Psoriasis — a chronic non-communicable diseases, dermatosis, affecting primarily the skin. Psoriasis usually causes the formation of excessively dry, red spots on the surface of the skin. However, some patients with psoriasis have no visible lesions.
Patches caused by psoriasis are called psoriatic plaques. These spots are areas of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin and excessive angiogenesis (formation of new small capillaries) to subject the layer of the skin. Excessive proliferation of keratinocytes in psoriatic plaques and skin infiltration of lymphocytes and macrophages leads to the thickening of the skin in the affected areas, its elevation above the surface of healthy skin and the formation of the characteristic pale, grey or silver spots, resembling melted wax or paraffin wax ("paraffin lakes").
Psoriatic plaques often first appear on the exposed to friction and pressure areas — the surfaces of elbow and knee bends, on the buttocks. However psoriatic plaques can occur and be located anywhere on the skin, including the skin of the scalp, the surface of the hands, plantar surface of feet, external genitalia. In contrast to eczema rash, usually affecting the inner surface of the knee and elbow joints, psoriatic lesions often are located on the external the extensor surfaces of joints.
Psoriasis is a chronic disease characterized by usually within waves, with periods of spontaneous or caused by various therapeutic effects of remission or improvement and periods of spontaneous or provoked by adverse external influences (alcohol, intercurrent infections, stress) recurrences or exacerbations.
The severity of the disease may vary in different patients and even in one and the same patient during the periods of remission and exacerbation in a very wide range, from small local lesions to fully cover the entire body psoriatic plaques. Often there is a tendency to progression of the disease over time (especially if untreated), to the weighting and increased frequency of exacerbations, increase the area affected, and involvement of new areas of the skin. In some patients there is a continuous course of the disease without spontaneous remissions, or even a continuous progression. Often also affects the nails on the hands and/or feet (psoriatic onychodystrophy). Nail involvement may be isolated and observed in the absence of cutaneous lesions. Psoriasis can also cause inflammation of the joints, called psoriatic arthropathy or psoriatic arthritis. From 10% to 15% of patients with psoriasis also suffer from psoriatic arthritis.
There are many different means and methods for the treatment of psoriasis, but due to the chronic recurrent nature of the disease itself and often there is the tendency to progression over time, psoriasis is a fairly difficult to treat the disease. Complete cure is not currently possible (that is, psoriasis is incurable at the current level of development of medical science), but possible more or less long, more or less complete remission (including life). However, it is always a risk of relapse.
The impaired barrier function of the skin (in particular, mechanical injury or irritation, friction and pressure on the skin, overuse of soap and detergents, contact with solvents, detergents, alcohol-containing solutions, the presence of infected lesions on the skin or skin allergies, excessive dryness of the skin) also play a role in the development of psoriasis.
Psoriasis is a lot of what psychic tv skin disease. Most patients experience suggests that psoriasis may spontaneously improve or worsens for no apparent reason. Studies of various factors associated with the occurrence, development or exacerbation of psoriasis tend to be based on the study of small, usually hospital (not outpatient), that is certainly more severe groups of patients with psoriasis. Therefore, these studies often suffer from lack of representativeness of the sample and the inability to identify causal relationships in the presence of a large number of others (including yet unknown) factors that can influence the nature of psoriasis. Often different studies found conflicting findings. However, the first signs of psoriasis often appear after a trauma (physical or mental), damage to the skin in places the first appearance of psoriatic lesions, and/or past streptococcal infection. Conditions, according to a number of sources that could contribute to the aggravation or worsening of psoriasis include acute and chronic infections, stress, climate change, and the change of seasons. Some medications, particularly lithium carbonate, beta blockers, antidepressants fluoxetine, paroxetine, antimalarial drugs chloroquine, hydroxychloroquine, anticonvulsants carbamazepine, valproate, according to several sources, are associated with worsening of psoriasis or even can cause its initial appearance. Excessive alcohol consumption, Smoking, overweight or obesity, poor diet can aggravate psoriasis or encumber its treatment, provoke aggravation. Hairspray, some creams and hand lotions, cosmetics and perfumes, household chemicals can also cause exacerbation of psoriasis in some patients.
