All about psoriasis: how to treat it, causes and symptoms, types

For more than two thousand years, humanity has been trying to solve all the riddles of this severe dermatosis, but there is still much to know. According to statistics, this disease affects 4 to 7% of the population, women and men are equally susceptible to it. The first signs of psoriasis usually appear during puberty and accompany a person for the rest of their life, then subside and disappear completely, then intensify.

Can psoriasis be cured?Modern medicine has achieved a lot in the treatment of this chronic dermatosis and is able to provide the patient with a decent level of quality of life.

Causes of psoriasis

Psoriasis is a chronic inflammatory process of the skin, which modern medicine refers to as autoimmune (associated with allergy to the tissues themselves). There are many causes of psoriasis and the factors that predispose to the development of this dermatosis, in relation to which several theories about its origin have been proposed.

Autoimmune

This is the leading theory, as it is well established that the immune system actively responds to certain types of skin exposure. The skin of people with psoriasis is very sensitive to mechanical, physical and chemical influences. Not only epithelial cells react to such influences, but the entire immune system.

Cellular immunity is impaired - the relationship between individual lymphocyte subtypes responsible for the formation of a normal immune response. So, in psoriasis, the number of helper T lymphocytes - the helpers that regulate immunity - increases, while the number of suppressor T lymphocytes, which suppress an excessively strong immune response, decreases. Lymphocytes and some other cells produce cytokines, active substances that stimulate the immune response. Humoral immunity also suffers, an imbalance of antibodies (immunoglobulins) develops in the blood serum, antibodies appear against the tissues of the patient's body.

Inflammation begins in the context of the activation of T lymphocytes, but why they are activated has not been established. Also in the research process is the question of how to suppress the autoimmune response without harming the patient.

Exchange

An imbalance in metabolism has a significant effect on the skin and immunity. In patients with psoriasis, there is an acceleration of metabolism, the appearance of a large number of toxic free radicals and other toxins that support the inflammatory response. The metabolism is altered:

• proteinaceous- the CDSN predisposition gene stimulates the synthesis of the corneodesmosin protein, which sensitizes (allergenic) the body; the protein content of albumin in the blood decreases and the content of globulins increases; This condition is called dysproteinemia and it further increases sensitization;
• fatty- increases the content of lipids and cholesterol in the blood; the use of predominantly plant foods and a general decrease in the caloric content of the daily diet can reduce the activity of psoriatic inflammation;
• carbohydrate- almost always raped;
• exchange of vitamins and minerals- increases the content of vitamin C in the skin, decreases the content of vitamins C, A, B6, B12, iron, copper and zinc in the blood.

Infectious

This theory was relevant at the beginning and middle of the last century. Certain bacteria (streptococci), fungi, and viruses were considered causative agents of psoriasis. These theories have not been confirmed. But dermatologists point out that any acute infectious process or the presence of a permanent source of infection can lead to relapses. Viral theory occupies a special place. Recent studies have revealed the effect of retroviruses (viruses containing RNA, HIV, etc. ) on the genetic apparatus with the formation of psoriatic predisposition genes.

Genetic

The predisposition to autoimmune reactions is inherited. If the loved ones of a person suffer from psoriasis, the probability of developing this disease increases many times. There are genes for susceptibility to psoriasis (the local complexes PSORS1 - PSORS9, PSORS1 is especially active, it contains the genes HLA-C, HLA-Cw6, CCHCR1 and CDSN, which are responsible for the development of the disease). Genes affect metabolism, immunity, and the development of autoimmune processes. But the presence of such genes in no way guarantees the development of the disease. The influence of provoking factors is of great importance.

Neurogenic

Prolonged stress, high neuropsychic stress, disorders of the autonomic nervous system (which innervate the walls of blood vessels and internal organs) can cause the development of psoriasis, which causes an imbalance in the endocrine system, metabolic and immune processesaltered.

