- high prevalence;
- unpredictability, Novitatis and variability of flow;
- the appearance of the first clinical signs, mainly in his youth;
- the increasing incidence in the last 10-15 years among young people;
- increase the percentage of the severe forms of disease, accompanied by serious mental disorders and sleep disorders;
- the deterioration of the quality of life of the patient;
- the difficulty of the treatment;
a large increase in the number of patients with disabilities as sick leave and disability, mainly among young men.
According to various sources, the disease was from 2 to 7% of the population. In the structure of the skin disease, psoriasis is 3-5%, among patients with dermatological hospitals — up to 25%.
This information is for some reason incomplete: problems in the identification of severe forms, such as, psoriatic arthritis, rare negotiability is, that the health care facilities of patients with mild forms etc
Causes of psoriasis and its pathogenesis
Despite the advantage of local skin manifestations in most forms of the disease, its causes and the nature of the infringement in the body, the disease is of a systemic nature.
At the time of the disease involved joints, blood vessels, kidneys, liver. There is also a high risk of diabetes, obesity and elevated blood pressure in persons with psoriasis, especially in women.
In 20-30% of patients later develop a syndrome of metabolic disorders, with a high content of triglycerides in blood, obesity predominantly in the abdomen, psoriatic arthritis.
Also in recent years has shown that the number of biological markers, which indicates a direct connection with psoriasis with crohn's disease, rheumatoid arthritis, cardiovascular disease, angina, and increased mortality due to myocardial infarction.
For these and other reasons an increasing number of researchers, who are prone to the system definition of Dermatosis as a "psoriatic disease" and not just "psoriasis."</1_img>
If passed, the psoriasis hereditary?
Despite the large number of hypotheses and research done at this time are still difficult, the answer to the question of whether psoriasis is transmitted by inheritance. However, it is generally accepted that the disease is genetically determined. In the absence of the disease in both the parents is only in 4.7% of children. When the disease one of the parents, the child's risk of the customer is increased to 15-17%, both parents — 41%.
The beginning of psoriatic disease can be at any age, but in most cases, the peak observed in the age of 16-25 years (type I psoriasis) and at 50-60 years of age (type II psoriasis). Psoriasis of the ith species can be a result of hereditary diseases, common lesions and prevalence of lesions varius. With type II disease, which are more favourable, of course.
Mechanism of development (pathogenesis)
The main link in the pathogenesis (mechanism of development) disease that causes lesions on the skin, is to increase the mitotic (cell division) activity and the accelerated proliferation (growth) epidermalibus cells. Result — cells in the epidermis, without orogovet, ejected by the cells of the underlying layers of the skin. This phenomenon accompanied by excessive flaking and is called Hyperkeratose.
Be the free communication and contact with patients, i.e. can you get? All studies related with this disease, refute this assumption. The disease does not spread to other people by droplets or by direct contact.
The implementation of a genetic predisposition to the disease (according to the genetic theory of psoriasis) are possible in the event of a disruption of the regulatory mechanisms of the following systems:
mentis.Mental instability contributes to the disruption of the function of the autonomic nervous system. The latter is one of reflex units in the implementation of certain emotional factors the effect of alpha - and beta-receptors on the vascular system of the skin, and therefore its Overall condition.
Mental trauma has a significant (if not primary role in the mechanism of the disease, and the frequency and duration of relapses. At the same time, dermatosis causes disruption in the functional status of the psyche. Endocrine.
psoriatic diseaseit is a reflection of the violation of adaptive mechanisms, the main role in which play of the endocrine glands (hypothalamus, pituitary gland, adrenal gland), the regulation, which is carried out, not only declinare, way (through the blood), but also with the participation of the nervous system. /For the purposes of adjustments of the hypothalamic-pituitary-adrenal system first turns on (in response to the impact of environmental changes, extreme and accentus factors) by increasing or decreasing secretion of the hormones resulting in altered cellular metabolism. </2_img>
Immune. The mechanism of realization of genetic predisposition to PSORIASIS with involvement of the immune system, which occurs through genes that control the cellular immune response and immune cell interactions with others (the HLA system). The immune system in psoriasis is also altered either genetically or under the influence of internal or external factors, as evidenced by the violation of all the parts of the skin immune regulation.
Genetically determined disorders of cell metabolism leads to accelerated growth and proliferation of the immature cells of the epidermis, which leads to the release of biologically active substances (BAS) lymphocytes, immature skin cells, activated keratinocytes and macrophages. The latter are mediatores, inflammation and immune response.
These substances, which include the protease, the protein information molecules, called cytokines (tumor necrosis factor, interleukins, interferons, and various subtypes of lymphocytes), polyamines (hydrocarbon radicals). The mediators, in turn, stimulate the growth of defective cells of the epidermis, changes in the walls of small vessels and the appearance of inflammation.
