One of the most common skin diseases is scaly lichen or psoriasis. According to statistics, it occupies 15% of dermatological diseases. 3% of the world's population suffer from this disease, most often in regions with a cool climate. The tendency to develop severe forms of the disease is increasing. Recently, the diagnosis of psoriasis has become relevant not only for adults, cases of making this diagnosis have become more frequent in very young people, and even in children. Until now, all the causes of this disease have not been disclosed.
What is psoriasis?
Psoriasis, the clinic and diagnosis of which is known to every dermatologist, is a chronic skin disease. It is characterized by the presence of red outlined spots, which are covered with flaky silver scales. Over time, the activity of the disease fades. The disease mainly affects the skin, although there are cases of illness of other organs, in particular joints and nails.
Although psoriasis is called scaly lichen, unlike other types of lichen, the disease is not contagious. The trigger mechanism of the disease is the process that occurs in the epidermis. In the deep (basal) layers keratinocytes are formed, then keratin, the protein from which nails, hair, and skin are built, should be produced from them. Keratinocytes in normal development from the lower to the upper layer move imperceptibly, about a month in time.
In patients with psoriasis, keratinocytes multiply too quickly and move to the upper layer in 4 days. The skin is not able to get rid of these cells so quickly, their number is constantly growing, and dry, thickened patches on the skin appear in the form of plaques. In this case, the lower layer of the dermis, where the blood and lymph vessels, nerves pass, becomes inflamed, swells. Diagnosis of psoriasis will help to establish the type of disease.
Types and symptoms of the disease
Different types of disease can occur in different ways, follow alternately or simultaneously. There are several types of psoriasis:
- Spotted. The most common type. It is manifested by rashes on the skin, first it covers small areas, then it grows, appears in the same places on the opposite side of the body. This type of disease is possible after a viral or streptococcal infection, after treatment with corticosteroids. Small spots, increasing, turn into plaques, combine into large areas. If damaged, minor hemorrhages are possible (Auspitz sign). Places of lesions: knees, elbows, legs (lower part), palms, hips, calves, lower back. In 50% of patients, psoriasis of the scalp is observed, plaques appear along the border of hair growth. Diagnosis of psoriasis in children is carried out mainly in the same ways as in adults.
- Teardrop-shaped . A rare form of ailment. Plaques suddenly appear on the legs, arms, on the head. Often disappear by themselves, but can reappear in stressful situations.
- Reverse . This form is difficult to treat. Inflamed, smooth areas occur in the folds of the body (under the chest, armpits, in the inguinal zone).
- Seborrheic . The spots are red scaly patches located above the shoulder blades, behind the ears, in the armpits, in the groin and on the face. It is difficult to treat. When diagnosing seborrheic psoriasis, attention is paid to the fact that, despite prolonged skin damage, there is no alopecia, hair thinning.
- P soriasis of nails. With this type, on the legs and hands, the nail plates change color, exfoliate. Often this type of psoriasis is associated with psoriatic arthritis. Diagnosis of nail psoriasis is usually easy. Sometimes a histological examination is performed.
- Psoriatic arthritis. An inflammatory disease that leads to inflammation and stiffness in the joints. It is divided into several types: symmetric, asymmetric, mutilic.
- Psoriatic erythroderma . A heavy, rare form in which almost the entire body is covered with a red scaly crust.
- Pustular. Pustules form on the legs and arms. This species can manifest itself, or be concomitant with another form of psoriasis. In the latter case, it is very dangerous.
Causes of the disease
The etiology, clinic (diagnosis of psoriasis does not cause problems) have long been studied, but here are the reasons why the disease occurs, are still being investigated:
- Medicine claims that psoriasis occurs during a malfunction in the immune system, with various factors that are responsible for the proper division of skin cells. Incorrect immune responses cause inflammation and dramatically increased production of immature cells.
- An important role in this disease is played by heredity. 35% of patients have these problems genetically. The genetic factor is leading in the causes of psoriasis.