Patients suffering from HIV or AIDS often suffer from psoriasis. It seems paradoxical for researchers of psoriasis, as treatment aimed at reducing the number of T cells or their activity as a whole contributes to the treatment of psoriasis, and HIV infection or AIDS is accompanied by a decrease in the number of T-cells. However, over time with the progression of HIV infection or AIDS by increasing viral load and a decrease in the number of circulating CD4+ T cells, psoriasis in HIV-infected patients or AIDS patients deteriorates or escalates. In addition to this mystery, HIV infection is usually accompanied by a strong shift of the cytokine profile towards Th2, whereas psoriasis vulgaris from uninfected patients is characterized by a strong shift of the cytokine profile towards Th1. According to the currently accepted hypothesis is that a reduced amount of and pathologically modified activity of CD4+ T-lymphocytes in patients with HIV infection or AIDS cause hyperactivation of the CD8+ T-lymphocytes, which are responsible for the development or exacerbation of psoriasis in HIV-infected or AIDS patients. However, it is important to know that most of psoriasis patients in relation to healthy carriers of HIV, and HIV is responsible for less than 1% of cases of psoriasis. On the other hand, psoriasis in HIV-positive occurs, according to different sources, with a frequency of from 1 to 6 %, which is approximately 3 times higher than the prevalence of psoriasis in the General population. Psoriasis in patients with HIV infection and AIDS in particular often occurs very hard and responds poorly or not at all amenable to standard therapies.
Psoriasis most often develops in patients with initially dry, sensitive skin than patients with oily skin, and is much more common in women than in men. One and the same patient psoriasis often first is in areas more dry or more thin skin than in thick skin areas, and is particularly often in places of damage of the integrity of the skin, including scratches, scuffs, abrasions, scratches, cuts, in areas that are exposed to friction, pressure or contact with aggressive chemicals, detergents, solvents (this is called the phenomenon Kebner). It is assumed that this phenomenon lesions of psoriasis primarily dry, delicate or injured skin associated with infection, because the infection (probably the most common Streptococcus) easily penetrates the skin with minimal secretion of sebum (which under other circumstances, protects the skin from infections) or skin damage. The most favorable conditions for the development of psoriasis, thus, opposite to the most favorable conditions for a fungal infection of the feet (the so-called "athlete's foot") or the armpits, groin area. For the development of fungal infections is most favorable moist, wet skin, for psoriasis, on the contrary, dry. Penetrated into dry skin infection causing dry chronic inflammation, which, in turn, causes the symptoms characteristic of psoriasis, such as itching and increased proliferation of skin cells. This in turn leads to a further increase in dryness of the skin due to inflammation and enhanced proliferation of keratinocytes, and due to the fact that the infection consumes the moisture, which otherwise would serve to moisturize the skin. To avoid excessive dryness of the skin and reduce the symptoms of psoriasis patients with psoriasis is not recommended to use washcloths and scrubs, especially hard, since they not only damage the skin, leaving microscopic scratches, but scraped from the skin of the upper protective stratum corneum and sebum, normally protects the skin from drying and from penetration of microorganisms. It is also recommended to use talc or baby powder after washing or bathing to absorb excess moisture from the skin, which otherwise "get" the infection. Additionally, it is recommended the use of the funds, moisturizing and nourishing the skin, and lotions that improves the function of the sebaceous glands. Not recommended to abuse of soap, detergents. Should try to avoid skin contact with solvents, household chemicals.
It has been shown that psoriasis may impair the quality of life of patients in the same degree as other severe chronic diseases, such as depression, myocardial infarction, hypertension, heart failure, or diabetes mellitus of the 2nd type. Depending on the severity and location of psoriatic lesions, patients with psoriasis may experience significant physical and/or psychological discomfort, difficulty with social and professional adaptation and even need disability. Strong itching or pain can interfere with performing basic life functions, such as self-care, walking, sleep. Psoriatic plaques on the exposed parts of the hands or feet can prevent the patient to work in certain jobs, to do some sports, take care of family members, Pets or house. Psoriatic plaques on the scalp often pose to patients with special mental problems and caused considerable distress and even social phobia, as pale plaques on the scalp can be mistaken for dandruff or surrounding the result of the presence of lice. Another big psychological problem gives rise to the presence of psoriatic lesions on the face, the earlobes. Psoriasis treatment can be expensive and take away from the patient a lot of time and effort, interfering with work and/or study, socialization of the patient, the device personal life.
Psoriasis patients can also be (and often are) excessively concerned about their appearance, attach too much importance (sometimes to the extent of being fixated, almost body dysmorphic disorder), suffer from low self-esteem, which is associated with fear of public rejection and the rejection or fear not to find a sexual partner due to problems of appearance. Psychological distress combined with pain, itching and immunopathological disorders (increased production of inflammatory cytokines) can lead to the development of severe depression, anxiety or social phobia, significant social isolation and maladjustment of the patient. It should also be noted that comorbidity (combination) psoriasis and depression as well as psoriasis and social phobia, occurs with increased frequency even in those patients who do not experience subjective psychological discomfort from the presence of psoriasis. It seems likely that genetic factors influencing predisposition to psoriasis and predisposition to depressions, anxiety States, social phobia largely overlap. It is also possible that in the pathogenesis of both psoriasis and depression play a role in common immunopathological and/or endocrine factors (for example, with depression also show elevated levels of inflammatory cytokines, increased cytotoxic activity of glial).