According to the WHO, currently 2-4% of the world's population suffers from psoriasis. This disease affects patients of all ages, however, most of the time they are young (15-25 years). Unfortunately, today medicine cannot completely cure psoriasis, but timely professional treatment significantly improves the quality of life. So, in case of detection of the first symptoms, it is better to immediately consult a doctor.
Psoriasis- It is a dermatosis, which manifests itself in the form of scaly papules on the skin. Its distinctive feature is that, in addition to the skin, it is capable of affecting joints and nail plates. In the pathogenesis of psoriasis, hereditary factors are clearly traced, and other irritants are only secondary causes of its occurrence.
During an exacerbation of the disease, the natural processes of formation are disrupted: keratinocytes (cells of which human skin is mainly composed). There are also pronounced biochemical changes in the skin. In addition, recently, doctors have been able to establish that during the acute phase of the disease, the functioning of the nervous system also differs from the norm. In general, the main reason for the appearance of psoriasis is the presence of dysfunctions in the functioning of the immune system.
Psoriasis prevalence
Psoriasis is common. At the moment, the incidence statistics are approximately the following:
- China: 0. 3%;
- United States - 1%;
- Denmark - 1-2, 3%;
- Northern Europe: 3%;
- Germany - 1-1, 3%.
It is curious that the indigenous population of South America is not affected by the disease. So far, at least not a single case of this type has been reported. If you look at the situation as a whole, the proportion of psoriasis is about 6 to 8% of all skin diseases.
As already noted, psoriasis manifests itself at any age, but most of the time young people (up to 25 years old) still suffer from it, and in both men and women it occurs with the same frequency.
Epidemiological situation
According to the causes of appearance, psoriasis is a non-infectious disease with a pronounced genetic predisposition. People most at risk of getting sick are those whose family members also suffer from this ailment (in this case, only the closest relatives are referred to). European researchers have established with certainty that if one of the parents is sick, she has a 14-25% chance of transmitting it to her child. If both parents are sick, this probability is already 41 to 60%.
Depending on the type of development of the disease, psoriasis is divided into two groups:
- early;
- late.
This is evidence that there are two main types of psoriasis (such as diabetes mellitus). The former occurs in humans at an early age (on average 16-22 years), is strictly hereditary in nature and is directly related to the HLA (HLA-Cw6) phenotype. The course of the disease is often severe and over time the disease only progresses.
The causes of type II psoriasis are quite random, so this disease is sporadic. It occurs most often in older people (around 60 years old). In general, it progresses quite easily, however, in some cases, it can be aggravated by joint and nail damage.
Factors that cause the appearance of psoriasis.
Although psoriasis tends to be inherited, it is generally multifactorial. Anything can trigger that fatal immune system malfunction. Therefore, the provoking factors are divided into external and internal (or, in scientific terms, exogenous and endogenous).
Exogenous factors
These, in turn, are divided into physical and chemical. The former include common mechanical damage to the skin, such as household injuries, thermal burns, abrasions, scars, tattoos, scratches, insect and pet bites. Injection site psoriasis has also been reported. X-ray and ultraviolet irradiation also play an important role. In about 5% of all cases, the disease occurs in the summer and 40% of them are due to sunburn.
Chemical factors are expressed in the toxic effect of harmful chemicals or other irritants on the skin. In addition, psoriasis is also caused by other skin diseases, such as:
- skin disease;
- fungal infections;
- contagious impetigo;
- acne;
- dyshidrosis;
- lichen;
- herpes infection;
- pyoderma gangrenosum;
- Allergic dermatitis of various nature.
Cases of the disease are known after performing elemental diagnostic skin tests to know the reaction of the body to cosmetics, hygiene products, formalin, chromium, nickel and other chemical substances.
Endogenous factors
Internal causes of psoriasis can be infectious diseases. The latest research in this area suggests that streptococcal infections and HIV are the most responsible. In addition, symptoms often do not appear during the disease itself, but even after regular vaccination. In these cases, psoriasis is often difficult to treat.
To induce remission, lithium preparations, beta-blockers, non-steroidal anti-inflammatory drugs, and ACE inhibitors are used. Corticosteroids are contraindicated in this case.
Pregnancy and childbirth
Significant changes in hormone levels caused by pregnancy can also become a triggering factor. A similar pattern is also seen during puberty. It is also curious that women who already have psoriasis can experience an improvement in their condition during pregnancy (40%). Deterioration is much less common (only in 14% of cases). It is true that after delivery in most patients, the condition worsens again (in 54% of cases)
Diet and nutrition
These factors often do not have a noticeable effect on the course of the disease. It is only known with certainty that the abuse of alcohol and cigarettes significantly increases the chance of getting psoriasis and worsens its course.