- A major role is played by weather conditions during the course of the illness. In dry, cold weather, an outbreak of the disease can occur. Some suffer from photosensitivity and experience relief only in the winter, when there is much less sunlight.
- Strong emotions, stress. Relapses of psoriasis occur with stress, emotional distress, depression and anxiety.
- Infections Some bacteria and viruses can provoke the occurrence of psoriasis, it can be streptococci, affecting the upper respiratory tract. Often transferred pharyngitis, tonsillitis, sinusitis in adolescence becomes the cause of drop-shaped psoriasis. Associated with psoriasis and HIV, as well as in some cases HPV (human papillomavirus).
- Skin injuries. A similar reaction of the body is called the Koebner phenomenon, when the skin is damaged in the form of red lines. In these places, the appearance of psoriasis is possible. It can develop in areas that have not been affected by the injury.
- Medicines can provoke psoriasis, these are: ACE drugs, beta-blockers, chloroquine, lithium, NSAIDs (indomethacin), the hormone progesterone, various steroid ointments covering large areas of the skin.
Diagnostic methods for psoriasis
The doctor who establishes the disease takes into account:
- clinical picture of the disease;
- the presence of the Kebner phenomenon;
- symptoms of the psoriatic triad.
Diagnosis of psoriasis is based on the psoriatic triad - these are emerging phenomena during scraping of plaque. This could be a phenomenon:
- stearin stain, scraping off the papule, you can observe peeling, which looks like pounded stearin;
- spot bleeding, after scraping the terminal film, individual droplets of blood appear;
- Kebner, new rashes appear in places of irritation, especially in the acute phase of the disease.
Sometimes a histological examination is required for certain changes.
Blood tests
If the doctor finds it difficult to diagnose by external signs, laboratory diagnosis of psoriasis is prescribed, the following tests are included in it:
- Complete blood count , the leukocyte formula and ESR are not included in it. Psoriasis is often a companion to anemia and leukocytosis.
- Rheumatoid factor helps to detect protein, the level of which rises with any inflammatory phenomena. With psoriasis, the result should be negative. This is its difference from rheumatoid arthritis, when this factor rises.
- ESR (erythrocyte sedimentation rate). This indicator should be normal. The exception is cases of pustular psoriasis or psoriatic erythroderma.
- Uric acid . With psoriasis, this indicator rises. Psoriatic arthritis resembles gout, which is characterized by an increase in the concentration of uric acid in the blood. In this case, a complete diagnosis of psoriasis is necessary, analyzes are one of the stages.
- HIV antibodies . This infection often causes a sudden onset of psoriasis symptoms.
Psoriasis: differential diagnosis
In clinical practice, situations often arise when similar symptoms resemble different diseases. It is necessary to distinguish one condition from the like, in this the differential diagnosis of psoriasis helps. Outwardly similar in the first signs of psoriasis and lichen. To prescribe adequate therapeutic measures, the doctor must clearly know the distinguishing features. When examining, the doctor sees typical clusters of papules that are covered with white silver scales, they then form psoriatic plaques. Pathological elements are bordered with a red corolla, which is called the rim of Pilnov, it indicates that there is a progression of psoriasis. Differential diagnosis allows this to be detected. It is easy to establish a diagnosis after grattage (scraping), which makes it possible to detect phenomena that are part of the psoriatic triad.
Severity of disease
Psoriasis, the diagnosis and treatment of which is carried out in each dermatological clinic, has a different severity of the disease. Starting from one, two papules, psoriasis develops to the postulose type, sometimes this poses a threat to life. There are several degrees of severity of psoriasis:
- Mild psoriasis . Cases when the skin surface on the body is covered by 3%, most often affects even only 2% of the skin.
- Mild psoriasis . The skin is affected by 3-10%.
- Severe psoriasis . In this case, the disease affects 10 or more percent of the skin. The severity is also measured by the effect of the disease on the patient's quality of life.
