Psoriasis — a chronic non-communicable diseases, dermatosis, affecting primarily the skin. Psoriasis usually causes the formation of excessively dry, red patches on the surface of the skin. However, some patients with psoriasis have no visible injuries.
Patches caused by psoriasis are called psoriatic panels. These points are areas of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin and excessive angiogenesis (formation of new small capillaries) the subject layer of the skin. Excessive proliferation of keratinocytes in the psoriatic plates and the skin infiltration of lymphocytes and macrophages causes thickening of the skin in the affected areas, its height above the surface of healthy skin and the formation of the characteristic light grey or silver spots, resembling melted wax or paraffin wax ("paraffin lakes").
Psoriatic panels often first appear on the exposed to friction and pressure areas — the surface of the elbow and knee bends, on the buttocks. However, the psoriatic plates can occur and be located anywhere on the skin, including the skin, the scalp, the surface of hands, plantar surface of feet, external genitalia. In contrast to eczema rash, usually affecting the inner surface of the knee and elbow joints, and the psoriatic lesions are often found on the outer extensor surface of the joints.
Psoriasis is a chronic disease characterized by usually above the waves, with periods of spontaneous or due to the different therapeutic effects of remission or improvement and periods of spontaneous or provoked by adverse external influences (alcohol, intercurrent infections, stress) recurrences or exacerbations.
The severity of disease may differ in different patients and even in one and the same patient during the periods of remission and deterioration in a very wide range, from small local damage, which completely cover the entire body psoriatic panels. Often there is a tendency to progression of the disease over time (especially if untreated), weigh and increased frequency of exacerbations, increase the area of impact, and the integration of new areas of skin. In some patients there is a continuous course of the disease without spontaneous remissions, or even a steady progression. Often also affect the nails on the hands and/or feet (psoriatic onychodystrophy). Nail involvement may be isolated and observed in the absence of skin lesions. Psoriasis can also cause inflammation of the joints which is called psoriatic arthropathy or psoriatic arthritis. From 10% to 15% of patients with psoriasis also suffer from psoriatic arthritis.
There are a lot of different means and methods for the treatment of psoriasis, but due to the chronic recurrent nature of the disease itself, and often a tendency to progress in time, psoriasis is fairly difficult to treat the disease. Complete cure is not currently possible (that is, psoriasis is incurable at the current stage of development of medical science), but can be more or less long, more or less complete remission (including life). However, there is always the risk of recurrence of the disease.
Causes of psoriasis
- Stress, depression;
- Skin infections, in particular viruses, bacteria (staphylococci. Streptococcus), fungi (Candida);
- Genetic predisposition;
- Metabolic disorders that affect the regeneration of skin cells;
- A failure in the endocrine system (hormonal disorders)
- Gastrointestinal disease is enteritis, colitis, dysbacteriosis (dysbiosis);
- Diseases of the liver.
Read more about the causes of psoriasis
The impaired barrier function of the skin (in particular, mechanical injury or irritation, friction and pressure on the skin, the overuse of soap and detergents, contact with solvents, detergents, alcohol-containing solutions, the presence of infected lesions on the skin or on the skin, allergies, excessive dryness of the skin) also play an important role in the development of psoriasis.
Psoriasis is a largely typical skin diseases. Most patients experience shows that psoriasis may spontaneously improve or worsen for no apparent reason. Studies of various factors associated with the occurrence, development or exacerbation of psoriasis tend to be based on the study of small, usually in a hospital (not outpatient), that is certainly more severe groups of patients with psoriasis. Therefore, these studies often suffer from a lack of representativeness of the sample and the inability to determine causal relations in the presence of a large number of other (including yet unknown) factors which may affect the nature of psoriasis. Often different studies found contradictory findings. However, the first signs of psoriasis often occur after a trauma (physical or mental), injury to the skin, in the places of the first appearance of psoriatic lesion and/or recent streptococcal infection. Conditions, depending on the number of sources that could have contributed to the aggravation or worsening of psoriasis include acute and chronic infections, stress, climate changes, changes of the seasons. Some medications, particularly lithium carbonate, beta blockers, antidepressants fluoxetine, paroxetine, antimalarial drugs chloroquine, hydroxychloroquine, anticonvulsants carbamazepine, valproate, according to various sources, that are associated with worsening of psoriasis or even may cause its initial appearance. Excessive alcohol consumption, Smoking, overweight or obesity, poor diet can worsen psoriasis or hinder his cure, cause the deterioration. Hairspray, some creams, and hand lotions, cosmetics and perfumes, household chemicals can cause exacerbation of psoriasis in some patients.
