A pathological condition characterized by scaly and nodular lesions of the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of the disease.
Psoriasis is a chronic skin and nail disease in which pink nodules and silvery scales appear on the skin. Usually, the nodules coalesce into large plaques around which the skin quickly becomes covered with scales. In the long-term development of the disease, joint damage is possible, accompanied by impaired mobility and constant pain. Different forms of psoriasis differ in the degree of skin damage: the patient may have only fine spots on the scalp or large plaques on different parts of the body. The likelihood of psoriasis complications also depends on many factors. This disease is especially dangerous for pregnant women, as the pustular form of the disease can cause miscarriage.
About the disease
Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually appear between the ages of 18 and 35. Psoriasis often occurs against the background of cardiovascular disorders, Crohn's disease and depression. About 30% of patients develop joint damage (arthritis). It is impossible to eliminate the root cause of psoriasis, but symptomatic therapy can significantly alleviate the course of the disease.
Types of psoriasis
Depending on the predominant symptoms, several types of psoriasis are distinguished:
- plaque: characterized by the appearance of classic plaques covered with silvery scales; preferred site: elbows, knees, trunk, scalp;
- teardrop-shaped: the main manifestation of nodules is orange-pink nodules, 1-10 mm in size;
- nail psoriasis: the nail plates are predominantly affected;
- psoriasis of large folds: rashes appear in the armpits, neck folds, genitals and other places with excessive friction; this form occurs more often in obese people;
- psoriasis of the head: the scalp is affected;
- arthropathic psoriasis (psoriatic arthritis): the joints are affected;
- pustular psoriasis: multiple small blisters with pus appear on the patient's skin;
- psoriatic erythroderma: in addition to the rash, pronounced reddening of the skin occurs in the area of the rash.
Symptoms of psoriasis
Plaques most often appear on the forearms, lower legs, navel, and scalp. The pustular form of psoriasis is characterized by the formation of purulent blisters on the skin. At certain periods, the color and structure of the nail changes in many patients. Damage to the scales of the skin leads to the appearance of pinpoint bleeding. Patients also complain of skin itching. Skin lesions sometimes disappear and reappear.
Other symptoms and signs:
- the appearance of red spots in the area of skin folds;
- abundant rashes appear after infectious diseases and stress;
- slight rise in body temperature;
- the appearance of new skin rashes in the winter months;
- joint pain;
- impaired mobility in the area of the affected joint;
- dryness and hypersensitivity of the skin.
The absorption of the plaques usually starts from the middle part, as a result of which the psoriasis elements take on a ring-like or garland-like shape. Temporary depigmentation (pseudo leukoderma) remains at the site of the eliminated rashes. During periods of incomplete remission, individual "must" plaques may remain in certain areas of the skin (more often in the areas of the elbow and knee joints).
The most severe types of psoriasis are psoriatic erythroderma and arthropathic psoriasis.
In psoriatic erythroderma, the entire (or almost the entire) skin is involved in the pathological process. The skin becomes tight, rough, infiltrated, red, and abundant large and single-plate peeling appears on its surface. Peripheral lymph nodes increase, subfebrile temperature appears, the general condition of the patients is disturbed, changes in the blood (leukocytosis, elevated ESR) and urine (proteinuria) are observed. The development of erythroderma in the progressive stage of psoriasis is facilitated by irrational, irritating therapy.
Arthropathic psoriasis mainly affects the small joints of the hands and feet, less often the wrists, ankles, intervertebral discs, etc. its changes are characteristic, which are accompanied by severe joint pain and swelling, limited movement and deformities. X-rays show lysis of the distal phalanges of the fingers and changes in the joints, similar to rheumatoid arthritis. The Waaler-Rose test and the latex test are usually negative. In the blood, leukocytosis, elevated ESR, hypergammaglobulinemia. Joint involvement may be associated with skin changes or may be isolated for several years.
In these forms of psoriasis, the nails may be damaged in the form of perforated nail plates ("thimble phenomenon"), darken or thicken, up to onychogryphosis. The course of the disease is chronic and undulating. The seasonality of the process is usually expressed - deterioration in winter, significant improvement in summer (winter type), less often - vice versa (summer type).
Causes of psoriasis
The exact mechanisms of the development of psoriasis are still unknown. It is thought to be an autoimmune disease in which the body's defense system mistakenly attacks healthy tissue. T cells and neutrophils needed to fight pathogens can begin to attack skin cells and joint structures. In this case, characteristic changes occur on the skin, including the formation of bubbles with inflammatory fluid. The expansion of blood vessels is accompanied by reddening of the skin in the area of inflammation. Autoimmune diseases can be caused by hereditary factors.
Additional risk factors:
- skin infections. First, these are bacterial infections caused by streptococcus;
- skin damage due to cuts and burns;
- prolonged stress and psychotraumatic factors;
- alcoholism and smoking;
- lack of vitamin D in the body;
- taking certain medications, including lithium and beta blockers;
- unfavorable family history. The discovery of psoriasis in a close relative of the patient indicates the possibility of a genetic predisposition to the disease;
- acquired or congenital impairment of immunity. It could be HIV infection, AIDS or another condition.
