Psoriasis
Psoriasis
- The Definition of the Psoriasis Disease
- The first symptoms of the psoriasis
- What are Papules?
- Different Signs of types of Psoriasis
o
Patchy psoriasis
o Irritated psoriasis
o Seborrheic psoriasis
o Psoriasis of the palms
o Psoriasis of the soles
o Follicular psoriasis
o Psoriasis of the mucous membranes
o Dermatosis
- Classification and stages of psoriasis
development
o Dermatosis
o Rubor — redness;
o Tumor — a lump or edema;
o Calor — fever, elevated temperature;
o Dolor-pain;
o Functia laesa — violation of functions.
o vulgar psoriasis — seborrheic, follicular,
warty, exudative, bullous, palm and sole psoriasis, mucosal psoriasis;
o pustular psoriasis;
o psoriatic erythroderma;
o psoriatic arthritis
- Complications of psoriasis
o
psoriatic arthritis
o psoriatic erythroderma
o pustular psoriasis
o
Lesions of internal organs
¨ pyelonephritis
¨
cystitis
¨
urethritis
¨
myocarditis
¨ Pericarditis
- Diagnosis of psoriasis
o
When to see a doctor
o
Preparing for a doctor's visit
o
Diagnostic
scheme
¨
General blood count
(with platelets)
¨
General urinalysis
¨
Biochemical blood
test
¨
Acute phase
reactions of the body — C-reactive protein and rheumatoid factor
¨
Immunoglobulins-IdA,
IgG, IdM, IdE)
¨
Complement binding
reaction with the gonococcal and chlamydial antigen
¨
Wright and
Heddelson's reactions
¨
Coagulogram-assessment
of blood clotting
¨
Blood test
for borreliosis
¨ Biopsy
¨ Laboratory diagnostics
¨ Blood tests
¨ X-rays
¨ ultrasound
- Psoriasis Treatment
o
effective treatment?
o
Phototherapy
- Forecast. Prevention
o
Drug treatment
o
What ointments and creams are effective in
treating psoriasis
o
How to treat psoriasis of the scalp
o
How to treat psoriasis on the elbows and hands
o
Is the treatment of psoriasis with monoclonal
antibodies effective?
o
How to recognize and treat psoriasis in
children
o
What baths to take for psoriasis
o
How to treat psoriasis by Pegano
o
The role of nutrition in the treatment
o
In which sanatoriums is recreation indicated
for the treatment of psoriasis?
o
Traditional methods
o
Forecast. Prevention
o
Do they take people with psoriasis to the army
- Sources
o List of literature
Definition of the disease.
Psoriasis is a chronic condition that affects your skin and sometimes the nails, joints, and the body's internal organs too. It is manifested by less or extreme itching and the appearance of pink-red rashes-papules that can merge into larger plaques on your skin. These papules rise above the surface of the skin and are covered with silvery scales that easily peel off when peeling. Although peeling is not recommended in this condition.
More often, in extreme conditions, the disease is combined with impotence, accelerated ejaculation, and Reiter's syndrome. Psoriatic arthritis can occur with extensive psoriasis which becomes very disturbing and dangerous sometimes for the patient.
Psoriasis Risk factors
microbial factor — various types of fungi, mycoplasmas; neuropsychiatric trauma, stress; endocrine diseases — diabetes mellitus, thyroid diseases; foci of chronic infection, especially streptococcal infection; immunodeficiency states; disorders of lipid and protein metabolism; injuries to the skin and joints.
Is psoriasis transmitted
Symptoms of Psoriasis
The first symptoms of psoriasis:
Rashes
Rashes started to form on the skin in the form of bright pink plaques with a flaky surface. Plaques are first isolated then they rise above the level of healthy skin, and are located on the elbow folds and in the popliteal cavities.
More often, psoriatic plaques occur on the skin of the knees, elbows, chest, abdomen, back, and scalp, but as the disease progresses, they can appear in any other, most unexpected places of the cover if not treated well in time.
Papules
Initially, the papules are small-3-5 mm, and the color is bright pink. Gradually increasing in size, they are covered with silvery scales and merge into larger formations called plaques.
