Psoriasis is a chronic multifactorial systemic disease with genetic predisposition that affects the skin and joints. Patients often complain of a pinkish-red rash with silvery-white scales. The rash is accompanied by itching, pain and scaling. When joints are damaged, their mobility is limited, which can lead to patient disability.
Causes of psoriasis
The cause of psoriasis remains unknown. There are only theories about the origin:
- neurogenic (appearance of skin rashes after stress, burns, mental trauma);
- endocrine (especially during the perimenopausal period);
- metabolic (fat metabolism disorder);
- infectious;
- viral (psoriatic antigens are isolated from healthy individuals, but with a high probability of developing psoriasis in the future, while psoriasis is a non-contagious disease);
- genetic.
Psoriasis can be found in an entire generation of people with the same risk factors. But it is assumed that the type of inheritance is multifactorial. If one parent is sick, the child has a 25% chance of getting sick. If both parents are sick – 60-75%.
Viral and genetic theories remain the leaders.
Factors contributing to flare-ups:
- infectious and parasitic diseases, including carriage (HIV, tonsillitis, decayed teeth, hepatitis);
- fatigue;
- obesity;
- perimenopausal period;
- drugs (interferons, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
- bad habits (alcohol, smoking, household chemicals);
- skin lesions; dryness, resulting in increased skin trauma.
Clinical classification
There is no single classification. One of them:
- vulgar (ordinary);
- exudative;
- psoriatic erythroderma;
- arthropathic;
- psoriasis of the palms and soles;
- pustular psoriasis.
Flow characteristics:
- they get sick at any age, cases of psoriasis in children are not rare;
- men and women get sick in the same way;
- prevalence worldwide;
- There are summer, winter and mixed seasonality of exacerbations.
Symptoms of psoriasis
The disease itself is characterized by a violation of keratinization of the skin with the production of insufficiently mature keratinocytes. Pink-red rashes appear, covered with silver-white scales.
A triad of symptoms is characteristic, thanks to which it is possible to make a diagnosis:
- stearin stain symptom: when scraped, the number of scales increases;
- the phenomenon of psoriatic film: when all the scales are scraped off, a smooth, shiny red surface appears;
- a symptom of localized bleeding: when the film is scraped, droplets of blood appear. This is due to the uneven stretching of the papillae in the dermis, the expansion of the capillaries and their swelling.
Signs of psoriasis
- Psoriasis on the body can start with a spot and merge into large damaged areas.
- Hand psoriasis is most often localized on the extensor surfaces.
- Psoriasis on the face: The rash often appears behind the ears, on the forehead. It is an independent factor to improve treatment.
- Psoriasis on the scalp is an isolated form, it does not affect the hair, the elements of the rash are located along the edge of the hair, the "psoriatic crown".
- Nail psoriasis: leads to characteristic changes, point depressions, the nail looks like a thimble. It may also thicken, become dull, or form yellow spots under the nail.
- Psoriatic arthritis: Affects peripheral joints with or without pain, often with inflammation at the attachment of ligaments to bones, the ligaments themselves, and the fingers.
Characteristics of psoriasis in children
Characterized by the presence of one or more elements up to 1 cm, they rise above the surface of the skin. Itching in children is more pronounced than in adults. After scratching, the spot bleeds and sores form. In children, psoriasis is often localized in the perineal area as a large red spot. In adolescents, spots appear on the palms of the hands and soles of the feet.
There are three stages of psoriasis:
- Progressive: The elements of the rash increase and are uniformly white in color, with a narrow red border along the edge;
- Stationary – the growth of the spot stops, a strip of lighter skin 2-5 mm wide appears along the edge;
- Regressive phase: the scales gradually fall off, the stain diminishes and disappears. A depigmented spot remains at the site of the rash.
