Parapsoriasis – several chronic not contagious dermatosis of not clear etiology and genesis with psevdopsoriatichesky superficial rashes on skin. Main kinds of parapsoriasis: tear-shaped, likhenoidny, blyashechny. Gabermana-Mucha is separately allocated sharp parapsoriasis. In clinic polymorphism of primary elements without essential violation of the general condition of the patient prevails. Diagnostics is based on the analysis of clinical manifestations and data of histology. The main thing in therapy of parapsoriasis – sanitation of the centers of a chronic infection and treatment of the accompanying somatic pathology.
Parapsoriasis (Brock's disease) – noncontagious pathology of skin with poorly studied the reasons and the mechanism of development. The eponymous name of a disease is connected with a name of the French dermatologist L. Brock who described a blyashechny form of a dermatosis and in 1902 united it with other known parapsoriases. Parapsoriasis includes, at least, three dermatosis possessing signs of independent nozologiya: red flat depriving, pink depriving also of Sukhoi of eczema. All of them clinically remind widespread psoriasis, however are deprived of its classical triad: effect of a stearin spot in attempt to scratch out scales, the varnished terminal film, dot bleeding as dew drops. Up to the end of the XX century parapsoriasis belonged to seldom found pathology. Today, in connection with deterioration in an ecological situation, uncontrolled reception of medicines, a high allergization of the population the frequency of developing of parapsoriasis steadily grows.
The causes of parapsoriasis, the mechanism of its development are in a studying stage. There are several theories, basic of which - infectious and immune.
The infectious theory is based that parapsoriasis in essence is a superficial vaskulit with the increased permeability of capillary walls for bacteria and viruses in response to which toxins skin reacts parapsoriatichesky rashes. About same says also the fact that there is parapsoriasis, as a rule, or against the background of infections (quinsy, flu, tonsillitis, pneumonia, measles, chicken pox, epidemic parotitis, etc.), or right after them. However, these arguments are not enough to consider parapsoriasis infectious pathology as the same picture is observed also at noninfectious toxicoses, an allergy, collagenases. Moreover, from blood of patients with parapsoriasis it is not allocated any activator capable to cause an infectious disease that unambiguously confirms its not contageousness.
In the immune theory it is about autoimmune reaction from skin to anti-genes of various nature which, having got into a human body, reduce the general and local immunity, participate in destruction of DNA and cellular T-lymphocytes. Breaking immune balance, they provoke an onset of the illness. The more anti-genes response gets to an organism, the more powerfully and rasprostranenny. Quite so there is parapsoriasis against the background of the centers of a chronic infection of digestive tract, kidneys, joints or in response to surplus of ultraviolet, overcooling, bad ecology.
Classification of parapsoriasis
Parapsoriasis belongs to diseases, manifestations, diagnostics which treatment are closely connected with a certain clinical form. In dermatology distinguish:
Tear-shaped parapsoriasis - a dermatosis form which distinctive morphological elements are small knots or papules of a rounded or hemispherical shape reminding drops.
Blyashechny parapsoriasis – is characterized by existence of scaly rashes – plaques. Depending on the sizes of plaques distinguish krupnoblyashechny (inflammatory and poykilodermichesky, or atrophic) and melkoblyashechny parapsoriasis.
Likhenoidny parapsoriasis – a disease form, which primary element – the flat, brilliant small knot of skin color, size about grain which is not towering over its surface, sometimes with a pupkoobrazny vdavleniye in the center.
Parapsoriasis Gabermana-Mucha - a sharp dermatosis which distinctive feature can be considered true and false polymorphism of rashes, and also sharp deterioration in the general health of the patient at the time of a debut.
Tear-shaped parapsoriasis, or psoriaziformny nodular dermatitis, is diagnosed most often. It can carry a sharp, subsharp or chronic current. The dermatosis is out-of-season, with recidivous character, has no gender component. The peak of incidence falls on 20-30 years, aggravations usually happen in the spring and in the fall. Arises against the background of heavy infections or after them, however can debut in the I trimester of pregnancy, against the background of hyper insolation, and also without any visible reasons. Primary element of rash is the small knot of the size of lentil of any shade of pink color or the flat papule of the size of a pin head covered with scales.
The sharp form arises suddenly, from the phenomena of a prodrom. Polymorphism of rash, lack of typical localization, defeat of mucous is characteristic. Prevalence of this or that element in a clinical picture testifies to degree of sharpness of process: emergence tells purples with a hemorrhagic component about the beginning of a disease, vesicles state proximity of remission, atrophic elements sum up the result of the parapsoriatichesky attack. During remission on the place of rashes there can be small scars or pigmentation.
Subsharp tear-shaped parapsoriasis proceeds without subjective feelings, but with more expressed hemorrhagic component. It is localized mainly on the lower and top extremities. On the place of rashes remains hyper - or a depigmentation. Chronic forms exist for years. Their distinctive feature is the specific triad of symptoms: false polymorphism (the same elements are at different stages of development), a wafer symptom (the attempt of removal of a scale from a surface of a papule or a small knot leads to its full removal and an exposure of the bleeding surface), existence of "a colloidal film" at a rassasyvaniye of primary element. Almost total absence of rashes on mucous, and also the expressed improvement by summer is noted.
