Severe psoriasis. Psoriatic Disease: Symptoms, Causes and Treatments

The skin is an organ that protects us from the penetration of foreign substances and pathogens into the body. Unfortunately, the skin is also prone to various diseases, and psoriasis is one of the most difficult to treat. In addition, the disease gives patients a lot of trouble.

What is psoriasis

The word "psora" in Greek means "skin itching, scabies." This name reflects the main symptom of the disease. Also, psoriasis is sometimes called psoriasis for its external form. From a scientific point of view, psoriasis is one of the pathologies of the skin - dermatoses. The disease changes the appearance of the skin, causes suffering to the patient, expressed, first of all, in severe itching.

Interesting fact:

Psoriasis was known in antiquity, but then it was often confused with other skin diseases. Medicine recognized it as an independent skin disease in 1799. Currently, doctors tend to consider psoriasis not even as a skin disease, but as a systemic disease, since it affects not only the skin, but also the immune, nervous and endocrine systems.

The mechanism of development of psoriasis

Psoriasis is a violation of the process of cell regeneration of the upper layer of the skin (epidermis). If normally epidermal cells (keratocytes) are updated every month or every three weeks, then with psoriasis this process takes much less time - only 3-6 days. It is also important that the cells of the stratum corneum of the skin in this case are undeveloped and are not able to perform their functions. As a result, intercellular connections are lost, the skin layer does not have time to properly form and take root. This is how psoriatic formations on the skin are formed - papules, pustules and plaques. Excessive angiogenesis is observed in them, that is, a lot of small vessels are formed. The lower layers of the skin are not affected. In the mechanism of the occurrence of pathological formations on the skin, cells of the human immune system - T-lymphocytes - are also taken.

Some features of the course and occurrence of psoriasis

Psoriatic skin rashes often form in places where the skin has been injured or cut, in places of burns, calluses, abrasions and even injections. A similar phenomenon is called the Koebner phenomenon, after the German dermatologist Heinrich Koebner, who first described this phenomenon in 1872. The Koebner phenomenon is characteristic of psoriasis in about half of the cases and in 90% of cases of severe psoriasis.

Psoriasis is characterized by a seasonal course. In most patients during the cold season, the manifestations of the disease on the skin become more noticeable. In some patients, on the contrary, heat contributes to the progress of the disease.

How is psoriasis spread?

According to modern concepts, this skin disease is not contagious, that is, it is not transmitted by contact with another person, even if the affected skin area touches the skin of a healthy person. Transmission of the disease through the blood has not been recorded. It is also impossible to catch psoriasis through contact with animals or pick up the disease from the environment. The cause of the disease lies solely in the patient's body, although some adverse external factors can also have their effect.

Epidemiology

It is estimated that the number of cases worldwide is between 2% and 4%. In some regions of Russia, the number of cases reaches 11%. In other regions, the incidence of psoriasis is low and is less than 1%.

Who has psoriasis

Psoriasis is slightly more common in women. The disease develops mainly at a young age (up to 25 years). The most dangerous period is from 16 to 20 years, at which time signs of the disease appear in 70% of patients. Although older people can also get sick. However, usually in old age, the symptoms are not so pronounced. On the other hand, in childhood (up to 16 years) the disease also occurs infrequently (about 4% of patients). There are also racial differences in incidence. Most often, representatives of the white race are sick, and in some groups, for example, among the Indians of South America, the disease does not occur at all.

The reasons

Despite the undoubted progress of medicine, science still has no answers to many questions. This mainly concerns the causes of the development of many pathologies. This also applies to psoriasis. The interest in this case is by no means academic. After all, if you understand how this skin pathology is born, then you can find ways to completely cure it. And since scientists do not have complete clarity on the etiology of psoriasis, it remains incurable. In this case, incurability only means that the patient cannot get rid of skin psoriasis until death. Although in most cases psoriasis is not the direct cause of death. Treatment methods can curb the development of psoriasis and prevent the occurrence of complications.

There are several theories explaining the occurrence of this skin disease, but none of them completely suits scientists:

• autoimmune,
• genetic,
• hormonal,
• viral,
• neurogenic,
• metabolic.

There are other theories, for example, associated with vasculitis (chronic inflammation of the vessels). It is possible that psoriasis is a multifactorial disease, the development of which is caused by several factors at once.

autoimmune theory

The main theory is autoimmune. According to her, skin cells are attacked by cells of the immune system T-lymphocytes (primarily T-killers and T-helpers). This leads to the release of a large number of inflammatory mediators and attracts other cells of the immune system, in particular macrophages and neutrophils, to the skin. This is what leads to the appearance of pathological formations. This theory is supported by the fact that there is an excess of lymphocytes and macrophages in the skin. In scaly formations on the skin there are certain antigenic complexes that are absent in other parts of the body. On the other hand, the patient's blood contains antibodies to these antigens. In addition, treatment with immunosuppressants in psoriasis has some effect.

However, critics of the theory point out that lymphocyte aggression is secondary. And the basis of this reaction is a primary skin disease - a pathological violation of the development of skin cells. This assumption is supported by the fact that drugs that inhibit the division of epidermal cells and improve their development have a positive effect in psoriasis. In addition, animal studies show that skin symptoms similar to those observed in psoriasis can occur in the absence of T-lymphocytes in the body. Another objection is that AIDS patients, who also have a reduced number of immune cells, are most susceptible to psoriasis.

Another version of the theory is the assumption that immune cells attack antigens contained in skin cells, which lymphocytes mistakenly take for antigens of viruses or bacteria. In particular, the antigens of some types of streptococci responsible for the development of acute respiratory infections are similar to the proteins contained in skin cells. The immune system fights the streptococcal infection, and as a result, "innocent" skin cells are under attack. This fact explains the fact that exacerbations of psoriasis are often observed simultaneously with infections of the respiratory system or shortly after the completion of their treatment.

Of course, autoimmune processes are not the only ones that lead to skin pathology. Its development is most likely unlikely without a violation of the barrier function of the skin as a result of trauma, exposure to the skin of aggressive substances, abnormal temperatures, etc.

genetic theory

Proponents of this theory argue that psoriasis is caused by breakdowns in the genetic code. And some research shows this. In particular, genes have been identified that may be responsible for the appearance of psoriasis symptoms. For example, the locus (chromosome region) PSORS1, located on chromosome 6, occurs in 3 out of 4 patients with guttate psoriasis and in half of patients with psoriasis vulgaris. A total of 9 loci were found that may be responsible for the disease.

The hereditary nature of the disease also speaks in favor of the theory. It is known that people who have one or both parents with psoriasis are more likely to get sick. If one of the parents is sick, the probability is 24%, if two - 65%. If one of the identical twins suffers from psoriasis, then with a probability of 70% it is also found in the other twin. It is also known that pathology can be traced in a family history for 3-5 generations. 60% of patients have one or more relatives suffering from the disease. However, skin pathology can also appear in children whose parents never suffered from it.

However, most researchers believe that genetic predisposition cannot be the only cause of the disease. We need unfavorable factors - triggers that trigger its development.

virus theory

If this theory were proven, then treatment could be greatly facilitated. It would be enough to develop a cure for the desired virus. In particular, retroviruses act as "suspects". Despite the fact that some facts speak in favor of the theory, for example, an increase in lymph nodes near those places where the most obvious manifestations of the disease are observed, however, there is no serious evidence of it. No virus has been found to be responsible for the disease. And most importantly, not a single case of transmission of psoriasis from person to person has been recorded. This is the way most viruses spread.

neurogenic theory

Among people who are far from medicine, there is a saying that all diseases are from nerves. Doctors are usually skeptical about this theory. However, in some cases it is not far from the truth. One such exception seems to include psoriasis. Some studies suggest that stress, nervous experiences, overwork, insomnia often (in about 40% of cases) can cause manifestations of psoriasis (a manifestation of the disease or its exacerbation). And studies on childhood psoriasis say that 90% of children develop exacerbations as a result of stressful situations.

In most cases, patients claim that the development of psoriasis began in them after some kind of nervous shock. This is not at all surprising, because our life is oversaturated with various stresses - problems at work, in the family, in personal life. However, many questions remain in this theory. What is the mechanism of the development of the disease in this case is still not entirely clear. It is possible that stress leads to a change in the work of the autonomic nervous system, as a result of which peripheral vessels are reduced, including those supplying blood to the skin. And this disrupts the formation of new skin tissues, and ultimately leads to the appearance of psoriatic plaques on the skin.

Hormonal theory

This theory states that hormonal disorders, diseases of the pituitary gland and the thyroid gland play a leading role in the development of the disease. In particular, psoriasis has been found to be favored by a lack of testosterone in men and progesterone in women. And in some women, skin pathology is provoked by an increased synthesis of estrogens. On the other hand, exacerbations of psoriasis can also be observed in women with low estrogen levels (during menopause).

During pregnancy, some women (about a third) experience an increase in skin symptoms, while the rest, on the contrary, are in remission.

Also, with psoriasis, there is a decrease in the synthesis of other hormones, in particular, melatonin, an increase in the level of growth hormone, prolactin and an increase in insulin resistance of tissues, and a decrease in thyroid function. However, the role of specific hormones in the development of psoriasis has not yet been fully elucidated.

Metabolic disease

Skin pathology is often accompanied by such a phenomenon as a decrease in body temperature. Consequently, in some patients, the metabolism may be slowed down. Also, with psoriasis, there is an excess of cholesterol in the blood. This circumstance makes it possible to consider psoriasis as cholesterol diathesis. Patients may also have a lack of vitamins of groups B, A and C, trace elements - zinc, copper and iron, which also indicates a metabolic disorder.

Psoriasis and obesity

The appearance of psoriasis is often characteristic of overweight people. Patients with psoriasis are 1.7 times more likely to be obese than those without psoriasis.

Proportion of patients who are obese:

• Light form - 14%,
• Medium form - 34%,
• Severe form - 66%.

Thus, excess weight contributes, if not to the appearance of symptoms, then at least to the fact that they take the most severe forms. However, such a relationship cannot be called one-sided. After all, psoriasis itself causes stress, which many people struggle with by eating more and more food. Thus, it would be plausible not only to say that obesity leads to psoriasis, but, conversely, that psoriasis leads to obesity. In addition, it was found that in overweight patients, the effectiveness of the treatment of the disease is reduced.

Factors contributing to the development of the disease

This category should include phenomena that cannot directly be the cause of psoriasis. However, if there is a tendency, for example, a hereditary predisposition, these factors can become a trigger that triggers a pathological mechanism. In particular, it has been noticed that people with thin, dry and sensitive skin get sick more often. This is due to insufficient secretion of the sebaceous glands, due to which irritants, in particular streptococci, can penetrate deep into the skin tissues.

There are quite a few factors that contribute to psoriasis:

• smoking;
• alcoholism;
• wounds, injuries and cuts of the skin;
• skin burns, including sunburn;
• bites of insects or other animals;
• stress;
• malnutrition, an abundance of fatty foods, sweets, lack of fruits and vegetables, increased consumption of caffeinated drinks;
• taking certain medications, primarily antibiotics, NSAIDs, antihypertensive drugs, vitamin complexes, antidepressants, antimalarial and anticonvulsant drugs;
• taking lithium preparations (lithium disrupts the synthesis of keratocytes);
• lack of vitamins in the body;
• infectious skin diseases (fungus, lichen, dermatitis, furunculosis, acne);
• systemic infections or infections of the respiratory system (, acute respiratory infections);
• infection with Helicobacter pylori, Yersinia, staphylococci;
• vaccination;
• moving to other climatic zones;
• hypothermia or cold microclimate;
• food poisoning;
• reduced immunity, including AIDS;
• exposure to the skin of aggressive chemicals, including detergents, cosmetics, perfumes;
• too frequent washing of the skin, destroying the beneficial microflora;
• violation of the digestive tract,.

Most of these factors are external. And this means that any person is able to prevent their effects on the body in order to avoid the development of the disease.

Types

The most common type of psoriasis is psoriasis vulgaris. It accounts for approximately 90% of cases.

The main types of psoriasis

Few people know that psoriasis can affect not only the skin, but also the joints and nails. Many people with skin psoriasis also have nail psoriasis (psoriatic onychodystrophy) or psoriatic arthritis (joint disease).

Psoriatic arthritis usually affects the small joints of the hands and feet. However, the pathology can also spread to large structures, affecting the spine. This threatens the patient with disability.

Also, psoriasis can be divided into mild, moderate and severe, depending on what percentage of the skin is affected.

Psoriatic arthritis refers to severe psoriasis, regardless of what percentage of the skin is affected. This form is observed in 15% of patients.

The most severe type of psoriasis is psoriatic erythroderma (2% of cases). Also a severe form is pustular (1% of cases). Nail psoriasis is observed in a quarter of patients. This type of psoriasis may not be accompanied by the appearance of rashes on the skin.

Guttate psoriasis usually occurs after infections (acute respiratory infections, influenza). In 85% of patients with guttate psoriasis, antibodies to streptococcus responsible for the development of angina are detected in the blood, and 63% of patients with this type of psoriasis have pharyngitis shortly before exacerbation. Pustular psoriasis usually occurs in overweight people.

There is also a psoriasis severity rating scale (PASI). This index takes into account the various manifestations of the disease:

• skin redness,
• skin itch,
• skin thickening,
• skin hyperemia,
• peeling,
• area of ​​skin lesions.

All these factors are summed up and expressed in points from 0 to 72 (the most pronounced symptoms).

stages

Psoriasis is a chronic skin disease with an undulating course. This means that periods of improvement (remissions) are replaced by periods of exacerbations.

After the onset of an exacerbation or after its first occurrence, skin pathology usually goes through three stages - progressive, stationary and regressive. The difference between them lies in the dynamics of the development of pathological manifestations on the skin. The frequency of exacerbations averages once a month. The severity of skin symptoms in each period of exacerbation can vary significantly even in one patient. Most often, in the absence of treatment, there is a tendency for a gradual increase in the severity of skin symptoms during each exacerbation.

