Psoriasis is a chronic, often relapsing non-infectious disease of the skin prone to damage periarticular tissues.
Causes of psoriasis
The most credible reason for the development of the process is considered to be a genetic predisposition, reinforced the influence of various precipitating factors.
It is known that psoriasis can occur at any age and equally affects men and women. While various factors external and internal environment create favorable conditions for the development of psoriasis. It is noticed that a kind of psoriatic rash elements appear on the skin in the area of any mechanical irritation factor, chemical or toxic substances contained in products for external use. Such a process is often preceded by various inflammatory processes in the skin through exposure to numerous pathogenic agents, bacterial or fungal nature. Precipitating factor that weakens the body from the inside, is considered to be strep. Established a clear pattern of development of a certain form of psoriasis (guttate) if during prolonged infections of the upper respiratory tract such as tonsillitis, bronchitis, etc. the Relationship of a hormone imbalance in the body and manifestations of psoriatic process under certain conditions of the body (puberty, pregnancy, menopause) say about the role of estrogens in the development of such lesions. Seen the role of various drugs, stress, smoking and alcohol as a triggering factor of psoriasis.
Symptoms of psoriasis
There are the following forms of psoriasis:
- Patchy the most typical form of red papules, clearly limited, flaky , coalesce and form pockets of different sizes. Affects the extensor surfaces(elbows and knees), scalp, lumbar region. Unaffected remain the face, palms, soles. The scales are tight to each other and when you try to remove them bleed.
- Guttate psoriasis is characterized by the sudden appearance of numerous spots. Often appears in young people aged 8-16 years. Often the appearance of this form is preceded by a streptococcal infection.
- Pustular psoriasis often localized on the palms and soles. Appear small sterile pustules, often painful.
- Intertriginous – there are eruptions on flexor surfaces and in the area of major folds(inguinal area, under milk glands).
- Generalized pustular psoriasis a severe form that requires immediate medical intervention. Accompanied by high fever and pain.
- Erythroderma is a severe form of psoriasis requires immediate medical intervention. Accompanied by chills, pain, marked redness of the whole body.
The disease usually begins acutely, with education in the area of previously traumatized skin planar pruritic papules are pink or red in color, with clear boundaries, the size of a pinhead to lentil grain. Almost immediately these papules covered with silvery, easily detachable scales. For acute (progressive) the disease is characterized by the emergence of new elements of the rash and rapid peripheral growth. Increasing papules coalesce with each other forming plaques kind of bizarre shapes, covered with silvery scaly elements only in the center, leaving a free edge.
Such a rash may be localized in any part of the skin, most often they are symmetrical, predominantly around large joints (elbows, knees, sacral region), the folds (inguinal, axillary) and on the scalp.
A few months later fixed period of psoriasis, which is characterized by the absence of peripheral growth of plaques and the appearance of “fresh” items. Peeling completely covers the plaque, around which the formation of the plot is light and thinning of the skin. In this condition patches may exist for a long time: months and years.
Resolution period is characterized by flattening of the elements of the rash and gradual cleansing plaque from peeling. In place of the long-existing elements will stain, often dark in color.
In this classical form of psoriasis General condition of patients is usually not affected.
Often psoriatic process affects the nails and is characterized by typical changes in the nail plate, in the form of punctate (superscripting) recesses. For psoriasis is characterized by the loosening and thickening of the free edge of the nail plate with changing its color to a dull yellow color. This pattern resembles a fungal infection of the nails, therefore, must be analyzed nail flakes pathogenic fungi. For a long time psoriatic process may be limited to only a barely noticeable specific changes in the nail plate. Should know that this lesion is quite often associated with lesions of the joints.
Psoriatic arthritis is a specific lesion of the joints as a result of inflammation of the periarticular tissues, characterseasy degenerative changes and the development of joint deformity with subsequent disability of the patient. In this process most often affects the interphalangeal joints of the fingers and toes, in the beginning is manifested by tenderness and increase in volume of the joints, and then change their shape with limited mobility. The joints are affected symmetrically. In the pathological process may involve larger joints, and the joints of the spine.
- swelling in the joints;
- pain on palpation;
- limited mobility, primarily in the morning (“morning stiffness”);
- functional decline activity of the joints and/or spine
- nail psoriasis
- psoriasis of blood relatives;
- adverse reaction to reumatoidea factor.When irrational use of topical treatment in the progressive phase of the disease psoriasis often develops nonspecific toxic-allergic reaction. Free from psoriatic plaques areas of redness appears, which merge to affect the entire skin. This process is accompanied by increased body temperature to 39°C and enlarged lymph nodes, and the emergence of a sense of contraction of the skin, itching and burning.Often there is an abundant desquamation, increased hair loss and detachment of the nail plate. This is a picture of the so-called psoriatic erythroderma, which can lead to a more severe form of psoriasis – pustular, when the background appear reddened skin pustules, increasing in size and merging into a “purulent lake” and dries in a scales-peel yellow-brown color. Thus the patient there is a General weakness and malaise. Such a state refers to the number of extremely heavy, so that when the first symptoms of this form of psoriasis need urgent specialist consultation and hospitalization of the patient.
For the purpose of prevention of development of such psoriatic conditions self-treatment in the progressive phase is considered invalid.
Examination if you suspect psoriasis
First appeared with psoriasis requires microscopic and mycological study of scales damaged skin pathogenic fungi to exclude infectious dermatosis. When an isolated lesion of the joints necessary x-ray picture and blood tests for rheumatologic tests. In difficult cases, resort to diagnostic biopsy modified skin.
- a symptom of the “stearin spot” – when grattage (scraping)psoriatic eruptions, the eruptive surface elements becomes intensely white, separated stearin flakes.
