Psoriasis is a chronic, non-infectious, inflammatory skin lesion with negative effects on the quality of life of patients ("psora" from the Greek - scales). From there, as with many other diseases, the first observations on psoriasis are described. This term was introduced by Galen, one of the most important researchers in medicine.
The cutaneous signs of psoriasis confused people and doctors as leprosy was widespread at the time and had dire consequences. Patients with psoriasis were exposed to social pressure, they were avoided, they were forcibly isolated. In Europe such people were forced to ring the bell to warn others of their arrival. Treatment attempts consisted of the use of manure, onions, sea salt, oil, and urine, but all were ineffective and made psoriasis patients disliked.
PREVALENCE OF PSORIASIS
The disease can occur at any age, but is more common in the 49 to 69 age group. The reported prevalence of psoriasis in countries ranges from 0. 09% to 11. 4%, making psoriasis a serious global problem.
Despite the widespread misconception that psoriasis is not as severe as other non-dermatological conditions, psoriasis creates a burden of disease that extends well beyond dermatological symptoms. Its psychological effects are similar to those of cancer, heart disease, and diabetes. Psoriasis plaques are often visible, which can have a negative impact on interpersonal relationships, school or work success. Unsurprisingly, people with psoriasis have higher rates of depression with an increased number of suicidal thoughts.
Patients with psoriasis are also at risk of developing serious comorbidities that make disease control difficult and increase the risk of early death. Cardiovascular disease and metabolic syndrome are more common in patients with psoriasis.
In addition, psoriasis is itself a risk factor for cardiovascular disease and triples the relative risk of developing myocardial infarction. Severe psoriasis is also associated with an increased risk of mortality, resulting in a reduction in life expectancy for men and women by 3, 5 and 4, 4 years, respectively, compared to people without psoriasis.
CAUSE OF PSORIASIS ON THE HEAD
There are many theories about the origin of psoriasis. This is the influence of microbes, viruses, allergies, poor hygiene, disturbed blood supply to the skin, disturbance of the functional balance of the internal organs and one of the most pressing factors at present is the autoimmunity of the disease when human immune cells attack their own tissues. And this assumption also remains a theory, since no skin-damaging antibodies have been found in patients with psoriasis.
At the moment the cause of the pathology is unknown. However, over the course of research, scientists have identified factors that have a certain likelihood of causing psoriasis.
The following points are highlighted:
- inheritance. There is no one hundred percent chance that even if the mother and father are sick, their child will necessarily have psoriasis. However, in such a situation, the risk of such a pathology is higher. It was also found that with identical twins, one is sick, the second twin is more likely to get sick than compared to the usual risk in the population. This proves that this nosology has a genetic background.
- Skin damage: accidental knife cuts, cat scratches, mosquito bites and sunburns increase the risk of triggering another outbreak.
- Infections: Staphylococci, streptococci and other infections can also act as triggers. Children often have streptococcal tonsillitis before the onset of skin psoriasis.
- There are drugs that can cause diseases, e. g. B. Malaria medications and some antidepressant medications.
- If you change your HIV status to positive, it can also stimulate the development of psoriasis. So it's not strange to test for HIV when you suspect psoriasis.
- stress. The most famous trigger for laypeople. "It's all because of stress" - every psoriasis patient has heard this sentence at least once. Some people are doubtful about this phrase, but it has its own justification. Scientists believe that our immune systems can respond to emotional and mental pressures, as well as physical defects such as trauma and infection.
- Obesity has a systemic negative effect on the entire body. If an overweight person has a history of psoriasis, treatment is more difficult and often less effective.
- smoking. It has been known for a long time and it is no secret to anyone that cigarettes negatively affect the condition of the skin. Therefore, the likelihood of psoriasis, especially the head and hands, is damaged.
- Alcohol is one of the most common individual triggers for psoriasis.
- Hormonal changes. The disease often manifests itself during puberty. Menopause can also cause psoriasis, but a decrease or even complete regression of plaques has been noted during pregnancy.
Symptoms of PSORIASIS on the head
In 50% of cases, psoriasis makes itself felt from the head. Psoriasis can appear anywhere on the head. Sometimes small plaques develop that are easy to hide in the hair. However, if the entire scalp is covered, it will be difficult to hide the plaques.
The appearance of psoriasis on the head manifests itself as follows:
- Reddish spots on the scalp. Some spots can be subtle due to their fading, but there are also bright red elements that are easy to spot.
- Dandruff peeling off the psoriatic skin. The condition of the scalp in this pathology can resemble ordinary dandruff. However, there are differences, for example in psoriasis, in which a silvery sheen is observed and which can also be accompanied by itching.
- Dry scalp. The scalp can be so dry that the skin cracks and bleeds, creating conditions for the addition of an infection, the treatment of which in such a place has some difficulty.
- itching. This is one of the most common symptoms. Someone has mild itchiness that the patient may forget about everyday activities, and some suffer from itching so bad that it is impossible to work, study, or even sleep.