The whole process accompanied by the accumulation in the epidermis and papillary layer of the dermis one - and multi-celled leukocyte. Predisposing and trigger factors The key pathological manifestation of psoriasis is the excessive growth of defective cells of the epidermis. It is therefore of fundamental importance for the clarification of the mechanism of the disease and deciding how to treat psoriasis is the creation of the starting factors. The most important:
Psychological— the impact of short-term severe stress, and unexpressed, but long-term or repeated negative psychological effects, the moral dissatisfaction, sleep disturbances, depressive States.
Metabolic disorders in the body, disorders of the digestive organs, especially the liver and exocrine function of the pancreas. Disease or dysfunction of the endocrine glands (hypothalamus, thyroid, parathyroid tissues and glands of the endocrine functioning of the pancreas). The immune system (allergichekie reactions and immune diseases).
The presence in the body of chronic foci of infection (tonsillitis, rhinosinusitis, inflammationibus profuere, etc). Pathogenic and conditionally pathogenic microorganisms, especially Staphylococcus aureus, streptococci and fermentum fungi, their toxins, the skin cells damaged by these microorganisms, are powerful antigens, can trigger the immune system and aggression against them, modified, and healthy cells in the body.
Mechanical and chemical damage to the skin, prolonged use of antibiotics or glucocorticoids on the disease, giperinsolyatsiya, Smoking and alcohol abuse, acute infectious diseases (respiratoriorum a viral infection, flu, angina, etc).
Symptoms and types of psoriasisAccepted clinical classification of psoriatic disease does not exist, but traditionally they are the most frequently encountered clinical form. These are in some cases so different between each other, that they are treated as separate diseases.
In the development of the disease there are three phases:
The progression of the process in which precipitation of up to 1-2 mm occur in large numbers in new areas. Are transformirovalsya in a typical psoriatic plaque.
The stationary phase— the lack of the appearance of a "fresh" elements, keeping the size and appearance of the existing panels, completely covered with peeling epidermis.
Phase of the regression— reduction and flattening of the plates, reducing the severity of the peeling and disappearance of elements, the resorption that begins in the middle. After their complete disappearance usually remain foci of depigmentation.
Psoriasis vulgaris(common, ordinary) It seems monographia (homogeneous) eruptionibus in the form of plates or papules — nodules in reddish or pink color, towering above the surface of the skin. Papules are clearly demarcated from the healthy areas and for which the statera dolosa is a silvery-white color. The size of the diameter can be from 1-3 mm to 20 mm and more. For them, the three characteristic phenomenon that occurs after their poskablivanii surface: </3_img>
a symptom of "stearin spot" — the strengthening of peeling after a light poskablivanii which cause the surface of the papule becomes similar to the fall of the oppressi tallow; this is the result of parakeratosis (thickening of the epithelium), Hyperkeratose (thickening of the stratum corneum of the skin, i.e. the stratum scale), the accumulation of fat and sicut crassus, the components in the outer layers of the epidermis; a symptom of the "terminal film" in the remote scale appears slimy epidermal layer in the form of a thin, velvety, shiny, wet surfaces; the symptom of "blood dew", or the phenomenon Auspittsa-Polotebnova — do not combine together drops of blood in the form of a rose, which operate on the shiny surface under the light poskablivanii is due to damage to the plenus sanguinis in contact with the skin papilla.
Favorite places localization rash pellis are part of the head, the symmetrical arrangement in extensoris indicis surfaces in the area of large joints — elbow, knee. Localization of panels can be a long time limited to these areas. So they are called "guard" or "officium". Rarely affects the nails, skin in the area of other joints, the genitals, the face, the soles of the feet and palms of the hands, the large wrinkles.
Another characteristic symptom is the appearance of psoriatic lesions in areas of mechanical or chemical damage to the skin (the emergence of Kebnera). Such injuries can scalpendi, cuts, chemical irritation for acids or bases.Depending on the localisation of the elements and the clinical course, psoriasis vulgaris is divided into several types:
- Manually quadratus plantae.
- On nail psoriasis.
Seborrheic psoriasis.This happens in areas of skin with many sebaceous glands on the forehead, the scalp, BTE region on areas of facial wrinkles (nasolabial and nososchechnyh), between the shoulder blades and in the upper part of the anterior surface of the chest.
If on the face, back and chest a rash is a sign of red papules, which are covered by squamea convolvens large plates of the silver-white color, the ears is similar to the rash of seborrheic dermatitis, complicated by the accession of infection.
The surface of the seborrheic spots and papules of the ear sinks more bright and edematous, in comparison with other areas. It is covered with statera dolosa yellow-white or grey-white color and serosum vehentem-purulent crust (due to the macerari), which fits tightly to the skin. Almost always rash accompanied by severe itching.