Hypocalcemia and hypokalemia
These factors can lead to the development of generalized pustular psoriasis. The chances of a favorable outcome in this case are very small.
Pustular psoriasis.
Psychogenic factors
His role today is considered quite controversial. Some researchers claim that the presence of traumatic psychogenic factors causes psoriasis in 60% of all cases. However, it is only known with certainty that they can only worsen the course of the disease and reduce the effectiveness of therapy.
Classification
At the moment, several separate types of psoriasis have been identified. They differ markedly in the clinical picture and the degree of effect on the body, therefore, to get an idea of what is at stake, it is better to look at the World Wide Web and carefully study the photos of psoriasis of various etiologies, as well as familiarize yourself with the description.
Vulgar psoriasis
Vulgar or common psoriasis occurs in most cases. This disease manifests as a profuse rash of small bright red papules (from the head of a match to a pea). After emerging, they grow rapidly and silvery-white scales appear on their surface. In the future, the papules transform into plaques, which merge into a large lesion. Very often they have clear boundaries that separate them from healthy skin.
When you try to comb or remove the papule, the flaking first increases. This phenomenon is known as the "stearin stain symptom" and, once all the scales have been removed, a smooth shiny surface can be found, the "terminal film symptom". If you continue to scrape, the capillaries are injured and drops of blood are released. This symptom is known as "blood spray. "
The development of psoriasis is divided into three main periods:
- progressive (acute);
- stationary;
- resolution period.
The success of treatment here depends primarily on how correctly the therapy methods are selected, since, depending on the period, their effectiveness varies significantly.
Progress period. A characteristic of this stage is the profuse appearance of a specific rash. In the exacerbation phase, certain parts of the patient's body are covered with small papules, which are actively peeling off. The peeling in this case is strictly localized and does not affect healthy skin. Acute psoriasis is easy to identify by the characteristic red or pink border that borders the papule.
The most characteristic symptoms at this stage are itching and the presence of the so-called Koebner's symptom. The latter is expressed in the fact that psoriatic papules appear at the site of any skin lesion (minor burns, scratches, injections, scrapes, etc. ). This phenomenon occurs on average two weeks after the injury itself and occurs in 38-76% of all patients.
It is also extremely curious that (much less frequently) the opposite effect is also observed. Scientists believe that it is due to the presence in the blood serum of some patients of special factors that inhibit Koebner syndrome.
Stationary period. On average, 2-3 months after the appearance of the first rashes, the formation of new papules stops. Plaque growth also stops. At this stage, its entire surface is already covered with scales. This period can last for months or even years. However, the latter is relatively rare.
Resolution period. This period is also called the regressive period, since during it a gradual decrease in plaque is observed. At first they stop peeling and then gradually soften until completely gone. If the disease is mild, this phenomenon occurs spontaneously. Treatment only accelerates its appearance. Often times, the place where the plaques were located stands out in the context of areas of healthy skin by depigmentation or, less frequently, by hyperpigmentation. With psoriasis vulgaris, the rashes can occur almost anywhere and are usually located symmetrically (extensor surfaces of the elbows and knees). It can also appear on the head, sacrum, hands, palms, soles, groin, and armpits. In addition, in many cases, the nail plates are also affected (appearance of pin holes, loosening, thickening). These symptoms are very similar to those that occur when infected with fungi, so the final diagnosis is made only after receiving a negative reaction to fungal spores in a special laboratory study. Vulgar psoriasis as a whole does not have a general negative effect on the patient's body and its course is chronic. Periods of exacerbation occur in autumn or winter, while in summer exacerbations, on the contrary, are much less common. The main incentive for active treatment lies in the fact that without proper therapy, psoriatic plaques can cover the body for years, while proper treatment improves after a few months.
Psoriatic erythroderma
Psoriatic erythroderma is one of the most unpleasant forms of this disease. On average, a similar reaction is seen in about 2% of patients and occurs both spontaneously and as a result of incorrectly selected treatment. Although, of course, if the drugs used irritate the skin or are exposed to ultraviolet radiation, the risk of psoriatic erythroderma is much higher. Most often, psoriatic erythroderma appears suddenly during the early stage of psoriasis. It can be combined with arthritis and generalized pustular psoriasis, and exposure to factors such as streptococcal infections or hypocalcemia significantly increases the likelihood of such a complication. Stopping corticosteroids abruptly can also make the condition worse. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by diffuse redness of the skin, severe itching and lamellar scaling.