Patients suffering from HIV or AIDS often suffer from psoriasis. This seems a paradox to researchers psoriasis treatment whose goal is to reduce the number of T cells or their activity as a whole contributes to the treatment of psoriasis and infection with HIV or AIDS is accompanied by a decrease in the number of T-cells. However, in time with the progression of HIV infection or AIDS by increasing viral load and a decrease in the number of circulating CD4 + + T cells, psoriasis in HIV-infected patients or AIDS patients worsens or escalates. In addition, that it is a secret, HIV infection is usually accompanied by a strong shift of the cytokine profile towards Th2, whereas psoriasis vulgaris uninfected patients is characterized by a strong shift of the cytokine profile towards Th1. According to the currently accepted hypothesis is that by reducing the amount and pathologically modified activity of the CD4 + T-lymphocytes in patients with HIV infection or AIDS may cause hyperactivation of the CD8+ T-lymphocytes, which are responsible for the development or exacerbation of psoriasis in HIV-infected or AIDS patients. However, it is important to know that most of psoriasis patients in relation to healthy carriers of the virus HIV, and HIV is responsible for less than 1% of cases of psoriasis. On the other hand, psoriasis in HIV-positive happens, according to various sources, with a frequency of from 1 to 6 %, which is approximately 3-fold higher than the prevalence of psoriasis in the General population. Psoriasis in patients with HIV infection and AIDS in particular often occurs very hard and responds poorly or not at all amenable to standard therapy.
Psoriasis most frequently develops in patients with initially dry, sensitive skin, as in patients with oily skin, and is much more common in women than in men. One and the same patient with psoriasis often first appears in areas, more dry or more thin skin, as in areas with oily skin and most often appears in places, damage to the integrity of the skin, including scratches, scuffs, abrasions, scratches, cuts, or in places exposed to friction, pressure or contact with aggressive chemicals, cleaning solvents, solvents (this is called the phenomenon Kebner). It is assumed that this phenomenon of injury, psoriasis, in particular dry, sensitive or damaged skin, associated with infection, because the infection (probably the most common Streptococcus) easily penetrates into the skin with minimal secretion of sebum (which, under other circumstances, protects the skin from infections), or damage to the skin. The most favourable conditions for the development of psoriasis, so the opposite, that the most favourable conditions for fungal infections of the feet (the so-called "athlete's foot") or under the armpit, in the groin area. For the development of fungal infections, is the most favourable moist, wet skin, psoriasis, on the contrary, dry. Penetration in dry skin, infection, causes of a dry chronic inflammation, which then causes the symptoms typical of psoriasis, such as itching and increased proliferation of skin cells. This leads to a further increase in dryness of the skin due to inflammation and enhanced proliferation of keratinocytes, and due to the fact that the infection consumes the moisture that would otherwise serve to moisturize the skin. To prevent excessive dryness of the skin and reduce the symptoms of psoriasis patients with psoriasis it is advisable not to use washcloths and scrubs particularly difficult, since they not only damage the skin, making a microscopic scratch, but scrape from the skin of the upper protective stratum corneum and sebum, which normally protects the skin from drying and from invasion of micro-organisms. It is also recommended to use talcum powder or baby powder after washing or bathing to absorb excess moisture from the skin, which otherwise "get" the infection. In addition, it is recommended to use the assets, moisturizing and nourishing the skin, lotions that improve the functioning of the sebaceous glands. It is advisable not to abuse of soap, detergents. Try to avoid skin contact with solvents, household chemicals.
The symptoms of psoriasis
- Severe itching on the skin;
- The appearance on the skin small rashes to the development of more liquid, reveal, form a crust, then joined in one the inflammatory areas and which are covered with a gray-white, sometimes yellowish shade (t. i. - psoriatic plaques);
- The blood from the platelets;
- Nail psoriasis is a first thickens, then delaminates and nails disappears;
- Possible, pain in the joints.
Quality of life in patients with psoriasis
It turns out that psoriasis may impair the quality of life of patients, in the same degree as other severe chronic diseases, such as depression, myocardial infarction, high blood pressure, heart failure, or diabetes 2. type. Depending on the severity and location of psoriatic injury, patients with psoriasis may experience significant physical and/or psychological discomfort, problems with social and professional adaptation and even need disability. Strong itching or pain can interfere with performing basic life functions, such as self-care, walking, sleep. Psoriatic panels on the exposed parts of the hand or foot can prevent the patient to work at certain jobs, to do some sports, take care of family members, Pets or house. Psoriatic panels on the scalp often present patients with special mental problems and caused considerable suffering and even social phobia, as the pale panels on the scalp can be confused with others, for dandruff or result of the presence of cheek. Another big psychological problem leads to the presence of psoriatic lesions on the face, the ears. Psoriasis treatment can be expensive and takes away from the patient a lot of time and effort that interferes with work and/or study, socialization of the patient, the device personal life.
Patients with psoriasis, it can also be (and often are) too concerned about their appearance, attach too much importance (sometimes to the extent that the fixed, almost body dysmorphic disorder), suffer from low self-esteem, which is associated with fear of public rejection and the rejection or fear that I would not find a sexual partner because of the difficulties in the look. Psychological distress combined with pain, itching and immunopathological disorders (production of inflammatory cytokines) can lead to the development of severe depression, anxiety, or social phobia, significant social isolation and maladjustment of the patient. It should also be noted that comorbidity (the combination of), psoriasis, and depression, as well as psoriasis and social phobia, occurs with increased frequency even in those patients who do not experience a subjective psychological discomfort due to the presence of psoriasis. It seems likely that genetic factors affecting the predisposition to psoriasis, and a predisposition to depression, anxiety states, social phobia largely overlap. It is also possible that in the pathogenesis of both psoriasis and depression play an important role in the common immunopathological and/or endocrine factors (for example, with depression also show elevated levels of inflammatory cytokines, increased cytotoxic activity of glial).