psoriasisis a systemic disease characterized by damage to the skin, the musculoskeletal system and functional and morphological disorders of other organs and systems. The main symptoms of pathology: nodular rashes on the scalp, palms, feet, extensor surfaces of the elbows and knees, hyperemia, itching. The disease can be diagnosed visually, but to exclude the possibility of developing accompanying pathologies, laboratory tests and instrumental diagnostic methods are prescribed. Systemic therapy includes taking aromatic retinoids and cytostatics as well as glucocorticosteroids.
introduction
The name of the disease comes from the Greek "psora" – "skin disease", "scab". In the Middle Ages, psoriasis was considered a form of leprosy (leprosy). The signs of psoriasis were first described from a professional point of view in 1808 by Robert Whelan in Great Britain. TheThe term "psoriasis" was introduced in 1841 by the Viennese dermatologist Ferdinand Gebra. Pathologies are recorded at all latitudes of the world with an uneven frequency of 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%).
causes
There are various theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurogenic, endocrine and 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 in inheritance. If one of the parents is sick, the risk of developing pathology in the child is 8%, and in the father and mother it is 41%.
Factors that contribute to the development of psoriasis are divided into external and internal factors.
- External factors include mechanical and chemical damage to the skin as well as dermatoses.
- Doctors count internal provoking factors: infections (streptococci and human immunodeficiency virus), medications (corticosteroids, nonsteroidal anti-inflammatory drugs), nervous stress.
Pathogenesis
Today, doctors around the world recognize the involvement of the immune system in the pathogenesis of psoriasis. Cells of the immune system that normally respond to antigens begin to attack healthy cells, most commonly skin cells. This process causes the cells of the epidermal layer to divide faster than usual. They do not have time to mature, which is why strong bonds are not formed between them. The cells that come to the surface 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.
- Ordinary (vulgar). The most commonly detected form of lichen planus, in which there are no complications. This group includes plaque and coin psoriasis.
- Generalized pustular psoriasis- a severe form of pathology complicated by secondary infection. It affects several areas at the same time. Includes Zumbusch syndrome and impetigo herpetiformis.
- Persistent acrodermatitis (Crocker dermatitis, Setton dermatitis)— The contents of the pustules are sterile and there is no secondary infection. Fingers and nails are particularly affected.
- Palmar and plantar pustulosis (pustular bacterium)- develops on the feet and palms. It appears as pustules with sterile contents, gradually increasing in area.
- teardrop-shaped- separately located papules that do not merge into plaques. The most commonly affected areas are legs, thighs, back, forearms, chest and neck.
- Arthropathic- The clinical course is similar to the rheumatic form of arthritis.
- Other psoriasis (reverse)- Conglomerates are localized in the armpits, inguinal and other natural folds. This type also includes psoriasis of the inverted flexor muscle.
- Unspecified psoriasis- combines several types of pathologies, the clinical picture is quite wide.
Depending on the seasonality of the exacerbation, several types of psoriasis are distinguished:
- Summer- Aggravation occurs when the skin is exposed to sunlight.
- winter- caused by extreme cold that affects the skin.
There are no periods of remission in nonseasonal psoriasis; the disease occurs all year round.
By affected skin area:
- limited psoriasis- occupies less than 20% of the body's skin;
- together- more than 20%;
- generalized- All skin is affected.
Symptoms
The clinical manifestations of psoriasis directly depend on the stage of development of the disease. There are 3 stages.
- Progressive phase. It is characterized by the appearance of papules, itching, the beginning of peeling, flaking and deformation of the nails.
- Stationary stage. No new papules appear, the old rash does not enlarge, and peeling is moderate.
- Regressive phase. The plaques heal and white depigmented spots form in their place, which no longer cause any symptoms.
Skin rashes are only external signs of psoriasis. In fact, the disease affects numerous organs and systems as well as tendons and joints. For this reason, 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, without timely diagnosis and effective treatment of psoriasis, the risk of developing serious chronic diseases increases: diabetes mellitus, arterial hypertension and metabolic syndrome.
diagnosis
To identify the pathology, laboratory and instrumental diagnostic methods are used.
The patient receives a referral for:
- general clinical analysis of blood and urine;
- blood biochemistry;
- blood test for C-reactive protein and rheumatism tests;
- Coagulogram – assessment of blood clotting;
- Blood test for human leukocyte antigen.
In complicated forms of psoriasis, which are accompanied by damage to the musculoskeletal system and internal organs, radiography of the joints, ultrasound examination of the kidneys and organs of the urinary system, and echocardiography are prescribed.
There are diseases that have similar symptoms. Therefore, there is a need for a differential diagnosis. To do this, use methods such as:
- biopsy (removal of a piece of skin with further histological examination);
- Laboratory tests – to differentiate psoriasis from papular syphilid.
Treatment
Psoriasis responds well to symptomatic treatment. Knowing the pathogenesis, the doctor can individually select a treatment method. Some of them are aimed at reducing rashes, eliminating dryness and itching, others – at preventing 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 in various forms of psoriasis as monotherapy or in combination with other drugs. They come in the form of dosage forms – ointments, creams or lotions.
Medicines containing analogues of vitamin D3. They are applied to the affected skin areas when the prevalence of psoriasis does not exceed 30% of the body surface.
Preparations containing activated zinc pyrithione are used in the form of an aerosol, cream and also shampoo for the scalp.
Phototherapy
In this case, the methods of medium wave phototherapy and PUVA therapy are used for treatment. PUVA therapy involves 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 methods to cure the disease. It is most often prescribed for widespread vulgar and exudative psoriasis, persistent pathology and 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 medications are mainly prescribed as the disease progresses.
Biological drugs
These drugs are manufactured using genetic engineering methods. They are monoclonal antibodies and are used for therapeutic purposes.
Prognosis and prevention
With timely diagnosis of pathology and effective treatment, the prognosis is quite favorable. As preventive measures, the following are often prescribed: a diet enriched with fish and vegetables, hydrotherapy, herbal medicine, spa treatments and emollients (mainly in the period between relapses - to restore the hydrolipid layer).