Psoriasisa systemic disease characterized by damage to the skin, musculoskeletal system, and functional and morphological abnormalities of other organs and systems. The main symptoms of the pathology: nodular rashes on the scalp, palms, feet, extensor surfaces of the elbows and knees, hyperemia, itching. The disease can be diagnosed visually, but in order to exclude the possibility of simultaneous pathologies, laboratory tests and instrumental diagnostic methods are prescribed. Systemic therapy includes taking aromatic retinoids and cytostatic drugs, glucocorticosteroids.
Introduction
The name of the disease comes from the Greek word "psora" - "skin disease", "flush". In the Middle Ages, psoriasis was considered a form of leprosy. The signs of psoriasis were first described in 1808 by Robert Whelan from a professional perspective in Great Britain. The term "psoriasis" was introduced by Viennese dermatologist Ferdinand Gebra in 1841. The pathology is recorded at all latitudes of the Earth, with an uneven frequency of 0. 1 to 3%. Psoriasis develops equally in men and women, but in children it occurs more often in girls and in adults in men (60-65%).
Cause
There are various theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurogenic, endocrine, hereditary. All of these theories are based on clinical observations and laboratory results.
Most scientists pay attention to the genetic nature of psoriasis. It is claimed that this disease is of polygenic origin. If one parent is sick, the risk of developing pathology in the child is 8%, if the father and mother are 41%.
Factors contributing to the development of psoriasis are external and internal.
- External factors include mechanical and chemical damage to the skin, as well as dermatoses.
- Doctors identify internal provoking factors: infections (streptococcal and human immunodeficiency virus), drugs (corticosteroids, non-steroidal anti-inflammatory drugs), nervous stress.
Pathogenesis
Today, doctors worldwide recognize the role of the immune system in the pathogenesis of psoriasis. Immune system cells that normally respond to antigens begin to attack healthy cells, most commonly skin cells. As a result of this process, the cells of the epidermal layer divide faster than usual. They do not have time to mature, so strong relationships do not develop between them. When the cells reach the surface, they form protruding plaques with silvery scales.
Classification
According to the International Statistical Classification of Diseases and Related Health Problems, there are many types of psoriasis.
- common (vulgar). The most commonly recorded form of lichen planus, in which there are no complications. Plaque and psoriatic psoriasis belong to this group.
- Generalized pustular psoriasis- a severe form of pathology complicated by secondary infection. It affects several areas at once. These include Zumbusch syndrome and impetigo herpetiformis.
- Persistent acrodermatitis (Crocker dermatitis, Setton dermatitis)— the contents of the pustules are sterile, there is no secondary infection. The main affected areas are the fingers and nails.
- Palmar and plantar pustulosis (pustular bacterium)- develops on the feet and hands. It appears as pustules with sterile content, the area of which gradually increases.
- teardrop shaped- isolated papules that do not merge into plaques. The most commonly affected areas are the legs, thighs, back, forearms, chest and neck.
- Arthropathic- its clinical course resembles the rheumatic form of arthritis.
- Other psoriasis (reversed)- conglomerates are localized in the armpits, groin and other natural folds. Inverse flexor psoriasis belongs to this type.
- Unspecified psoriasis- it combines several pathologies, the clinical picture is quite broad.
Depending on the seasonality of the exacerbation, several types of psoriasis are distinguished:
- summer- exacerbation occurs as a result of exposure of the skin to sunlight;
- winter- occurs due to extreme cold affecting the skin.
In non-seasonal psoriasis, there are no periods of remission, the disease occurs all year round.
According to the affected skin area:
- limited psoriasis- occupies less than 20% of the body's skin;
- frequent— more than 20%;
- generalized- the whole skin is affected.
Symptoms
The clinical manifestation of psoriasis depends directly on the stage of development of the disease. There are 3 sections.
- Progressive stage. It is characterized by the appearance of papules, itching, peeling, peeling and deformation of the nails.
- Standing stage. New papules do not appear, the size of old rashes does not increase, peeling is moderate.
- Regressive stage. The plaques heal, and white depigmented spots form in their place, which no longer cause discomfort.
Skin rashes are only external signs of psoriasis. In fact, the disease affects many organs and systems, as well as tendons and joints. Because of this, patients complain of depression, a constant feeling of weakness and chronic fatigue.
Complications
Among the complications of psoriasis, psoriatic arthritis and psoriatic erythroderma are particularly important. In addition, in the absence of timely diagnosis and effective treatment of psoriasis, the risk of developing serious chronic pathologies increases: diabetes mellitus, arterial hypertension and metabolic syndrome.
Diagnostics
Laboratory and instrumental diagnostic methods are used to identify the pathology.
The patient receives a referral:
- general clinical analysis of blood and urine;
- blood biochemistry;
- blood test C-reactive protein and rheumatism;
- coagulogram - evaluation of blood coagulation;
- blood test for the detection of human leukocyte antigen.
For complicated forms of psoriasis, which are associated with damage to the musculoskeletal system and internal organs, radiography of the joints, ultrasound examination of the kidneys and urinary organs, and echocardiography are prescribed.
There are diseases that have similar symptoms. As a result, a differential diagnosis is required. To do this, use methods such as:
- biopsy (excision of a piece of skin with further histological examination);
- laboratory tests - used to distinguish between psoriasis and papular syphilis.
Treatment
Psoriasis responds well to symptomatic treatment. Knowing the pathogenesis, the doctor can choose the treatment method individually. The goal of some is to reduce skin rashes, eliminate dryness and itching, others - to suppress the immune system from "attacking" healthy cells.
Therapeutic tactics directly depend on the severity of the disease and the location of the lesions.
External therapy
Topical glucocorticosteroids are used for various forms of psoriasis as monotherapy or in combination with other medications. They exist in the form of dosage forms - ointments, creams or lotions.
Medicines containing analogues of vitamin D3. It is applied to the affected areas of the skin if the occurrence of psoriasis does not exceed 30% of the body surface.
Preparations containing activated zinc pyrithione are used in the form of aerosols, creams and scalp shampoos.
Phototherapy
In this case, medium wave phototherapy and PUVA therapy methods are used for treatment. PUVA therapy is the combined use of long-wave ultraviolet radiation (UVA) (320-400 nm) and photosensitizer (8-methoxypsoralen). PUVA therapy is one of the most effective ways to cure the disease, and it is most often prescribed for extensive vulgar and exudative psoriasis, persistent pathology, and severe infiltration.
Combined therapy
Such treatment includes several therapeutic modalities, such as: light therapy and topical corticosteroids; light therapy and systemic retinoids.
Systemic therapy
It is prescribed for moderate and severe forms of psoriasis. Systemic therapeutic drugs are mainly prescribed during disease progression.
Biological drugs
These drugs are created using genetic engineering methods. These 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 a preventive measure, the following are often prescribed: a diet rich in fish and vegetables, hydrotherapy, herbal cure, sanatorium-resort treatment and emollient (especially in the period between relapses - to restore the hydrolipid layer).