Psoriasis - What Is This Disease?

Psoriasis on the elbows

Although psoriasis is a common and well-known disease, it is not yet fully understood. And most patients do not even know that psoriasis is not a bacterial infection or a fungus, but a non-standard reaction of the immune system, which is caused for unknown reasons. Information about the causes and symptoms of psoriasis is very useful for patients as it helps overcome the disease.

What is this disease?

Lichen scaly is another name for psoriasis, and that name perfectly describes this disease. Psoriasis manifests itself in the formation of inflamed plaques of various sizes on the skin, which are densely covered with thick flakes of skin.

Surely almost everyone has heard of a disease like psoriasis. And that's not surprising, given that scaly lichen is common. This disease is diagnosed in 4-10% of the world's population. In addition, statisticians who collect information on the prevalence of psoriasis argue that the number of patients is growing steadily.

Scaly lichens have been known to humans since ancient times, even healers in ancient Greece tried to treat this disease. The modern history of the study of psoriasis is about 150 years old. During that lengthy period, however, researchers failed to learn enough about the causes and treatment of psoriasis.

Wide prevalence, aetiological uncertainty (causes of occurrence), inadequately effective treatment - all these characterize psoriasis as one of the most difficult problems in dermatology.

Dermatologists today regard psoriasis as a complex systemic disease associated with disorders of the immune system, a malfunction of metabolic processes and the occurrence of trophic disorders. These defects lead to specific skin changes.

Therefore, when answering the question of what psoriasis is, a modern dermatologist will answer that it is trophism disorders and metabolic processes in the skin caused by a dysfunction of the body systems. Today, two theories about the etiology of psoriasis are considered most likely: genetic and viral.

  • The gene theory has many proponents, since psoriasis often acts as a hereditary or familial dermatosis. Careful study of the patient's family history in 60-80% confirms the presence of psoriasis in one form or another in the patient's relatives. However, in some patients it is not possible to confirm the fact of the hereditary origin of psoriasis. This fact is the reason for assigning these cases to a special group in which the main reason is not genetic but phenotypic errors.
  • The virus theory, according to which psoriasis develops as a result of an infection, has its supporters. Confirmation of information about the viral origin of psoriasis is the detection of antibodies in the blood of patients, as well as the "elementary bodies" in the cells of the epidermis. According to this theory, psoriasis develops not only when infected with a virus, but also under certain conditions.

There are other theories that explain psoriasis. For example, endocrine, neurogenic, metabolic, etc. Of course, all of these theories are not unfounded and their study will allow you to get more important information about psoriasis disease. However, it is already known with certainty today that the state of the endocrine and nervous systems, as well as the work of the gastrointestinal tract, do not cause psoriasis, but have a significant influence on the course of this disease.

For example, pathologies affecting the liver lead to a severe deterioration in the quality of the blood purification carried out by this organ. And this, in turn, can provoke the appearance of various skin conditions, including psoriasis.

Girl with psoriasis

Liver diseases (hepatitis, primary cirrhosis, etc. ) lead to the fact that the tissues of this organ are reborn, that is, the liver is gradually replaced by connective tissue. As a result, the liver stops performing its cleansing functions. Outwardly, this is manifested by yellowing of the mucous membranes and skin, and the development of skin diseases, including psoriasis, is possible.

There is also an inverse relationship, psoriasis is often accompanied by fat loss, which affects the liver. Therefore, when treating this skin disease, it is important to follow a diet so as not to overload the liver. Patients are advised to limit fatty foods and completely eliminate alcohol.

Therefore, despite numerous studies, it has not been possible to get an exact answer to the question of what psoriasis is. However, the work continues, so there is a chance that the mystery of this mysterious disease will be solved and we will learn a lot about the skin disease psoriasis.

International classification

Psoriasis disease manifests itself in different forms. To facilitate navigation for those skilled in the art, a generally accepted classification of psoriasis is used.

Psoriasis added to the International Classification of Diseases (ICD). To date, 10 revisions of the international disease registry are in use, so the abbreviation ICD 10 is used. Work on 10 revisions of the international classifier of diseases began in 1983 and was completed in 1987.

In essence, ICD 10 is a standard assessment tool used in medical and health administration. The manual in revision 10 is used to monitor the prevalence of various diseases and other health problems.

Version 10 of the ICD enables data on morbidity and mortality in different countries to be compared, which enables statistical data to be called up and diagnostic information to be systematized. With the consent of WHO members, ICD 10 is used to assign codes to various diseases. In the 10th version of the classifier, alphanumeric codes are adopted, with the help of which information can be conveniently stored in electronic form.

