Although psoriasis is a common and well-known disease, it is not yet fully understood. And most of the time, patients do not know at all that psoriasis is not a bacterial infection or a fungus, but an atypical reaction of the immune system, caused by unknown reasons. Information about the causes and symptoms of psoriasis will be very useful for patients, as they will help to overcome the disease.
What is this disease?
Scaly lichen is another name for psoriasis, and this name perfectly describes this disease. Psoriasis is manifested by the formation of inflamed plaques of various sizes on the skin, densely covered by thick cutaneous scales.
Certainly, almost everyone has heard of a disease like psoriasis. And this is not surprising, since scaly lichen is quite common. This disease is diagnosed in 4-10% of the world population. In addition, statisticians who collect information on the prevalence of psoriasis argue that the number of patients is growing continuously.
Scaly lichen has been known to people since ancient times, even ancient Greek healers tried to treat this disease. The modern history of the study of psoriasis is about 150 years old. But during that very substantial period of time, researchers were able to learn enough about the causes and treatment of psoriasis.
Wide prevalence, uncertainty of etiology (causes of occurrence), insufficiently effective treatment - all this characterizes psoriasis as one of the most difficult problems in dermatology.
Today, dermatologists consider psoriasis to be a complex systemic disease associated with disorders of the immune system, with malfunction of metabolic processes and the appearance of trophic disorders. These failures result in specific skin changes.
Therefore, when answering the question of what psoriasis is, a modern dermatologist will answer that these are disorders of the trophism and metabolic processes of the skin caused by a malfunction of the body's systems. Today, two theories about the etiology of psoriasis are considered more likely: genetic and viral.
- Genetic theory has many defenders, since psoriasis often acts as a hereditary or familial dermatosis. A careful study of the patient's family history in 60-80% confirms the presence of psoriasis in one way or another in the patient's relatives. However, in some patients it is not possible to confirm the fact of the hereditary origin of psoriasis. This circumstance is the reason for the allocation of these cases in a special group, in which the main reason is not genetic, but phenotypic failures.
- The viral theory, according to which psoriasis develops as a result of an infection, has its defenders. Confirmation of information about the viral origin of psoriasis is the detection of antibodies in the blood of patients, as well as "elementary bodies" in the cells of the epidermis. According to this theory, psoriasis develops not only when infected with a virus, but also under certain conditions.
There are other theories that explain psoriasis. For example, endocrine, neurogenic, metabolic, etc. Naturally, all of these theories are well founded, and their study provides more important information about psoriasis. However, it is now known with certainty that the state of the endocrine and nervous systems, as well as the functioning of the gastrointestinal tract, do not cause psoriasis, but have a significant effect on the course of this disease.
For example, pathologies that affect the liver lead to the fact that the quality of blood purification performed by this organ is greatly reduced. And this, in turn, can cause the appearance of various appearances on the skin, including psoriasis.
Pathologies that affect the liver (hepatitis, primary cirrhosis, etc. ) cause the tissues of this organ to be reborn, that is, the liver is gradually replaced by connective tissue. As a result, the liver stops dealing with its cleaning functions. Externally, this is manifested by the yellowing of mucous membranes and skin, and the development of skin diseases, including psoriasis, is possible.
There is also an inverse relationship: psoriasis is often accompanied by fatty degeneration that affects the liver. Therefore, in the treatment of this skin disease, it is important to follow a diet to avoid unnecessarily overloading the liver. Patients are advised to limit fatty foods, to eliminate alcohol completely.
So, despite several studies, it was not possible to get an exact answer to the question about what psoriasis is. However, the work continues, so there is a chance that the mystery of this mysterious disease will be solved, and we will learn a lot about psoriasis skin disease.
Psoriasis disease manifests itself in several ways. To facilitate navigation by specialists, a generally accepted classification of psoriasis is used.
Psoriasis added to the International Classification of Diseases (ICD). So far, 10 revisions of the International Disease Registry are in use, so the abbreviation ICD 10 is used. The work started on 10 revisions of the International Disease Classifier in 1983 and was completed in 1987.
In essence, ICD 10 is a standard assessment tool used in medicine and health management. The manual in revision 10 is used to monitor the prevalence of various diseases and other health problems.
With version 10 of the ICD, it is possible to compare data on morbidity and mortality in different countries, which allows obtaining statistical data and systematizing diagnostic information. By agreement of WHO members, ICD 10 is used to assign codes to various diseases. In the 10th version of the classifier, alphanumeric codes are adopted, with the help of which it is convenient to store information in electronic format.
All types of psoriasis are included in ICD 10 and each one receives a specific code. In dermatology, the following forms and types of psoriasis are differentiated:
- Common psoriasis(synonyms: common, simple, plaque-like). The disease received a code according to ICD 10 - L-40. 0. This is the most common form, seen in 80-90% of patients. The main symptoms are the formation of raised plaques above the surface of the skin unchanged, covered with gray-white skin scales. This shape is characterized by a slight flaking of the scales. After its removal, the inflamed red skin opens, which bruises easily and begins to bleed. As the inflammatory process progresses, plaques can increase significantly in size.