Progressive stage

The progressive period is observed when the number of plaques on the skin increases and they grow. It can take from 1 to 4 weeks. Each new skin plaque has a red border around its edges. This means that she continues to grow. During this period, the Koebner phenomenon may appear, which consists in the fact that each new formation occurs in those places where the skin was injured. Aggravation can occur as a result of cuts, burns and abrasions. At this time, even such actions as visiting the bath and sauna, washing with hot water in the shower are dangerous. All this can have a negative effect on the skin, leading to a deterioration in its condition.

Stationary stage

However, in the future, the progressive period may be replaced by a stationary stage. During this period, no new formations appear on the skin. The red line at the edge of the skin plaques becomes pale. The Koebner phenomenon does not appear.

regressive stage

Then there is a period of lessening of the symptoms, when the number of plaques on the skin decreases. First, the center of the formation disappears, then its edges. In place of the disappeared plaques, depigmented areas of the skin appear. Then skin pigmentation is restored. Psoriatic plaques do not leave scars on the skin. This is due to the fact that psoriasis affects only the top layer of the skin - the epidermis.

There is a period of remission. Although in some patients no remissions are observed, and the plaques remain on the skin permanently.

Symptoms

The manifestations of psoriasis on the skin are seasonal. In most patients, deterioration occurs in the cold season.

Depending on the size of the plaques, psoriasis is divided into coin-shaped, teardrop-shaped, dotted. With punctate psoriasis, the size of plaques on the skin does not exceed the size of a match head, with teardrop-shaped psoriasis they resemble small droplets of water, with coin-shaped plaques, the size of the plaques is about 5 mm.

The appearance of formations on the skin is accompanied by severe itching. If there are a lot of spots, then they can merge. The hair on the affected part of the skin is preserved. Therefore, if psoriasis occurs on the scalp, it does not lead to baldness. Then the plaques begin to peel off and silver-white scales appear. The scales on the surface of the plaques are easily torn off, as they are composed of dead skin cells. Scales are formed initially in the center of the plaque, and then spread to its edges. If you tear off such scales, then droplets of blood appear under them.

Where do psoriatic formations occur?

Formations appear on the skin mainly in the area of ​​extensor surfaces - on the knees, elbows. Plaques can also affect the scalp. Most of them occur along the hairline. The skin of the palms and soles, inguinal folds, abdomen, lower back, lower leg, inner and outer surface of the auricles may be affected. If papules appear on the skin of the face, then the areas of the eyebrows and eyes are more often affected, less often the lips.

In general, psoriasis formations can appear on any part of the skin. In rare cases, they can occur not on the skin, but on the mucous membranes.

Manifestations of psoriasis vulgaris

With psoriasis vulgaris, small papules are observed on the skin. These are small, slightly raised bright red spots or plaques. Skin plaques vary in size from a few mm to 10 cm and can be either nearly round or slightly elongated. If skin plaques tend to increase, then they can merge with each other. As a result, so-called "paraffin lakes" form on the skin. Such a plaque can be easily torn off. The skin underneath is bleeding heavily. Psoriasis vulgaris is rarely severe. It usually proceeds in a mild or moderate form.

Manifestations of psoriasis of the flexor limbs

Flexor psoriasis differs from psoriasis vulgaris in that it develops in the folds of the skin. Peeling in this type of disease is insignificant. The usual locations for this type of psoriasis are:

• skin of the groin and genitals,
• skin of the inner thighs,
• armpit skin,
• skin folds,
• skin folds of the mammary glands.

This type of psoriasis often progresses as a result of rubbing, sweating or injury, often accompanied by a fungal or streptococcal skin infection.

Manifestations of guttate psoriasis

They are somewhat different from the symptoms of psoriasis vulgaris. This type of disease is accompanied by the formation of many fluid-filled pustules on the skin.

With guttate psoriasis, a large number of small plaques of lilac, red or purple color appear on the skin. Skin plaques in this case are similar in shape to drops (hence the name) or simple dots. A feature of this form of the disease is the defeat of large surfaces of the skin.

The skin of the thighs is most commonly affected. Also guttate psoriasis can be observed on the shins, shoulders, forearms, scalp, neck, back

The trigger for the development of guttate psoriasis is usually a streptococcal infection.

Manifestations of pustular psoriasis

Apart from these types of disease, there is also pustular psoriasis. This form is characterized by the appearance of small formations on the skin - pustules. They are small bubbles, slightly raised above the surface of the skin, filled with exudate. The skin around the pustules is red and inflamed. Subsequently, the exudate may turn into pus.

Pustular psoriasis can be either localized or generalized. With a localized form, pustules are most often located on the skin of the palms or soles, shins or forearms.

With generalized pustular psoriasis, the number of purulent foci on the skin increases. Also, the patient may have a fever, signs of intoxication of the body. This form of psoriasis is very dangerous, in some cases it can be fatal.

Manifestations of nail psoriasis

With psoriasis of the nails, small dots or longitudinal grooves are observed on the nails or under the nails. Nails may turn yellow, gray or white. The nail itself or the skin underneath may thicken. In some cases, psoriasis affects only one of the nails, in others - all nails at once. Changes in the nail usually start at the edge of the nail and move towards its base. The nails become brittle and brittle, the nail plate can generally come off.

There are three main symptoms that allow us to speak with confidence about nail psoriasis:

• thimble symptom (small pits, resembling holes in a thimble),
• subungual hemorrhages (spots under the nails of red, brown or black color),
• trachyonychia (roughness, dullness, depression and flattening of the nail plates).

Psoriatic onychodystrophy can also be accompanied by the appearance of plaques on the skin, but this is not always the case.

Manifestations of psoriasis of the joints

The most commonly affected joints are the small joints of the hands and feet. However, the following may also be affected:

• shoulder joint,
• hip joint,
• knee-joint,
• vertebrae.

The main symptom of psoriatic arthritis is joint pain. However, pain in psoriasis is not as pronounced as in rheumatoid arthritis. Joints change their shape. Also, the joints may be characterized by swelling, inflammation, and limited mobility.

With psoriatic arthritis, fever, general weakness, and fatigue are not uncommon.

Manifestations of psoriatic erythroderma

This type of disease is usually generalized. There is extensive inflammation, in which red spots cover the entire skin. Pathology is accompanied by severe itching, peeling and detachment of the skin, swelling of the skin and subcutaneous tissue. This form of the disease can be fatal due to a violation of the barrier and thermoregulatory functions of the skin, sepsis. Localized erythroderma, however, may occur as the first stage of psoriasis, and subsequently transform into psoriasis vulgaris. Or it can develop as a result of improper treatment of psoriasis, for example, with the sudden withdrawal of hormonal drugs. Also, this form can be triggered by alcohol intake, stress, infections.

Other manifestations

Of the common manifestations of psoriasis, not related to the condition of the skin, it should be noted the deterioration of the psycho-emotional background, depression, weakness. Often, skin pathology is accompanied by depression. There is an assumption that depression is caused by the same genetic abnormalities as psoriasis itself. But another explanation is also possible - the effect of inflammatory mediators, such as cytokines, on the patient's nervous system. In general, the disease is more severe in women than in men.

Types of psoriasis and their characteristic manifestations

When should you see a doctor?

It is usually difficult for a person far from medicine to separate psoriasis from another skin disease. However, there are a number of signs that are cause for concern:

• painful microtrauma or cracks in the skin;
• change in the shape of the nails, their delamination, the appearance of spots on them;
• blisters on the feet and palms;
• excessively flaky skin;
• spots on any parts of the skin, especially the face, knees and elbows.

Nevertheless, it is not necessary to make a diagnosis on your own and, moreover, treat psoriasis. It is necessary to see a doctor so that he examines the skin and prescribes treatment.

Complications

Psoriasis is not a fatal pathology. The main danger is the addition of a bacterial and fungal infection of the skin. Also, in some cases, psoriasis can become generalized and affect the entire surface of the skin. Especially dangerous are such types of generalized skin lesions as psoriatic erythroderma and generalized pustular form of the disease. Psoriatic arthritis can affect not only small joints, but also the spine. The joints and spine can be deformed, which leads to disability of the patient.

Less often taken into account the difficulties that psoriasis brings with it are psychological problems. Pathology has its negative impact on the quality of life in much the same way as hypertension and diabetes.

Approximately 71% of patients consider psoriasis a serious problem in their lives. People, especially young people, who have psoriatic plaques on visible parts of the body, primarily on the face, may experience communication difficulties, which leads to low social adaptability, the inability to do a certain job or arrange a personal life. And this, in turn, leads to psychological problems, neurosis, depression, alcoholism. Which, in turn, further aggravates the patient's condition. It turns out a vicious circle, getting out of which is not easy.

Diagnostics

Usually, the pathology is easily diagnosed by a doctor during examination. Psoriasis plaques on the skin have a characteristic appearance and are difficult to confuse with signs of other skin pathologies, including those of an allergic nature. With psoriasis, edema on the skin is usually not present, but with allergic dermatitis, this is a common occurrence.

With the exception of severe forms of the disease, there are no specific systemic parameters, for example in blood tests, by which an unambiguous diagnosis can be made. In severe psoriasis, changes in the blood are observed that are characteristic of an intense inflammatory process (, increased ESR, etc.).

A skin biopsy may be performed to exclude other dermatological pathologies. Also, a biopsy reveals immaturity of keratocytes, an increased content of T-lymphocytes and macrophages in the skin. Increased fragility of blood vessels (Auspitz syndrome) is observed at the sites of injury.

It should also be borne in mind that there are forms of psoriasis that are not similar to vulgaris, such as drip, pustular and erythroderma. The patient can often take them for manifestations of allergies on the skin and be treated incorrectly. Nail psoriasis can be confused with fungal infections.

Psoriatic arthritis is similar to rheumatoid arthritis in many ways. However, when diagnosing rheumatoid arthritis, special tests are made, therefore, if their result is negative, then there is reason to suspect psoriatic arthritis.

When diagnosing psoriasis, the doctor identifies signs of the presence of the psoriatic triad:

• stearin stains,
• terminal film,
• spot bleeding.

This means that the surface of the skin plaques feels oily and similar to stearin. After removing the plaque, a thin and smooth film is observed under it, on the surface of which small drops of blood appear (“blood dew”).

Psoriasis in children

In children, this skin pathology is less common than in adults. However, the main manifestations in childhood are about the same as in adults. Localization of rashes in children - the skin of the knees, elbows, scalp. Treatment of the disease in children is basically the same as in adults. However, the systemic use of corticosteroids has to be abandoned, since they can cause irreparable harm to a growing organism.

Should psoriasis be treated?

Since psoriasis is not fatal, many patients do not always treat it with due attention. Moreover, as you know, it is not contagious, and the patient cannot infect others. But in fact, psoriasis is incurable. This is not furunculosis, which can go away on its own. And in the case of psoriasis, even the right treatment can not always guarantee the result.

And, nevertheless, the treatment of psoriasis is necessary - to reduce the severity of skin symptoms, to prevent complications, such as a generalized form. In the absence of treatment, each exacerbation will proceed more and more severely, an increasing surface of the skin will be involved in the inflammatory process. Remissions will occur less and less and, eventually, may disappear completely.

However, in addition to the possibility of complications, there is another circumstance. Many people with psoriasis experience discomfort with their appearance, fear of rejection, embarrassment or shame. These are not only subjective complexes of patients. After all, most people who are far from medicine, seeing, for example, some strange plaques on the scalp or on the hands of a person, will decide that he is sick with a contagious disease, and will not want to have anything to do with him, will not approach him, communicate and etc.

And this leads to a decrease in social activity, problems with personal life. The patient may be disturbed sleep, he loses the opportunity to engage in certain activities.

Treatment

Methods for a complete cure for psoriasis have not yet been developed. This is largely due to the fact that there is still no generally accepted theory of the etiology of the disease. Therefore, treatment is mainly symptomatic.

It has two main strategies - the fight against T-lymphocytes penetrating the skin and the fight against cytokines and other inflammatory mediators. In the treatment of simple psoriasis, the treatment designed to compensate for the lack of vitamin D in the body is recognized as the most effective. In particular, the use of cholecalciferol (vitamin D3) can bring the pathology into remission in 70% of patients.

Treatment includes both medications and non-pharmacological methods.

Which doctor to contact

Psoriasis is a disease treated by doctors of various specialties. First of all, this is a dermatologist - a specialist in skin diseases. You may also need to consult a neurologist, allergist, endocrinologist.

What criteria is guided by the doctor prescribing treatment:

• age and gender of the patient;
• whether the symptoms occurred for the first time, or there is an exacerbation;
• a form of psoriasis;
• the presence or absence of systemic symptoms (temperature, swollen lymph nodes, changes in blood parameters);
• the rate of progression of skin symptoms;
• localization of skin lesions;
• the duration of the illness;
• anamnesis;
• the general health of the patient;
• influence of professional factors.

Medications

Medicines used in the treatment of psoriasis are divided into two main groups: external and internal. External applied directly to the skin, to the area of ​​​​inflammation. Internal are taken orally or (in severe cases) are administered as injections.

The most commonly used medicines are:

• local anti-inflammatory drugs;
• skin moisturizing ointments;
• ointments that reduce skin peeling;
• systemic anti-inflammatory (glucocorticosteroid) drugs;
• cytostatic drugs (to reduce the rate of division of keratocytes);
• immunosuppressive agents;
• non-steroidal anti-inflammatory drugs (indomethacin, diclofenac).

Local funds

They are applied directly to the skin and act most quickly. There are three main forms of topical preparations - creams, gels and ointments.