Fresh elements of papules, as a rule, are bright in color, up to red, while "old" ones are more faded. At the initial stage of psoriasis, the edges of the papule do not peel off. They represent a hyperemic border — (a corolla of growth)
the phenomenon of stearin stain — the layering of a large number of silvery-white scales, which are easily separated by scraping ; a symptom of the psoriatic film is an exudated surface made with a spiky layer, which opens after peeling off the lower layers of the horny plates ; the phenomenon of "blood dew" is the exposure of surface capillaries in the form of small blood dots after the detachment of the psoriatic film.
.jpg "psoriasis of Auspitz triad")
Signs of various types of psoriasis
Clinical types of psoriasis:
Patchy psoriasis
Patchy psoriasis -represented by pale pink weakly infiltrated spots. It resembles taxidermy.
Irritated psoriasis
Irritated psoriasis occursdue to exposure of the skin to aggressive environmental factors (sunlight, cold, heat) and irritating medications. The color of the plaque becomes more intense, it increases in size and rises more above the surface of the skin, and a belt is formed along the edges in the form of redness.
Seborrheic psoriasis
- Seborrheic psoriasis often develops in patients with seborrhea. The clinical picture is very similar to seborrheic eczema.
Exudative psoriasis
- Exudative psoriasis occurs quite often. Occurs due to excessive release of inflammatory fluid — exudate. It permeates accumulations of scales, turning them into scales-crusts.
Psoriasis of the palms and soles
- Psoriasis of the palms and soles-represented by either ordinary plaques and papules, or hyperkeratosis formations similar to calluses and calluses.
Follicular psoriasis
A follicular psoriasis is a rare form of the disease. The rash consists of miliary nodules of white color with a funnel-shaped depression in the center. They are itchy and irritating.
Psoriasis of the mucous membranes
- Psoriasis of the mucous membranes is a rare form of the disease. Occurs on the mucous membrane of the mouth and bladder. It appears as gray-white areas with a red border. In your mouth.
Frequency of psoriatic manifestations.
Psoriasis is characterized by cyclical exacerbations. Most often they occur in the autumn and spring seasons every year.
Pathogenesis of psoriasis
Dermatosis
Dermatosis is an inflammatory process associated with the work of immune T cells. As a result of this inflammation, the proliferation of keratinocytes, the main cells of the epidermis, accelerates.
Psoriasis, as a type of dermatosis, is a chronic inflammatory disease. It occurs with the participation of microbial pathogens that can bind to the surface of the skin.
Everything that happens in the skin under the influence of the pathogen is a classic inflammatory reaction according to the RTCDF principle:
Rubor — redness;
Tumor — a lump or edema;
Calor — fever, elevated temperature;
Dolor-pain;
Functia laesa — violation of functions.
Redness and thickening of the skin in the affected areas, itching, and increased keratinization with the subsequent formation of scales — all these are manifestations of the inflammatory process, a protective reaction of the body aimed at combating the microbial pathogen. Without timely help from the outside, the body is often defeated.
Some scientists adhere to the theory of genetic predisposition to disruption of the process of cell division. With such a violation, there is an increased death and keratinization of cells with their subsequent growth and the appearance of a large number of not completely keratinized epithelial cells. But this theory does not contradict the above microbial one.
Classification and stages of psoriasis development
There is no generally accepted classification of psoriasis.
Traditionally, there are four types of the disease:
- Vulgar psoriasis, seborrheic, follicular, warty, exudative, bullous, palm, and sole psoriasis, mucosal psoriasis;
- pustular psoriasis;
- psoriatic erythroderma;
- psoriatic arthritis.
According to ICD-10, there are:
L40. 0 Psoriasis vulgaris (coin-shaped and plaque psoriasis);
L40. 1 Generalized pustular psoriasis (impetigo herpetiformis, Zumbusch disease);
L40. 2 Acrodermatitis resistant;
L40. 3 Palmar and plantar pustules;
L40. 4 Teardrop-shaped psoriasis;
L40. 5 Psoriasis arthropathic;
L40. 8 Other psoriasis;
L40. 9 Unspecified psoriasis.
Complications of psoriasis
Without timely and competent treatment, psoriasis begins to negatively affect vital organs and systems: joints, heart, kidneys, and nervous system. These conditions can lead to disability and even cause death.
What is psoriatic arthritis?
Psoriatic arthritis is the most severe form of psoriasis, as it often causes disability.
This complication is most often encountered by doctors. It occurs as a result of inflammatory changes in the joints.