- Reverse psoriasis. It is a disease that affects the folds of the skin (flexor surfaces). For this form of the disease, code L83-4 is adopted at ICD 10. Dermatosis occurs with the formation of folds in the skin of smooth or minimally scaly patches. Deterioration is seen when the skin is injured by rubbing. The disease is usually complicated by an associated streptococcal infection or fungus.
- Guttate psoriasis. This form of psoriasis is characterized by the formation on the skin of a large number of small red or purple spots, in the form of water droplets. According to version 10 of the international classifier, this disease received the code L4. Most of the time, guttate psoriasis affects the skin on the legs, but rashes can occur on other parts of the body. At the same time, tear psoriasis is known to develop as a complication after streptococcal infections - pharyngitis, tonsillitis, etc.
- Pustular or exudative psoriasisis a severe cutaneous form, according to ICD 10 the code L1-3 and L 40 has been assigned. 82. It is characterized by the formation of blisters or pustules. The skin on the lesions becomes swollen, red, inflamed and peels off easily. If fungi or bacteria enter the pustules, the contents of the pustules become purulent. Pustular psoriasis usually affects the distal extremities, but in the most severe cases, a generalized process can occur with the spread of rashes throughout the body.
- Psoriatic arthritis or arthropathic psoriasis. According to version 10 of the CDI pathology, the code L5 was assigned. It is manifested by inflammation of the joints. Arthropathic psoriasis can affect all types of joints, but in most cases the joints of the phalanges of the toes and hands become inflamed. Knee, hip or shoulder joints can be affected. The injuries can be so severe that they can lead to the patient's disability. Therefore, you should not think that psoriasis is an exclusively skin disease. Severe types of psoriasis can cause systemic damage, disability or even the death of the patient.
- Erythrodermic psoriasis. A rare but severe type of psoriasis, according to ICD 10, this disease has been assigned the code L85. Erythrodermic psoriasis often manifests itself in a general way, all or almost the entire surface of the skin can enter the affected area. The disease is accompanied by severe itching, swelling and pain.
- Psoriatic onychodystrophy or nail psoriasis. According to version 10 of the ICD, the disease received the code L86. The pathology is manifested by changes in the appearance of the nails of the fingers and toes. Nails can change color, become thicker and start to deteriorate. Total nail loss is possible.
In psoriasis, the classification of the disease takes into account not only the types of the disease, but also the severity of the symptoms:
- localized psoriasis is a disease in which less than 20% of the skin is affected;
- common psoriasis affects more than 20% of the body surface;
- if almost the entire surface of the skin is affected, we are talking about universal psoriasis.
If we consider all types of diseases, common psoriasis is more common than other forms.
Limited or disseminated psoriasis goes through three stages in its course: progressive, stable and regressive.
The following is characteristic of the progressive stage of psoriasis:
- the appearance of new skin rashes;
- growth of existing plates;
- the appearance of new elements of the rash at the site of skin lesions (scratches, abrasions);
- profuse flaking of the existing plates.
The following symptoms are characteristic of the stationary stage of psoriasis:
- no new elements appearing;
- moderate peeling of elements;
- with no signs of element growth.
The appearance of folds in the stratum corneum around the elements is a sign of the transition from a stationary to a regressive stage.
The regression stage is characterized by the following types of symptoms:
- decreased peeling intensity;
- resolution of elements.
After the resolution of the psoriatic plaques, the hypopigmented or hyperpigmented spots remain in place.
Scaly lichen is characterized by a long course with periodic exacerbations. The following types of psoriasis are differentiated:
- winter (worsening in autumn and winter);
- summer (with exacerbations during the hot period);
- out-of-season psoriasis is the most serious type, since there is no clear relationship between recurrences and seasons, remission periods can be practically absent.
If psoriasis has a typical clinical picture, the diagnosis will not be so difficult. However, this disease is usually disguised as other pathologies.
For example, nail psoriasis is often confused with nail fungus, as the external manifestations at an early stage of these diseases are very similar. However, nail fungus and psoriasis are of a completely different nature, so treatment must be different.
A layman may mistake psoriasis and fungus for fungus. Skin mycoses (skin fungi) are manifested by similar symptoms - the formation of scaly plaques. So if you notice suspicious symptoms on your body or nails, you don't have to diagnose yourself and keep reading to treat the fungus using pharmacies or folk remedies.
If the diagnosis is wrong, and in fact the cause of the appearance of the symptoms is not fungus, but psoriasis, the treatment will not bring benefits, but, on the contrary, will aggravate the symptoms.
When contacting a dermatologist, an analysis will be done for fungi, a scraping will be done on the nail or on the skin. Then, the resulting material is placed in nutrient medium. If the fungus is present in the material, a large colony will grow in the test sample after a few days. By the appearance of the material, it will be possible to understand what type of fungus caused the infection.