Despite the discovery of the purported immunopathological causes of psoriasis, the disease remains poorly understood. There are many diseases and lifestyle characteristics that trigger the manifestation of hidden factors of disease susceptibility.
Diagnosis of psoriasis
If skin changes occur, a dermatologist should be consulted. The doctor at our clinic first performs a general skin examination to assess the nature of the rash. Soft scraping allows detection of scaly papules and a thin film under nodules. Beneath the film is a moist surface of the skin that is prone to small bleeds. At the same time, there are atypical signs of psoriasis that resemble other diseases, so the doctor must perform instrumental and laboratory diagnostics.
- Blood analysis. The dermatologist prescribes a venous blood test to rule out other diseases and recognize the signs of psoriasis. In the treatment room, the nurse treats the skin of the patient's cubital cavity with an antiseptic, applies a tourniquet, and takes blood with a syringe. In our laboratory, the specialists first of all rule out the presence of rheumatic factors. An increase in the sedimentation rate of erythrocytes is often observed in pustular psoriasis. Elevated levels of uric acid are detected;
- Examination of the fluid of the pustules. The doctor collects the fluid in a sterile container and sends the material to the laboratory. The microbiological examination does not reveal a bacterial culture, but an increase in the number of neutrophils characteristic of psoriasis is found;
- Skin biopsy. The dermatologist prescribes this test for the accurate diagnosis of atypical rashes. During the procedure, the doctor treats the skin with an antiseptic, anesthetizes it and removes a small area of skin with a scalpel. The tissue material is examined under a microscope in our clinic's laboratory. The results make it possible to clarify the cellular composition of the nodules;
- X-ray of the affected joint. The doctor prescribes this test to determine the type of arthritis. In addition, X-ray diagnostics of the bones is necessary in case of severe complications of arthropathic psoriasis;
- Skin scraping to rule out fungus. The doctor cleans the surface of the skin and uses a special spatula to collect several scales for microbiological examination. This analysis is primarily necessary if rashes appear only in the area of the feet and nails.
If necessary, a rheumatologist will be consulted.
Expert opinion
Psoriasis is a disease with many manifestations. It can be almost invisible or cause serious health problems. The most dangerous complications of psoriasis are joint damage, which can cause disability in the patient. In addition, the disease can lead to autoimmune disorders, especially Crohn's disease and ulcerative colitis, metabolic pathology, erectile dysfunction in men. Women with psoriasis may experience infertility and miscarriage. In order to prevent these complications, it is necessary to immediately consult a doctor after the appearance of suspicious signs, and carefully follow all the recommendations of a specialist with an already diagnosed diagnosis.
Treatment of psoriasis
The main goal of psoriasis treatment is symptomatic therapy. Patients need medications that reduce inflammation and prevent rashes. In addition to drug therapy, the dermatologist of our clinic necessarily prescribes a special diet for the patient. Normalizing your lifestyle and eliminating stressors can reduce the severity of psoriasis symptoms.
Depending on the situation, the dermatologist can use different methods to treat the disease.
- Administration of corticosteroids. The dermatologist prescribes ointments containing these drugs. Beneficial effects of corticosteroids include reducing tissue inflammation and eliminating itching;
- Vitamin D supplements. Synthetic forms of this vitamin slow down the growth of skin cells, thereby preventing the formation of scales and lumps;
- Therapy with drugs containing vitamin A derivatives. The dermatologist prescribes ointments based on retinoids to reduce inflammation and itching. These drugs increase the skin's sensitivity to light, so sunscreen should be used;
- Use of calcineurin inhibitors. These are immunosuppressants that reduce inflammation. The dermatologist prescribes topical agents such as tacrolimus. Such drugs are used in a short way to prevent the development of side effects and complications;
- Treatment of the skin with salicylic acid to remove dead skin cells. The dermatologist prescribes this drug together with corticosteroids for complex skin treatment;
- Using a moisturizing cream to eliminate dry skin and itching;
- Irradiation of the skin with ultraviolet light. This safe physiotherapy treatment method improves the functioning of local immunity. The doctor selects an individual radiation dose for the patient;
- Phototherapy. This method involves irradiating the skin with special devices. Phototherapy combines the technologies of laser therapy and photochemotherapy;
- Joint puncture in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, anesthetizes the tissues and inserts a needle. Medicines are injected into the joint cavity using a syringe to reduce the inflammatory process.
The dermatologist supervises all stages of the treatment in order to achieve the best results and prevent complications. Corticosteroids, retinoids and calcineurin inhibitors are used strictly under the supervision of a specialist.
Psoriasis prevention
The recommendations of our clinic's dermatologist help reduce the severity of skin rashes and ease the course of the disease.
Prevention of worsening of psoriasis:
- relieve anxiety and stress by improving sleep, avoiding coffee, and taking prescription tranquilizers;
- exclusion of foods containing allergens from the diet;
- timely treatment of infectious skin diseases.
Rehabilitation
Psoriasis is a chronic disease that cannot be cured. The goal of rehabilitation measures is to prevent relapses. Depending on the form of the disease, physiotherapy, spa, mud therapy, spa and other procedures may be prescribed.
Questions and answers
Is it possible to treat psoriasis with folk remedies?
There are no proven effective methods. It is important not to trust dubious 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.