
People who are engaged in heavy physical labor, more common psoriasis of the palms and soles. In this type of psoriasis the main part of the rash localized on the palms, on the body there are only isolated areas of rash.
Pustular forms of psoriasis begin with one small bubble, which quickly degenerates into a pustule, and when opening forms a crust. In the future, the process extends to healthy skin in the usual form of psoriatic plaques. In severe forms of generalized pustular psoriasis infiltrated into the skin may occur intraepithelial small pustules that merge to form purulent the lake. Such pustules are not prone to Stripping and dry up in a thick brown crust. In pustular forms of psoriasis lesions are symmetrical, often the process involves the nail plate.
Arthropathy psoriasis is one of the severe, there is pain without deformation of the joint, but in some cases the joint is deformed, which leads to ankylosis. When psoriatic arthritis symptoms of psoriasis of the skin may occur much later than arthralgic phenomenon. Primarily affects small joints later, the process involved large joints and the spine. Due to gradually developing osteoporosis and destruction of the joints arthopathic form of psoriasis often results in disability of patients.
In addition to the skin rash in psoriasis is observed vegeto-dystonic and neuroendocrine disorders, exacerbations patients reported fever. Some patients with psoriasis may be asthenic syndrome and muscle atrophy, disorders of the internal organs and symptoms of immune deficiencies. If your psoriasis progresses, the visceral disorders become more pronounced.
Psoriasis has a seasonal period, the majority of relapses are observed in the cold season and very rarely psoriasis is exacerbated in the summer. Although in recent years mixed forms of psoriasis, recurrent at any time of year, are diagnosed more often.
Diagnosis of psoriasis
Diagnosis is made by dermatologists on the basis of the appearance of cutaneous manifestations and complaints of the patient. For psoriasis typical psoriatic triad, which includes the phenomenon of stearin spot, the phenomenon of psoriatic film and the phenomenon of blood dew. When poskablivanii papules smooth even enhanced by the peeling, and the surface adopts the similarity with stearic spot. With further poskablivanii after the complete removal of flake detachment is subtle delicate translucent film that covers the entire element. If you continue the action, the terminal film rejected and exposed wet surface where there is a point bleeding (a blood drop, resembling a drop of dew).
When atypical forms of psoriasis it is necessary to conduct a differential diagnosis with seborrheic eczema, papular form of syphilis, and pink ringworm. Histological studies revealed hyperkeratosis, and almost total absence of the granular layer of the dermis, spiny layer of the dermis edematous with foci of accumulations of neutrophils, the increase in the volume of such a focus, it migrates under the Horny layer of the dermis and forms microabscesses.
The treatment of psoriasis
Psoriasis treatment should be complex, first apply local medication, and exchange drug treatment are connected with the ineffectiveness of local treatment. Adherence to work and rest, hypoallergenic diet, avoiding physical and emotional stress are of great importance in the treatment of psoriasis.
Sedatives, such as tincture of Valerian, peony, and relieve nervous irritability of patients, thereby reducing the release of adrenaline in the blood. Take antihistamines of new generation reduces the swelling of tissues, and prevents exudation.
The use of diuretics lung with exudative form of psoriasis reduces exudation and as a consequence reduces the formation of extensive layered crusts. If there are lesions from the joints, that is shown taking nonsteroidal anti-inflammatory drugs for the relief of pain. If psoriatic disorders in the joints more severe use therapeutic puncture of joints with the introduction inside the joints, betamethasone and triamcinolone.
When pustular form of psoriasis, psoriatic nail lesions and erythrodermic psoriasis aromatic retinoids are appointed for a period of not less than one month give a good effect. The use of corticosteroids is justified only when the crises of psoriasis drugs of prolonged action, followed plasmaphoresis allows to quickly arrest psoriatic crisis.
Physiotherapy treatments such as paraffin baths, UV irradiation is shown in different forms of psoriasis. In an advanced stage of psoriasis apply anti-inflammatory ointment if there is infection, then ointment with an antibiotic. Effective laser treatment of psoriasis and phototherapy. In the transition of psoriasis in a stationary stage is shown keratolytic ointments and creams. Cryotherapy is psoriatic plaques.
In the stage of reverse development reducing locally applied ointments, gradually increasing their concentration. Local application of low concentrated corycosteroids ointments shown at all stages of psoriasis. Drugs that modulate the proliferation and differentiation of keratinocytes is a perspective direction in the modern treatment of psoriasis. During the period of rehabilitation of sanatorium-resort treatment with a sulphide and radon sources help achieve the persistent and prolonged remission.