Psoriasisis a systemic disease characterized by damage to the skin, musculoskeletal system, and dysfunction and morphology of other organs and systems. The main symptoms of the pathology: nodular rash on the scalp, palms, feet, extensor surfaces of the elbows and knees, hyperemia, itching. The disease can be diagnosed visually, but to exclude the possibility of the development of accompanying pathologies, laboratory tests and instrumental diagnostic methods are prescribed. Systemic therapy includes aromatic retinoids and cytostatic agents, glucocorticosteroids.
Introduce
The name of the disease comes from the Greek word "psora" - "skin disease", "scabies". In the Middle Ages, psoriasis was considered a form of leprosy (leprosy). The signs of psoriasis were first described from a professional perspective in 1808 by Robert Whelan in England. The term "psoriasis" was introduced by the Austrian dermatologist Ferdinand Gebra in 1841. The pathology is recorded in all latitudes of the world with an uneven frequency from 0. 1 to 3%. Psoriasis develops equally in men and women, but in children it is more common in girls, and in adults - in men (60-65%).
reason
There are many different theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurological, endocrine, genetic. Each of these theories is based on clinical observations and laboratory results.
Most scientists pay attention to the genetic nature of psoriasis. They believe that this disease is caused by polygenic inheritance. If one of the parents is sick, the risk of developing the disease in the child is 8%, if both parents are 41%.
Factors that contribute to the development of psoriasis are divided into external and internal.
- External factors include mechanical and chemical damage to the skin, as well as dermatological diseases.
- Doctors include internal provoking factors: infections (strep and human immunodeficiency virus), drugs (corticosteroids, nonsteroidal anti-inflammatory drugs), nervous stress.
Pathogenesis
Today, physicians around the world recognize the involvement of the immune system in the pathogenesis of psoriasis. Immune system cells, which normally react to antigens, begin to attack healthy cells, usually skin cells. The result of this process is that the cells of the epidermis divide faster than normal. They do not have time to mature, which is why a strong bond between them is not established. The cells rise to the surface forming silvery scaly protrusions.
Classify
According to the International Statistical Classification of Diseases and Related Health Problems, there are many types of psoriasis.
- Normal (vulgar). The lichen planus form is the most commonly reported and has no complications. This group includes plaque and coin psoriasis.
- Whole body pustular psoriasis- a severe form of pathology, complicated by secondary infection. It affects several areas at once. Includes Zumbusch syndrome and herpetiform impetigo.
- Persistent acrodermatitis (Crocker's dermatitis, Setton's dermatitis)- The contents of the pustules are sterile, there is no secondary infection. The main areas affected are the fingers and nails.
- Pustular disease on the palms and soles (bacterial pustules)- develops on the feet and palms. It appears as pustules with sterile contents, gradually increasing in area.
- teardrop-shaped- The papules are located separately and do not merge into plaques. The most commonly affected areas are the legs, thighs, back, forearms, chest, and neck.
- arthropathy- The clinical course resembles the rheumatic form of arthritis.
- Other psoriasis (opposite)- colonies localized in the armpits, groin and other natural folds. This type includes inverse flexor psoriasis.
- unspecified psoriasis- combines many types of pathologies, the clinical picture is quite wide.
Depending on the seasonality of exacerbations, several types of psoriasis are distinguished:
- summer- aggravation of the condition occurs due to skin exposure to sunlight;
- winter- occurs because too much cold affects the skin.
With non-seasonal psoriasis, there is no period of remission, the disease occurs year-round.
According to the affected skin area:
- limited psoriasis- covers less than 20% of the body's skin;
- shared- greater than 20%;
- general- the entire skin is affected.
Symptom
Clinical manifestations of psoriasis directly depend on the stage of development of the disease. There are 3 stages.
- Progressive stage. It is characterized by the appearance of papules, itching, the beginning of peeling, peeling and deformation of the nail.
- Fixed phase. New papules do not appear, old rashes do not increase in size and moderately peel.
- Regression phase. The plaque heals and forms depigmented white spots in that location, which no longer cause discomfort.
Skin rashes are only an outward sign of psoriasis. In fact, the disease affects many organs and systems as well as tendons and joints. For this reason, patients complain of depression, a constant feeling of weakness and chronic fatigue.
symptoms
Among the complications of psoriasis, psoriatic arthritis and psoriatic erythrodermatitis are especially important. In addition, without timely diagnosis and effective treatment of psoriasis, the risk of developing serious chronic pathologies increases: diabetes, arterial hypertension and metabolic syndrome.
Diagnose
To determine pathology, laboratory and instrumental diagnostic methods are used.
Patients are referred to:
- General clinical analysis of blood and urine;
- blood chemistry;
- blood tests for C-reactive protein and rheumatoid arthritis tests;
- coagulation - assessment of blood coagulation;
- Blood test for human leukocyte antigens.
For complex forms of psoriasis, which are associated with damage to the musculoskeletal system and internal organs, radiography of the joints, ultrasound of the kidneys and organs of the urinary system and echocardiography are indicated. .
There are diseases with similar symptoms. As a result, a differential diagnosis is needed. To do this, use methods such as:
- biopsy (removal of a piece of skin for further histological examination);
- laboratory test - used to differentiate psoriasis from papular syphilis.
Treatment
Psoriasis responds well to symptomatic treatment. Knowing the pathogenesis, doctors can choose individual treatment methods. Some of them are aimed at reducing rashes on the skin, eliminating dryness and itching, others - at limiting the immune system from "attacking" healthy cells.
Treatment tactics directly depend on the severity of the disease and the location of the lesion.
External therapy
Topical glucocorticosteroids are used for various forms of psoriasis as monotherapy or in combination with other medications. They exist in dosage forms - ointments, creams or lotions.
Medicines containing vitamin D3 analogues. They are applied to affected skin areas if the incidence of psoriasis is not higher than 30% of the body surface.
Preparations containing active zinc pyrithione are used in the form of sprays, creams, as well as shampoos for the scalp.
Phototherapy
For treatment in this case, medium wave light therapy and PUVA therapy are used. PUVA therapy is a combination of long-wave ultraviolet (UVA) light (320-400 nm) and a photosensitizer (8-methoxypsoralen). PUVA therapy is one of the most effective methods of treating the disease, it is often prescribed for widespread and exudative psoriasis, persistent pathology, severe infiltration.
Combination therapy
Such treatment includes several treatment modalities, e. g. , phototherapy and topical corticosteroids; phototherapy and systemic retinoids.
Systemic therapy
Prescribed for moderate and severe forms of psoriasis. Systemic drugs are prescribed mainly during the progression of the disease.
Biological drugs
These drugs are created using genetic engineering methods. They are monoclonal antibodies and are used for therapeutic purposes.
Prognosis and prevention
With timely diagnosis of the pathology and effective treatment, the prognosis is quite favorable. As preventive measures, the following are usually prescribed: a diet rich in fish and vegetables, hydrotherapy, a course of herbal treatment, treatment at a sanatorium and emollients (mainly in the relapse phase - to restore the hydrolipid layer).