Most often, ointments are used for psoriasis. Their active ingredients remain on the skin for a long time. For the treatment of psoriasis, ointments can be used to reduce peeling and inflammation. They contain substances such as:

• dithranol,
• salicylic acid,
• sulfur,
• urea.

Also in the treatment are used:

• naftalan ointment 5-10%,
• sulfur-tar ointment 5-10%,
• ointments with vitamin D.

Zinc ointment is also used for psoriasis. Effective for psoriasis and hydrogen peroxide, which is used in the form of compresses. Hydrogen peroxide is able to saturate skin tissues with oxygen.

Often, a bacterial or fungal infection can join psoriasis on the skin. In this case, it is best to use antibiotics and antifungal drugs.

There are also combined external preparations - for example, ointments containing GCS and salicylic acid.

Dithranol

In the treatment of psoriasis, skin ointments and creams based on dithranol - Psorax and Cygnoderm - are widely used. They have an anti-inflammatory effect. Treatment with these drugs is best done with a mild form. Apply the ointment to the skin 1-2 times a day. The ointment must also be used in short courses, as they can cause allergies.

Naftalan ointment

The composition of the ointment includes naftalan oil. It has an antiseptic, anti-inflammatory and analgesic effect, dilates peripheral vessels. Treatment with naphthalon ointment is used for regressive and stationary forms. The ointment helps to get rid of itching and inflammation on the skin.

Salicylic ointment

It has a softening and anti-inflammatory effect. The course of treatment with this ointment contributes to the speedy removal of skin flakes. Ointments of various concentrations are used - from 0.5% to 5%. The ointment is applied in a thin layer to the affected areas of the skin. Do not apply a thick layer of ointment to the skin if there is severe inflammation on it. Apply salicylic ointment can be 1-2 times a day.

Ointments based on glucocorticosteroid drugs

The most commonly used skin ointments are hydrocortisone, prednisone, and dexamethasone. The doctor should tell the patient which ointment to choose, since all GCS have different performance indicators, as well as the level of side effects. In 70% of cases, treatment with GCS-based ointments relieves itching and inflammation within 2 weeks. Ointments can be applied to the skin 2-3 times a day.

Popular skin hormonal ointments:

• flumethasone,
• triamcinolone,
• hydrocortisone.

Folk remedies and herbal medicines

Treatment with folk remedies is effective mainly for mild psoriasis. Folk remedies include linseed oil, birch tar, strawberry and celandine juice, egg ointment, meadowsweet root ointment, decoctions and infusions from:

• celandine,
• raspberries,
• series,
• chicory,
• cranberries,
• Hypericum.

Systemic therapy

The treatment of mild psoriasis is usually limited to topical and least toxic drugs. If this technique does not lead to success, then ultraviolet treatment is used. And systemic treatment with drugs taken by mouth is usually prescribed for skin lesions greater than 20% or for psoriatic arthritis.

Inside taken cytostatics, such as methotrexate. These funds are designed to stop the division of skin cells. They are prescribed for severe forms of psoriasis. Also inside (orally or parenterally) can be taken:

• retinoids,
• hormonal drugs,
• immunosuppressants (cyclosporine, timodepressin, efalizumab, alefacept),
• anti-cytokine drugs (infliximab, adalimumab, etanercept, ustekinumab),
• multivitamin complexes,
• calcium gluconate,
• antidepressants and tranquilizers.

When treating with certain drugs, for example, based on GCS, care should be taken, as an abrupt cessation of the course of treatment can lead to a withdrawal syndrome. At the same time, new manifestations of pathology may develop or old ones may intensify. Or a more severe form of psoriasis may develop.

Treatment with non-drug means

Of the non-drug treatments, physiotherapy is most widely used:

• irradiation with an ultraviolet lamp,
• electrosleep,
• radiotherapy,
• ultrasound therapy,
• cryotherapy (exposure to temperatures up to –160 °С),
• magnetotherapy,
• laser therapy.

Plasmaphoresis (blood purification) is also used.

Treatment with electrosleep is useful for strengthening the nervous system of the patient, stabilizing his psychological state. As already mentioned, nervous factors have a great influence on the development of psoriasis. And magnetotherapy helps to reduce skin itching, stabilizes the patient's psycho-emotional state, and stimulates regeneration processes.

Ultrasound treatment

This is a relatively new method of treatment, which gives good results with a mild form. For ultrasound treatment, oscillations with a frequency of 800-3000 kHz are used. A beam of ultrasonic waves is directed directly to the affected area. Ultrasound treatment helps to reduce inflammation, pain and itching.

Photochemotherapy

The method of photochemotherapy (PUVA) is effective. This is a method of treatment in which skin irradiation is combined with the use of drugs that increase sensitivity to light. Ultraviolet radiation improves immunity, improves metabolism and stimulates the production of vitamin D. The patient's skin is irradiated with UV radiation with a wavelength of 320 to 420 nm.

The duration of the course of treatment is 20-25 sessions. There are 3-4 sessions per week, so the full course of treatment takes 5-6 months. However, there are contraindications for PUVA therapy:

• acute infectious diseases,
• exacerbation of chronic pathologies,
• pathology of the cardiovascular system in a decompensated form,
• severe stage of diabetes,
• severe liver and kidney failure,
• tuberculosis,
• age up to 3 years.

Other types of non-drug treatment

Useful for the treatment of mud baths, swimming in the sea, sunbathing. It is especially useful to visit the Dead Sea resorts, which contain water with a unique composition of dissolved salts, which helps with psoriasis.

It is forbidden to stay in the sun for a long time only with a rare variety of psoriasis, in which ultraviolet rays lead to an exacerbation. Therefore, before starting UV therapy, it is necessary to consult a doctor.

Another exotic alternative treatment is fish therapy. The patient is placed in a pool inhabited by Garra rufa fish that feed on human psoriatic plaques. The rest of the human body is not touched by the fish. As a result, the patient gets rid of the manifestations of psoriasis vulgaris on the skin.

An additional method of treatment that helps to cope with depression and stress is psychotherapy.

diet therapy

Treatment also includes the selection of the right diet - a method that has shown high efficiency. The diet allows you to stimulate the body's defenses, improves the normal functioning of the gastrointestinal tract, rids the body of toxins, normalizes metabolism, which has a beneficial effect on the skin. Normalization of metabolism is very important, given that metabolic disorders play an important role in the development of psoriasis.

The Pegano Diet

It has gained great popularity, developed by John Pegano, author of the book "Treatment of psoriasis - the natural way." The essence of treatment using this method is to remove from the diet those foods that lead to increased acidity of the blood. Lowering the acidity of the blood, in turn, leads to a decrease in the number of antibodies.

What foods are alkaline?

• fruits (recommended apples, dates, apricots, oranges, peaches, raisins),
• berries (except for cranberries, currants, plums, grapes),
• vegetables (excluding legumes, pumpkin, potatoes, tomatoes, Brussels sprouts, peppers and eggplant),
• cereals (buckwheat, wheat, barley porridge, rice are recommended).

List of acid-forming foods:

• cream,
• meat,
• starch,
• sugar,
• oil.

This, of course, does not mean that products from the second group should not be eaten at all. It is just necessary to observe the correct proportion between the products of the first and second groups. 70-80% of the dishes should consist of alkaline-forming foods, and the rest - of acid-forming.

Therefore, the emphasis in this diet is on fresh vegetables and fruits. Recommended beets, carrots, spinach, zucchini, white cabbage, lettuce. Canned vegetables and fruits are undesirable, as is their intense heat treatment. You should also exclude fast food and semi-finished products from the menu.

In addition, the diet involves the consumption of a significant amount of water (up to 2 liters of pure water per day).

Fish can be consumed only low-fat varieties and only 4 times a week. From meat, chicken or turkey is preferable. It must be consumed 2-3 times a week. Milk can only be consumed skimmed. Soft-boiled eggs 2-3 per week are also allowed. Vegetable oil is consumed at the rate of 3 teaspoons per day.

Other nutritional guidelines

Vegetarian and paleo diets have also been shown to be highly effective in treating most forms of psoriasis. All diets agree that it is necessary to exclude fried and smoked dishes, foods containing dyes, preservatives, and fast carbohydrates from the menu.

It is undesirable to use chocolate, pepper, dishes containing vinegar. On the other hand, it is useful to use vegetable oils containing polyunsaturated fatty acids, cereals and other foods containing a large amount of vegetable fiber, vitamins, especially group B.

When choosing a diet, it is also important to consider that the body must be cleansed of toxins. To this end, the patient needs to drink as much clean water, tea and juices as possible.

Basic treatments for psoriasis

Forecast

The prognosis is conditionally unfavorable. This means that it is impossible to completely get rid of psoriasis. But if the treatment is carried out correctly, then it is possible to reduce the severity of symptoms and achieve stable remission, improve the quality of life of the patient. However, exacerbation can lead to temporary disability, and in severe cases - to disability.

Prevention

Anyone can get psoriasis. However, no one knows the exact causes of psoriasis. Does this mean that it is impossible to protect yourself from it? Of course no. First of all, the danger should be paid attention to those who have relatives with psoriasis. Such people are at risk. Also at risk are people who smoke, have diabetes, or have excessively dry skin.

People at risk are advised to monitor their health and skin condition, to avoid skin injury or injury. After all, pathology can develop even after applying a tattoo in a tattoo parlor. It is also important to follow the principles of proper nutrition, fight infections.

Secondary prevention is the prevention of relapse. This type of prevention is necessary in order to minimize measures to treat exacerbations. Secondary prevention includes skin care, a rational diet, stress management. To combat anxiety and depression, it is recommended to visit a psychotherapist.

clothing

You also need to pay attention to clothing. It should be selected in such a way as not to irritate the skin in the affected areas. Wear clothes made from natural fabrics that prevent excessive perspiration. Both extremely high and extremely low temperatures should be avoided.

Stress management

An important place in the secondary prevention of psoriasis should be occupied by the fight against stress. After all, about half of the cases of exacerbation of this skin pathology is associated with stressful situations. Therefore, it is necessary to pay attention to the improvement of the psycho-emotional state. Sports, walking, meditation, auto-training are well suited for this. But such methods of raising the mood, like tobacco and alcohol, are unacceptable, since, on the contrary, they can lead to an aggravation.

Refusal of uncontrolled medication

Many cases of exacerbation of psoriasis are caused by taking certain medications. Therefore, people prone to psoriasis should stop taking drugs uncontrolled. Before using unfamiliar drugs, you should read the instructions for them, since many drugs are contraindicated in case of illness or can exacerbate it.

alcohol for psoriasis

Alcohol is especially dangerous in psoriasis, both during the period of exacerbation and during remission. This is due to the fact that alcohol puts a lot of stress on the liver. Therefore, part of the task of removing toxins from the body takes on the skin. And this can lead to an aggravation. Also, alcohol disrupts metabolic processes in the body. But psoriasis is largely a metabolic disorder.

Nicotine and psoriasis

There is also a link between smoking and the development of psoriasis. It is well known that nicotine has a negative effect on the skin. For those who smoke from 1 to 14 cigarettes a day, the risk of developing this skin disease increases by 1.8 times, from 14 to 25 cigarettes - by 2 times, more than 25 cigarettes - by 2.3 times.

Hygiene procedures for psoriasis

Is it worth taking a bath if a person has psoriasis? Doctors say that it is undesirable to do this. It is best to wash under the shower. Such washing is certainly useful, as jets of water cleanse the skin of small scales of the epidermis. However, hot water should be avoided. For washing, you can not use a hard washcloth, a soft sponge that does not injure the skin is more suitable. As a detergent, it is better to use a shower gel with a neutral (not alkaline) reaction, rather than a bar soap. Wipe the body should also be careful, you can not rub with a towel. After water procedures, it is recommended to apply an emollient to the body.

During the progressive stage, when a lot of plaques appear on the skin, baths and saunas are prohibited.

Prevention of acute respiratory infections and influenza

Exacerbations are often associated with the flu. Therefore, measures to prevent or treat them are also an excellent way of secondary prevention. Ways to protect yourself from acute respiratory infections and influenza have long been known - do not catch a cold, engage in hardening and strengthening immunity.

Sports and fitness

Is it possible to play sports or fitness with psoriasis? This is not prohibited, moreover, such activities are more than desirable, as they restore health and strengthen the psycho-emotional background of the patient. The only thing is that it is recommended to avoid such activities in the progressive stage, since due to profuse sweating, the number of psoriatic plaques on the skin may increase.

Sunbathing

You can also sunbathe on the beach, naturally avoiding sunburn on the skin. In most patients, ultraviolet rays and sunbathing help reduce the number of exacerbations, contribute to the production of vitamin D, which is useful for strengthening the nervous system. However, there is a small category of patients (approximately 5-20%) for whom tanning is contraindicated, as it leads to an exacerbation of symptoms. This type of psoriasis is called photosensitivity. Also, all patients are not recommended to sunbathe in standard solariums, since the lamps used there can negatively affect the skin, and are not intended for the treatment of skin pathologies. For treatment, special lamps are used, in which the optimal parameters for the intensity and length of UV waves are selected.

Nail care

Nail care is also important. They must be cut short. Long nails can severely injure the skin when combing sores. And when the nails are damaged, care for them becomes mandatory. After all, any injury to the nail can lead to the fact that it can crumble or come off the finger.

Skin care

You should also protect the skin from injuries and cuts. When working with chemically aggressive substances that can cause skin burns or dermatitis, gloves must be worn. Exposure to air-conditioned air should also be avoided, as air conditioners tend to dry out the air, which can be detrimental to the skin. Instead of air conditioning, it is better to use humidifiers.

Diet as a prophylactic

Another method of prevention is the right diet. A patient with psoriasis-affected skin during remission should avoid eating too fatty, fried, salty, smoked and pickled foods, drink more fluids (at least 2 liters per day). You should consume a large amount of vegetables and fruits, dairy products. The method of cooking also matters. It is best to steam or boil rather than fry.