Endocrine

Endocrine disorders in psoriasis are common and mainly play the role of a provoking factor. A clear connection between the two has not been proven. Dermatologists note that patients often have dysfunctions of the thyroid gland, adrenal glands, and pituitary gland. There are menstrual irregularities in women and sexual function in men.

Symptoms of psoriasis

The main symptoms of psoriasis are skin rashes. But there are other signs too. The first manifestations usually appear in adolescence or childhood in the context of hormonal disorders, vegetative-vascular dystonia and prolonged stress.

The disease begins with a feeling of constant fatigue, altered mood. Characterized by small pink formations (papules) that rise above the surface, sprayed from above with whitish scaling. They are surrounded by an imposing and brighter edge.

The elements of the eruption grow and combine into large, strangely shaped plates. The base of the papule is an inflammatory infiltrate. By the nature of the rash, psoriasis is divided into:

• point- elements no more than 1 mm in diameter;
• tear- papules-droplets up to 2 mm;
• in the form of a coin- Round papules-coins up to 5 mm in size.

Characteristic features of the rash:

• stearin stain- if it scrapes, the surface of the papules;
• terminal film- Thoroughly cleaning the surface of the scale papules, we will see a transparent film;
• blood spray (Auspitz phenomenon)- having scraped the film and violating its integrity, we will see small drops of blood protruding from the surface.

Stages of psoriasis

There are three stages of the disease:

1. progressive- the first elements of the eruption appear, their number increases, all new areas are captured; rashes also appear when scratching the itchy skin or when being exposed to some external irritating factors (Kebner phenomenon); in the initial stage of psoriasis, the papules begin to merge into large plaques;
2. stationary- there are no new elements and those that appeared before do not go back;
3. regressive- the rash turns pale, its base becomes less dense; the rash gradually recedes, the process often starts from the central part, so the plates may be in the form of rings; if the plaques in psoriasis dissolve from the periphery to the center, then they simply gradually decrease in size and a white ring forms around them - the pseudoatrophic Voronov border; where there was a rash, white pigmented areas remain - psoriatic leukoderma.

Occasionally, papules are present simultaneously on the skin in all three stages of development. There are also summer and winter forms with a predominance of exacerbations in summer or winter.

Is psoriasis contagious?

Numerous studies have confirmed that this is not a contagious disease. If infectious pathogens participate in its development, only through a general effect on metabolism, immunity and the genetic apparatus.

Patients often ask:

• How is psoriasis spread?

  Psoriasis is not spread from person to person.

• Is psoriasis inherited?

  The answer is again negative, but there is a hereditary predisposition in the form of metabolic characteristics and the functioning of the immune system, which is passed on to close relatives.

Types of psoriasis

The nature of the rash, its location, the damage to other organs and systems in this chronic dermatosis can be different. According to these signs, various types of diseases are distinguished.

Simple (vulgar, plate)

The most common. Its symptoms are papules of a characteristic bright pink color, covered with white scales. Subsequently, plaque psoriasis is divided into the following forms:

• easy- if the lesion does not cover more than 3% of the skin; in the progressive phase, the papules increase, but then rapidly undergo a reverse development;
• moderate- the rash lasts from 3 to 10%; papules are large, merge into plaques;
• heavy- defeat captures more than 10%; the eruptions are numerous, merge and form a wide variety of forms.

Vulgar psoriasis progresses in the form of relapses, alternating with remissions, but also has a continuous course.

Elbow psoriasis

This is one of the manifestations of a mild form of plaque inflammation. A distinctive feature of psoriasis on the elbows is the constant presence of one or more "duty" plates on the extensor side of the elbow joints. If these elements are injured, an exacerbation begins.

Guttate psoriasis

In the development of guttate psoriasis, bacterial (most often streptococcal) and viral infections are of great importance. It occurs in childhood. Inflammation begins after an infection. Streptococci secrete toxins (antigens, substances foreign to the human body) that bind to proteins in tissues. Antibodies are produced and autoimmune inflammation develops.

The beginning is sharp. On the skin of the extremities (less often on the body and face), small red papules appear, tears with a scaly surface. With lesions in the area of the rash, small erosions and sores form, the risk of infection increases.

