Psoriasis: Causes, Symptoms, Treatment

Psoriasis is a chronic systemic multifactorial disease with a genetic predisposition to affect the skin and joints. Patients often complain of a pink rash with silvery white scales. The rash is accompanied by itching, pain, and peeling. When a joint is damaged, its ability to move is limited, which can lead to disability for the patient.

causes of psoriasis

The cause of psoriasis is unknown. Only origin theory:

• Neurogenic (rash after stress, burns, trauma);
• endocrinology (especially perimenopause);
• metabolism (lipodystrophy);
• contagious;
• Viruses (psoriasis antigens are isolated from individuals who are healthy but have a high likelihood of developing psoriasis in the future, a non-communicable disease);
• genetics.

Psoriasis can be found in an entire generation of people with the same risk factors. But inherited types are considered multifactorial. If one parent becomes ill, the child has a 25% chance of becoming ill. If both parents are sick - 60-75%.Viral and genetic theories still dominate.Factors that worsen the condition:

• Infectious and parasitic diseases, including carrier diseases (HIV, tonsillitis, dental caries, hepatitis);
• pressure;
• obesity;
• perimenopause;
• Medications (interferons, beta-adrenoceptor antagonists, ACE antagonists, NSAIDs);
• Bad habits (alcohol, smoking, household chemicals);
• Skin damage; dryness, leading to increased skin trauma.

clinical classification

There is no single classification. one of them:

• vulgar (ordinary);
• exudative;
• psoriatic erythroderma;
• Arthropathy;
• Psoriasis of the palms and soles of the feet;
• Pustular psoriasis.

Process features:

• They can get sick at any age; cases of psoriasis are not uncommon in children;
• Men and women are affected in equal proportions;
• Popular worldwide;
• Exacerbations are summer, winter and mixed seasonal.

Symptoms of psoriasis

The disease itself is characterized by disruption of skin keratinization and the production of immature keratinocytes. A pink rash appears, covered with silvery white scales. The triad of symptoms is characteristic and allows a diagnosis to be made:

• Symptoms of stearin stains - increased number of scales when scratched;
• Psoriasis membrane phenomenon - when all the scales are scraped off, a smooth, shiny red surface appears;
• Symptoms of needle bleeding - drops of blood that appear when the film is scratched. This is due to uneven elongation of the dermal papilla, telangiectasias, and their swelling.

signs of psoriasis

• Psoriasis on the body can start as a single spot and then coalesce into large lesions.
• Psoriasis on the hands is usually localized to the extensor surface.
• Facial psoriasis - The rash usually appears behind the ears and on the forehead. It is an independent factor that enhances treatment.
• Psoriasis on the scalp is an isolated form that does not affect the hair, with elements of the rash located at the edges of the hair, known as the "psoriasis crown. "
• Nail psoriasis - causes characteristic changes where the tips of the nails are sunken and the nails look like thimbles. It may also thicken, darken, or form yellow spots under the nails.
• Psoriatic arthritis - affects surrounding joints with or without pain, often with inflammation of where ligaments attach to bones, the ligaments themselves, and the fingers.

Characteristics of psoriasis in children

It is characterized by the presence of one or more elements up to 1 cm long that emerge from the surface of the skin. Itching is more noticeable in children than in adults. When scratched, the area bleeds and a wound forms. In children, psoriasis is usually limited to the perineal area and appears as large red spots. In adolescence, spots may appear on the palms of the hands and soles of the feet.Psoriasis has three stages:

1. Progressive - the rash becomes more complex and uniformly white in color with a narrow red edge;
2. Quiescent - the spots stop growing and a 2-5 mm wide band of pale skin appears at the edge;
3. The catagen phase - the scales gradually fall off and the spots reduce and disappear. Depigmented spots remain at the rash site.