Diagnosis of psoriasis
Most often, patients see a primary care physician, dermatovenerologist, or rheumatologist (for psoriatic arthritis). The doctor collects complaints (presence of rashes, itching, pain, swelling and tenderness of the joints), anamnesis (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatment, concomitant diseases). On examination, changes are found in the skin and joints.
Laboratory tests are carried out:
- general blood test (including white blood cell count, ESR, platelets);
- general urinalysis;
- biochemical analyzes (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total proteins, CRP, rheumatoid factor);
- in difficult situations, a skin biopsy is performed with additional pathohistological examination (sharply expressed acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements);
- before prescribing biological treatment, an examination for HIV, viral hepatitis B and C and tuberculosis is carried out;
- x-ray of the affected joints;
- CT and MRI for axial lesions;
- ECG.
If necessary, consultations are held with an infectious disease specialist, a physiatrist, an orthopedic traumatologist, a surgeon and other specialists.
When diagnosing psoriasis, it is worth excluding diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, Zhiber rosea and papular syphilis.
The severity of psoriasis is determined by BSA (Body Surface Area - area of skin affected by psoriasis), PASI (Psoriasis Area and Severity Index - index of prevalence and severity of psoriasis), DLQI (Dermatology Life Quality Index - dermatological quality index of life).
The PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (Psoriatic Arthritis Classification Criteria) criteria are used to diagnose psoriatic arthritis.
Treatment of psoriasis
The treatment is complex, aimed at eliminating inflammation, normalizing the proliferation and differentiation of keratinocytes.
Local therapy:
- ointments and creams with vitamin D3 and its analogues;
- calcineurin inhibitors;
- glucocorticoids for local use;
- phototherapy.
Systemic therapy:
- PUVA therapy;
- cytostatics;
- immunosuppressants;
- biological drugs.
For psoriatic arthritis use:
- non-steroidal anti-inflammatory drugs;
- disease-modifying drugs;
- intra-articular injections of glucocorticoids;
- biological drugs.
For chronic cases, it is recommended to use psoriasis ointments, for exacerbations psoriasis creams are used.
When applying ointment or cream, do not rub it into the skin or apply a bandage. This can increase the penetration of the drug into the skin and cause side effects.
It is not recommended to use hormonal ointments for more than 4 weeks. Incorrect dosing of medications can be ineffective or cause side effects. The expected effect of the treatment occurs after 1-2 weeks of use.
There are several ways of using creams and ointments for psoriasis containing glucocorticoids:
- continuous mode;
- tandem therapy modality;
- descending therapeutic regimen;
- how to apply the steps.
It is worth noting that the treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis using ointments and creams directly on the affected area. For the most severe forms, treatment is carried out in a hospital setting using phototherapy, systemic therapy and biological drugs.
The course of the disease is considered moderate and systemic treatment can be started in the following cases:
- skin areas of aesthetic importance are affected;
- large areas of the head are affected;
- the external genitalia are affected;
- the palms of the hands and soles of the feet are affected;
- at least 2 nails are affected;
- There are individual elements that cannot be treated locally.
Systemic therapy is carried out only in the hospital, under the strict guidance of doctors, since systemic treatment is associated with a wide range of side effects, which can be reduced by selecting individual treatment.
General recommendations for patients with psoriasis:
- minimize trauma and dehydration of the skin;
- after applying creams and ointments for psoriasis on your hands, use gloves to prevent the drug from getting into your eyes;
- use sunscreens with a protection factor of 30;
- avoid stressful situations, consult a psychologist if necessary;
- control your weight, eat rationally.
Diet for psoriasis
Advised:
- alkaline drink 1200-1600 ml per day;
- use of lecithin;
- fruits and vegetables;
- Porridge;
- lean meats and fish;
- dairy products.
Not recommended:
- citrus fruits;
- bread made with premium flour;
- fatty fish and meat;
- high-fat dairy products;
- coffee – no more than 3 cups a day;
- products with yeast;
- alcohol, sweets, pickling, smoked, spicy.