Psoriasis quickly takes a subacute and chronic course. Relapses are replaced by remissions, independent recovery or transition to the adult form of the disease is possible.

Palmar-plantar psoriasis

It develops in those who perform physical work, is accompanied by severe itching and almost always gives a complication to the nails. There are subspecies:

• fan-shaped plate- with large elements on the palmar and plantar surfaces, covered with white scales, melting into fan-shaped plates; such psoriasis on the hands is more common;
• circular- ring-shaped scaly elements on the palmar and plantar surfaces;
• horny- characterized by the growth of thick epithelium with the formation of calluses;

A separate subspecies is pustular psoriasis on Barber's palms and soles. The areas under the thumbs of the extremities are covered with vesicles and pustules (with purulent contents), intense itching appears. Abscesses fuse together, then dry up and crust over. In other parts of the body, characteristic psoriatic elements develop. The disease often spreads to the nails.

Psoriasis on the legs persists and is aggravated by varicose veins, in which case the rash will be mainly in the lower leg area.

Nail psoriasis

Damage to the nails can be independent or a complication. Typical symptoms:

• small dimples of different depths appear on the nail plate; in other dermatitis similar lesions are found on the nails, but in psoriatic lesions they are deeper and slightly painful when pressed;
• slow and painless spontaneous separation of the nail (onycholysis);
• subungual hemorrhages in the toenails, especially if the patient wears tight shoes;
• trachonychia: cloudiness and irregularities in the nail plate; a depression forms in the middle of the nail and the nail becomes spoon-like (koilonychia).

Sometimes the periungual roller is affected with the transition of inflammation to other tissues (psoriatic paronychia).

Scalp psoriasis

Here, the disease proceeds independently or as part of a general pathological process. Characterized by suppuration, the formation of scabs in parts or on the entire surface of the head. Hair growth is not affected at the same time: psoriasis on the head does not alter the function of the hair roots. But the suppuration creates a threat of infection with subsequent damage to the hair follicles.

It flows in waves, then disappears with the disappearance of the scabs, then again aggravates and is accompanied by severe itching, which often leads patients to neurosis.

Seborrheic psoriasis

Seborrhea is a condition caused by a malfunction of the sebum-producing glands of the skin. A viscous oil is produced that irritates the skin and contributes to the development of inflammation - dermatitis.

Seborrheic psoriasis spreads rapidly to the entire head, covering it in the shape of a cap and accompanied by intense itching. In the areas behind the ear, sometimes a cry develops and an infection joins. The head covered with dandruff and solid scabs sometimes looks like a psoriatic crown.

Psoriasis on the face

In general, psoriasis on the face is located in the area of the nasolabial triangle, eyelids, above the eyebrows, in the areas behind the ear. The fused elements of the rash form large areas of redness and swelling. If there is a dysfunction of the sebaceous glands, the process is often accompanied by crying, crusting and an increased risk of infection.

Psoriasis on the genitals

This is not an isolated process. Simultaneously with the defeat of the genitals, there are characteristic psoriatic rashes all over the body, so it is not difficult to identify the disease.

Psoriasis on the penis in men and the labia majora in women, as well as adjacent areas of the skin, manifests itself in the form of oval pink scaly papules that rise slightly above the skin. There is practically no itchiness. Sometimes the process spreads to the mucous membranes and looks like vulvovaginitis in women and balanoposthitis in men.

Atypical psoriatic eruptions can be seen in obese people in folds located next to the genitals (inguinal, intergluteal). Here, deep red areas with a mirror-like surface are formed with no signs of flaking due to constant wetting.

What is the danger of psoriasis and should it be treated?

The danger is that psoriasis can take a severe generalized form, the eruptions will occupy more than 10% of the integument. This stage of the disease is difficult, relapses, the elements of the rash are injured and wet, an infection often joins. Only over time, the prescribed psoriasis treatment can stop the process of spreading.

