Psoriasis (psoriasis) – a chronic contagious disease that affects the skin, nails and joints. The distinctive appearance of the skin monomorphic rash nodules are bright pink, covered with silvery scales. Elements of the rash may be grouped together in different configurations, which is reminiscent of the geographic map. Together with moderate pruritus. Psoriasis affects the appearance of the skin, provides psychological discomfort for the patient. When joint damage develops psoriatic arthritis. The threat of generalized pustular psoriasis pregnant women leads to fetal damage and miscarriage.
Psoriasis is a common chronic skin disease, characterized by a monomorphic rash flat papules, which are usually grouped together in large plates, which are very quickly covered with loose silvery-white scales. Psoriasis is fluctuated, of course, the incidence is 2% of the total population, is diagnosed equally in men and women.
The causes and pathogenesis of psoriasis
In the etiology and pathogenesis of psoriasis are not fully understood, but research results suggest that genetic, infectious or neurogenic nature's most likely. Hereditary nature of psoriasis attest to the fact that the incidence is higher in those families in which psoriasis are already sick, except in monozygotic twins, the concentration of morbidity is also higher in comparison with other groups. The infectious etiology of psoriasis is limited to the presence of the modified complexes and inclusions, such as during a viral infection, but identification of the virus is not yet possible.
And, to date, psoriasis is considered a disease with a large number of factors affecting the infection of the proportion of genetic and infectious components. The risk of incidence of psoriasis are the people with the constant damage to the skin, the presence of chronic streptococcal infections of the skin, disorders of the autonomic and Central nervous system, endocrine disorders, additionally, alcohol abuse increases the risk for psoriasis.
Clinical manifestations of psoriasis
The primary element in psoriasis is one of the papule is a pink or red color that is covered with a lot of loose silvery-white scales. Important diagnostic feature is the triad of psoriasis: the phenomenon of a stearin stain, a terminal film, and the point of bleeding when trying to remove the scales.
In the stage of development of psoriasis rash a little, gradually over a period of months and even years, their number increases. Psoriasis very rarely will debut an intense and generalized rash, such as at the beginning, can be observed after acute infectious diseases, severe neuropsychiatric overloads and after a huge treatment with medications. If psoriasis is the beginning, the rash is swollen, have a bright red color and quickly spread throughout the body, psoriatic panels hyperemic, swollen, and often itch. The papules are localized on the flexor surfaces, particularly in the area of the knee and elbow joints, torso and scalp.
The next stage is the psoriasis is characterized by the emergence of new, small elements in the areas of scratch, damage and abrasion, this clinical feature is called the phenomenon Kebner. In the result of peripheral growth, new elements blend with the existing form and symmetric plates or in the form of lines.
In the third stage of psoriasis the intensity of the peripheral growth plate, reduced, and their boundaries become more clear, the color of the affected skin acquires a blue shade is an intense exfoliation on the entire surface of the elements. After the last stop the growth of the plates psoriasis on their surroundings shaped pseudoatrophic blade - blade Voronova. In the absence of treatment of psoriasis plaques of thicken, sometimes you can see the papillomatous and warty growths.
In the stage of regression of the symptoms of psoriasis starts to fade, while normalizing the skin goes from the center of the affected area on the outskirts, the first disappears peeling, normal skin color, and finally disappears infiltration of the tissues. With deep lesions of psoriasis and when the lesions are thin and soft skin can sometimes be a temporary hypopigmentation after skin cleansing with the rashes.
Exudative psoriasis differs from the usual presence of crusts scales and plates, which are due to absorb exudate, in the wrinkles of the body, can humidity. Risk factors for the incidence of exudative psoriasis get with diabetes, people with hypofunctions of the thyroid gland (hypothyroidism), and have excess body weight. Patients with this form of psoriasis, they found, itching and burning in the affected areas.
Psoriasis, occurring in the seborrheic type, which is localized in areas that are prone to seborrhea. A lot of dandruff does not allow to diagnose psoriasis, because it masks the rash. Eventually, the patches of skin affected by psoriasis, grow and move on to the skin of the forehead, in the form of a "psoriatic crown".
People who perform heavy physical work, more in common with psoriasis in the palms and soles. In this type of psoriasis the main part of the rash localized on the palms of the body, exist only in isolated areas of rash.
