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Psoriasis: causes, signs, treatment

Psoriasis manifests itself as red and itchy skin

Psoriasis is a chronic systemic multifactorial disease with a genetic predisposition that affects the skin and joints. Patients often complain of a pink-red rash with silvery-white scales. The rash is accompanied by itching, pain, and peeling. When joints are damaged, their mobility is limited, which can lead to disability in the patient.

Causes of psoriasis

The cause of psoriasis is still unknown. Only theory of origin:

  • nervous (rash appears after stress, burns, mental trauma);
  • endocrine (especially during perimenopause);
  • metabolism (disorder of fat metabolism);
  • Infectious;
  • viruses (psoriasis antigens isolated from healthy people with a high likelihood of developing psoriasis in the future, while psoriasis is a non-communicable disease);
  • genetic.

Psoriasis can be traced to an entire generation of people with the same risk factors. But the inheritance pattern is believed to be multifactorial. If one parent is sick, the child has a 25% chance of getting the disease. If both parents are sick – 60-75%.

Theories about viruses and genetics still lead the way.

Factors that contribute to exacerbation:

  • infectious and parasitic diseases, including communicable diseases (HIV, tonsillitis, dental caries, hepatitis);
  • emphasize;
  • fat;
  • premenopause;
  • medications (interferon, beta-adrenergic receptor antagonists, ACE antagonists, NSAIDs);
  • bad habits (alcohol, smoking, household chemicals);
  • skin wounds; dryness, leading to increased skin damage.

Clinical classification

There is no single classification. One of them:

  • vulgar (normal);
  • secretion;
  • psoriatic erythema;
  • arthropathy;
  • psoriasis on the palms and soles;
  • pustular psoriasis.

Flow characteristics:

  • They get the disease at any age, cases of psoriasis in children are not uncommon;
  • Men and women suffer the same disease;
  • popular globally;
  • There are summer, winter and mixed seasonal acute exacerbations.

Symptoms of psoriasis

The disease itself is characterized by a violation of the keratinization process of the skin with the production of insufficiently mature keratinocytes. Pink red rashes appear, covered with silvery white scales.

A trio of symptoms is characteristic, thanks to which the diagnosis can be made:

  • symptoms of stearin stains - when scraping, the number of scabs increases;
  • psoriatic membrane phenomenon - when all scales are scraped off, a red, smooth surface appears;
  • Symptoms of spot bleeding - when scraping the membrane, drops of blood will appear. This is due to uneven elongation of papillae in the dermis, dilation of capillaries and their swelling.

Signs of psoriasis

  • Psoriasis on the body can start as a spot and merge into large areas of lesions.
  • Hand psoriasis is most often localized to the extensor surface.
  • Psoriasis on the face - rashes often appear behind the ears, on the forehead. It is an independent factor for enhancing treatment.
  • Psoriasis on the scalp is a solitary form of the disease, which does not affect the hair. The rash is located along the edges of the hair, called "psoriasis".
  • Nail psoriasis - leads to characteristic changes, indentations at the fingertips, the nail looks like a thimble. It can also thicken, become dull or form yellow spots under the nail.
  • Psoriatic arthritis - affects the peripheral joints with or without pain, often with inflammation of the attachments of ligaments to bones, the ligaments themselves and the fingers.

Characteristics of psoriasis in children

Characterized by the presence of one or several 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 wound bleeds and a wound forms. In children, psoriasis is often localized in the perineal area in the form of 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:

  1. Progressive - the elements of the rash increase and acquire a uniform white color, with a narrow red border along the edge;
  2. Fixed – the spot stops growing, a strip of lighter skin appears along the edge 2-5 mm wide;
  3. Regression phase - scales gradually fall off, spots gradually decrease and disappear. At the site of the rash there is still a depigmented spot.

Diagnosis of psoriasis

Typically, patients see a general practitioner, a dermatologist, or a rheumatologist (for psoriatic arthritis). The doctor collects complaints (rash, itching, pain, swelling and joint pain), medical history (seasonality of exacerbations and their frequency, genetic predisposition, effectiveness of previous treatmentthat is, comorbidities). On examination, changes are found in the skin and joints.