Sometimes psoriasis is complicated by the addition of secondary infections, it can be a bacterial infection or a fungus. Therefore, when the clinical picture changes (appearance of purulent secretion, discoloration of plaques, etc. ), patients should be tested periodically for fungi and other infectious agents.
In the diagnosis process, a certain role is assigned to a set of phenomena that are called the psoriatic triad. The phenomena appear sequentially, when scraping the eruption element.
The psoriatic triad looks like this:
- when scraping the rash element, the scales are removed in the form of "shavings";
- After removing the chips, a thin transparent film similar to polyethylene opens;
- when the film is damaged, bleeding opens.
A dermatologist diagnoses psoriasis, but if necessary, the doctor can refer the patient for consultations with other specialists - rheumatologist, gastroenterologist, surgeon, etc.
Interesting facts about psoriasis
People have known psoriasis for a long time. Even the name of the disease itself came from ancient Greek for our language. At the time of the prosperity of Ancient Hellas, the word "psora" meant all skin diseases that manifested by flaking and itching.
The first person to write a detailed treatise on psoriasis was a Roman named Cornelius Celz. In the fifth volume of his work "De Medicina", there is an extensive chapter on this disease.
They knew about psoriasis, but this disease was not evaluated unambiguously, as it was called, sometimes "imperial" disease, sometimes "diabolic".
Of course, the ancient healers knew very little about psoriasis. Until the 19th century, this disease used to be associated with other skin diseases. For the first time, psoriasis was identified as an independent nosological form in 1799. This was done by English dermatologist Robert Villan, who highlighted psoriasis in an extensive group of skin diseases, manifested by itching and flaking.
Not only ordinary people, but prominent political figures also knew about psoriasis first hand. For example, Winston Churchill, who suffered from this disease, promised to erect a monument of pure gold for a person who could learn everything about psoriasis and offer an effective treatment for this disease.
Modern understanding of the disease
It must be said that modern science does not know much about this mysterious disease. There are several theories about the origin, as well as the course and treatment of psoriasis.
Here are some facts about psoriasis that are beyond doubt:
- Although the causes of the disease are not clear, it was possible to discover the nature of psoriasis. This disease is autoimmune, that is, it is caused by a malfunction of the immune system;
- another established fact about psoriasis: the disease can be hereditary. However, this is not always the case, even if both parents are ill, the risk of developing the disease in the child is 65%. At the same time, some patients develop psoriasis, although none of their relatives are ill;
- An interesting fact about psoriasis is that this disease is characterized by Kebner's phenomenon. This phenomenon is manifested in the fact that the elements of the rash are formed at the sites of skin lesions - scratches, burns, frostbite. Sometimes, psoriasis appears after a while, at the site of the scars;
- An important observation that allows more information about psoriasis is the relationship of this disease to climatic factors. Exacerbations and relapses are usually programmed to coincide with the change of season;
- Patients have probably noticed the connection between exacerbations and stress in practice. All patients must know with certainty that the disease recurs or worsens its course in the context of tension and nervous experiences;
- a new fact about psoriasis is that the disease can occur at any age, although it is believed that scaly lichen occurs after 30;
- It is important for everyone to know that psoriasis is not a contagious disease. Even in close contact with the patient, there is no risk of infection;
- Almost everyone has heard about the incurability of psoriasis, and this is true, as no cure has been found that could defeat the disease with certainty. But patients should be aware that psoriasis can be controlled. Adequate and timely treatment allows long-term remission.
Modern methods of treatment
Talking about the common disease of psoriasis, we can not fail to talk about the treatment of this common disease. It must be said that it is impossible to cure psoriasis only with pills or ointments.
To forget the manifestations of psoriasis for a long time, the patient, in close cooperation with the doctor, will need to make an effort. It will be necessary to organize food properly. Some experts argue that you can only forget about psoriasis forever with the help of a well-composed diet and regular body cleansing.
The doctor will draw up a preliminary outline for the treatment. As a rule, external therapy (ointments, creams) and systemic (tablets, injections) methods are used. In addition, physiotherapeutic methods will be used and treatment at resorts will be recommended. It is recommended to treat psoriasis with healing mud, mineral and thermal water.
Resorts can also offer non-traditional treatment methods. For example, with the help of fish that live in thermal springs. These small healers effectively remove scales from dead skin and disinfect the skin, promoting faster healing.
Can offer other treatments for scaly lichens at resorts. For example, leech therapy, baths and healing applications, solar therapy, etc.
You need to be prepared for the fact that the treatment regimen changes periodically. Since not all methods are suitable for a specific patient. If the selected treatments do not work, they will need to be replaced.
Alternative treatments for psoriasis are also widely advertised. In fact, some of them can help you achieve remission. However, when choosing a method, it is necessary to remember common sense so as not to harm your health. If there is any doubt about a recipe or recommendation, it is best not to use it. Consult a doctor before using any treatment.
You need to understand that it will only be possible to forget psoriasis forever if the patient himself and his immediate environment are positively attuned. Only faith in success and an optimistic attitude will help to overcome this mysterious and insidious illness.