Pustular forms of psoriasis begin with the one small bubble that quickly degenerates into a pustule, and in the opening to form a crust. In the future, the process of covering the healthy skin in the usual form of psoriatic plates. In severe forms of generalized pustular psoriasis infiltrated in the skin can occur intraepithelial small pustules that merge to form purulent the lake. Such pustules are not prone to Flaking and dry to a brown crisp crust. In pustular forms of psoriasis lesions are symmetrical, often the process involves the nail plate.
Arthropathy psoriasis is one of the serious pain is without deformity of the joint, but in some cases the joint is deformed, which leads to ankylosis. When psoriatic arthritis symptoms of psoriasis of the skin may occur much later than arthralgic phenomenon. Primarily affects the small joints of the later, the process involved large joints and the spine. Due to the gradual development of osteoporosis and destruction of the joints arthopathic form of psoriasis often results in disability patients.
In addition to the skin rash in psoriasis is observed, vegeto-dystonic and neuroendocrine disorders, exacerbations patients reported fever. Some patients with psoriasis can be asthenic syndrome, and muscle atrophy, diseases of the internal organs and symptoms of immune deficiencies. If your psoriasis progresses, the visceral disturbances which become more pronounced.
Psoriasis is a seasonal period, the majority of relapses are observed in the cold season and very rarely psoriasis is exacerbated in the summer months. Although in recent years the mixed forms of psoriasis, recurrent in every time of the year, were found more often.
The diagnosis of psoriasis
The diagnosis is made by dermatologists on the basis of appearance of skin manifestations and complaints of the patient. For psoriasis typical psoriatic triad, which includes the emergence of stearin spot, the occurrence of psoriatic film and the phenomenon of blood dew. When poskablivanii papules smooth also enhanced by the peeling, and the surface adopts the similarity with stearic spot. With further poskablivanii after the complete removal of flake detachment is subtle, delicate transparent film, which covers the entire element. If you continue the action, the terminal film rejected and exposed to a wet surface, where there is a point of blood clotting (blood drop, which resembles a drop of rose).
In the atypical forms of psoriasis it is necessary to perform differential diagnosis with seborrheic eczema, papular form of syphilis, and pink ringworm. Histological study revealed hyperkeratosis, and almost total absence of granular layer of the dermis, the float layer of the dermis edematous with foci of accumulations of neutrophils, increase in the scope of focus, that migrates under the Horny layer of the dermis and form microabscesses.
Treatment of psoriasis
Psoriasis treatment should be complex, first apply local medication, and exchange drug treatment, that are connected with the ineffectiveness of local treatment. Respect for work and rest, hypoallergenic diet, avoiding physical and emotional stress, are very important in the treatment of psoriasis.
Sedatives, such as tincture of Valerian, peony, and relieve the nervous irritability of patients, thus reducing the release of adrenaline in the blood. Take the antihistamines the new generation, reduces the swelling of the tissue and prevents exudation.
Use of diuretics lung with exudative form of psoriasis reduces the exudation and, consequently, reduces the formation of extensive layered crust. If the injury is of the joints, that is shown when non-steroidal anti-inflammatory drugs to relieve pain. If the psoriatic disorders in the joints more severe use therapeutic puncture of joints with the introduction of the inside of the joints, betamethasone and triamcinolone.
When pustular form of psoriasis, psoriatic nail lesions and erythrodermic psoriasis aromatic retinoids are appointed for a period of not less than one month give a good effect. The use of corticosteroids is justified only when the crisis of psoriasis drugs a prolonged action, then plasmaphoresis allows to quickly arrest psoriatic crisis.
Physiotherapy treatments, such as paraffin baths, UV irradiation is shown in different forms of psoriasis. In a later stage psoriasis used anti-inflammatory ointment if there is infection, then ointment with an antibiotic. Effective laser treatment of psoriasis and phototherapy. In the transition to a psoriasis in the stationary phase is shown keratolytic ointments and creams. Is cryotherapy psoriatic panels.
In the phase of reverse development to reduce the local use of ointments, gradually increasing their concentration. Local application of low concentrated corycosteroids ointments, which is displayed on all stages of psoriasis. Medicines which adjustment on the proliferation and differentiation of keratinocytes is the view direction in a modern treatment of psoriasis. In the period of rehabilitation of sanatorium-resort treatment with the sulfide and radon sources to achieve a durable and long-lasting remission.