In this article, we will describe in detail the causes of psoriasis. Knowing them is extremely important, because it is by getting rid of the causes of the disease that one can achieve recovery.

We will look at the causes of psoriasis using scientific evidence and medical research data. But we will be interested not only in the theoretical side of the issue. First of all, the practical applicability of this information is important for us.

Our goal is to help you determine the causes of psoriasis in your particular case. And, therefore, to understand, by influencing what factors, you can achieve an improvement in your condition and recovery.

There are different points of view on what psoriasis is. Anyway

Psoriasis occurs as a result of exposure to various external and internal causes.

The disease manifests itself if the combination of external factors and internal mechanisms exceeds a certain individual threshold. As a result, autoimmune processes are activated in the body (an immune reaction against its own cells) and characteristic manifestations of the disease occur.

• External causes are lifestyle and environmental factors that provoke the onset of psoriasis or lead to its exacerbation.
• The main intrinsic cause of psoriasis is a genetic predisposition. These are the genes we inherit from our parents. Genes determine the innate properties of the body, which are also involved in the development of psoriasis. These include, for example, features of hormonal metabolism or the body's immune system.

There is no one single reason for the development of psoriasis. Disease occurs as a result of a combination of internal and many external causes.

Approaches to psoriasis: eliminate symptoms or causes?

Consider possible approaches to the problem of psoriasis.

It is extremely difficult to eliminate the internal causes of psoriasis, since medicine has not yet learned how to influence the patient's genes.

At the same time, the external causes of psoriasis can be eliminated. It is thanks to the impact on them that it is possible to achieve a stable remission. That is why it is so important to pay attention to them.

All external causes of psoriasis are united by two important factors:

• the influence of these external causes on the development of psoriasis is scientifically confirmed;
• the impact on external causes is devoid of adverse effects and has many advantages.

Therefore, the elimination of external causes that led to the appearance of psoriasis is the most effective and at the same time the safest way to get rid of the disease.

Benefits of Dealing with External Causes of Psoriasis

Consider the benefits of exposure to external factors leading to disease:

• stable result: due to the elimination of external causes due to which psoriasis arose, a stable remission of the disease is achieved;
• medicines are not used;
• there are no complications and side effects that occur due to drugs;
• there is no addiction to therapy, as happens with drugs, when in order to obtain a previously achieved effect, it is necessary to increase their dosage;
• no need to go to the hospital;
• does not require large financial costs, on the contrary, money and time are saved;
• there is a general healing effect.

The key aspects of working with external causes are to identify provocateurs in your particular case and eliminate them.

Problems of the medical approach to psoriasis

Official medicine is mainly focused not on eliminating the causes, but on a quick impact on the manifestations of the disease.

But, unfortunately, this approach has its drawbacks and helps only temporarily. In addition, it often leads to side effects, and after the cessation of exposure, psoriasis returns or even worsens.

Both doctors and patients often do not pay due attention to the external causes of the disease.

For this, patients have their own reasons:

• Eliminating the external causes of psoriasis will require completely different efforts from the patient. After all, it is much easier to take a pill than to follow a diet, give up alcohol or quit smoking.
• Patients are not aware of all the disadvantages of drugs.
• Patients do not understand that with the help of drugs only the external manifestations of the disease can be eliminated, and then only for a while.
• Patients are not aware of effective alternative methods.

Also, doctors have their own reasons to eliminate not the external causes of psoriasis, but only its external manifestations:

• Such an approach would also require other efforts from the specialist. After all, it is much easier and faster for a doctor to write a prescription for a hormonal ointment than to convince the patient to eat right, stop smoking and learn how to cope with stress.
• Doctors are overloaded with work: they have a large flow of patients and limited time to see one patient.
• Doctors, as a rule, are not told about the external causes of psoriasis in universities and educational courses, paying attention mainly to the use of pills and hormonal ointments.

Thus, official medicine is still mainly focused only on the elimination of external manifestations of psoriasis. Therefore, it is important for patients to independently take steps in working with external causes.

Impact on external causes does not require drugs. Therefore, it does not entail the difficulties that arise when trying to get rid of the manifestations of psoriasis with the help of drugs. And at the same time, the elimination of external causes can lead to a stable remission.

Because it is important to address the external causes of psoriasis in the first place, in this article we will focus on the external triggers and only briefly look at the internal ones.

IMPORTANT CONCLUSIONS AND WHAT TO DO

• Psoriasis manifests itself as a result of exposure to internal and external causes.
• It is almost impossible to influence the internal causes of psoriasis.
• External causes of psoriasis can be eliminated.
• Working with external causes can lead to persistent remission of psoriasis.
• Impact on external causes is devoid of disadvantages and has many advantages.
• The approach of official medicine allows only temporarily eliminating the manifestations of psoriasis. However, this can lead to side effects, and after the withdrawal of exposure, psoriasis reappears.
• The best way to get rid of psoriasis is to identify its external causes in your particular case and eliminate them.

External causes of psoriasis

The main external causes leading to the occurrence of psoriasis include the following. Skin injuries, malnutrition, stress, alcohol, tobacco, infections, and the use of certain drugs.

Below we consider each of these main external factors that provoke the onset or exacerbation of psoriasis.

Skin injury

Psoriasis is directly related to skin damage.

Injury can provoke an exacerbation or the appearance of new rashes where they were not there before.

This phenomenon is called the Koebner reaction.

Any damage to the skin can lead to this reaction. For example, cuts, insect bites, skin infections, surgery, tattoos.

IMPORTANT CONCLUSIONS and WHAT TO DO:
SKIN INJURIES

Take care and protect your skin!

• Use products to moisturize and nourish it.
• Be careful with household chemicals: always use gloves when working, especially if you suffer from allergies.
• Sunburn is also an injury, in no case do not burn in the sun.
• Deal with skin problems of an infectious nature. Maintain hygiene.
• Do not tease cats and dogs, they may scratch or bite.
• Before getting a tattoo or piercing, weigh the pros and cons.

Diet, obesity and leaky gut

There are two points of view on the relationship between the patient's nutrition, the state of his gastrointestinal tract and psoriasis. One is the point of view of official medicine, the other is the point of view of alternative, or alternative, medicine.

The point of view of official medicine

Official medical science almost does not study the direct impact of nutrition and the state of the digestive system on the onset and development of psoriasis. And at the same time, he considers such a connection unproven. Few scientific articles have been published on this topic. Perhaps this is due to the prevailing practice in mainstream medicine of solving problems with drugs, rather than natural methods and prevention.

However, the association between being overweight and the severity and susceptibility of psoriasis to standard therapy has been extensively researched.

Psoriasis is often associated with obesity

It was found that

among patients with psoriasis, obesity is common: 1.7 times more common than among people without psoriasis.

For example, in one clinical study among 10,000 patients with moderate to severe psoriasis, the body mass index was 30.6 kg/m 2 on average (grade 1 obesity starts at 30).

Also, the severity of psoriasis is directly related to the frequency of obesity:

• With a mild form of psoriasis - with a lesion<2% кожи — ожирение встречалось у 14% больных.
• With moderate psoriasis - from 3 to 10% of the skin is affected - in 34% of patients.
• In severe psoriasis—>10% of the skin affected—obesity occurred in 66% of cases.

In children, the same pattern was found: the more severe the psoriasis, the more often obesity occurs.

Interaction between obesity and psoriasis

There is a two-way relationship between psoriasis and being overweight.

On the one hand, obesity itself is a factor that increases the risk of developing psoriasis. For example, the relative risk of developing psoriasis in girls aged 18 with a body mass index of more than 30 (from 30 obesity of the 1st degree begins) is 1.7 times higher than in girls of the same age with a body mass index of 21 to 22.9 (normal weight bodies).

On the other hand, psoriasis as a psychosocial problem itself can lead to weight gain due to the “jamming” of the problem.

Excess weight reduces the effectiveness of the impact on psoriasis

Scientists have found an inverse relationship between obesity and the outcome of standard and biological therapies: their effectiveness in obese patients was lower. For example, this has been found with ustekinumab.

And with weight loss, susceptibility, for example, to Cyclosporine, on the contrary, improved.

Low-calorie diet and weight loss relieve psoriasis

It is believed that the increased permeability of the intestinal wall can also lead to the development of other diseases, including autoimmune diseases. For example, to rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, Crohn's disease, ulcerative colitis, diabetes, chronic fatigue syndrome, autism and others.

Official science recognizes the presence of such a pathology as increased intestinal permeability. However, the fact that the "leaky gut syndrome" directly causes the diseases listed above is considered unproven. And he regards all the arguments on this score as a way to increase sales of probiotics, nutritional supplements, herbal remedies and the like, the effectiveness of which has not been studied and also not proven.

Causes of Leaky Gut Syndrome

The very occurrence of leaky gut syndrome is provoked by:

• irrational or unhealthy diet:
  • alcohol,
  • caffeinated drinks (coffee, tea, cola, energy drinks, etc.)
  • fast food and semi-finished products containing preservatives, dyes, flavorings, etc.,
  • foods high in sugar, fat, white flour, gluten, and the like;
• certain types of products - nightshade, which include, for example, tomatoes and potatoes;
• dysbacteriosis, including due to the irrational use of antibiotics;
• insufficient water intake (the norm for a person weighing 70 kg is at least 2 liters of clean water per day);
• chronic constipation;
• stress;
• heredity;
• diseases of the spine with displacement of the vertebrae and infringement of the nerves leading to the intestines.

How to Repair a Leaky Gut

The main method of recovery is to stop eating food containing potential.

Thanks to this, the barrier function of the intestine will quickly recover.

Official medicine considers this method unproven. However, she also acknowledges that normalization of weight has a positive effect on skin condition. A low-calorie, but complete diet is an important condition for defeating psoriasis.

The study is the subject of the only review study published in a scientific journal in 2017. According to this study, it is important to avoid foods that trigger psoriasis. And at the same time, bring plenty of fiber-rich fruits and vegetables into the diet, preferring organically grown foods. Take probiotics, vitamin D, OMEGA-3 fatty acids and follow special diets.

Possible Difficulties in Repairing a Leaky Gut

Elimination of leaky gut syndrome can be accompanied by some difficulties. However, they are mostly psychological in nature and are largely related to our unwillingness to limit ourselves in the usual way of eating and change food preferences. In addition, you may encounter misunderstanding and lack of support from relatives, friends and doctors who do not know and do not understand this approach.

In these cases, it is important to remember that avoiding unhealthy foods will go a long way in resolving psoriasis problems. You can help yourself by developing the determination to follow your chosen diet until you recover.

IMPORTANT CONCLUSIONS and WHAT TO DO:
OBESITY, NUTRITION, AND A LEAKY GUN

• What we eat is directly related to the condition of our skin.
• By following a therapeutic diet and some additional conditions, you can completely get rid of psoriasis.
• Not only to get rid of psoriasis, but also to normalize weight and metabolism will help a full-fledged low-calorie - vegan diet, paleo diet or Pegano diet.
• Avoid psoriasis-provoking foods, processed foods, fast food, baked goods, and sugary sodas.
• Make sure that there is no lack of vitamins and trace elements, if necessary, take them additionally.
• Eat more fruits and vegetables, drink more plain water.

Stress

The occurrence of psoriasis on the nerves is confirmed by scientific data. Moreover, stress can become both a cause of the development of psoriasis and its consequence.

Back in the 70s of the last century, it was found that stress preceded the exacerbation of psoriasis in 40% of patients. Also, more than 60% of patients believe that stress has become the main reason for its development.

In another study of 5,000 patients

40% of those surveyed reported that psoriasis first appeared on the background of anxiety. And 37% noted its aggravation against this background.

In children, the recurrence of psoriasis in 90% of cases is associated with previous stress.

IMPORTANT CONCLUSIONS and WHAT TO DO:
STRESS

• Psoriasis is triggered by stress and generates stress itself.
• Find relaxation and stress management techniques that work for you.
• Opt for natural ways to deal with stress: yoga, meditation, cognitive behavioral therapy, walking, and physical activity.
• To relieve stress, do not resort to various harmful substances, such as alcohol, tobacco, as well as excessive and unhealthy food. Firstly, they themselves can provoke psoriasis, and secondly, they lead to additional health problems.
• In severe depression, it is imperative to seek the advice of a doctor and strictly adhere to the medication prescribed by him.

Alcohol

There is a strong direct relationship between alcohol and the risk of developing psoriasis.

However, the mechanism of the relationship between psoriasis and alcohol has not been fully elucidated. Alcohol increases the toxic load on the liver. Because of this, the skin takes over part of the function of removing toxins.

Also, alcohol leads to metabolic disorders: insufficient absorption of proteins, vitamins and trace elements. This deprives the body, including the skin, of its normal ability to recover.

Scientific evidence confirms that among those suffering from psoriasis, alcohol consumption is more common than among healthy people. Also, with alcohol abuse, psoriasis loses its seasonality and proceeds in a more severe form. This increases the area of ​​the affected skin up to the development of psoriatic erythroderma.

Also often psoriasis occurs in patients with alcoholic liver disease - hepatitis or cirrhosis.

IMPORTANT CONCLUSIONS and WHAT TO DO:
ALCOHOL

• The more often and in greater quantities the patient consumes alcohol, the more active and severe the manifestations of psoriasis.
• The best possible solution is to give up all types of alcohol completely.
• If it is not possible to completely give up alcohol, try to reduce its use to a minimum. However, it should be borne in mind that each use of alcohol can provoke an exacerbation.

Smoking

The greater prevalence of psoriasis among smokers compared to non-smokers is undeniable.

The risk of developing psoriasis and its severity in smokers is significantly higher than in non-smokers ="">

Smokers are much more likely to develop psoriasis than non-smokers.