Psoriatic arthritis
Types of psoriatic arthritis
The joints of the hands, wrists, feet, and knees are most affected. Over time, the disease can spread to the hip, shoulder, and spine joints. With further progression, the muscles begin to ache near the affected joints. Patients complain of stiffness of movement, especially in the morning hours. Their body temperature is often elevated throughout the day.
The clinical picture of psoriatic arthritis develops like normal arthritis: first, there is pain, then swelling, stiffness, and limited mobility. A characteristic symptom of this complication is a sausage finger. It appears due to damage to all interphalangeal surfaces.
Pathognomonic symptom
Other complications of psoriasis
Slightly less common is psoriatic erythroderma. This condition occurs when the skin is completely affected. Patients are concerned about itching and burning, heavy peeling of dead tissues, a strong reaction of the skin to a change in temperature.
Psoriatic erythroderma
The next most common type of psoriasis is pustular psoriasis. This complication is associated with the addition of secondary infections — staphylococci and streptococci. Clinically, pustular psoriasis is accompanied by the appearance of pustules — pustules the size of buckwheat grains. Pustules occur in different places. They rise above the surface of the skin, and are characterized by rapid growth and a tendency to merge. The existing symptoms are accompanied by a high fever and signs of serious intoxication.
Pustular psoriasis
Lesions of internal organs in psoriasis are now extremely rare. As a rule, they affect people who lead an antisocial lifestyle. The genitourinary system is more often affected: the kidneys, the mucous membrane of the bladder, and the urethra. This leads to the development of pyelonephritis, glomerulonephritis, cystitis, and urethritis.
From the heart, psoriasis can cause damage to the mitral valves and inflammation of the heart muscle and the outer shell of the heart — myocarditis and pericarditis. When the nervous system is affected, patients complain of a crawling sensation, increased irritability or depression, constant fatigue, drowsiness, and apathy.
Diagnosis of psoriasis
When to see a doctor
A doctor should be consulted, when the first symptom of psoriasis appears on your skin and body: the appearance of bright pink plaques on the skin with a flaky surface.
Preparing for a doctor's visit
You should stop applying therapeutic ointments to the skin three days before visiting the doctor. No other special training is required.
Psoriasis is such a recognizable disease that it is not difficult to diagnose it by external signs. Often, patients can be diagnosed, as they say, "from the threshold". If necessary, the doctor makes a scraping from the surface of the skin to detect the Auspitz triad.
Candidate of Medical Sciences O. V. Terletsky, together with co-authors, proposed a diagnostic scheme developed on the basis of data from the American Rheumatology Association. It includes the following surveys::
- General blood count (with platelets);
- General urinalysis;
- Biochemical blood test;
- Acute phase reactions of the body — C-reactive protein and rheumatoid factor;
- Immunoglobulins-IdA, IgG, IdM, IdE)
- Complement binding reaction with gonococcal and chlamydial antigen;
- Wright and Heddelson's reactions;
- Coagulogram-assessment of blood clotting;
- Blood test for borreliosis and toxoplasmosis (according to indications);
- A blood test for HLA.
However, there are many diseases that occur under the guise of psoriasis. In this regard, there is a need for differential diagnosis, in particular between papular syphilis, Reiter's syndrome, neurodermatitis, pink lichen, systemic lupus erythematosus and seborrheic eczema. For this purpose, use:
biopsy — pinching of a piece of the skin followed by histological examination;
laboratory diagnostics — often used to distinguish psoriasis from papular syphilis;
blood tests for other latent infections for better selection of antibiotics.
A biopsy
Instrumental diagnostic methods are mainly used for complicated forms of psoriasis associated with damage to the joints and internal organs. These include X-rays of the joints, and ultrasound of the heart, kidneys, and bladder [2].
Psoriasis Treatment
Is there an effective and promising treatment for skin psoriasis?
Despite the fact that psoriasis is a persistently recurrent disease, you can completely get rid of this skin issue and for that, you have to contact a dermatologist in a timely manner, who can identify the true causes of psoriasis. Over the past decade, many systemic and local drugs have appeared aimed at eliminating the cause and suppressing the mechanism of development of the disease. Drugs that interact with each other using chemical signals (cytokines) have proven themselves very well. They eliminate the increased proliferation of skin keratinocytes.
Phototherapy
The team of the Department of Dermatovenerology of MAPO SPb in 1994 introduced a method of treating psoriasis using UV blood-photo modification of blood with ultraviolet light.
