A medical condition characterized by scaly and nodular changes on the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of diseases.
Psoriasis is a chronic skin and nail disease in which pink papules and silvery scales appear on the skin. Usually, the nodules merge into large patches around the skin that are quickly covered with scabs. With prolonged development of the disease, joint damage can occur, which is accompanied by poor mobility and constant pain. The different types of psoriasis vary in the extent of the skin damage: patients may have only small nodules on the scalp or large patches on different parts of the body. The likelihood of complications from psoriasis depends on many factors. This disease is especially dangerous for pregnant women, since the pustular form of the disease can cause miscarriage.
about disease
Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually occur between the ages of 18 and 35. Often, psoriasis occurs in the context of cardiovascular disorders, Crohn's disease, and depression. About 30% of patients have joint damage (arthritis). It is not possible to eliminate the root cause of psoriasis, however, symptomatic therapy can significantly reduce the course of the disease.
Types of Psoriasis
Depending on the common symptoms, several types of psoriasis are distinguished:
- plaque: characterized by the appearance of classical plaques covered with silver scales; priority locations: elbows, knees, torso, scalp;
- teardrop shape: the main manifestation is pink-orange nodules with size from 1 to 10 mm;
- nail psoriasis: the nail plate is mainly affected;
- psoriasis in large folds: rash occurs in the armpits, in the folds of the neck, on the genitals and other places where there is excessive friction; This form is more common in obese people;
- psoriasis of the head: scalp is affected;
- psoriatic arthritis (psoriatic arthritis): affected joints;
- pustular psoriasis: on the patient's skin appear many small pustules;
- erythrodermic psoriasis: in addition to the rash, the skin rash also has a pronounced reddening phenomenon.
Symptoms of Psoriasis
Usually, the patches appear on the forearms, lower legs, navel, and scalp. The pustular form of psoriasis is characterized by the formation of pus-filled blisters on the skin. At certain periods, many patients experience a change in the color and structure of the nails. Lesions of the skin lead to a precise bleeding appearance. The patient also complains of itchy skin. Skin changes periodically disappear and reappear.
Other symptoms and signs:
- the appearance of red spots in skin folds;
- intense rashes that occur after infectious diseases and stress;
- slight increase in body temperature;
- the appearance of new skin rashes in the winter months;
- athritis;
- impaired mobility in the affected joint area;
- dryness and hypersensitivity of the skin.
The resorption of the plaques usually begins in the central part, so the psoriatic elements have an annular or wreath-like shape. Temporary depigmentation (pseudo-whiteness) remains at sites of resolved rash. During periods of incomplete remission, individual patches of "mission" may remain in certain areas of the skin (more often in the elbow and knee joint areas).
The most serious types of psoriasis are erythrodermic psoriasis and rheumatic psoriasis.
In erythrodermic psoriasis, all (or nearly all) of the skin is involved in the pathological process. The skin becomes tight, rough, infiltrated, red, on the surface there are many large and small slabs of peeling. Peripheral lymph nodes are increased, subcutaneous temperature appears, the general condition of the patient is disturbed, changes in the blood (leukocytosis, increased ESR), urine (proteinuria) are observed. . The development of erythroderma, which is promoted by stimulant therapy, is not justified in the advanced stages of psoriasis.
Arthritis psoriasis is characterized by lesions mainly in the small joints of the hands and feet, less commonly in the wrists, ankles, discs, etc. v. , accompanied by severe pain and swelling of the joints, limiting their mobility and deforming. X-rays show lysis of the distal phalanges of the finger and joint changes, similar to rheumatoid arthritis. The Waaler-Rose test and the latex test are usually negative. In the blood, leukocytosis, increased ESR, hypergammaglobulinemia. Joint damage may be associated with skin lesions or be isolated for a number of years.
With all of these forms of psoriasis, the nails can become damaged in the form of punctured nail plates ("thimble phenomenon"), their freezing or thickening leading to onychomycosis. The course of the disease is chronic and undulating. The seasonality of the process is often manifested - a decrease in winter with a significant improvement in the summer (winter type), less often - the opposite (summer type).
Causes of Psoriasis
The exact mechanisms of psoriasis formation are still poorly understood. It is believed to be an autoimmune disease in which the body's defenses mistakenly attack healthy tissue. The T cells and neutrophils needed to fight pathogens can begin to attack skin cells and joint structures. In this case, characteristic changes in the skin occur, including the formation of bubbles with inflammatory fluid. Widening of blood vessels in the area of inflammation is accompanied by redness of the skin. Autoimmune diseases can be caused by genetic factors.
Additional risk factors:
- skin infection. First of all, these are streptococcal bacterial infections;
- skin damage from cuts and burns;
- prolonged stress and traumatic factors;
- alcoholism and smoking;
- lack of vitamin D in the body;
- taking certain medications, including lithium and beta-blockers;
- Favorable family history. The discovery of psoriasis in the patient's relatives indicates the possibility of a genetic predisposition to the disease;
- acquired or congenital immunodeficiency. It could be HIV infection, AIDS, or another condition.
Although immunopathological causes of psoriasis have been discovered, the disease is still poorly understood. There are a large number of diseases and lifestyle features that induce the manifestation of underlying factors predisposing to this disease.