It has been proven that:

• Those who smoke from 1 to 14 cigarettes per day have a 1.8-fold increased risk;
• From 15 to 24 cigarettes per day - 2 times;
• From 25 cigarettes and more - 2.3 times.

Smoking also directly affects the severity of psoriasis and increases the risk of developing psoriatic arthritis.

Those who quit smoking have a 1.4 times higher risk of developing psoriasis than non-smokers. However, it gradually decreases with an increase in the duration of smoking cessation. And after 20 years, the risks for quitters and never smokers become equal.

IMPORTANT CONCLUSIONS and WHAT TO DO:
SMOKING

• Smoking and psoriasis are mutually supportive phenomena, because for some smoking helps to cope with the psychological problems that accompany psoriasis.
• Unfortunately, quitting smoking is just as difficult as quitting alcohol. But the data of scientific research convince that it is necessary to do this.

infections

Psoriasis is not an infectious disease and. However, infections often provoke the appearance of psoriasis or cause its exacerbation.

This has been confirmed by many studies.

Streptococcus

Streptococcus is a bacterium that lives in the mouth and nose. It is one of the most common causes of angina (inflammation of the tonsils or acute tonsillitis).

As early as the beginning of the 20th century, a connection was established between guttate psoriasis and tonsillitis, which was confirmed by further research. So, in 85% of patients with guttate psoriasis, antibodies (Antistreptolysin-O) are detected, produced by the immune system to fight streptococcus.

It is believed that streptococcus is responsible for the appearance of point (teardrop-shaped) rashes in patients with chronic plaque psoriasis. It also exacerbates other forms of psoriasis, including psoriatic arthritis.

In 63% of patients with psoriasis, a previous streptococcal pharyngitis (sore throat) was detected.

And in half of the children with psoriasis, two weeks after pharyngitis, exacerbation of psoriatic rashes was noted.

Also, the connection between infection and psoriasis confirms the presence of the same immune defense cells (T-lymphocytes) in the tonsils, psoriatic plaques and in the blood of patients with psoriasis.

Why streptococcus provokes psoriasis

Streptococci inside the tonsils are inaccessible to antibiotics and immune system defense mechanisms. Streptococci produce M-protein - a protein similar to the protein of normal skin cells - keratinocytes. Cells of the immune system detect an M-protein-like protein on the surface of keratinocytes and start an immune reaction against their own cells - an autoimmune process.

There is information that the removal of the palatine tonsils (tonsillectomy) and the use of antibiotics can bring a positive effect in the case of guttate psoriasis. But data from different studies are contradictory. Therefore, it is hardly possible to speak unambiguously about the positive effect of removing the tonsils. Tonsil problems are best treated without surgical methods, such as yoga and the lion pose or tempering.

HIV infection

An important provocateur of psoriasis is the human immunodeficiency virus (HIV, AIDS - the final stage of HIV infection). Among HIV carriers, psoriasis occurs in 5% of cases.

HIV is suspected in a patient if the psoriasis is frequently aggravated and resistant to conventional or biological agents. Also, another signal can serve as a sharp onset of guttate psoriasis.

Other infections

Also, exacerbation of psoriasis can provoke other infections, for example:

• herpes simplex and varicella viruses,
• cytomegalovirus,
• parvovirus B19,
• staphylococci,
• candida,
• helicobacter pylori,
• malassesia,
• Yersinia (may cause psoriatic arthritis).

IMPORTANT CONCLUSIONS and WHAT TO DO:
INFECTIONS

• Don't get cold!
• Treat throat problems with preventive and natural methods such as yoga.
• Protect yourself from potential sources of infection.
• Get fit and move more!
• Live a healthy lifestyle, eat more fruits and vegetables, and take a quality multivitamin.

Medicinal provocateurs

Medicines can lead to the onset of psoriasis or exacerbate it.

Most often, the following drugs can lead to this:

• non-steroidal anti-inflammatory drugs (NSAIDs) - used as pain relievers, antipyretics and anti-inflammatory drugs;
• hormonal agents - are used as anti-inflammatory and immunomodulatory agents;
• beta-blockers and angiotensin-converting enzyme inhibitors (ACE inhibitors) - to lower blood pressure;
• tetracyclines - broad-spectrum antibiotics;
• lithium preparations - used in psychiatry to stabilize mood;
• antimalarials - for the prevention and control of malaria;
• interferon alpha (IF-alpha) - an antiviral agent;
• Tumor necrosis factor-alpha (TNF-alpha) inhibitors - have an anti-inflammatory immune-suppressing effect. Used for autoimmune diseases such as rheumatoid arthritis and Crohn's disease.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world. Some studies have reported an association between them and exacerbation of psoriasis, for example, with the use of indomethacin. Although this relationship was not further confirmed, caution should be exercised with drugs in this group.

Hormonal remedies

The problem of the use of hormonal agents deserves separate consideration. After all, they are often the first drugs prescribed for psoriasis by a doctor.

In this article, we will only briefly touch on some of the adverse effects.

For example, the abrupt withdrawal of these drugs can provoke the development of a pustular form against the background of already existing plaque psoriasis.

An abrupt cessation of the use of corticosteroids - hormones produced by the adrenal cortex - can cause a withdrawal syndrome: an increase in old or the appearance of new foci of psoriasis.

There may also be a rapid decrease in the effect with repeated use of corticosteroids (tachyphylaxis).

Medicines for hypertension

An association between psoriasis and blood pressure lowering drugs, such as beta-blockers and angiotensin-converting enzyme (ACE) inhibitors, has been previously reported. Although later this information was not confirmed, caution should be exercised.

Tetracycline antibiotics

These antibiotics are used for streptococcal infections - one of the factors that provoke psoriasis. Information about the possibility of antibiotics themselves to provoke psoriasis is contradictory. However, for example, the concentration of tetracycline in the area of ​​psoriatic rashes is higher than in intact skin. Also, tetracycline has a photosensitizing effect, that is, it increases the sensitivity of the skin to ultraviolet radiation. And this can lead to the appearance of the Koebner phenomenon and the appearance of psoriatic plaques.

Lithium preparations

Lithium salts have been used in psychiatry since the middle of the last century for the prevention and elimination of bipolar disorders and severe depressions refractory to conventional therapy. It is believed that lithium disrupts the maturation (in medical language - differentiation) of skin cells - keratinocytes, which can provoke psoriasis or exacerbate it.

Antimalarial drugs

These drugs interfere with the immune system, which can cause an exacerbation of psoriasis or its primary appearance. Due to the side effects of antimalarial drugs - chloroquine and hydroxychloroquine - inflammation of the skin (dermatitis), discoloration of the skin and mucous membranes, hair loss can develop. With the use of hydroxychloroquine, the development of psoriatic erythroderma, a lesion of more than 90% of the skin, has been reported.

Interferon-alpha

Exacerbation of psoriasis has been frequently reported with the use of interferon-alpha in patients with hepatitis C and multiple sclerosis. Such exacerbations are usually amenable to conventional medical treatments for psoriasis and do not require withdrawal of interferon.

Tumor necrosis factor-alpha inhibitors

Tumor necrosis factor inhibitors - drugs Remicade, Enbrel and Humira - are also prescribed for psoriasis. However, scientific articles describe cases when their use, on the contrary, led to an exacerbation of psoriasis or the appearance of its new foci on previously unaffected skin.

IMPORTANT CONCLUSIONS and WHAT TO DO:
MEDICATIONS

And the sun too?! Photosensitive summer psoriasis

The sun is essential for health. For example, for the synthesis of vitamin D, the lack of which is associated with the development of depression in the northern hemisphere.

In most patients with psoriasis, the skin condition improves with exposure to sunlight.

However, in 5-20% of cases there is a so-called photosensitivity psoriasis, the condition of which worsens under the influence of the sun.

The disease occurs, as a rule, at an early age in families with a pre-existing history of psoriasis and a clear genetic predisposition - this is the so-called type 1 psoriasis. Usually women suffer from it.

Such psoriasis is also called summer psoriasis, as it manifests itself primarily in summer, and subsides in autumn and winter. It was associated with the development of the Koebner effect after sunburn, but this assumption was not confirmed.

Summer psoriasis occurs only when the skin is exposed to broadband ultraviolet type A. At the same time, the appearance of external manifestations of psoriasis takes several days after exposure to sunlight. Apparently, under the influence of ultraviolet radiation, previously hidden violations of susceptibility to the sun appear.

IMPORTANT CONCLUSIONS and WHAT TO DO:
SUN

• Sunbathe gently without burning.
• The UV in commercial tanning beds is not the type of UV needed for psoriasis. Although it can improve the condition of the skin.

Internal causes of psoriasis

The internal causes of psoriasis include genetic predisposition. Genes, in turn, determine the characteristics of immunity and hormonal metabolism, which also affect the occurrence of psoriasis.

We will dwell on the genetic and immune causes of psoriasis in detail in separate articles, but here we will talk about them only briefly.

genetic predisposition

Genetic predisposition is a change in the genes that are observed in psoriasis or contribute to its development.

In 70% of cases of psoriasis in children, it is possible to detect a family history of the disease, that is, the mother or father of the child suffers from psoriasis.

If in a pair of identical twins with the same genes (monozygous twins) one suffers from psoriasis, then the risk of developing the disease in the second is 70%. If twins have half the same genes (dizygotic), the risk is 23%.

No single mutation has been found that would lead to psoriasis in 100% of cases. However, in the 1970s, Finnish researchers first discovered a region on the sixth chromosome (locus) called PSORS1.

This locus was found in 73% of guttate psoriasis and 46% of psoriasis vulgaris. The locus contains several genes associated with the immune system. These genes encode proteins, the increased content of which is found in the skin with psoriasis.

Prospects and problems of the genetic approach

The study of genes should help in understanding the causes of psoriasis and the choice of therapy. Thus, pharmacogenomics, a discipline at the intersection of genetics and pharmacology, explains the difference in the results of using the same methods of therapy in different patients.

This has been proven with coal tar, vitamin D3, ultraviolet light, and immune-suppressing drugs. According to the results of this study, it turned out that patients with different genes reacted differently to the same drugs.

However, genetic analysis explains only 20% of psoriasis cases. Moreover, each of the many genes found is only partially responsible for the risk of developing the disease.

In total, more than 50 chromosome regions (loci) associated with an increased risk of developing psoriasis have been identified.

However, the very mechanism of the influence of genes on the development of psoriasis remains unknown.

Since the relationship between genes and psoriasis was established statistically in the processing of a large number of genetic studies of patients with psoriasis.

Unfortunately, for the real application of pharmacogenomics, there is still not enough verified information, and the results of studies are contradictory. In addition, genetic research methods are still too expensive.

Perhaps in the future, choosing the “right” methods for a particular patient and turning off the “wrong” genes will become commonplace. But for now, this approach is more applicable in scientific research.

Immune pathways for the development of psoriasis

The immune system is a system of organs and cells to protect the body from external pathogens (for example, bacteria, viruses or helminths), as well as from its own cells that have mutated into tumor cells.

Simply explaining how autoimmune inflammation develops in psoriasis is hardly a feasible task. Indeed, this process involves many different types of cells of the immune system (T and B lymphocytes and their many varieties, dendritic cells, etc.), skin cells (keratinocytes) and chemicals that transmit signals between cells (cytokines).

In a nutshell, then

in response to the influence of external provoking factors, excessive activation of the immune system occurs, which ultimately leads to the onset of psoriasis.

It happens like this. Immune cells migrate to the zone of influence of the provoking factor, and inflammation develops in it. The most numerous skin cells - keratinocytes - respond to stimulating signals from the immune system with accelerated division with the formation of psoriatic plaques. Also, keratinocytes produce cytokines, which in turn further stimulate the immune system. In the area of ​​inflammation and thickening of the skin, new blood vessels begin to form. A vicious circle of self-perpetuating inflammation is formed. All this leads to the appearance of reddish and silvery-white plaques raised above the skin - the main manifestation of psoriasis on the skin.

Influence of the hormonal system

Psoriasis can be triggered by changes in the hormonal system of women.

Evidence of this is the frequent appearance of the first manifestations of psoriasis during puberty in girls.

Female sex hormones - estrogens - provocateurs or defenders?

In some women, an increase in the level of female sex hormones - estrogens - provokes the development of psoriasis. This is confirmed by research data on the occurrence of psoriasis at a certain time:

• during puberty in girls due to an increase in estrogen activity,
• when using estrogens as medicines,
• during certain phases of the menstrual cycle, when estrogen levels rise.

Other studies have found that in some women, psoriasis, on the contrary, worsens with the onset of menopause, that is, with a decrease in hormonal activity and a drop in estrogen levels.

Thus, the relationship between the level of female sex hormones and psoriasis can be traced, but not completely unambiguous. Psoriasis can worsen both with an increase in estrogen levels and with its decrease.

Pregnancy and psoriasis

The behavior of psoriasis during pregnancy cannot be predicted.

About a third of pregnant women complain of exacerbation of psoriasis. However, twice as many women experienced an improvement in skin condition during pregnancy. Why skin condition may improve during pregnancy is not fully understood, but scientists believe it is due to exposure to anti-inflammatory cytokines.

Unfortunately, usually after childbirth, psoriasis returns to its previous state.

CONCLUSION and CONCLUSIONS

• In the fight against psoriasis, special attention should be paid to eliminating its external causes.
• Compared with drugs that suppress the internal mechanisms of psoriasis, the impact on external causes is devoid of adverse effects and has many advantages.
• It is not necessary to act on all causes at once. Study the main causes of psoriasis, evaluate which ones are especially important in your case and start by eliminating them. But remember that the most positive result will bring the elimination of all external causes.