The ability of sunlight to have a beneficial effect on the skin in numerous diseases, including psoriasis, has been known since time immemorial. At the beginning of the twentieth century, a group of German scientists suggested that since ultraviolet radiation has a therapeutic effect on exposed skin, this effect is likely to occur when blood is exposed to ultraviolet light. After all, this is also a kind of fabric. This assumption was confirmed by the first session on the influence of UFOs on blood, which was conducted in Germany in 1924.
The therapeutic effect of ultraviolet rays on the blood is associated with profound structural changes at the molecular and atomic level, which are detected by immunocompetent organs — the liver, spleen, bone marrow, and lymphoid tissue. These changes are regarded by the organs as an alarm signal, producing tens of times more immune complexes. Ultraviolet light in this case is a kind of" whip " that forces the body to dramatically increase its defenses to fight the disease.
It is also worth noting the RT-effect-the defrosting therapy of ultraviolet light. This method of treatment is important given the chronic nature of psoriasis, which is associated with numerous complications of internal organs caused by a variety of microbial pathogens. The longer microbes stay in the body, the wider their habitat becomes. These microscopic creatures capture more and more anatomical areas through the blood and lymph flow. Once in the tissues, they tend to penetrate as deeply as possible into the intercellular spaces. There they form microcolonies protected by the remains of dead, destroyed cells and a white blood cell shaft. This allows microorganisms to stay out of the reach of antibiotics for years. They easily compensate for the lack of nutrients by entering a state of suspended animation-something between life and death.
The ability of ultraviolet rays helps to destroy microbial "shelters". They create favorable conditions for the penetration of antibiotics and other drugs that affect the cause of psoriasis.
The skin application of ultraviolet light is also relevant. The most well-known treatment method that uses this principle is PUVA therapy. Although it is less effective than blood UFO. The therapeutic effect does not last long, a relapse may occur two weeks after the end of treatment.
Drug treatment
Of the medicinal products, they have proven themselves well.
- vitamin A derivatives (Neotigazone, Tigasone) that reduce the rate of keratinocyte maturation and normalize cell differentiation;
- immunosuppressants (Cyclosporin A) that reduce the activity of T-lymphocytes that promote increased division of epidermal cells;
- drugs for the treatment of malignant tumors (Methotrexate) that inhibit the proliferation and growth of atypical skin cells.
- What ointments and creams are effective in treating psoriasis
- Ointments and creams with anti-inflammatory components will help ease the patient's condition: Dermovate, Psorilom, Acriderm, and Celestoderm.
How to treat psoriasis of the scalp?
In the treatment of psoriasis of the scalp, ointments are not effective. In addition to medical methods and ultraviolet treatment, you can use a special shampoo, such as Nizoral.
How to treat psoriasis on the elbows and hands?
Psoriasis on the elbows and hands is treated with the same methods as on the rest of the body. The peculiarity of the course of psoriasis in this area is that the skin of the hands is subject to physical, mechanical, and chemical influences, which are considered aggravating factors for the course of the disease.
Is the treatment of psoriasis with monoclonal antibodies effective?
Treatment of psoriasis with monoclonal antibodies is very effective. Monoclonal antibody preparations are laboratory-derived antibodies similar to those produced by human immune cells. Monoclonal antibodies selectively affect the targets responsible for the development of the disease. Infliximab, adalimumab, and ustekinumab are used to treat psoriasis.
How to recognize and treat psoriasis in children?
In children, psoriasis is often more violent and masquerades as other diseases (eczema, erysipelas, herpes), which makes it difficult to diagnose. Therapy methods are similar to adult treatment: phototherapy, medication, and topical treatment.
What baths to take for psoriasis?
Baths with aloe supplements will help reduce inflammation and itching. Aloe vera). Lukewarm baths with soothing additives help reviving your skin from psoriasis .
How to treat psoriasis with Pegano?
The Pegano method for the treatment of psoriasis involves cleansing the intestines, diet, and herbal teas. The effectiveness of this method has not been proven by clinical studies.
The role of nutrition in the treatment?
Nutrition strongly affects the course of psoriasis. During treatment, it is necessary to exclude alcohol, salty, spicy, pickled, nuts, citrus fruits, honey, chocolate, and smoked products.
Which sanatoriums are recreation indicated for the treatment of psoriasis?
For psoriasis, a spa treatment is preferable to take place at the sea in a region with a warm, dry climate and a large number of sunny days. The most suitable for this purpose are the resorts of Crimea.