- a symptom of the “psoriatic film” (“terminal film”) – when removing the scales from psoriatic papules appears brilliant red surface.
- Symptom Auspitz (the phenomenon “blood dew”, a phenomenon the point of bleeding) – if grattage (scraping) psoriatic lesions, after the phenomenon of the “stearin spot” and the “terminal film”, appears the bleeding point.
Progressive stage of psoriasis:
- Symptom Elnova (rim Elnova) – red rim of hyperemia on the periphery of psoriatic papules that are not covered in these lesions scales.
- Symptom of Cabrera in case of damage to or irritation of the skin at the site of injury appear fresh eruptions.
- Symptom Voronova (pseudo-atrophic rim) – round of psoriatic papules – a brilliant, bright ring is slightly wrinkled skin.
Treatment of psoriasis
Because psoriasis is characterized by chronic relapsing course (roughly speaking – the incurable psoriasis), your doctor should be challenged to achieve as much prolonged remission. Selection of treatment is carried out, respectively, the phase and form of psoriasis. It is necessary to normalize the conditions of work and rest, to exclude provoking factors, namely, skin irritation, stress, Smoking, use of alcoholic beverages.
In the progressive period of psoriasis are appointed by means of General therapy and external preparations. Inside is vitamin therapy, the so-called “Hungarian scheme”, which includes a combination of vitamin C and folic acid in powders to be taken 3 times a day for 30 days, and intramuscular injections of vitamin B12 400 mcg, a day, №15. Additionally appointed inhalation drugs (15 injection of 10% calcium gluconate 10 ml intramuscularly, every other day, alternated with injections of vitamin B12). Sedative therapy (drugs bromine or Valerian) have had a positive effect for the stabilization process. Externally in this phase of psoriasis only mild exfoliating products: ointments, creams, lotions containing salicylic acid (2%), sulfur (2%), and in some areas – “Flutsinar”, “Ftorokort”, “lorinden-A”, “Diprosalic” and other corticosteroid ointment. Constantly apply moisturizers that have a softening effect within 12 hours (“? Yn cream”, “Trickser”, cream Unna). Good effect of dexpanthenol, zinc pyrithione in the composition of the various external means.
After stabilization of the process are assigned to allow external means in gradually increasing concentrations and a longer fixation on the plaque. Numerous keratoplastic ointment: 5-10% Ichthyol, 2-5% sulfur-tar, 10-20% naphthalan with the addition of corticosteroids and hydroxyestrone. Tar 2-5-10% and anthralin is used in the form of compresses and Vann leaving the face, folds, scalp and genitals. These drugs also have proven themselves well in combination with topical steroids and ultraviolet irradiation in suberythermal doses (only patients with “winter” form of psoriasis). Proven re-PUVA therapy and photochemotherapy, autohemotherapy, pirogenal, injection of staphylococcal toxoid (in the presence of chronic foci of infection), hemosorption and plasmapheresis. For the treatment of psoriatic arthritis are used paraffin baths and physiotherapy.
Exacerbation of psoriasis occurring with heavy and torpid course docked cytotoxic immunosuppressants (methotrexate), appointed inside.
From modern tools, successfully used worldwide for the treatment of psoriasis, noteworthy calcipotriol is a synthetic analogue of the active metabolite of vitamin D. Its effectiveness is due to the ability to inhibit the proliferation of keratinocytes and to accelerate their morphological differentiation. The use of this component in isolation and in combination with betamethasone contributes to the formation of long-term remission. You need to know and remember that external agents containing these substances should only be used under medical supervision.
Self-treatment of psoriasis
Among the folk remedies used to treat psoriasis, a good effect is observed with the application of birch tar with honey and egg white based on the different oils. It must be remembered that such procedures are safe and effective when stationary and regressive phases of the disease. When you use these tools in the acute phase there is a risk of disease progression.
During exacerbation of psoriasis in the diet is recommended to limit foods high in animal fats and carbohydrates, to exclude spicy foods and alcohol. Drinking plenty of fluids helps the excretion of various toxic substances that accelerates the stabilization process.
To maintain a long-term remission patients with psoriasis without exacerbation shows the various Spa treatments such as sunbathing and sea bathing, mud (for joints), hydrogen sulfide and radon sources (Matsesta, Tskaltubo, etc.), heliotherapy. Patients with psoriatic process are under constant medical supervision of a dermatologist and receive appropriate supportive care.
Advice of a dermatologist on psoriasis:
1. Can a mosquito bite to cause psoriasis?
In this case, the bite acts as irritant triggering factor for the formation of psoriatic elements. This so-called isomorphic reaction of irritation or a symptom of Cabrera, which are characterized by the emergence of new elements in the field of mechanical trauma of the skin within 1-2 weeks. It scratches, and ejectee, and insect bites, and the friction of clothes and much more.
2. What is “Psoriatic Triad”?
To psoriatic triad includes 3 classic for psoriasis symptom revealed by a dermatologist when examining a patient. When scraping psoriatic plaques with a scalpel first, there is a growing silvery flaking (a symptom of the “stearin spot”), under the scales reveals a shiny surface (a symptom of the “terminal film”),and then drops of blood ( a symptom of “blood dew”).
3. Recently I had dandruff white, began to scratch his head and very much hair fall out. Could this be psoriasis?
For scalp psoriasis typical “psoriatic corona” plaque, which goes beyond the hair growth and the patient is primarily concerned about the cosmetic defect. Hair loss in psoriasis is generally not the case.
4. What is a “winter” and “summer” form of psoriasis?
Exacerbation of psoriasis most often observed in autumn-winter period is the so-called winter uniform. When the summer form of this disease exacerbations are associated with increased UV exposure and occur in the spring and summer. To distinguish between these forms of psoriasis it is necessary to determine the tactics of treatment.