WHAT TO DO

• Follow your diet and drinking regimen. Give preference to vegetables and fruits, avoiding processed foods, caffeinated drinks, as well as fatty, starchy foods and sweets.
• Protect your skin from injury.
• Give up smoking and alcohol.
• Do not abuse drugs.
• Maintain immunity and prevent infections.
• Find ways to deal with stress that work for you.

Your recovery is in your hands!

• If the article was useful to you, share it with those who can benefit from it too.
  And in the comments to the article, you can share your experience and thereby help other readers.
  Thanks a lot! We appreciate your attention!

Officially, there is no such thing as internal psoriasis in medicine. But with the development of skin psoriasis, not only skin tissues, but also internal organs can be affected. If you follow all the recommendations of the doctor, then the disease can be cured, and there will be no internal manifestations.

Causes

Psoriasis of internal organs can develop as a result of a violation of biochemical processes in the body. The disease is often caused by factors such as severe stress, radiation, various pathologies, poor environmental conditions,.

Cases have been recorded when dermatosis developed during pregnancy or after childbirth. The disease is worse tolerated after 60 years. In middle-aged people, psoriasis is milder and faster to treat.

Psoriatic lesions on the skin can develop under the influence of any circumstances, and the internal manifestations of psoriasis are concomitant.

Until now, the exact causes of the development of pathology have not been established.

The effect of psoriasis on internal organs

Psoriasis of the internal organs can lead to disability and death, so it is necessary to start treatment as early as possible.

The cardiovascular system

It has been established that there is a connection between the development of skin pathology and malfunctions of the cardiovascular system. Due to metabolic disorders and weakening of the liver, the level of bad cholesterol rises, and this gives impetus to the development of atherosclerosis and hypertension.

Signs and symptoms that occur with complications that affect the functioning of the heart and the condition of the vessels:

Timely treatment of the disease can improve the functioning of the cardiovascular system.

Liver

With a long course of psoriasis, the condition of the liver worsens, the organ does not perform its functions in full, as a result of which it can increase in size. There is a risk of liver failure.

Symptoms of the influence of psoriasis on the body:

kidneys

When as a complication, renal failure may develop. If a person has extensive rashes caused by pathology, then there are risks of chronic kidney disease. With psoriatic lesions of the skin surface of more than 3%, it is necessary to undergo an examination, identify kidney pathologies in time and take urgent measures by starting treatment.

Intestinal psoriasis

With the development of the inflammatory process, gastritis and peptic ulcer in the intestine become aggravated. There is a thickening of the gastric mucosa with areas of atrophy, in place of which ulcers subsequently form, and this leads to the development of gastric bleeding. Based on this, the patient may develop metabolic syndrome, Crohn's disease or stomach cancer.

Symptoms of the development of pathology in the gastrointestinal tract:

• frequent bouts of heartburn;
• the appearance of nausea and vomiting;
• severe pain in the epigastrium;
• violation of the stool (constipation, diarrhea);
• increase or decrease in secretion of gastric juice;
• decreased or complete loss of appetite.

Gastric and duodenal ulcers, gastritis, colitis and other diseases of the intestines and stomach slow down the treatment of psoriasis. This is especially the case with complex forms of the disease - erythroderma and exudative psoriasis. Not always signs of abnormalities developing in the intestines are pronounced. A patient suffering from psoriasis should be examined by a gastroenterologist to identify problems with the digestive system.

joints

In people with psoriasis, skin lesions precede the development of joint pathology -. But in 15% of patients, this problem appears before the formation of lesions on the skin.

The disease can develop gradually or rapidly. The following symptoms appear:

In psoriasis, dactylitis is often manifested - the result of inflammation of the tendons and cartilaginous surfaces of the joints, accompanied by the following symptoms:

• severe pain;
• development of edema of the finger, the joints of which have psoriatic changes;
• limitation of mobility associated with joint deformity and pain when it is flexed.

In articular psoriasis, the ligaments are damaged at the site of their attachment to the bones, accompanied by inflammation and subsequent destruction of the bone tissue.

Psoriatic arthritis often affects the nails. At the beginning of the process, pits or grooves form on the nail, then its color changes, and the surface is deformed.

Psoriasis of the joints cannot be cured, but there are methods that reduce the manifestations of the disease. To relieve inflammation, glucocorticosteroids and nonsteroidal agents are prescribed.

In severe cases, a surgical operation is performed to remove the affected tissues or replace the destroyed joint.

Lungs

Psoriasis of the lungs leads to disturbances in the functioning of the respiratory system. In the tissues of the organ, inflammation develops, provoked by the skin form of the disease. Problems with the heart and blood vessels impede the blood supply to the lungs and bronchi, stagnant processes appear, leading to the formation of sputum.

Constant cough and shortness of breath occur not only at night, attacks torment the patient at any time of the day. Timely treatment is necessary, because due to malfunctions in the respiratory system, oxygen supply to the body is disrupted, and tissues begin to receive nutrients in small quantities.

Improper treatment or lack of it can lead to the death of the patient.

Nervous system

Psoriasis affects the human nervous system. The patient begins to manifest encephalopathy, the brain is affected, seizures of epilepsy begin, delirium. Muscle weakness and atrophy develops, and this causes rapid weight loss. Due to inflammatory processes, the lymph nodes in the thighs and groin are enlarged.

The patient experiences stress due to the hostile attitude of others, as a result of which depression, apathy and social phobia may develop.

To relieve nervous tension, sedatives are prescribed. Traditional medicine recommends infusions and teas from herbs such as valerian, motherwort, chamomile, etc. But before taking any remedy, you need to find out if a person is allergic to the components. In psoriasis, an allergic reaction can complicate the course of the pathology.

Conclusion

Psoriasis is an autoimmune disease that affects the entire body and can cause severe consequences. It cannot be completely cured, but with the right choice of means and methods of treatment, it is possible to achieve an increase in remission periods. Forms of psoriasis and the stage of the disease also affect the outcome of treatment.

The patient should not be in constant stress, because nervous tension causes an exacerbation of the disease. The consequences of psoriasis of the internal organs can threaten a person's life.

Psoriasis is a chronic skin disease with an unknown cause that causes red, scaly patches to appear on the skin.

Treatment is carried out by a dermatologist.
Synonym - scaly deprive.
ICD 10 code: L40. According to the international classification, it refers to papulosquamous skin diseases.

Psoriasis as a disease has been studied for about 200 years. Prior to this period, such patients were considered to have leprosy and were treated accordingly as lepers. Difference: leprosy (leprosy) is an infectious disease (pathogen - Mycobacterium leprae). Psoriasis is non-infectious.

The reasons

The etiology (cause) of psoriasis is not known!!!

To begin with, I will talk about the pathogenesis (development mechanism) of the disease, and then I will talk about the possible causes.

The pathogenesis of psoriasis:

1. Cells of the surface layer of the skin (epidermis) - keratinocytes begin to multiply intensively. Their number increases several times. Their life cycle is shortened, that is, they are covered with scales much earlier than normal skin cells. Externally, this process is manifested by thickening and reddening of the skin, the surface of which is also covered with whitish scales.
2. Immune cells penetrate into the thickness of the altered skin cells - lymphocytes: T-killers and T-helpers (). These cells secrete special substances that attract other cells of the immune system - macrophages and neutrophils.
   An inflammatory reaction develops in the skin without infection. Such a reaction is called autoimmune, that is, the immune system is directed against its own body, and not against bacteria or viruses.

And now about the reasons.

Scientists are still arguing what is the trigger - a sharp growth of keratinocytes, in response to which a mass of immune cells comes to the skin? Or is it the primary autoimmune reaction in the skin, and keratinocytes after this begin to grow excessively and develop rapidly?

In any case, no one has yet reached the main reason - WHAT IS THE IMPACT to launch this or that mechanism at the beginning of the development of psoriasis?

And again an interesting fact. It is known that in HIV patients there is a suppression of the immune system, primarily T-lymphocytes. It seems that they should not develop psoriasis. However, there is an increase in the incidence of psoriasis in HIV patients. And the course of the disease in AIDS patients is more severe.

Provoking (trigger) factors of the disease

1. Heredity: if one parent is sick - the risk of psoriasis in children is 7%, if both parents - the risk is 40%.
2. Skin injury:
   - mechanical - scratches, cuts, abrasions,
   - chemical - solvents, varnishes, paints, detergents, household chemicals, perfumery,
   - thermal - hypothermia, burns.
3. Endocrine diseases - diabetes mellitus, hypothyroidism, hormonal changes in the body.
4. Stress.
5. Infectious skin diseases - staphylococcal, streptococcal, fungal infection.
6. Alcohol abuse, smoking.
7. HIV infection.

Symptoms

The main symptom of psoriasis is the appearance of pink-red spots on the skin, the surface of which is covered with silvery scales of the keratinized layer of the skin (epidermis).

1. Symptom of "stearin stain".
   This is a pathognomonic (that is, characteristic only for this disease) sign. Scraping (grattage) of psoriatic spots. Produced with a blunt scalpel or glass slide (not a fingernail!!).
   With light scraping, the surface of the stain becomes white, as if covered with wax - this is a symptom of the "stearin stain".
2. Symptom of "psoriatic film".
   
   With further scraping, gently removing the scales from the psoriatic plaque, a shiny surface is visible under the scales - the so-called symptom of the psoriatic, or terminal, film.
3. Symptom of "Polotebnov's blood dew" (Auspitz's symptom).
   Another pathognomonic symptom for psoriasis.
   With further scraping (grottage) of the plaque, that is, when the terminal film is removed, pinpoint bleeding appears, which do not merge with each other. This is the symptom of "blood dew".
4. Pilnov's symptom. It is typical for the initial stage and the stage of progression. Rounded pink spot without peeling, with clear boundaries. With the progression of the disease along the periphery of the spot (plaque), there is a rim of red skin that is not yet covered with scales.
5. Koebner's sign. Psoriatic foci appear on the skin in places of injury - in places of scratches, abrasions, in places of friction against clothing.
6. Symptom of Kartamyshev. When the fingers explore (palpate) the plaques on the scalp (VCH), the fingers feel a clear border of the plaques. Unlike seborrheic dermatitis, when there is no clear boundary between spots and healthy skin during palpation.
7. Voronov's symptom is a symptom of a regressing (passing) spot. On the periphery of the psoriatic patch, wrinkled skin remains for some time, lighter and shinier than healthy skin.
8. The symptom of "thimble" on the nails is a sign of nail psoriasis. The nail is all in dotted recesses, like a thimble.
9. Symptom of the "oil spot" on the nails: a yellow-brown spot under the nail plate is also a sign of nail psoriasis.
10. Onychogryphosis - deformation of the nail plate with nail psoriasis. The nail takes on ugly forms, sometimes resembling a bird's claw.
11. Beau-Reil line. A longitudinal line passing through the entire nail is a sign of malnutrition of the nail plate.

Types of psoriasis and clinic

Psoriasis vulgaris

Synonyms - simple, vulgar, coin-like or plaque-like psoriasis. ICD10 code: L40.0
This type occurs in 90% of patients.

What does psoriatic plaque look like?

Psoriatic plaque: a pink-red area of ​​the skin of a rounded shape, raised above the rest of the skin by 1-2 mm, clearly demarcated from healthy skin. On top of the plaque is covered with silvery scales, which are easily peeled off, after which the plaque may bleed a little. Mild skin itching. Plaques can merge with each other, forming the so-called. "paraffin (or stearin) lakes".

In the photo: plaques in psoriasis vulgaris

Localization of psoriatic plaques: knees, elbows, scalp (VCH), hands, feet, lumbosacral region. These are the most favorite places for the location of plaques. Doctors also call them "on duty" plaques (or "sentry"), as they persist for a very long time. Only one spot in psoriasis is a common picture. This is exactly the duty plaque.

In the photo: psoriasis of the scalp

X-rays of the joints should be performed, as most patients have changes in the joints.

Generalized pustular psoriasis (L40.1) and palmar and plantar pustulosis (L40.3)

These two forms of the disease differ only in the prevalence of the process. Their pathogenic mechanisms are the same.
Pustular forms occur in 1% of patients with psoriasis.

Vesicles (vesicles) and pustules (pustules) appear on the skin, which can merge with each other, forming "purulent lakes". There may be peeling of the skin around. May cause skin itching. The skin around the pustules is red, inflamed, hot to the touch.
Increase in body temperature.
In the blood - an increase in leukocytes (leukocytosis).
These are the rarest and most severe types of psoriasis. But they require an immediate examination by a doctor and the appointment of a comprehensive treatment. And generalized pustular psoriasis requires inpatient treatment. In very rare cases, with the addition of a bacterial infection, even cases of sepsis and deaths are described in the literature.

One of the varieties of pustular psoriasis is an exudative form. In this case, there are no abscesses and blisters on the skin, but there is weeping of the affected skin, the formation of crusts and skin itching.

Acrodermatitis resistant Allopo

ICD 10 code: L40.2.

Pustular (pustular) psoriatic changes and peeling appear on the skin of the fingers and toes. Nail plates are involved in the process.
The nails are deformed, flake off in places from the nail bed, have punctate depressions.

A milder form is nail psoriasis without pustular changes, that is, without abscesses on the skin.

Guttate psoriasis

ICD 10 code: L40.4

Dotted, teardrop-shaped spots 1-3 mm in size of pink color with peeling appear on the skin. There may be mild itching.
Localization: the whole body - on the trunk, on the arms and legs. Rarely - on the face.

Often the drop-shaped form appears after infectious diseases (tonsillitis, SARS).

Psoriasis arthropathic

ICD 10 code: L40.5

Other names are joint psoriasis, psoriatic arthropathy, psoriatic arthritis.

It develops in 10% of patients with psoriasis.
Articular surfaces and periarticular tissues are affected - ligaments, tendons, articular bags.

Localization - any joints, but small interphalangeal joints of the fingers are mainly affected. However, cases are known, for example, of psoriatic spondyloarthritis - damage to the intervertebral joints, or psoriatic coxarthrosis - damage to the hip joint.