- bleeding. Since psoriasis can make the scalp itch, the patient can scratch and damage the skin. In addition to bleeding, scratching can make the course of psoriasis worse by making the plaque larger and denser. This is why dermatologists tell their patients, "Try not to injure the scalp. "
- burn. The patient can literally describe their scalp as "burning".
- hair loss. Scratching the scalp and forcibly removing dandruff can lead to hair loss. Although this phenomenon is temporary, it can still cause discomfort to the patient.
These clinical manifestations can increase and collapse quickly. This is an individual process. In one patient, the entire pathological process ends on a pale plaque under the hair, while the other has a lot of light-colored lesions all over the head. This is influenced, among other things, by the triggers described above.
A number of problems the patient may face:
- Skin manifestations that are visible to others. Living with psoriasis can make a person shy. Any aspect of social life can be stressful for these people, such as holding hands on a date.
- finance. Treating psoriasis can be costly. This is more true for widespread psoriasis that is resistant to conventional therapy and for which new drugs based on monoclinal antibodies are used.
- pain. With psoriasis, chronic pain can occur, which further increases stress. This is especially true when combining skin manifestations with inflammation of the joints, and at the same time reducing a person's daily activity.
- healing. In particular, if the patient seeks help late, some procedures do not have the expected effect, which naturally worries the patient and emotionally suppresses him. Other procedures can take a long time. For example, you may need to have phototherapy three times a week for up to a year. For some, it will be difficult to reconcile such a regime with the normal rhythm of life.
- Living with a chronic illness. Psoriasis, like many other chronic pathologies, requires a great deal of voluntary effort. Especially in the early stages, it is difficult for the patient to deal with a number of additional problems that have "fallen on their heads". This creates conditions for depression to appear.
DIAGNOSIS OF PSORIASIS ON THE HEAD
The decision whether to see a doctor or not depends on the patient, depending on the severity of the symptoms. However, the best solution, regardless of the location of the plaque, would be to see a doctor. For further treatment to be as effective as possible, an accurate diagnosis must be made, even if symptoms are mild.
In most cases, scalp psoriasis is diagnosed after a physical exam and medical history analysis.
A dermatologist can determine scalp psoriasis by examining pathological elements of the skin.In exceptional cases, the patient may be advised to undergo a skin biopsy to rule out other diseases.
TREATMENT OF PSORIASIS ON THE HEAD
Unfortunately there is no cure for this disease at the moment. Therapy is required for life and aims to maintain remission. In addition, caring for patients with psoriasis not only requires skin treatment, but it is also very important to control existing chronic diseases and prevent new ones from occurring.
These conditions include cardiovascular disease, metabolic disease, and mental health.
- Achieve the patient's clinical recovery as soon as possible.
- The remission must be stable and long-term.
- Maintaining a positive psychological status of the patient.
Treatment traditionally begins with diet. Foods that contain antioxidants like vitamins C, E, beta-carotene (vegetables, fruits, sage, ginger, and others) can play a beneficial role, as can omega-3 fatty acids, which are high in salmon, sardines, and other fish.
The link between alcohol and psoriasis is unclear, but experts say that people who drink less respond to treatment and that remission of psoriasis continues after alcohol abuse stops. In addition, some antipsoriatic drugs are incompatible with alcohol.
A clearer correlation is observed with overweight. In overweight people, the pathology, as a rule, proceeds faster with a lighter clinical picture.
Hair makes the treatment of psoriasis on the scalp particularly difficult. Few people agree to having their hair removed in order to more effectively resolve the clinical manifestations of the disease, especially given the fact that the defects are even more noticeable to others.
Conventional hair care products are not suitable in this situation, as they can also irritate the scalp and contribute to the progression of the pathology. Therefore, tar shampoos are used, the effectiveness of which in the fight against psoriasis on the scalp has long been established.
Tar has a "calming" effect on the epidermis of the scalp and inhibits the formation of dandruff. Shampoos with phenolic acid are also used, as these have a keratolytic effect (destroy dense horn scales). The plus is used to improve the penetration of other drugs, including corticosteroids.
When prescribing shampoo, the individual characteristics of a person in hair hygiene are taken into account. For example, some women don't wash their hair every day, so it is best if they apply the solution to their hair 2-3 times a week before going to bed, and then wash their hair in the morning.
Phenolic acid can also be used on its own as an ointment. The fact that the ointment is used for a relatively long time increases the effectiveness of the hyperkeratic properties. And for patients who complain about the difficulty of separating dandruff from their hair, applying an ointment before a shower can help resolve this situation.
Coal tar has been used to treat psoriasis for several decades due to its antiproliferative, anti-inflammatory and strong anti-pruritic properties.
Although raw coal tar is the most effective resin. Applying raw stone tar to the scalp is problematic. It is generally recommended to use a resin solution (5-20%) formulated as a lotion or added to a corticosteroid. This remedy helps to fight psoriasis, but it has a number of side effects: coloring, hair loss and a more serious negative effect - carcinogenic, which is why the use of this method is limited.