Blyashechny parapsoriasis – a classical disease of Brock, chronic spotty deprive, or pink deprive the dermatosis without subjective feelings which is clinically reminding psoriasis. The disease meets at men aged from 30 up to 50 years more often. The aggravation period – winter, remissions – summer. The provocative moment in development of a dermatosis consider a gastrointestinal disease and urinogenital system. Sometimes it is enough to sanify of them that there occurred improvement or a long "light interval".
Primary element is the spot or an infiltrirovanny roundish plaque of light pink color with a yellowish-brown shade. Its size makes from 2 to 10 cm, she does not act over skin level, is covered with otrubevidny scales or the corrugated film reminding tissue paper. Rashes settle down on a trunk - parallel to edges, standing and hands, do not tend to merge and distribution. Dot hemorrhage at a poskablivaniye is absent. Skin of a hairy part of the head, a palm and a sole are practically not surprised.
Melkoblyashechny parapsoriasis is localized on the side surfaces of a trunk, plaques have a diameter at most 2-3 cm, sometimes look as strips of various length. Plaques do not itch, but are always shelled. Krupnoblyashechny parapsoriasis has essentially other sizes of plaques (to 10 cm), the itch begins to disturb the patient. At inflammatory option around plaques there is hyperaemia and small morbidity, and at poykilodermichesky - the atrophy in the center of a plaque becomes the main sign. Besides, at skin along with plaques there can be teleangioektaziya, a depigmentation, a mesh hyperpegmentation, follicular and purple. This option is capable to regenerate, according to scientists, in fungoid mycosis, a skin lymphoma.
Rare forms of parapsoriasis
Likhenoidny parapsoriasis is extremely rare. Has no gender division, it is actively shown at the age of 20-40 years. Distinctive feature is localization of primary elements – cone-shaped papules of an oval form of all shades red – in eyes, and not just on a trunk and extremities.
Separately there is sharp varioliformny (ospopodobny) parapsoriasis Gabermana-Mucha. The disease has no age and gender distinctions. Some consider it a kind of likhenoidny parapsoriasis, others - option of tear-shaped parapsoriasis, the third – one of forms of an independent allergic vaskulit. Distinctive features are: the sharp beginning with an obligatory prodromalny syndrome (subfebrilitt, weakness, increase in peripheral lymph nodes), polymorphism of rash, bystry generalization of process on all integument, up to a hairy part of head skin and soles. Primary elements are symmetric and do not tend to merge. Mucous oral cavities, a nose, genitals are involved in process. If full regress does not occur within 6 months, parapsoriasis gets a chronic current. On the place of rashes there are small atrophic scars.
Diagnostics and treatment of parapsoriasis
Parapsoriasis very difficult gives in to diagnostics as has no independent clinical signs. There are no special laboratory researches for its exact diagnostics also now. Taking into account polymorphism of rashes the only objective way of confirmation of a disease – histology, but also it does not yield 100% of result therefore diagnostics needs to be carried out at the specialist dermatologist. Differential diagnostics is carried out, first of all, with psoriasis which classical characteristic is the diagnostic triad: the phenomenon of a stearin spot, a terminal film and drop bleeding which are absent at parapsoriasis.
From pink depriving (depriving of Vidal) parapsoriasis it is possible to distinguish on color and a peeling. At depriving of Vidal it brightly pink, a peeling insignificant. At last, parapsoriasis is often differentiated with a papular sifilid. In this case, except syphilitic papules of copper-colored color with their tangible infiltration which even visually differ from rashes of light pink parapsoriasis serological reactions on help (RPR test).
Taking into account the received result complex treatment is appointed. As etiotropny therapy does not exist, sanify the centers of a chronic infection, strengthen immunity, hold sessions of Ural federal district and PUVA-therapy, sanatorium treatment. In treatment of a tear-shaped parpsoriaz antihistaminic medicines for removal of an itch () in combination with vasoprotectives (), calcium medicines are used. Complex vitamin therapy is shown (In, C, PP, A, E). In case of resistance - external steroids (Prednisolonum), antibiotics and antibacterial medicines (from amoxicillin to a ftivazid). Sharp forms strengthen vascular medicines (a ksantinola ) and antiallergic ().
Blyashechny parapsoriasis is a reason for dispensary observation of patients with an obligatory kuration of the gastroenterologist. In case of resistance apply a short course of hormonal therapy (Prednisolonum). PUVA-therapy in combination with medical bathtubs (Naftalan, Matsesta) is shown. Likhenoidny parapsoriasis to any treatment therefore to each patient the dermatologist develops the therapeutic program individually. In extreme cases appoint antineoplastic medicines (methotrexate). Good results are yielded by stay on the Dead Sea.
Forecast of parapsoriasis
The correct diagnostics and timeliness of complex therapy – guarantee of long remission of parapsoriasis and high quality life. To avoid parapsoriasis complications, timely and exact diagnostics for the purpose of an exception classical red flat is necessary depriving. The incorrect treatment appointed with delay fixes violation of vascular permeability, leads to emergence of forms, resistant to therapy, formation of paraospenny hems on the place of rashes. Besides, developing of an itch – a reason for close attention to a course of disease not to allow an ozlokachestvleniye of blyashechny parapsoriasis.