Complaints of patients: pain, stiffness in the joints. There is swelling and redness of the skin in the joints. There are frequent cases when patients do not bother at all, however, arthrosis-like changes on the articular surfaces are noted on radiographs.

Articular pain and limitation of movement in the joints lead to disability of patients. Such patients should be referred for examination by MSEC to determine the disability group.

Other psoriasis

ICD 10 code: L40.8

This type includes reverse psoriasis (inverse, intertriginous).

Localization - on the contrary - not on the extensor surfaces, but on the flexion ones. Elbows, popliteal fossae, armpits, inguinal folds, under the mammary glands. At the same time, there are no rashes on other parts of the body.

It develops in patients with obesity and diabetes mellitus.
Manifestation: red spots appear on the skin, almost without peeling, slightly raised above the surrounding skin.

Psoriasis, unspecified

ICD 10 code: L40.9

All other species that, for one reason or another, cannot be attributed to the species described above, are assigned to this group.

Seasonal forms of psoriasis

1. Winter form (photosensitive psoriasis). Rashes appear in the cold season. Well treated with ultraviolet radiation.
2. Summer form (phototoxic psoriasis). Exacerbations happen in the summer. UV radiation exacerbates the disease.

Stages of psoriasis

If the crust of psoriasis disappears, and the skin remains red and shiny, while new rashes appear, this may be a signal of the progression of the disease. Treatment must begin!

The course of the disease

1. Light flow. No more than 3% of the skin area is involved in the process.
2. Medium severity. 3 to 10% of skin.
3. Severe course of the disease. More than 10% of the skin is affected by psoriasis.
   Pustular form, exudative form and joint damage is always a severe form of the disease.

Remember: the area of ​​the palm with fingers is 1% of the skin. The area of ​​the lesion can be measured with the palm of your hand.

In Western medicine, PASI and DLQI indices are used to assess the severity of the lesion and the activity of the process. In Russian practice, these indices are rarely used and do not affect the effectiveness of patient treatment.

Diagnostics

The diagnosis is made on the basis of clinical symptoms and patient complaints.

Differential diagnosis of psoriasis is carried out with diseases:

• Lichen planus -
• Pink lichen -
• Atopic dermatitis
• Eczema
• Papular syphilis
• Seborrheic dermatitis on the scalp
• Dermatophytosis on the head
• Reiter's disease, rheumatoid arthritis, arthrosis
• Drug allergic dermatoses
• Hives

Treatment of psoriasis

Remember: it is impossible to completely cure psoriasis. You can only achieve a long-term remission.

Local treatment

Attention: if pustules appear from the ointment, then the ointment should be canceled and contact your doctor to correct the treatment!

1. Ointments and creams with vitamin D. For example, preparations containing - Daivonex, Psorkutan.
2. Corticosteroid ointments and creams. These drugs reduce the immune response in the skin, reduce the activity of inflammation.
   Ointments:, prednisolone ointment, locoid, akriderm (), sinaflan, belosalik (betamethasone + salicylic acid -), elocom-C (mometasone + salicylic acid).
3. Combinations in the same composition of vitamin D preparations and corticosteroids. For example, or.
4. Preparations based on naphthalan.
   Cream Losterin (), Naftaderm ().
   Lubricate the affected area of ​​the skin 2-3 times a day - 4 weeks.
5. Birch tar and preparations based on it.
   Berestin, birch tar.
   Lubricate the affected areas and give an exposure of 15-30 minutes, then wash off with warm water and soap.
6. Creams and ointments based on grease. You can use the grease itself, but you need to find exactly the old Soviet grease, and not the grease that is now sold in car dealerships with various additives.
   Creams and ointments: Kartalin, Cytopsor.
   Solid oil and creams based on it help in half of the cases with psoriasis. Itching decreases on the 3rd day, peeling disappears and the stain itself gradually decreases.
7. Keratolytic (exfoliating) ointments and creams. Used intermittently! Only to remove excess peeling. Often combined with corticosteroids to reduce itching and inflammation.
   Do not use with exudative psoriasis!
   Ointment Belosalik: glucocorticoid Bepanten + keratolytic agent Salicylic acid.
8. Zinc preparations.
   Skin-cap - in the form of an aerosol, shampoo or cream. Reduces irritation and redness of the skin, dries the skin. Skin-cap is especially useful in exudative psoriasis, as well as in children. Does not contain hormones.
   Attention: do not use tar and salicylic acid on "duty plaques"! Irritation of plaques on duty can provoke the spread of pathological rashes further along the skin.

General treatment

1. First of all, we eliminate the provoking factor (see above) !!! Otherwise, all our treatment will not work on the disease.
2. Retinoids. Tigazon and. This is one of the main drugs for psoriasis. The action of drugs - excessive growth is inhibited, the processes of keratinization of skin cells are normalized. Membrane structures of cells are stabilized.
   Neotigazon is taken in a dosage:
   25-30 mg per day - 8 weeks.
   In severe forms, 50-75 mg per day is also 8 weeks.
3. Antihistamines. assigned to all patients. Reduce the activity of the immune response, reduce the allergic background, relieve itching and inflammation in the skin as a whole.
   Preparations: claritin, loratadine, erius, telfast, tavegil, suprastin, diphenhydramine.
4. Enterosorbents. These drugs reduce the absorption of various toxins from the intestines into the blood. They are used only in combination with other drugs and diet.
   Preparation: enterosgel.
5. Cytostatics and immunosuppressants. These are drugs that inhibit the growth and reproduction of cells and depress the immune system. They are prescribed only for severe psoriasis by a dermatologist.
   Methotrexate, fluorouracil, cyclosporine, neoral. The course of treatment is 4 weeks.
6. Corticosteroids in tablets and injections (intravenously): dexamethasone, prednisolone, betamethasone (diprospan). Also prescribed for severe disease and short courses under the supervision of a doctor. Mostly prescribed in stationary conditions.
7. NSAIDs (non-steroidal anti-inflammatory drugs) - with damage to the joints. Drugs: indomethacin, voltaren, ibuprofen, diclofenac.
8. infusion therapy. Washes out toxic immune complexes from the body. It is carried out in stationary conditions in severe cases with general manifestations of the disease. Intravenously administered: sodium chloride, reopoliglyukin, gemodez.
9. 30% sodium thiosulfate intravenously. It is currently not used due to the low effectiveness of thiosulfate, the presence of side effects and the release of more effective drugs for psoriasis.
10. psychotropic substances. These can be antidepressants, anxiolytics (or tranquilizers). They reduce anxiety, depression, increase stress resistance.
    Drugs: afobazole, amitriptyline.
    They are prescribed only with appropriate manifestations in patients.
11. sedatives. Reduce anxiety and increase stress resistance. Infusion of motherwort herb, valerian.
12. multivitamin preparations. Complivit, selmevit, undevit and others.
13. Drugs that improve metabolism.
    Befungin is a preparation made from the birch fungus "chaga".
    Folic acid.
14. Psychotherapy. It is used in combination with other areas of treatment.

Instrumental methods of treatment

An effective psoriasis treatment regimen (example)

• Neotigazon 25 mg - 2 months
• xamiol - lubricate the affected areas 1 time per day
• PUVA therapy - 15-20 procedures
• motherwort infusion at night
• strict adherence to diet

Diet for psoriasis

Exclude:

Citrus fruits, tomatoes, pineapples and other foreign fruits, honey, sweets, sugar, biscuits, spices, alcohol, spicy and salty dishes, coffee, white bread, smoked meats, products with dyes and sweeteners, potatoes and semolina.

Don't overeat!

Necessarily:

Kashi (buckwheat, oatmeal),
vegetable oils (sunflower, olive),
fruits and vegetables - apples, carrots, beets, cabbage, cucumbers,
boiled meat,
fish,
one day a week (usually Saturday) - fasting (or even fasting). On this day, drink only water or eat buckwheat porridge filled with water.

Folk remedies

At home, you can use various folk remedies for psoriasis. But the effect of them is minimal or zero.

Remember: self-treatment at home in half of the cases leads to the progression of the disease and the transition to a more severe form.

List of folk remedies for psoriasis used in patient reviews:

1. Solidol.
2. Therapeutic mud of salt lakes.
3. Sea salt baths.
4. Birch tar.
5. Naftalan oil.
6. A decoction of a string - compresses (applications) to the affected areas of the skin.
7. A decoction of celandine grass.
8. Nettle decoction.
9. Aloe juice.
10. Turpentine baths.
11. Starvation.
12. ASD fraction 3.
13. Linseed oil.
14. Milk thistle.
15. Dietary supplements and anthelmintic drugs. Ineffective or with zero efficiency. At best, they contain extracts of ordinary herbs, or even ordinary starch with vitamins and trace elements. Very expensive and bring good profits to manufacturers and distributors of dietary supplements. They are not a medicine, so it is impossible to expect help from them in the treatment of psoriasis.
16. Ointment for psoriasis Akrustal. In fact, the active agent is solid oil. The cost is about 1000 rubles. At the same time, the composition contains many more herbal extracts, bee products, which can cause an allergic reaction and exacerbate the disease.
17. Chinese lotion Fufan. The preparation contains acids, which can lead to skin irritation and disease progression.

Exotic treatments

Ichthyotherapy.
In Turkey, fish "gara-rufa" are found. They pinch off dead skin from human skin and contribute to the “rejuvenation” of the skin. This effect is also used in the treatment of patients with psoriasis.
On the video - treatment with fish "gara-rufa":

The effect of ichthyotherapy is positive only with careful observance of the methodology and the choice of the very fish. There are similar “chin-chin” fish - they pinch off scales with sharp teeth, thereby injuring psoriatic plaques. The effect of the influence of fish "chin-chin" is exactly the opposite - the spread of plaques by the type of the Koebner phenomenon.
On the video - fish "chin-chin":

Poor hygiene in some spas can lead to the appearance of fungal or viral lesions on the skin (mycosis, warts).

Prevention of relapses

• Eliminate risk factors!
• Observe the regime of the day, the regime of work and rest
• Proper nutrition
• Timely treatment of infectious and endocrine diseases
• UVR and PUVA therapy courses
• Complex vitamins
• Spa treatment, swimming in the sea
• Healthy lifestyle!

Is psoriasis contagious?

No, it's not contagious! This is a non-communicable disease.

Attention: if the doctor did not answer your question, then the answer is already on the pages of the site. Use the search on the site.

Psoriasis, or psoriasis, is a chronic multifactorial systemic disease that manifests itself as epidermal-dermal papular rashes. It occurs with equal frequency among males and females and lasts for years with alternating periods of relapse and remission. This is one of the most common, difficult to treat and often severe, dermatoses. Effective treatment of psoriasis requires considerable effort, but in many cases it is untenable.

The relevance of this medical and social problem is associated with:

• significant prevalence;
• unpredictability, originality and inconstancy of the current;
• the appearance of the first clinical signs mainly at a young age;
• an increase in the incidence in the last 10-15 years among young people;
• an increase in the percentage of severe forms of the disease, accompanied by serious psychological disorders and sleep disorders;
• deterioration in the quality of life of patients;
• the difficulty of treatment;
• a significant increase in the number of patients with disability, both on sick leave and in connection with disability, especially among young men.

According to various sources, the disease is registered in 2-7% of the world's population. In the structure of skin diseases, psoriasis is 3-5%, and among patients in dermatological hospitals - up to 25%. These data are incomplete for some reasons: the difficulty of identifying severe forms, for example, psoriatic arthritis, rare access to medical institutions for patients with mild forms, etc.

Causes of psoriasis and its pathogenesis

Despite the advantage of local skin manifestations in most forms of the disease, due to its causes and the nature of disorders in the body, the disease is systemic in nature. Joints, blood vessels, kidneys, liver are involved in the process of the disease. There is also a high risk of diabetes, obesity and hypertension in people with psoriasis, especially women.

In 20-30% of patients, a syndrome of metabolic disorders subsequently develops with an increased content of triglycerides in the blood, obesity mainly in the abdomen, and psoriatic arthritis. Also, a number of biological markers have recently been identified that indicate a direct link between psoriasis and Crohn's disease, rheumatoid arthritis, cardiovascular disease, angina pectoris, and increased mortality due to myocardial infarction. For these and other reasons, an increasing number of researchers are leaning towards a systematic definition of dermatosis as a "psoriatic disease" and not just "psoriasis".

Is psoriasis hereditary?

Despite the presence of a large number of hypotheses and studies conducted to date, it remains difficult to answer the question of whether psoriasis is inherited. However, it is generally accepted that the disease is genetically determined. In the absence of the disease in both parents, it occurs only in 4.7% of children. When one of the parents falls ill, the risk of the child's illness increases to 15-17%, and for both parents - up to 41%.

The onset of psoriatic disease can be at any age, but in most cases the peak occurs at the age of 16-25 years (type I psoriasis) and 50-60 years (type II psoriasis). In type I psoriasis, the hereditary nature of the disease, articular lesions and the prevalence of plaque rashes are more often traced. In type II, the disease has a more favorable course.

Mechanism of development (pathogenesis)

The main link in the pathogenesis (development mechanism) of the disease, leading to the appearance of rashes on the skin, is an increase in mitotic (cell division) activity and accelerated proliferation (growth) of epidermal cells. As a result, the cells of the epidermis, not having time to become keratinized, are pushed out by the cells of the underlying layers of the skin. This phenomenon is accompanied by excessive peeling and is called hyperkeratosis.

Is psoriasis contagious?

Is free communication and contact with patients possible, that is, is it possible to get infected? All studies related to this disease refute this assumption. The disease is not transmitted to other people either by airborne droplets or as a result of direct contact.

