A pathological condition characterized by scaly and nodular changes on the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of the disease.
Psoriasis is a chronic disease of the skin and nails in which a rash of pink nodules and silvery scales appears on the skin. Usually, the nodules merge into large plaques, around which the skin is quickly covered with scales. With the prolonged development of the disease, damage to the joints is possible, accompanied by impaired mobility and constant pain. Different forms of psoriasis differ in the degree of skin damage: the patient may have only subtle patches on the scalp or large plaques on different parts of the body. The likelihood of developing psoriasis complications also depends on many factors. This disease is especially dangerous for pregnant women, as the pustular form of the disease can cause miscarriage.
about the disease
Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually occur between the ages of 18 and 35. Often, psoriasis occurs against the background of cardiovascular disorders, Crohn's disease and depression. Approximately 30% of patients develop joint damage (arthritis). It is impossible to eliminate the root cause of psoriasis, however, symptomatic therapy can significantly alleviate the course of the disease.
types of psoriasis
Depending on the predominant symptoms, several types of psoriasis are distinguished:
- plaque: characterized by the appearance of classic plaques covered with silvery scales; preferred location: elbows, knees, trunk, scalp;
- teardrop-shaped: the main manifestation is orange-pink nodules ranging in size from 1 to 10 mm;
- nail psoriasis: nail plates are predominantly affected;
- large fold psoriasis: rashes occur in the armpits, neck folds, genitals, and other places with excessive friction; this form is more common in obese people;
- psoriasis of the head: the scalp is affected;
- arthropathic psoriasis (psoriatic arthritis): joints are affected;
- pustular psoriasis: several small vesicles with pus appear on the patient's skin;
- psoriatic erythroderma: in addition to the rash, there is a pronounced reddening of the skin in the area of \u200b\u200bthe rash.
symptoms of psoriasis
Most often, plaques appear on the forearm, leg, navel and scalp. The pustular form of psoriasis is characterized by the formation of pus-filled blisters on the skin. At certain times, many patients experience a change in nail color and structure. Damage to the skin scales leads to the appearance of spot bleeding. Patients also complain of itchy skin. Skin changes disappear and reappear periodically.
Other symptoms and signs:
- the appearance of red spots in the area of \u200b\u200bthe skin folds;
- profuse rashes occur after infectious diseases and stress;
- slight increase in body temperature;
- the appearance of new rashes in the winter months;
- joint pain;
- impaired mobility in the affected joint area;
- dryness and hypersensitivity of the skin.
Plaque resorption usually begins in the central part, so that the psoriatic elements acquire an annular or garland-like shape. Temporary depigmentation (pseudo leucoderma) remains at sites of resolved rashes. During periods of incomplete remissions, individual "service" plaques may remain on certain areas of the skin (most often in the area of \u200b\u200bthe elbow and knee joints).
The most serious types of psoriasis are psoriatic erythroderma and arthropathic psoriasis.
In psoriatic erythroderma, the entire (or almost entire) skin is involved in the pathological process. The skin becomes tense, rough, infiltrated, reddish in color, with abundant large and small lamellar desquamation on the surface. Peripheral lymph nodes increase, subfebrile temperature appears, the general condition of patients is disturbed, changes in blood (leukocytosis, elevated ESR), urine (proteinuria) are observed. The development of erythroderma is promoted by irrational and irritating therapy in the progressive stage of psoriasis.
Arthropathic psoriasis is characterized by lesions predominantly of small joints of the hands and feet, less frequently of the wrist, ankle, intervertebral joints, etc. , accompanied by severe pain and swelling of the joints, limitation of their mobility and deformities. X-ray reveals lysis of the distal phalanges of the fingers and joint changes similar to rheumatoid arthritis. The Waaler-Rose test and the latex test are usually negative. In the blood, leukocytosis, elevated ESR, hypergammaglobulinemia. Joint involvement may be associated with skin lesions or be isolated over several years.
With all these forms of psoriasis, it is possible to damage the nails in the form of perforated nail plates ("thimble phenomenon"), their clouding or thickening up to onychogryphosis. The course of the disease is chronic and wavy. The seasonality of the process is usually expressed - deterioration in winter with significant improvement in summer (winter type), less often - vice versa (summer type).
causes of psoriasis
The exact mechanisms of psoriasis formation are still not understood. It is believed to be an autoimmune disease in which the body's defense system mistakenly attacks healthy tissue. T cells and neutrophils needed to fight pathogens can begin to attack skin cells and joint structures. In this case, characteristic skin changes occur, including the formation of blisters with an inflammatory fluid. Expansion of blood vessels in the area of \u200b\u200binflammation is accompanied by reddening of the skin. Autoimmune disease can be caused by hereditary factors.
Additional risk factors:
- skin infections. First of all, these are bacterial infections caused by streptococci;
- skin damage caused by cuts and burns;
- prolonged stress and psychotraumatic factors;
- alcoholism and smoking;
- vitamin D deficiency in the body;
- taking certain medications, including lithium and beta-blockers;
- unfavorable family history. The discovery of psoriasis in a close relative of the patient indicates the possibility of a genetic predisposition to this disease;
- acquired or congenital impairment of immunity. It could be HIV infection, AIDS or another condition.