Sometimes the disease is complicated by inflammation of the joints with the formation of psoriatic arthritis, against which the function of the joints can be significantly impaired.

Against the background of a systemic autoimmune process, which has a significant effect on the patient's condition, other autoimmune diseases often develop (rheumatoid arthritis, some types of osteoarthritis, Crohn's disease, etc. ), as well as serious cardiovascular pathology, diseases of the digestive system, neurological reactions.

If you do not start psoriasis treatment in time, the patient's condition will drastically worsen and lead to disability.

There is also a complication such as psoriatic erythroderma, which develops with inadequate or insufficient treatment of psoriasis, as well as when various irritating factors are exposed to inflamed skin. The skin acquires a bright pink color with a clear delimitation of the affected areas from the healthy ones, small and large laminar peeling. Such a patient requires emergency medical attention.

Is psoriasis treated?

Yes, and quite successfully, but a full recovery cannot be guaranteed.

Treatment methods

Autoimmune inflammation requires individually selected complex therapy, lifestyle changes, nutrition, and the elimination of all bad habits. Modern medicine has proposed three basic principles for the successful treatment of psoriasis:

• strict adherence to the algorithms for the prescribed therapy;
• regular monitoring of the effectiveness of therapy;
• timely correction of the prescribed therapy with its insufficient effectiveness.

Nutrition for psoriasis

There is no special diet for psoriasis, but nutrition is of great importance. Therefore, when prescribing complex treatment, recommendations on nutrition are necessarily given:

• identify an increased sensitivity of the body to certain foods and exclude them from the diet;
• give preference to fresh vegetables, non-acidic fruits and berries, boiled and baked lean meat, drink more;
• what not to eat with psoriasis:
  1. products containing essential oils: onions, garlic, radishes;
  2. beverages containing caffeine (concentrated tea, coffee), alcohol;
  3. everything is more salty, sour and sweet, rich;
  4. products that promote sensitization (allergy) of the body: orange fruits, honey, nuts, cocoa, eggs;
  5. do not eat fatty products of animal origin.

Pegano diet for psoriasis

This diet was developed by the American doctor John Pegano, but has not found official medical examination. The principle of making the Pegano diet for psoriasis is associated with alkalizing the body by selecting the correct diet. According to this principle, all products are divided into:

• alkali formers (two-thirds in the daily diet) - non-acidic fruit and berry mixtures and juices, vegetables (exclude those that cause increased gas formation);
• acid formers (one third of the diet): meat, fish, dairy products, beans, peas, potatoes, cereals, sweets and pastries.

Patients are advised to drink still mineral water, drinking water up to 1. 5 liters per day, in addition to other ingested liquids (compotes, juices, etc. )

Drug therapy

Mild psoriasis is treated with topical medications. Severe and rapidly progressive forms of the disease are primarily treated in a hospital setting with the prescription of general-acting (systemic) drugs.

Treatment of external psoriasis

The drug is selected by a dermatologist. For vulgar psoriasis with dry constricting plaques, ointments are suitable, if suppuration develops (with seborrheic), medicinal creams and solutions are used. To prevent the body's resistance (resistance) to a certain drug, it changes over time.

In the acute (progressive) stage, the following external therapy is carried out:

• agents that have a softening effect: boric petroleum jelly, 2% salicylic ointment;
• effective non-hormonal psoriasis ointments containing activated zinc pyrithione; suppress infection and have a cytostatic effect (suppress tissue proliferation);
• external agents containing glucocorticosteroid hormones (GCS);
• a combined agent with calcipotriol (a vitamin D3 analog) and betamethasone corticosteroids; perfectly suppresses the inflammatory process.

External treatment of psoriasis in the stationary stage:

• ointments that dissolve the scales (keratolytics) and have an anti-inflammatory effect: 5% naphthalan, boron-naphthalan, tar-naphthalene;
• corticosteroid medications.

External treatment of psoriasis in resolution stage:

• the same keratolytic ointments, but in a higher concentration: tar-naphthalene ointments 10%;
• ointments based on vitamin D3 analogues - within 6 to 8 weeks; suppresses the inflammatory process and the peeling of the rash.