All types of psoriasis are included in ICD 10, and each of them is assigned a specific code. In dermatology, the following forms and types of psoriasis are distinguished:

  • Common psoriasis(synonyms: vulgar, simple, plaque-like). The disease became a code according to ICD 10 - L-40. 0 assigned. This is the most common form, seen in 80-90% of patients. The main symptoms are the formation of plaques over the surface of unchanged skin, which are covered with white-gray flakes of skin. This form is characterized by slight flaking of the scales. After its removal, the inflamed red skin opens, which is very easily injured and begins to bleed. As the inflammatory process progresses, the plaques can increase significantly in size.
  • Inverse psoriasis. It is a disease that affects the folds of the skin (flexor surfaces). For this form of the disease, the code L83-4 is adopted in ICD 10. Dermatosis occurs with the formation of wrinkles on the skin from smooth or minimally flaky areas. Worsening is observed when the skin is injured by friction. The disease is often complicated by an associated strep infection or fungus.
  • Guttate Psoriasis. This form of psoriasis is characterized by the formation on the skin of a large number of small red or purple spots that are similar in shape to water droplets. According to version 10 of the international classifier, such a disease received the L4 code. Most commonly, guttate psoriasis affects the skin of the feet, but rashes can appear on other parts of the body. At the same time, tear psoriasis is known to develop as a complication after streptococcal infections - pharyngitis, tonsillitis, etc.
  • Pustular or exudative psoriasisis ​​a severe type of skin. According to ICD 10, the codes L1-3 and L 40. 82 were assigned to her. It is characterized by the formation of blisters or pustules. The skin in the lesions is edematous, red, inflamed, and easily peeled off. When fungus or bacteria invade the pustules, the contents of the pustules become purulent. Pustular psoriasis often affects the distal extremities, but in the most severe cases, a generalized process with the spread of rashes throughout the body can develop.
  • Arthritis psoriatic or arthropathic psoriasis. According to version 10 of the ICD pathology, the code L5 has been assigned. It manifests itself in inflammation of the joints. Arthropathic psoriasis can affect all types of joints, but in most cases the joints in the phalanges of the toes and hands become inflamed. Knee, hip or shoulder joints can be affected. The lesions can be severe enough to obstruction the patient. Hence, you should not think about psoriasis, that it is solely a skin disease. Severe types of psoriasis can lead to systemic damage, disability, or even death to the patient.
  • Healthy skin and psoriasis
  • Erythrodermic psoriasis. This disease, a rare but severe type of psoriasis, was given the code L85 according to ICD 10. Erythrodermic psoriasis often manifests in a generalized manner, with all or almost all of the skin surface entering the affected area. The disease is accompanied by severe itching, swelling and pain.
  • Onychodystrophy psoriasis or psoriasis of the nails. According to version 10 of the ICD, the disease has been assigned the code L86. The pathology is manifested in changes in the appearance of the nails on the toes and hands. Nails can change color, get thicker, and begin to deteriorate. Complete loss of the nails is possible.

In psoriasis, the classification of the disease takes into account not only the types of the disease, but also the severity of the symptoms:

  • localized psoriasis is a disease that affects less than 20% of the skin;
  • widespread psoriasis affects more than 20% of the body surface;
  • If almost the entire surface of the skin is affected, it is universal psoriasis.

If we look at all types of the disease, common psoriasis is more common than other forms.

Flow levels

Limited or widespread psoriasis goes through three phases in its course: progressive, stable and regressive.

The following is characteristic of the progressive stage of psoriasis:

  • the appearance of new rashes;
  • growth of already existing plaques;
  • the appearance of new elements of the rash at the site of injuries to the skin (scratches, abrasions);
  • strong scaling of existing plaques.

The following symptoms are characteristic of the stationary stage of psoriasis:

  • No new elements are displayed.
  • Psoriasis on the face
  • moderate detachment of elements;
  • no signs of element growth.

The appearance of wrinkles in the stratum corneum around the elements is a sign of a transition from a stationary to a regressive stage.

The regression stage is characterized by the following types of symptoms:

  • decrease in peeling intensity;
  • resolution of elements.

After the dissolution of psoriasis plaques, hypo- or hyperpigmented spots remain in their place.

Scaly lichens are characterized by a long course with periodic exacerbations. The following types of psoriasis are distinguished:

  • winter (exacerbated in autumn and winter);
  • summer (with exacerbations during the warm period);
  • Off-season psoriasis is the most severe type, as there is no clear link between relapses and the season, periods of remission can practically be absent.

Diagnostic functions

If psoriasis has a typical clinical picture, the diagnosis is not that difficult. However, this disease is often disguised as another pathology.

For example, nail psoriasis is often confused with nail fungus, since the external manifestations in the early stages of these diseases are very similar. However, nail fungus and psoriasis are completely different in nature, so treatment should be different.

A layperson can confuse psoriasis and fungus with fungus. Since mycoses of the skin (skin fungus) are manifested in similar symptoms - the formation of scaly plaques. After discovering suspicious symptoms on the body or nails, there is no need to self-diagnose and read on to treat the fungus with pharmacy or folk remedies.

If the diagnosis is incorrect and the cause of the appearance of symptoms is psoriasis rather than fungus, then treatment is not beneficial, on the contrary, it makes symptoms worse.

When contacting a dermatologist, a fungal analysis is performed and the nail or skin is scraped off. Then the resulting material is placed in nutrient media. If the fungus is present in the material, a large colony will grow in the test sample after a few days. By the appearance of the material, it will be possible to understand what kind of fungus provoked the infection.