Despite the discovery of the supposed immunopathological causes of psoriasis, the disease remains poorly understood. There is a huge number of diseases and lifestyle features that provoke the manifestation of hidden predisposing factors to this disease.
diagnosis of psoriasis
If skin changes appear, you should consult a dermatologist. The doctor at our clinic first performs a general skin examination to assess the nature of the rash. Gentle scraping allows you to detect peeling papules and a thin film under the nodules. Under the film lies a moist surface of the skin, prone to small hemorrhages. At the same time, there are atypical signs of psoriasis that resemble other diseases, so the doctor needs to carry out instrumental and laboratory diagnostics.
- Blood analysis. The dermatologist prescribes a venous blood test to rule out other diseases and detect signs of psoriasis. In the treatment room, the nurse treats the skin of the patient's cubital fossa with antiseptic, applies a tourniquet and draws blood with a syringe. In our laboratory, specialists first of all exclude the presence of rheumatoid factors. In pustular psoriasis, an increase in the erythrocyte sedimentation rate is often found. Elevated uric acid levels are detected;
- Examination of the liquid from the pustules. The doctor collects the liquid in a sterile container and sends the material to the laboratory. Microbiological examination does not reveal bacterial culture, but an increase in the number of neutrophils characteristic of psoriasis is observed;
- Skin biopsy. The dermatologist prescribes this study to make an accurate diagnosis for atypical skin rashes. During the procedure, the doctor treats the skin with antiseptic, anesthesia and removes a small area of \u200b\u200bthe skin with a scalpel. The tissue material is studied in the laboratory of our clinic by means of microscopy. The results allow clarifying the cellular composition of the nodules;
- X-ray of the affected joint. The doctor prescribes this study to determine the type of arthritis. Also, in severe complications of arthropathic psoriasis, X-ray diagnosis of bones is necessary;
- Skin scraping to rule out fungus. The doctor cleans the surface of the skin and, using a special spatula, collects several scales for microbiological examination. This analysis is necessary mainly if the rashes occur only in the area of \u200b\u200bthe foot and nails.
If necessary, an appointment with a rheumatologist is carried out.
Opinion of an 'expert
Psoriasis is a disease with many manifestations. It can be almost invisible or cause serious health problems. The most dangerous complications of psoriasis are joint damage, which can cause disability in the patient. In addition, the disease can lead to autoimmune disorders, in particular Crohn's disease and ulcerative colitis, metabolic pathology, erectile dysfunction in men. Women suffering from psoriasis may suffer from infertility and miscarriage. To prevent such complications, it is necessary to consult a doctor immediately after the appearance of suspicious signs and, with an already diagnosed diagnosis, carefully follow all the recommendations of a specialist.
psoriasis treatment
The main goal of psoriasis treatment is symptomatic therapy. Patients need medications that reduce inflammation and prevent rashes from forming. In addition to drug therapy, the dermatologist in our clinic necessarily prescribes a special diet for the patient. Normalizing your lifestyle and eliminating stress factors can reduce the severity of psoriasis symptoms.
Depending on the situation, a dermatologist can use different methods to treat the condition.
- Administration of corticosteroids. The dermatologist prescribes ointments containing these drugs. Beneficial effects of corticosteroids include reducing tissue inflammation and eliminating itching;
- Vitamin D supplements. The synthetic forms of this vitamin slow the growth of skin cells, thus preventing the formation of scales and lumps;
- Therapy with drugs containing vitamin A derivatives. A dermatologist prescribes ointments based on retinoids to reduce inflammation and itching. These medications increase the skin's sensitivity to light, so sunscreen should be used;
- Use of calcineurin inhibitors. These are immunosuppressants that reduce inflammation. The dermatologist prescribes topical agents such as tacrolimus. These drugs are used in a short course to prevent the development of side effects and complications;
- Skin treatment with salicylic acid to remove dead skin cells. A dermatologist prescribes this drug along with corticosteroids for complex skin treatment;
- Using a moisturizer to eliminate dry and itchy skin;
- Irradiation of the skin with ultraviolet light. This safe physiotherapeutic method of treatment improves the functioning of local immunity. The doctor selects an individual dose of radiation for the patient;
- Phototherapy. This method involves irradiating the skin using special devices. Phototherapy combines laser therapy and photochemotherapy technologies;
- Joint puncture in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, anesthetizes the tissues and inserts a needle. With the help of a syringe, drugs are injected into the joint cavity to reduce the inflammatory process.
The dermatologist controls all stages of the treatment to obtain the best result and prevent complications. Corticosteroids, retinoids and calcineurin inhibitors are used strictly under specialist supervision.
prevention of psoriasis
The recommendations of the dermatologist of our clinic will help reduce the severity of rashes and alleviate the course of the disease.
Prevention of exacerbations of psoriasis:
- relieve anxiety and stress by improving sleep, avoiding coffee and taking prescription sedatives;
- exclusion from the diet of foods containing allergens;
- timely treatment of infectious skin diseases.
Rehabilitation
Psoriasis is a chronic disease that has no cure. Rehabilitation measures aim to prevent relapses. Depending on the form of the disease, physiotherapy, spa treatment, mud therapy, therapeutic baths and other procedures may be prescribed.
Questions and answers
Is it possible to treat psoriasis with folk remedies?
There are no methods with proven effectiveness. It is important not to rely on dubious types of treatment, but to follow the recommendations of the attending physician.
Does stress affect the course of psoriasis?
Yes, stressful situations can aggravate the course of the disease.