Laboratory tests performed:

  • General blood tests (including white blood cell count, ESR, platelets);
  • General urinalysis;
  • biochemical analysis (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
  • in difficult situations, a skin biopsy is performed with a deeper histopathological examination (clear manifestation of acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of piles of 4-6 or more elements);
  • Before prescribing biological treatment, conduct tests for HIV, hepatitis B and C, tuberculosis;
  • X-ray of affected joints;
  • CT and MRI for axial lesions;
  • ECG.

If necessary, a consultation will be held with an infectious disease specialist, pediatrician, orthopedic traumatologist, surgeon and other specialists.

When diagnosing psoriasis, diseases such as seborrheic dermatitis, lichen planus, parapsorosis, Zhiber rosea and papular syphilis should be excluded.

The severity of psoriasis is determined by BSA (Body Surface Area - skin areas affected by psoriasis), PASI (Psoriasis Area and Severity Index - an index of the severity of psoriasis). prevalence and severity of psoriasis), DLQI (Dermatology Life Quality Index) quality of life index).

To diagnose psoriatic arthritis, the PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (Classification Criteria for Psoriatic Arthritis) criteria are used.

Psoriasis treatment

Treatment is complex, aimed at eliminating inflammation and normalizing the proliferation and differentiation of keratinocytes.

Topical treatment:

  • ointments and creams with vitamin D3 and its analogues;
  • calcineurin inhibitors;
  • glucocorticoids for topical use;
  • phototherapy.

Systemic therapy:

  • PUVA therapy;
  • cytostatic drugs;
  • immunosuppressive drugs;
  • biological medicine.

For psoriatic arthritis use:

  • nonsteroidal anti-inflammatory drugs;
  • medicine to treat diseases;
  • glucocorticoid injection into the joint;
  • biological medicine.

For chronic cases, psoriasis ointments should be used, for exacerbations, psoriasis creams should be used.

When applying ointment or cream, do not rub it into your skin or apply a bandage. This may increase the drug's penetration into the skin and cause side effects.

Hormonal ointments should not be used for more than 4 weeks. Using the wrong dosage may be ineffective or cause side effects. Treatment effects are expected to occur after 1-2 weeks of use.

There are several ways to use glucocorticoid-containing psoriasis creams and ointments:

  • continuous mode;
  • Parallel therapy regimen;
  • tapering treatment regimen;
  • step application mode.

It is worth noting that treatment of mild and moderate forms of psoriasis is carried out on an outpatient basis using ointments and creams applied directly to the affected area. For more severe forms, treatment is performed in the hospital using phototherapy, systemic therapy, and biologic drugs.

The course of the disease is considered moderate and systemic treatment can be initiated in the following cases:

  • Skin areas of aesthetic importance are affected;
  • Large areas of the head are affected;
  • External genitalia are affected;
  • the palms of the hands and soles of the feet are affected;
  • at least 2 nails are affected;
  • There are single elements that cannot be processed locally.

Systemic therapy is performed only in a hospital, under the strict guidance of a doctor, as systemic treatment is associated with many side effects, which can be reduced by choosing individual treatments.

General recommendations for psoriasis patients:

  • minimize skin damage and dry skin;
  • After applying psoriasis creams and ointments to your hands, wear gloves to prevent the medication from getting into your eyes;
  • Use sunscreen with a protection factor of 30;
  • Avoid stressful situations, consult a psychologist if necessary;
  • Control your weight, eat properly.

Diet for psoriasis

Encourage:

  • drink alkaline 1200-1600 ml per day;
  • use lecithin;
  • vegetables and fruits;
  • porridge;
  • lean meat and fish;
  • milk product.

Not recommended:

  • citrus;
  • bread made from premium flour;
  • fatty fish and meat;
  • high-fat dairy products;
  • coffee – no more than 3 cups per day;
  • yeast products;
  • alcohol, sweets, pickles, smoked, spicy.