Psoriasisis a systemic disease characterized by damage to the skin, musculoskeletal system, functional and morphological disorders of other organs and systems. The main symptoms of the pathology: nodular rash on the scalp, palms, feet, extensor surfaces of elbows and knees, hyperemia, itching. The disease can be diagnosed visually, but to exclude the possibility of developing concomitant pathology, laboratory tests and instrumental diagnostic methods are prescribed. Systemic therapy includes taking aromatic retinoids and cytostatic drugs, glucocorticosteroids.
identification
The name of the disease comes from the Greek word "psora" - "skin disease", "scab". In the Middle Ages, psoriasis was considered a form of leprosy. The symptoms of psoriasis were first described from a professional point of view in 1808 by Robert Whelan in Great Britain. The term "psoriasis" was introduced by the Viennese dermatologist Ferdinand Gebra in 1841. 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%).
Cause
There are various theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurogenic, endocrine, hereditary. Each of these theories is based on clinical observations and laboratory results.
Most scientists pay attention to the genetic nature of psoriasis. They claim that this disease is polygenic inheritance. If one of the parents is sick, the risk of developing pathology in the child is 8%, if both father and mother 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 dermatosis.
- Doctors include internal provocation factors: infections (streptococcus and human immunodeficiency virus), drugs (corticosteroids, non-steroidal anti-inflammatory drugs), nervous stress.
Pathogenesis
Today, doctors around the world recognize the involvement of the immune system in the pathogenesis of psoriasis. Immune system cells, which normally respond to antigens, begin to attack healthy cells, often 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, which is why a strong relationship is not established between them. The cells, which come to the surface, form prominent plaques with silvery scales.
Classification
According to the International Statistical Classification of Diseases and Related Health Problems, there are many types of psoriasis.
- Normal (coarse). The most common form of lichen planus is recorded, where there are no complications. This group includes plaque and coin psoriasis.
- Generalized pustular psoriasis- severe forms of pathology, complicated by secondary infections. It affects several areas at the same time. Includes Zumbusch syndrome and impetigo herpetiformis.
- Persistent acrodermatitis (Crocker's Dermatitis, Setton's Dermatitis)- the content of the pustule is sterile, there is no secondary infection. The main areas affected are the fingers and nails.
- Palmar and plantar pustulosis (pustular bacterides)- develops on the feet and palms. It appears as a pustule with sterile content, which gradually increases in area.
- in the form of teardrops- isolated papules that do not merge into plaques. The most commonly affected areas are the legs, thighs, back, forearms, chest and neck.
- Arthropathy- the clinical course resembles a form of rheumatic arthritis.
- Other psoriasis (inverse)- localized conglomerate in armpit, inguinal and other natural folds. This type includes inverse flexor psoriasis.
- Unspecified psoriasis- combines several types of pathology, the clinical picture is quite broad.
Depending on the seasonal severity, several types of psoriasis are distinguished:
- summer- aggravation occurs due to exposure of the skin to sunlight;
- winter- occurs as a result of an extreme cold that affects the skin.
With non-seasonal psoriasis, there is no period of remission; This disease occurs throughout the year.
According to the affected skin area:
- limited psoriasis- occupies less than 20% of the body skin;
- normal- more than 20%;
- generalized- the whole skin is affected.
symptoms
The clinical manifestations of psoriasis directly depend on the stage of development of the disease. There are 3 levels.
- Progressive stage. It is characterized by the appearance of papules, itching, the beginning of peeling, peeling and deformation of the nail.
- Stationary stage. New papules do not appear, old rashes do not enlarge, and peeling is moderate.
- Regressive stage. Plaques heal, and white depigmented spots form in their place, which no longer cause discomfort.
A skin rash is just an outward sign of psoriasis. In fact, this disease affects many organs and systems, as well as tendons and joints. For this reason, patients complain of depression, constant weakness and chronic fatigue.
Complications
Among the complications of psoriasis, psoriatic arthritis and psoriatic erythroderma are particularly important. Also, in the absence of timely diagnosis and effective treatment of psoriasis, the risk of developing severe chronic pathologies increases: diabetes mellitus, arterial hypertension and metabolic syndrome.
Diagnostics
To identify pathology, laboratory and instrumental diagnostic methods are used.
Patients are referred for:
- general clinical analysis of blood and urine;
- blood biochemistry;
- blood test for C-reactive protein and rheumatism test;
- coagulogram - assessment of blood clotting;
- blood test for human leukocyte antigen.
For complicated forms of psoriasis, which are associated with damage to the musculoskeletal system and internal organs, joint radiography, ultrasound examination of the kidneys and organs of the urinary system, and echocardiography are prescribed.
There are diseases that have similar symptoms. As a result, there is a need for differential diagnosis. To do this, use methods like:
- biopsy (removal of a piece of skin with further histological examination);
- laboratory tests - used to differentiate psoriasis from papular syphilide.
Treatment
Psoriasis responds well to symptomatic treatment. Knowing the pathogenesis, the doctor can individually choose a treatment method. Some of them are aimed at reducing skin rashes, eliminating dryness and itching, others - to prevent the immune system from "attacking" healthy cells.
Therapeutic 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 drugs. They exist in the form of dosage forms - ointments, creams or lotions.
Medicines containing vitamin D3 analogues. They are used on the affected skin area if the prevalence of psoriasis is not higher than 30% of the body surface.
Preparations containing activated zinc pyrithione are used in the form of aerosols, creams, and even shampoos for the scalp.
Phototherapy
For treatment in this case, medium wave phototherapy and PUVA therapy are used. PUVA therapy is the combined use of long-wave ultraviolet rays (UVA) (320-400 nm) and a photosensitizer (8-methoxypsoralen). PUVA therapy is one of the most effective ways to cure diseases; it is most often prescribed for widespread abrasive and exudative psoriasis, persistent pathology, severe infiltration.
Combination therapy
Such treatment includes several therapeutic modalities, for example: phototherapy and topical corticosteroids; phototherapy and systemic retinoids.
Systemic therapy
Prescribed for moderate and severe forms of psoriasis. Systemic therapy drugs are prescribed mainly during the development 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 pathological diagnosis and effective treatment, the prognosis is quite favorable. As preventive measures, the following are often prescribed: a diet enriched with fish and vegetables, hydrotherapy, courses of herbal medicine, sanatorium-resort treatments and emollients (especially in the inter-relapse period - to restore the hydrolipid layer).