Psoriasisis a systemic disease characterized by damage to the skin, musculoskeletal system, functional and morphological disorders of other organs and systems. The main symptoms of pathology: nodular rashes on the scalp, palms, feet, extensor surfaces of the elbows and knees, hyperemia, itching. The disease can be diagnosed visually, but to exclude the possibility of developing concomitant pathologies, laboratory tests and instrumental diagnostic methods are prescribed. Systemic therapy includes the use of aromatic retinoids and cytostatic drugs, glucocorticosteroids.
Introduction
The name of the disease comes from the Greek "psora" - "skin disease", "scabies". In the Middle Ages, psoriasis was considered a form of leprosy (leprosy). The signs of psoriasis were first described from a professional point of view in 1808 by Robert Whelan in Great Britain. The term "psoriasis" was introduced by the Viennese dermatologist Ferdinand Gebra in 1841. The pathology is recorded in all latitudes of the globe with an unequal frequency of 0. 1 to 3%. Psoriasis develops equally in men and women, but among children it is more common in girls, and among adults - in men (60-65%).
Causes
There are several theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurogenic, endocrine, hereditary. Each of these theories is based on clinical observations and laboratory results.
Most scientists pay attention to the genetic nature of psoriasis. They claim that this disease is of polygenic inheritance. If one of the parents is sick, the risk of developing pathology in the child is 8%, if the father and mother are 41%.
The factors that contribute to the development of psoriasis are divided into external and internal.
- External factors include mechanical and chemical damage to the skin, as well as dermatoses.
- Doctors include internal provoking factors: infections (streptococci and human immunodeficiency virus), medications (corticosteroids, non-steroidal anti-inflammatory drugs), nervous stress.
Pathogenesis
Today, doctors around the world recognize the involvement of the immune system in the pathogenesis of psoriasis. Immune system cells, which usually react to antigens, begin to attack healthy cells, most often skin cells. As a result of this process, the cells in the epidermal layer divide more quickly than normal. They don't have time to mature, so strong bonds are not established between them. The cells, coming to the surface, form protruding plates with silvery scales.
Classification
According to the International Statistical Classification of Diseases and Related Health Problems, there are many types of psoriasis.
- Common (vulgar). The most commonly recorded form of lichen planus, in which there are no complications. This group includes plaque and coin psoriasis.
- Generalized pustular psoriasis- a severe form of pathology complicated by secondary infection. It affects several areas at the same time. Includes Zumbusch syndrome and impetigo herpetiformis.
- Persistent acrodermatitis (Crocker's dermatitis, Setton's dermatitis)— the contents of the pustules are sterile, there is no secondary infection. The main affected areas are fingers and nails.
- Palmar and plantar pustulosis (pustular bacterid)- develops on the feet and palms. They appear as pustules with sterile contents, which gradually increase in area.
- teardrop shaped- separately located papules that do not merge into plaques. The most commonly affected areas are legs, thighs, back, forearms, chest and neck.
- Arthropathic- the clinical course resembles the rheumatic form of arthritis.
- Other (reverse) psoriasis- conglomerates are located in the armpits, inguinal folds and other natural folds. This type includes inverse flexor psoriasis.
- Unspecified psoriasis- combines several types of pathology, the clinical picture is quite broad.
Depending on the seasonality of the exacerbation, several types of psoriasis are distinguished:
- summer- exacerbation occurs as a result of exposure of the skin to sunlight;
- winter- occurs due to extreme cold that affects the skin.
In non-seasonal psoriasis, there are no periods of remission, the disease occurs year-round.
By affected skin area:
- limited psoriasis- occupies less than 20% of the body's skin;
- common- more than 20%;
- widespread- all skin is affected.
Symptoms
The clinical manifestations of psoriasis directly depend on the stage of development of the disease. There are 3 steps.
- Progressive stage. It is characterized by the appearance of papules, itching, the appearance of scaling, peeling and deformation of the nails.
- Stationary stage. No new papules appear, the old rash does not increase in size and the scaling is moderate.
- Regressive stage. The plaques heal and depigmented white spots form in their place, which no longer cause discomfort.
Rashes are just outward signs of psoriasis. In fact, the disease affects multiple organs and systems, as well as tendons and joints. For this reason, patients complain of depression, a constant feeling of weakness and chronic fatigue.
Complications
Among the complications of psoriasis, psoriatic arthritis and psoriatic erythroderma are especially important. In addition, in the absence of timely diagnosis and effective treatment of psoriasis, the risk of developing serious chronic pathologies increases: diabetes mellitus, high blood pressure and metabolic syndrome.
Diagnosis
To identify pathology, laboratory and instrumental diagnostic methods are used.
The patient is referred to:
- general clinical blood and urine analysis;
- blood biochemistry;
- blood test for C-reactive protein and rheumatic tests;
- coagulogram - assessment of blood clotting;
- blood test for human leukocyte antigen.
For complicated forms of psoriasis, which are associated with damage to the musculoskeletal system and internal organs, x-rays of the joints, ultrasound examination of the kidneys and organs of the urinary system, and echocardiography are prescribed.
There are diseases that present similar symptoms. As a result, there is a need for differential diagnosis. To do this, use methods such as:
- biopsy (excision of a piece of skin with subsequent histological examination);
- laboratory tests - used to distinguish psoriasis from papular syphilis.
Treatment
Psoriasis responds well to symptomatic treatment. Knowing the pathogenesis, the doctor can individually select a treatment method. Some of them are aimed at reducing skin rashes, eliminating dryness and itching, others - to prevent the immune system from "attacking" healthy cells.
Therapeutic tactics directly depend on the severity of the disease and the location of the lesions.
External therapy
Topical glucocorticosteroids are used for various forms of psoriasis as monotherapy or in combination with other medications. They exist in the form of pharmaceutical forms - ointments, creams or lotions.
Medicines containing vitamin D3 analogues. They are applied to the affected areas of the skin if the prevalence of psoriasis is not more than 30% of the body surface.
Preparations containing activated zinc pyrithione are used in the form of an aerosol, cream and also scalp shampoo.
Phototherapy
For treatment in this case, the methods of medium wave phototherapy and PUVA therapy are used. PUVA therapy is the combined use of long-wave ultraviolet (UVA) rays (320-400 nm) and a photosensitizer (8-methoxypsoralen). PUVA therapy is one of the most effective ways to cure the disease; is most often prescribed for generalized vulgar and exudative psoriasis, persistent pathology, severe infiltration.
Combination therapy
Such treatment includes several therapeutic modalities, such as: phototherapy and topical corticosteroids; phototherapy and systemic retinoids.
Systemic therapy
Prescribed for moderate and severe forms of psoriasis. Systemic therapy medications are prescribed mainly during disease progression.
Biological drugs
These medicines are created using genetic engineering methods. They are monoclonal antibodies and are used for therapeutic purposes.
Prognosis and prevention
With timely diagnosis of the pathology and effective treatment, the prognosis is quite favorable. As preventive measures, the following are often prescribed: diet enriched with fish and vegetables, hydrotherapy, herbal medicine course, sanatorium treatment and emollients (especially in the inter-relapse period - to restore the hydrolipid layer).