The implementation of a genetic predisposition to the disease (in accordance with the genetic theory of psoriasis) is possible in case of a disorder in the regulatory mechanisms of the following systems:

1. Psychoneurological. Mental instability contributes to dysfunction of the autonomic nervous system. The latter is one of the reflex links in the implementation of certain emotional factors of influence through alpha and beta receptors on the vascular system of the skin, and hence on its general condition.

   Psychic trauma plays a significant (if not primary) role in the mechanism of the development of the disease, as well as in the frequency and duration of relapses. At the same time, dermatosis itself causes disturbances in the functional state of the psyche.

2. endocrine. Psoriatic disease is a manifestation of a violation of adaptive mechanisms, in which the main role is played by the endocrine glands (hypothalamus, pituitary gland, adrenal glands), the regulation of which is carried out not only by the humoral route (through the blood), but also with the participation of the nervous system. / In order to adapt the body, the hypothalamic-pituitary-adrenal system is the first to turn on (in response to environmental changes, extreme and stress factors) by increasing or decreasing hormone release, as a result of which cellular metabolism changes.
3. immune. The mechanism of implementation of the genetic predisposition to psoriasis with the participation of the immune system occurs through genes that control the cellular immune response and the immune interaction of cells with each other (the HLA system). The immune system in psoriasis is also changed either genetically or under the influence of internal or external factors, which is confirmed by a violation of all links of skin immune regulation.

   Genetically determined disorders of cellular metabolism lead to accelerated growth and proliferation of immature epidermal cells, which leads to the release of biologically active substances (BAS) by lymphocytes, immature skin cells, activated keratinocytes and macrophages. The latter are mediators of inflammation and immune response.

   These substances include proteases, protein information molecules called cytokines (tumor necrosis factor, interleukins, interferons, various subtypes of lymphocytes), polyamines (hydrocarbon radicals). Mediators, in turn, stimulate the growth of defective cells of the epidermis, changes in the walls of small vessels and the occurrence of inflammation. The whole process is accompanied by the accumulation of unicellular and multicellular leukocytes in the epidermis and papillary dermis.

Predisposing and provoking factors

The key pathological manifestation of psoriasis is the overgrowth of defective epidermal cells. Therefore, the fundamental point in elucidating the mechanism of the development of the disease and deciding how to treat psoriasis is the establishment of trigger factors. The main ones are:

1. Psychological - the influence of short-term strong stresses, as well as unexpressed, but long-term or often recurring negative psychological influences, moral dissatisfaction, sleep disturbances, depressive states.
2. Metabolic disorders in the body, dysfunction of the digestive organs, especially the liver and exocrine function of the pancreas.
3. Disease or dysfunction of the endocrine glands (hypothalamus, thyroid, parathyroid and thymus glands, endocrine activity of the pancreas).
4. Disturbances in the immune system (allergic reactions and immune diseases).
5. The presence in the body of chronic foci of infection (tonsillitis, rhinosinusitis, otitis media, etc.). Pathogenic and conditionally pathogenic microorganisms, especially Staphylococcus aureus, streptococci and yeast-like fungi, their toxins, skin cells damaged by these microorganisms, are powerful antigens that can provoke the immune system to aggression against them, altered and healthy body cells.
6. Mechanical and chemical damage to the skin, prolonged use of antibiotics or glucocorticoids for any diseases, hyperinsolation, smoking and alcohol abuse, acute infectious diseases (respiratory viral infection, influenza, tonsillitis, etc.).

Symptoms and types of psoriasis

There is no generally accepted clinical classification of psoriatic disease, but the most common clinical forms are traditionally distinguished. In some cases, they are so different from each other that they are regarded as separate diseases.

There are three stages in the development of the disease:

1. The progression of the process, in which rashes up to 1-2 mm in size appear in large numbers in new areas. In the future, they are transformed into typical psoriatic plaques.
2. Stationary stage - the absence of the appearance of "fresh" elements, the preservation of the size and appearance of existing plaques, completely covered with exfoliating epidermis.
3. Regression stage - reduction and flattening of plaques, a decrease in the severity of peeling and the disappearance of elements, the resorption of which begins in the center. After their complete disappearance, foci of depigmentation usually remain.

Psoriasis vulgaris (common, common)

It manifests itself as monomorphic (homogeneous) rashes in the form of plaques or papules - reddish or pink nodules that rise above the surface of the skin. Papules are clearly demarcated from healthy areas and are covered with silvery-white scales. Their size in diameter can be from 1-3 mm to 20 mm or more. They are characterized by three phenomena that occur after scraping on their surface:

• a symptom of a "stearin spot" - increased peeling after a slight scraping, as a result of which the surface of the papules becomes similar to a drop of pounded stearin; this is due to parakeratosis (thickening of the epithelium), hyperkeratosis (thickening of the stratum corneum of the skin, i.e., stratification of scales), the accumulation of fats and fat-like components in the outer layers of the epidermis;
• a symptom of a “terminal film” - a mucous epidermal layer appears from under the removed scales in the form of a thin, velvety, shiny, moist surface;
• a symptom of "blood dew", or the Auspitz-Polotebnov phenomenon - droplets of blood that do not merge with each other in the form of dew, which act on a shiny surface after a slight scraping; this is due to trauma to the full-blooded dermal papillae.

Favorite places of localization of the rash are the scalp, symmetrical location on the extensor surfaces in the area of ​​large joints - elbows, knees. Localization of plaques can be limited only to these areas for a long time. Therefore, they are called "watchmen", or "on duty". Less commonly, nails, skin in the area of ​​other joints, genitals, face, soles and palms, large folds are affected.

Another characteristic symptom is the occurrence of a psoriatic rash in places of mechanical or chemical damage to the skin (Koebner phenomenon). Such injuries can be scratches, cuts, chemical irritation with acids or alkalis.

Depending on the localization of the elements and the clinical course, psoriasis vulgaris is divided into several varieties:

• Seborrheic.
• Palmar-plantar.
• Drop-shaped.
• Intertriginous.
• Nail psoriasis.

seborrheic psoriasis. It occurs in areas of the skin with a large number of sebaceous glands - on the forehead, scalp, behind the ear, in the areas of the facial folds (nasolabial and nasobuccal), between the shoulder blades and in the upper sections of the anterior surface of the chest. If on the face, back and chest the rash has the character of red papules, which are covered with scaly large plates of silver-white color, then behind the auricles it looks like a rash with an attached infection.

The surface of seborrheic spots and papules behind the auricles is brighter and more edematous than other areas. It is covered with yellowish-white or grayish-white scales and a serous-purulent crust (due to wetting), which adheres tightly to the skin. Almost always, rashes are accompanied by severe itching.

This kind of seborrhea behind the ears and on other parts of the body, which is accompanied by weeping of the surface and bleeding when the crusts are removed, is distinguished by some authors into an independent form - exudative psoriasis ("exudate" - effusion). Despite the significant similarity with seborrheic dermatitis, these diseases are based on different causes and mechanisms of development, which means that a different approach is required in their treatment.

Palmar-plantar psoriasis occurs quite frequently. Diagnosis of the disease is not difficult if rashes in the palms and soles are part of a common form of psoriasis. But in recent years, in some patients, especially in women in the pre- and menopausal periods, the first localization of psoriatic rash is observed in isolation (only in these areas), resembling acquired dermatosis or keratoderma of other etiologies. In the plantar region, rashes characteristic of psoriasis are often combined with fungal ones, which requires careful diagnosis and combined treatment.

In practical dermatology, there are three forms of palmar-plantar psoriasis:

1. Papular-plaque, characterized by dense rashes with clear boundaries with a diameter of 2-5 to 25 mm, almost not rising above the skin surface. They have a reddish color and are covered with silvery-whitish scales, which are difficult to separate, unlike other localizations.

   The characteristic psoriatic triad of symptoms is often difficult to identify, due to the structure of the skin in these areas. Rashes are often localized on the marginal zones of the palms and feet. In these places, diagnosing the triad and taking material for microscopic examination is quite easy.

   Rashes are accompanied by severe keratosis and edema, which gradually leads to the formation of deep cracks, pain, reduced ability to work and quality of life. In addition, these cracks are good conditions for the penetration of infection and the occurrence of often aggravated erysipelas.

2. Horny, or "psoriatic calluses", in which rounded dense foci of outgrowths of the keratinized epidermis of a yellowish color, difficult to peel off, predominate. Reddening of the skin in these areas is insignificant. In diameter, the foci can be from a few millimeters to 2-3 cm. They look like corns or lesions on the feet and palms in secondary syphilis. Large psoriatic papules sometimes merge, cover the entire surface of the palms and feet, resembling fungal and other forms of keratoderma.
3. vesicular-pustular is a relatively rare form of the disease. It can manifest itself as single vesicles with serous-purulent contents against the background of erythema (redness) with blurred boundaries, as well as tense pustules (purulent vesicles) up to 2 mm in diameter, located on typical psoriatic papules and plaques. Usually these pustules are located symmetrically on the eminences of the palms and feet, as well as in the region of the periungual ridge, rarely on the fingertips. Sometimes they tend to merge and form large purulent areas (“purulent lakes”).

Many experts refer to severe forms. It is observed in 2% of patients with this disease. The teardrop form is more common in adults under 30 years of age and children. In the latter, it is the most common type of psoriatic disease. The clinical features of guttate psoriasis is the sudden appearance of rashes after a streptococcal infection of the upper respiratory tract (in 80%), for example, acute pharyngitis, tonsillitis, tonsillitis.

Orange-pink, scaly papules 1-10 mm in diameter are drop-like and often accompanied by mild itching. Localization of papules - torso, shoulder and femoral limbs, less often - scalp and ears. Extremely rarely, elements can appear in the area of ​​\u200b\u200bthe palms and soles, while damage to the nail plates is often absent.

During 1 month, new elements may appear, which remain unchanged for 2 months. Sometimes they form small abscesses. Regression of elements occurs with the formation of areas of increased pigmentation or depigmentation without scarring. In 68% of cases, the disease becomes chronic with exacerbations in winter and remission in summer.

Intertriginous psoriasis more common in people who are obese, have cardiovascular disease, or have diabetes. A large, sharply painful psoriatic rash in the form of plaques with clear boundaries is localized in large skin folds - between the buttocks, under the mammary glands, in the skin folds on the abdomen, in the axillary and inguinal regions. The skin surface in these places becomes wet, acquires an unpleasant odor, cracks can form on it. Thus, all favorable conditions are created for the attachment and reproduction of pathogenic microorganisms.

Changes in the general condition are expressed in high temperature (up to 38 - 40 0), nausea, soreness in the muscles and joints, headache, enlarged peripheral lymph nodes, pain in the affected areas. As the pustular rash disappears, the temperature decreases, the general condition improves. Erythema and the usual symptoms of psoriasis persist for a long time after the end of the acute period.

1. Limited, or Barber's palmoplantar pustular psoriasis

In contrast to the palmar-plantar psoriasis described above, the rashes are predominantly pustular (with purulent contents) in nature.

Arthropathic form

It consists in inflammation of the distal joints, mostly small ones. It can have varying degrees of severity, affect one or more asymmetrically located joints, precede or accompany skin manifestations. Arthritis can occur even with minor pain, especially at the initial stage. In the future, a generalization of the process often occurs with the appearance of swelling in the area of ​​the joints, accompanied by severe pain, limitation of movements, the formation of articular ankylosis (immobility) and dislocations. This form most often leads to disability.

Therapy of psoriasis (general principles)

In recent years, a group of experts from 19 European countries have proposed 3 main principles on which effective treatment of psoriasis should be based:

1. Strict adherence to the algorithms of complex therapeutic treatment.
2. Constant monitoring by a specialist dermatologist of the response of the disease to the remedies prescribed to the sick patient.
3. Timely modification of therapy in case of its ineffectiveness.

The choice of drugs and methods of treatment is directly dependent on the severity of the manifestations of the disease - in mild and moderate cases, it is possible to limit the means of local exposure, in severe forms, systemic therapy is necessary.

Approximate schemes of local treatment

They are selected depending on the stage of the process:

1. Stage of progression:

• cream "Unna", the components of which are olive oil, lanolin and distilled water;
• salicylic ointment 1-2%;
• lotions, creams or ointments containing corticosteroids - Fluorocort, Flucinar, Lorinden, Elocom, Okoid, Laticort, Advantan;
• Beclomethasone, which has anti-allergic, anti-inflammatory and anti-edematous effects, in combination with calcipotriol (an analogue of vitamin D 3 , which accelerates the maturation of keratinocytes and inhibits their growth;
• modern, highly effective, pathogenetically substantiated psoriasis ointment "Daivobet", recommended for its various clinical forms. It is a combination of the glucocorticoid betamethasone with calcipotriol;
• the drug "Skin - Cap" (zinc pyrithione, cinocap) in the form of a cream, ointment, spray or emulsion, which has anti-inflammatory, antibacterial and antifungal activity;
• detoxification and antiallergic drugs are prescribed intravenously.

2. Stationary stage:

• salicylic ointment 3-5%;
• sulfur-tar - 5-10%;
• naftalan - 10-20%;
• calcipotriol, Daivobet ointment, Skin-Cap;
• and other types of phototherapy in winter and spring.

3. Stage of regression- the same means as in the previous stage.

In nail psoriasis, an additional injection of Triamsinolone (glucocorticoid) into the nail folds is used, the systemic retinoid acitretin, which regulates the maturation and keratinization of epithelial cells, and local PUVA therapy are administered orally.

In severe forms, in addition to external tar and corticosteroid preparations, synthetic retinoids, cytostatics Cyclosporine and Methotrexate are added, which have powerful immunosuppressive (immune suppression) activity, intravenous detoxification, anti-inflammatory, antipyretic, cardiovascular and other means of intensive care.

It should be remembered that each form of psoriasis at each stage requires a specific individual selection of drugs for local and general effects under the supervision of an experienced dermatologist.