For this reason, coal tar is banned in Canada and the European Union, for example.
Of all the topical treatments available, corticosteroids have been shown to be the most effective in clinical trials for treating scalp psoriasis and are the most widely prescribed treatments. Corticosteroids are also useful in that there are a large number of forms of production for every situation: creams, lotions, ointments, oils, gels, foams, solutions, sprays and shampoos.
Do not underestimate the importance of psychological harmony in this pathology. Stress can become a trigger, cause a detailed clinical picture, and also inhibit the treatment process. Therefore, patients with internal anxiety are advised to consult a psychotherapist or psychologist.
CARE RECOMMENDATIONS FOR THE HEAD PSORIASIS
For a patient with psoriasis, it is important to first follow the advice of a doctor. Nevertheless, you can continue to improve the quality of life by following the simple rules described below:
- Use moisturizing lotions. Skin manifestations of the disease significantly worsen when the skin is dry, so it is important to maintain skin hydration. Special cosmetic ointments, lotions or, for example, normal petroleum jelly can help.
- Take good care of the skin with psoriasis plaques. When washing your hair, never forcibly pull off the dense scales, as you can only transfer the process to nearby, healthy tissues.
- be careful when cutting your nails. Cases are described when accidental damage to the growth zone of the nail with manicure scissors provoked the appearance of new skin elements.
- Find the right shampoo for you that won't flake your skin and use it on your scalp in remission. Or use tar only at a lower concentration for daily care.
- The climate can also play a role. It is found that cold has a negative effect on patients and provokes the development of plaques. Sunny weather leads to regression of skin manifestations, but not always.
- Use a humidifier. This can keep the skin moist and eliminate dry air, which is bad for psoriasis patients.
- Do not take any drugs that can damage your skin. The doctor should be informed of any medication you are taking, including those that you think are harmless. For example, for the treatment of depressive states, preparations containing lithium salts, which are contraindicated for patients with psoriasis, can be used.
- Avoid all types of skin damage: scratches, cuts, bumps. Injury to the skin can cause a condition called the Koebner phenomenon (when psoriatic elements develop along the line of damage to the skin). Be careful when shaving. Avoid acupuncture, avoid getting tattoos on your body, and do everything possible to prevent insect bites.
- Try to appear in the sun, but in moderation. Ultraviolet rays in sunlight slow the growth of skin cells, so it is beneficial to receive moderate doses of UV (30 minutes each is sufficient). Paradoxically, excessive sun exposure can lead to psoriasis. Also, keep in mind that certain medications can make your skin more sensitive to UV rays.
- Patients with psoriasis should reduce their anxiety. Of course, this is easily said than done, but relaxation techniques like meditation or yoga can be tried.
- Estimate how much alcohol you are drinking. The link between alcohol and psoriasis is unclear, but scientists still believe it can make symptoms worse, especially in men. It is known that alcohol is dangerous when combined with certain psoriasis medications.
- Balance your diet and try to lose weight. If it is difficult for you to do this yourself, then turn to specialists who will be able to assess in which direction it is worth working better.
RECOMMENDATIONS FOR CONTROLLING PSORIASIS OUTBREAKS ON THE HEAD
By monitoring the progression of psoriasis, you can help the patient better control their disease, take the necessary measures in a timely manner and increase the productivity of the doctor-patient relationship. A few simple rules will help you with this:
- Create a "self-portrait" of a psoriasis outbreak. A digital camera, smartphone, or just a piece of paper will help you where to record any changes that occur to the badges. It is also worth recording where the changes initially occur and in what order they increase. For such introspection, the doctor will only praise you, knowing that you are determined. Over time, analyzing the records can identify structured situations. For example, an outbreak always starts with a plaque in the back of your mind.
- Every time the psoriasis goes down or worsens, try to figure out what it is. Maybe the weather has changed? From medicine? Are you taking a new drug? Recently damaged skin? Such triggers can be individual, which makes it difficult for the doctor to understand the patient without self-observation (e. g.provokes an attack on a certain type of coffee).
Although the disease is not transmitted through contact, the appearance of patients discourages those who do not know. Beauty salons are afraid to provide services, some taxi drivers do not want to transport such people, it is difficult to find a job. Not to mention starting a family and the fear that their children will be sentenced to the same suffering prevents them from having children.
There have even been reports of people with psoriasis being denied access to the Olympic swimming pool due to collective complaints from other athletes. Management had to refuse such people, although they fully understood that this pathology is not dangerous in the contagious sense.
It is difficult for them to engage in everyday activities because the burden of psychological pressure is high and a person needs social contact. For these reasons, societies are being established in many countries to protect and support psoriasis patients. Companies are used to educate outsiders about this disease.
People should be judged on their actions, deeds, and not on their looks. Indeed, among patients with such a nosology there are highly professional doctors, police officers, firefighters, athletes and many others, whose actions not only their relatives, but also their country can be proud of.