For the treatment of psoriasis on the nails, special varnishes are used that suppress the development of the pathological process. It is recommended to treat the periungual phalanges with hydrating gels.

Systemic treatment of psoriasis

• drugs that relieve inflammation and intoxication - calcium chloride, sodium thiosulfate, unitiol in the form of injections;
• tablets for psoriasis, which suppress the processes of proliferation (multiplication of epithelial cells): cytostatics that suppress the activity of the immune system, vitamin A analogs, corticosteroid hormones;
• biological agents containing human monoclonal antibodies of the IgG class, which act on certain inflammation bonds by suppressing the synthesis of cytokines; It is a very effective modern drug that is administered by injection;
• vitamins for psoriasis help restore metabolism and keratinization of epithelial cells; doctors prescribe vitamins A, E, D3, group B.

Folk remedies for psoriasis

Any treatment for psoriasis, even with the use of home remedies, can only be prescribed by a doctor. Self-treatment can lead to the opposite effect - the spread of the disease.

As part of a complex therapy, the following methods can be used:

• grease- product from the production of industrial oils; to prepare the ointment, you need to buy a medical solid oil in a pharmacy; recipe: in 0. 5 kg of solid oil, add 50 g of honey and half a packet of baby cream; procedures are carried out on a daily basis; at the pharmacy, you can buy ready-made preparations based on solidol.
• sodium bicarbonate- a folk remedy for psoriasis, which helps to clean scabs, relieves itching; recipe for soda applications: take 60 g of soda, dissolve in 0. 5 liters of water, soak a gauze cloth in the solution, fold it in several layers and apply on the lesion for 20 minutes; after the procedure, dry the skin and apply any emollient ointment on it; treatment of psoriasis with soda is carried out once a day;
• mummy- has a pronounced anti-inflammatory effect, well relieves itching; can be taken orally once a day, 0. 2 g for two weeks; external therapy is carried out with a mummy solution; applied to dry itchy plaques twice a day; treatment of psoriasis on the head is carried out by rinsing the scalp with a mummy solution after washing;
• sea salt- relieves inflammation, itching well; baths with sea salt: take 1 kg of salt, dilute in two liters of water and add to the bath; take a bath for 15 minutes, then wash off the solution with a warm shower, pat the body dry with a towel and apply an emollient ointment; treat psoriasis with baths no more than twice a week;
• clay- has a pronounced cleansing effect, adsorbing on its surface toxins formed as a result of inflammation and improper metabolism; helps dry, remove scabs and itchiness; you can take any clay, but it is better to buy blue clay in a pharmacy; chunks of clay need to be thoroughly dried, broken with a hammer, diluted with water and allowed to stand for several hours; put the resulting plate-shaped clay on a napkin (up to 3 cm thick) and apply to the foci of inflammation for three hours; to treat psoriasis with clay every other day.

Important: treatment of psoriasis at home with folk remedies should be carried out with caution and strictly according to the doctor's prescription. Such treatment will help one patient, while in another it can lead to an exacerbation and rapid spread of inflammation. Therefore, if, against the background of therapy, the patient's condition has worsened, it is necessary to stop it immediately and consult a doctor.

Home treatment for psoriasis

When treating psoriasis at home, it is important to follow dietary recommendations, lead a healthy lifestyle, exclude bad habits, and strictly follow all the prescriptions of a dermatologist.

How to cure psoriasis at home? Some patients try to cleanse themselves of toxins and toxins using all sorts of unconventional methods (enemas, etc. ). This can give exactly the opposite result: the work of the digestive tract will be interrupted and an exacerbation will begin. Modern medicine recognizes the cleansing of the body in the form of proper nutrition and getting rid of bad habits.

It is important to follow all the doctor's prescriptions and pay attention to how the prescribed therapy works. If it is not effective enough, the doctor will replace the treatment, achieving the maximum therapeutic effect.