Diagnosis of psoriasis

Most commonly, patients refer to their general practitioner, dermatologist or rheumatologist (for psoriatic arthritis). Physicians collect chief complaints (rash, itching, pain, swelling and joint tenderness), past history (seasonality and frequency of exacerbations, genetic predisposition, effectiveness of previous treatments, concomitant diseases). Upon examination, changes in the skin and joints were noted.Perform lab testing:

• General blood tests (including white blood cell count, ESR, platelets);
• General urinalysis;
• Biochemical analysis (ALT, AST, urea, uric acid, cholesterol, triglycerides, bilirubin, glucose, total protein, CRP, rheumatoid factor);
• In difficult cases, perform a skin biopsy and perform further histopathological examination (marked acanthosis, parakeratosis, spongiosis and accumulation of leukocytes in the form of accumulations of 4-6 or more elements);
• Test for HIV, viral hepatitis B and C, and tuberculosis before starting biologic therapy;
• Radiographic examination of affected joints;
• CT and MRI of axial lesions;
• Electrocardiogram.

Consultation with infectious disease specialists, pulmonologists, orthopedic traumatologists, surgeons, and other specialists may occur, if necessary.When diagnosing psoriasis, it is worth excluding diseases such as seborrheic dermatitis, lichen planus, parapsoriasis, Japanese rosea and papular syphilis.The severity of psoriasis is measured by BSA (Body Surface Area - the area of skin affected by psoriasis), PASI (Psoriasis Area and Severity Index - Psoriasis Prevalence and Severity Index), DLQI (Dermatology Lifestyle Index)Quality Index - Dermatology) to determine the Quality of Life Index).To diagnose psoriatic arthritis, PEST (Psoriasis Epidemiology Screening Tool) and CASPAR (Classification Criteria for Psoriatic Arthritis) criteria are used.

psoriasis treatment

Treatment is complex and aims to eliminate inflammation, normalize proliferation and differentiation of keratinocytes.Topical treatment:

• Ointments and creams containing vitamin D3 and its analogues;
• Calcineurin inhibitors;
• topical corticosteroids;
• Phototherapy.

Systemic treatment:

• PUVA therapy;
• Cytostatic;
• immunosuppressants;
• Biological drugs.

For psoriatic arthritis use:

• nonsteroidal anti-inflammatory drugs;
• disease-modifying drugs;
• Intra-articular injection of corticosteroids;
• Biological drugs.

For chronic cases, psoriasis ointment is recommended; for more severe cases, psoriasis cream is recommended.When using ointment or cream, do not rub it into the skin or use a bandage. This may increase the penetration of the drug into the skin and cause side effects. It is not recommended to use hormonal ointments for more than 4 weeks. Incorrect doses of medications may be ineffective or cause side effects. The desired therapeutic effect can be achieved after 1-2 weeks of use.Psoriasis creams and ointments containing corticosteroids can be used in a variety of ways:

• continuous mode;
• tandem treatment model;
• Step-down treatment regimen;
• Step application mode.

It is worth noting that treatment of mild and moderate psoriasis is done on an outpatient basis, using ointments and creams directly on the affected area. For more severe forms, it can be treated in the hospital using phototherapy, systemic therapies and biologic drugs.The course of the disease is moderate, and systemic treatment can be started in the following cases:

• Areas of skin that affect aesthetic appearance;
• Large areas of the head are affected;
• External genitalia are affected;
• The palms of the hands and soles of the feet are affected;
• At least 2 nails are affected;
• Some single elements cannot be processed locally.

Systemic treatment can only be carried out in hospitals and under the strict guidance of doctors, because systemic treatment can produce a variety of side effects, which can be reduced by choosing individualized treatment.General advice for people with psoriasis:

• Minimize skin trauma and dryness;
• After applying psoriasis creams and ointments to your hands, wear gloves to prevent them from getting into your eyes;
• Use sunscreen with a protection factor of 30;
• Avoid stressful situations and consult a psychologist if necessary;
• Control your weight and eat properly.

psoriasis diet

Respected:

• 1200-1600 ml of alkaline drinks per day;
• Use lecithin;
• vegetables and fruits;
• porridge;
• lean meats and fish;
• Dairy products.

Not recommended:

• Tangerine;
• Bread made from high-quality flour;
• fatty fish and meat;
• high-fat dairy products;
• Coffee - no more than 3 cups per day;
• Products containing yeast;
• Wine, sweets, pickled, smoked, spicy.