Sometimes psoriasis is complicated by the addition of secondary infections. It could be a bacterial infection or a fungus. Therefore, if the clinical picture changes (the appearance of a purulent discharge, discoloration of plaques, etc. )Diagnosis of psoriasis by a dermatologist, patients must therefore be tested regularly for fungi and other infectious agents.

In diagnosis, a specific role is assigned to a number of phenomena known as the psoriasis triad. The phenomena appear one after another when scraping the element of the rash.

The psoriatic triad looks like this:

  • When the skin rash element is scraped off, the scales are removed in the form of "chips".
  • After removing the chips, a thin transparent film similar to polyethylene opens.
  • If the film is damaged, a pinpoint bleeding opens.

A dermatologist diagnoses psoriasis, but if necessary, the doctor can refer the patient to other specialists for consultation - a rheumatologist, gastroenterologist, surgeon, etc.

Interesting facts about psoriasis

People have known psoriasis for a long time. Even the name of the disease came into our language from ancient Greek. At the time of the prosperity of ancient Hellas, the word "psora" meant all skin diseases that manifested themselves through peeling and itching.

The first person to write an extensive treatise on psoriasis was a Roman named Cornelius Celz. In the fifth volume of his work "De medicina" there is an extensive chapter on this disease.

You knew about psoriasis, but this disease was not clearly valued as it was called, sometimes "imperial", sometimes "diabolical" disease.

Of course, the ancient healers knew very little about psoriasis. Until the 19th century, this disease was often mixed with other skin conditions. Psoriasis was first identified as an independent nosological form in 1799. This was done by the English dermatologist Robert Villan, who identified psoriasis as one of a large group of skin diseases manifested by itching and flaking.

Not only ordinary people but also prominent political figures knew about psoriasis firsthand. For example, Winston Churchill, who suffered from this disease, promised to erect a monument of pure gold to a person who can learn all about psoriasis and offer effective treatment for the disease.

Modern understanding of the disease

It must be said that modern science does not know much about this mysterious disease. There are various theories about the origin, course and treatment of psoriasis.

Here are some facts about psoriasis that are beyond doubt:

  • Despite the fact that the causes of the disease are unclear, it was possible to find out the nature of psoriasis. This disease is autoimmune, that is, it is caused by a malfunction of the immune system;
  • Another well-known fact about psoriasis: the disease can be inherited. However, this is not always the case, even if both parents are sick, the risk of developing a disease in their child is 65%. At the same time, although none of its relatives are sick, some patients develop psoriasis;
  • An interesting fact about psoriasis is that this disease is characterized by the Kebner phenomenon. This phenomenon is manifested in the fact that the elements of the rash are formed in the places of skin lesions - scratches, burns, frostbite. Sometimes after a while, psoriasis appears on the site of the scars;
  • An important observation that will help you get more information about psoriasis is the relationship of this disease to climatic factors. Exacerbations and relapses are often timed to match the change of season.
  • Patients have likely noticed the link between exacerbations and stress in the office. All patients should know for sure that on a background of nervous tension and experience, the disease is recurring or worsening.
  • A new fact about psoriasis is that the disease can appear at any age, although it was previously thought that lichens were scaly after 30 years of age.
  • It is important that everyone knows that psoriasis is not a contagious disease. Even in close contact with the patient there is no risk of infection.
  • Almost everyone has heard of the incurability of psoriasis, and this is true as no cure has been found that could safely defeat the disease. However, patients should be aware that psoriasis can be controlled. Appropriate and timely treatment enables long-term remission.

Modern treatment methods

When talking about the common disease of psoriasis, one can only tell about the treatment of this common disease. It must be said that it is impossible to cure psoriasis with just tablets or ointments.

In order to forget the manifestations of psoriasis for a long time, the patient must make an effort in close cooperation with the doctor. It will be necessary to properly organize the meal. Some experts argue that only with the help of a properly composed diet and regular cleansing of the body can you forget forever about psoriasis.

The doctor draws up a preliminary treatment plan. As a rule, methods of external (ointments, creams) and systemic (tablets, injections) therapy are used. In addition, physiotherapy methods are used and treatment in resorts is recommended. It is recommended to treat psoriasis with healing mud, mineral and thermal water.

The resorts also offer non-traditional treatments. For example, with the help of fish that live in thermal springs. These little healers effectively remove dead skin cells and disinfect the skin, promoting its fastest healing.

The spas may offer other treatments for flaky lichen. For example leech therapy, therapeutic baths and treatments, sun therapy, etc.

You have to be prepared for the fact that the treatment regimen changes regularly. As not all methods are suitable for a particular patient. If the selected treatments don't work, they will need to be replaced.

Popular treatments for psoriasis are also widely advertised. In fact, some of them can help achieve remission. But when choosing a method, you need to use common sense so as not to harm your health. When a prescription or recommendation is in doubt, it is better not to use it. Consult a doctor before using any method of treatment.

It goes without saying that it will only be possible to forget about psoriasis forever if the patient himself and his immediate surroundings are positive. Only belief in success and an optimistic attitude will help to overcome this mysterious and insidious disease.

16.09.2020