Another classification is also proposed, which involves a two-tier system according to which patients are divided into those in need of systemic and local treatment.
Common and severe psoriasis is more difficult to treat. Some forms are very resistant to treatment, even if they are not severe. This includes:
- psoriasis on the soles and palms;
- in the folds of the skin (reverse psoriasis);
- psoriatic arthritis;
- psoriasis affecting the scalp.
Psoriasis treatment
The treatment of severe and moderate forms of psoriasis includes methods such as phototherapy, systemic drugs, combined and excimer laser therapy, which are often very effective.
TNF inhibitors reduce the activity of immunity factors, help with severe forms of psoriasis, but other infections can cause complications.
Ustekinumab. This product contains monoclonal antibodies. It helps with severe and moderate forms of the disease. Studies of the drug are still ongoing, at the moment, positive qualities have been identified.
There are the latest drugs that are not yet fully understood. Preliminary studies indicate a positive trend. There are methods that are not approved. The use of various ointments, sprays, creams can alleviate the symptoms of psoriasis. The clinic, diagnosis, treatment of the disease are described by many medical scientists. They distinguish three main treatment options for the disease:
- Local products (creams, shampoos, ointments, sprays).
- Drug treatment. Used drugs (injections, tablets) affect not only the skin, but also the entire body.
- Phototherapy. For treatment, light is used.
For each person, treatment is selected separately, taking into account all the individual characteristics of the body, as well as the type and form of the disease.
Alternative methods
Those who suffer from a protracted course of psoriasis are trying to seek out some alternative, non-traditional methods of curing the disease. But it is worth remembering that this is not an ordinary skin pathology, although it resembles lichen. The reason for it lies inside the body. The choice of treatment is best left to the doctor.
So, for example, it was found that green tea slows down the growth of skin cells, but studies have so far been conducted only on animals. What kind of reaction the human body will give is not yet known.
Non-traditional methods offer some kind of herbal preparations for the treatment of psoriasis, but clinically confirmed data on their effectiveness still does not exist.
You should not use on yourself the again heard some folk remedy, you must make sure, after consulting with your doctor, that it will not do your body any more harm.
Herbal preparations, as well as dietary supplements are not controlled by the system, so permission to sell them to manufacturers is not required. Do not forget that any substance of plant origin also has its side effects, in some cases it can even cause damage to health.
Sometimes patients have real problems after using natural remedies.
The effectiveness of zinc pyrithione-containing preparations is doubtful. In many countries, this connection is even prohibited for use, but, unfortunately, such tools are available on the Internet.
Used to treat Gotu Kola in the form of a cream. If you apply this herb inside, many side effects can occur. For pregnant women, it is also dangerous to terminate the pregnancy.
Disease prevention
Despite the fact that there is an unequivocal opinion about the dangers of sunburn and sunlight, it is very useful for psoriasis. Regular use of moderate sunbathing develops a positive trend, reduces anxiety and stress.
There is a relationship between relapses and negative emotions, so symptoms can be alleviated by any anti-stress methods. A visit to a psychotherapist and psychologist greatly alleviates the symptoms.
If the skin is too dry, itching begins, you can try the following remedies:
Take a warm bath for 15 minutes. Then apply salicylic acid, which removes flakes from the skin. After that, use some emollient cream - “Cetafil”, petroleum jelly or “Eucerin”. You can wear moisturizing gloves at night.
Capsaicin ointment will help with itching and irritation, where the active ingredient is chili pepper seeds. It helps relieve psoriatic itching. At first burning sensation is felt, but then it fades.
Nutrition Factors. Patients should consume folic acid in sufficient amounts. It is found in foods such as asparagus, leafy greens, fruits, peas, dried beans, liver, yeast, and orange juice.
It is necessary to include foods containing Omega-3 in the diet, to consume fish oil, which has an anti-inflammatory property and has a positive effect in autoimmune diseases.