Diagnosis of psoriasis
If skin changes appear, you should consult a dermatologist. Our clinic doctor first conducts a general examination of the skin to assess the nature of the rash. Soft shaving allows you to detect peeling nodules and a thin film under the nodules. Under the film, the skin surface is wet, prone to small hemorrhages. At the same time, there are atypical signs of psoriasis that resemble other diseases, so the doctor needs to conduct an instrumental and laboratory diagnosis.
- Blood analysis. Dermatologists recommend a venous blood test to rule out other diseases and detect signs of psoriasis. In the treatment room, the nurse treats the patient's pelvic skin with an antiseptic, places a tourniquet, and draws blood with a syringe. In our laboratory, experts first rule out the presence of rheumatoid factors. In pustular psoriasis, an increase in the rate of red blood cell deposition is often found. Elevated uric acid levels are detected;
- Examination of pustules. The doctor collects the fluid in a sterile container and sends the material to the lab. Microbiological examination did not reveal a bacterial culture, but found an increase in the neutrophil count characteristic of psoriasis;
- Skin biopsy. Dermatologists order this study to accurately diagnose atypical rashes. During surgery, the doctor treats the skin with an antiseptic, numbs it, and removes a small area of skin with a scalpel. Tissue material is studied in our clinic laboratory using a microscope. The results allow to clarify the cellular composition of the nodule;
- X-ray of the affected joint. Doctors prescribe this study to determine the type of arthritis. In addition, in severe complications of psoriatic arthritis, an X-ray diagnosis of bone is required;
- Scrape the skin to remove the fungus. The doctor cleans the surface of the skin and, using a special spatula, collects some flakes for microbiological examination. This analysis is mainly needed if the rash occurs only in the area of the feet and fingernails.
If necessary, a consultation with a rheumatologist is carried out.
Expert opinion
Psoriasis is a disease with many manifestations. It can be almost invisible or cause serious health problems. The most dangerous complication of psoriasis is joint damage, which can be disabling. In addition, the disease can lead to autoimmune disorders, especially Crohn's disease and ulcerative colitis, metabolic diseases, erectile dysfunction in men. Women with psoriasis may experience infertility and miscarriage. To prevent these complications, it is necessary to visit a doctor immediately after the appearance of suspicious signs, and with the diagnosis confirmed, carefully follow all the recommendations of the specialist.
Treatment of psoriasis
The main goal of psoriasis treatment is to treat symptoms. The patient needs medication to reduce inflammation and prevent the formation of a rash on the skin. In addition to drug treatment, the dermatologist of our clinic necessarily prescribes a special diet for the patient. Normalizing lifestyle and eliminating stressors can reduce the severity of psoriasis symptoms.
Depending on the case, the dermatologist can apply different methods to treat the disease.
- Management of corticosteroids. Dermatologists prescribe ointments containing these drugs. The beneficial effects of corticosteroids include reducing inflammation in tissues and eliminating itching;
- Added vitamin D. Synthetic forms of this vitamin slow down the growth of skin cells, thereby preventing the formation of scales and nodules;
- Treatment is with drugs containing vitamin A derivatives. Dermatologists prescribe ointments based on retinoids to reduce inflammation and itching. These drugs increase the skin's sensitivity to light, so sunscreen must be used;
- Use calcineurin inhibitors. These are immunosuppressants that reduce inflammation. Dermatologists prescribe topical medications such as tacrolimus. These drugs are used for a short time to prevent the development of side effects and complications;
- Treat the skin with salicylic acid to remove dead cells. Dermatologists prescribe this drug along with corticosteroids for complex skin treatment;
- Use moisturizer to get rid of dry and itchy skin;
- Skin irradiation with ultraviolet light. This safe physiotherapy treatment improves local immune function. The doctor chooses an individual radiation dose for the patient;
- Phototherapy. This method involves irradiating the skin with special equipment. Phototherapy combines laser and phototherapy technologies;
- Arthroscopy in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, numbs the tissues, and inserts the needle. With the help of a syringe, the drug is injected into the joint cavity to reduce the inflammatory process.
Dermatologists control all phases of treatment to achieve the best results and prevent complications. Corticosteroids, retinoids, and calcineurin inhibitors are used strictly under the supervision of a specialist.
Prevention of psoriasis
The recommendations of our clinic's dermatologists will help reduce the severity of skin rashes and ease the course of the disease.
Prevention of exacerbations of psoriasis:
- reduce anxiety and stress by improving sleep, avoiding caffeine and taking prescription tranquilizers;
- exclude from the diet foods containing allergens;
- timely treatment of infectious skin diseases.
Rehabilitation
Psoriasis is a chronic disease that cannot be cured. Rehabilitation measures are aimed at preventing recurrence. Depending on the form of the disease, physiotherapy, spa, mud therapy, therapeutic baths and other procedures may be indicated.
Question and answer
Is it possible to treat psoriasis with folk remedies?
There is no method with proven effectiveness. It is important not to trust questionable types of treatment, but to follow the recommendations of the attending physician.
Does stress affect the course of psoriasis?
Yes, stressful situations can aggravate the course of the disease.