Traditional methods
Some folk remedies can help reduce itching and flaking of the skin in patients with mild to moderate psoriasis. These methods include:
Cream with aloe extract (lat. Aloe vera);
Apply Fish oil to the skin with a coated bandage for six hours a day for four weeks;
Cream with Oregon grape extract (lat. Mahonia aquifolium).
Forecast. Prevention
Psoriasis is not a sentence. If the patient promptly sought qualified help from a specialist who can determine the real causes of the disease and prescribe effective treatment, then the disease will be defeated.
A simple form of psoriasis is manifested only by a skin defect. Therefore, the patient does not need any special working conditions. An exception is working at a chemical plant: in this case, you will have to exclude arrival at the workplace.
It is worth remembering that psoriasis can cause complications. Most often, psoriatic arthritis develops. Its severe forms can limit the performance of duties at work, and in the future lead to complete disability.
Prevention of psoriasis is an integral part of therapeutic measures to eliminate one of the most serious skin diseases. After recovery, the patient needs to completely reconsider their lifestyle, eliminate bad habits, pay attention to the treatment of chronic diseases of other organs, adjust their diet, and include outdoor walks and sports in their daily routine.
Do they take people with psoriasis to the army?
Severe forms of psoriasis are sufficient grounds for declaring a conscript unfit for military service, while light forms are considered only partially suitable.
For more on Psoriasis, Psoriasis Symptoms, Causes, and Psoriasis treatments, "Click Below" and "learn more".
List of literature
Terletsky O. V. Psoriasis. Differential diagnosis of "psoriasis-like" rare dermatoses. Therapy. - SPb., 2007. Molochkov V. A., Badokin V. V. Psoriasis and psoriatic arthritis — Moscow, 2007. Terletsky O. V. Psoriasis and other skin diseases. Therapy, diet. - SPb., 2010. Babushkina M. V., Zagratdinova R. M. Pustular psoriasis. Differential diagnosis of noninfectious pustules, Moscow, 2012. Terletsky O. V., Raznatovsky K. I. Psoriasis. Guidelines for the diagnosis and treatment of various forms of psoriasis and psoriatic arthritis. - SPb., 2014. Hahnemann S. Chronic diseases, their peculiar nature, and homeopathic treatment. - SPb., 2014. Pavlova O. V. Psycho-neuro-immune interactions in psoriasis, Moscow, 2007. Dmitruk V. S., Levitsky E. F. Physical and natural factors in the treatment of psoriasis. - Tomsk, 2003. Dontsova E. V. New pharmacological and therapeutic approaches for psoriasis. - Voronezh, 2017. Raznatovsky K. I. Psoriatic disease. Diagnostics, therapy, and prevention — Moscow, 2017. Moshkalova I. A., Mikheev G. N. Bubble dermatoses. Psoriasis. Modern methods of treatment. - SPb., 1999. Shilov V. N. Psoriasis-problem solving (etiology, pathogenesis, treatment). - M., 2001. Kungurov N. V., Filimonov N. N. Psoriatic disease. - Yekaterinburg, 2002. Dovzhansky S. I., Utts S. R. Psoriasis or psoriatic disease. - Saratov, 1992. Anderson D M., Maraskovsky E., Billingsley W. L., Dougall W. C., et al. A homolog of the TNF receptor and its ligand enhance T-cell growth and dendritic-cell function // Nature. — 1997; 390 (6656): 175-179. link Antony C., Smolen J. The infliximab multinational psoriatic arthritis controlled trial. — San Francisco, 2003. Baker H. Pustular psoriasis // Dermatologic Clinics. — 1984; 2 (3): 455-470. Berbis P. Palmaplantar pustulosis // Rev Prat . — 1991; 41 (22): 2165-2168. link Borel J. F. Mechanism of action and rationale for cyclosporin A in psoriasis // Br J Dermatol. - 1990; 122: 5-12. link Clegg D. O., Reda D. J., Abdellatif M. Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of the seronegative spondyloarthropathies: a Department of Veterans Affairs cooperative study // Arthritis Rheum. — 1999; 42 (11): 2325-2329. link International Statistical Classification of Diseases and Health-related Problems. 10th revision (ICD-10). - Geneva, 1992. Psoriasis // Mayo Clinic. — 2020.
---------------------------------------------------------------------------------------------------------------------------
Comments
Post a Comment