Pustular psoriasis
It is also a serious form of psoriasis. It is characterized by the appearance of abscesses, which often remain the only symptom. Much less often they are combined with the classic symptoms of psoriasis vulgaris. Pustular psoriasis is generalized and localized. The second differs only in that the abscesses in this case are concentrated only in the area of the palms or soles.
Psoriasic arthritis
Currently, psoriatic arthritis is classified as an autoimmune disease in its own right. It is expressed in damage to bones and muscles in patients who already suffer from psoriasis or have a high risk of suffering from the disease due to a family history. Most often, psoriatic arthritis is combined with classic psoriasis, as well as psoriatic nail lesions. This disease is diagnosed by the appearance of back pain, accompanied by the following conditions:
- lack of a clearly stated reason for the appearance;
- the age of the patient is over 40 years old;
- deep, unexplained pain in the lower back or buttocks;
- indistinct location of pain;
- reduction of pain after exercise;
- pain or stiffness is felt early in the morning or at night;
- the presence of pain with an excellent general condition of the musculoskeletal system.
Psoriasis of the nail plates.
Most often, psoriasis vulgaris is accompanied by nail damage. In this case, its pronounced dystrophy is noted, as well as the characteristic symptoms of fungal infections. It is a frequent companion of psoriatic arthritis. Considering that around 4% of the world's population suffer from common psoriasis, 30-50% of them also suffer from nail psoriasis.
Psoriasis treatment
Unfortunately, at present, medicine is not yet capable of curing psoriasis, as this requires a much deeper understanding of the peculiarities of the work of the basic mechanisms of the human immune system. Since this type of research proceeds rather slowly and the disease itself is not particularly life-threatening, symptomatic therapy is currently the priority. Before starting treatment, the patient needs a complete examination, since each organism contains an individual set of factors that influence the course of the disease. Sex, age, profession, general health, type of psoriasis - all this must be taken into account when prescribing therapeutic therapy. Establishing the nature of the disease course, individual susceptibility to drugs, and the current stage of the disease also play an important role.
General activities
First, the doctor must determine the mental and physical state of the patient, assess the general condition of her body and find out how tolerant she is to the disease. The best prerequisites for effective treatment are a good rest, staying in a quiet environment, switching to a less intensive work mode, or a short-term hospitalization. Various methods of psychotherapy (spa rehabilitation with the use of cognitive behavioral therapy, etc. ) have also been tested quite well. It is also very important that the patient knows that the healing process is progressing as it should, because, without receiving a quick effect, about 40% of patients lose faith in the effectiveness of the therapy and begin to ignore it. It is important not to forget that psoriasis is a chronic disease, therefore the safety of therapy must be taken into account. Many drugs are toxic and can accumulate in the body, becoming a time bomb. An addictive effect is also possible, so it is better to save the most powerful drugs until the really dangerous symptoms appear.
Evolution of the disease and long-term prognosis
The course of psoriasis is often unpredictable. Modern doctors have practically not been successful in this, therefore, as before, psoriasis remains an unpleasant and uncontrollable disease. In each case, it proceeds completely individualized, so that any attempt to make a prognosis about the course of the disease, as well as the duration of the phases of exacerbation and remission, is doomed to failure beforehand. Only one thing pleases: despite the difficulty of treatment, it rarely represents a real threat to the patient's life. As for psoriatic arthritis, this disease is much easier than rheumatoid arthritis, and the decrease in the quality of life of patients, compared to the latter, is very insignificant. Statistics show that with proper treatment, most psoriatic arthritis patients remain functional and can lead full lives. If the necessary therapy is absent, or the disease progresses with complications, joint deformities can develop with the further development of serious pathologies. However, these complications are found only in a very small number of psoriasis patients. Most patients can expect a gradual stabilization of the condition and the appearance of remissions in the long term (more than two years). In very rare cases, the disease progresses mainly into the active phase, however, in this case, it can be effectively localized. Today, effective psoriasis treatment can be obtained in any major city. And, although, as you know, final recovery cannot be achieved, diet, special medications and procedures will quickly do their job. Also, you will not need long-term treatment in a hospital. The task of the doctor is only to quickly avoid the first two stages of psoriasis and bring the person into remission. After that, the patient can only take care of himself, follow the instructions and forget about the disease for a long time.