Psoriasis (scaly deprive) – the chronic noncontagious disease affecting skin, nails and joints. It is characterized by emergence on skin of monomorfny rash: the small knots of bright pink color covered with silvery scales. Elements of rash can merge in various configurations reminding the map. Is followed by a moderate skin itch. Psoriasis worsens appearance of skin, brings psychological discomfort to the patient. At damage of joints psoriatichesky arthritis develops. The generalized pustulous psoriasis of pregnant women leading to defeat of a fruit and an abortion is dangerous.
Psoriasis – the widespread chronic skin disease which is characterized by monomorfny rash from the flat papules tending to merge in large plaques which very quickly become covered by friable silver-white scales. Psoriasis has a wavy current, incidence – 2% of all population, is diagnosed equally both for men, and for women.
Causes and pathogenesis of psoriasis
The etiology and pathogenesis of psoriasis are up to the end not studied, but results of researches suggest that the hereditary, infectious or nevrogenny nature are most probable. The hereditary nature of psoriasis is confirmed by the facts that incidence is higher in those families in which psoriasis was already diagnosed, besides at monogerminal twins concentration of incidence is higher too, than in other groups. The infectious etiology of psoriasis comes down to existence of the changed complexes and inclusions as at a viral infection, but, however it is not possible to identify a virus yet.
And, today, psoriasis is read out a multifactorial disease from shares of genetic and infectious components. People from constant travmatizatsiy skin, with existence of chronic streptococcal infections of skin, with violations vegetative and the central nervous system, with endocrine violations get into risk group on incidence of psoriasis, besides abuse of alcohol increases probability of developing of psoriasis.
Clinical displays of psoriasis
Primary element of psoriasis is the single papule of pink or red color which is covered with a large number of friable silver-white scales. An important diagnostic sign is the psoriasis triad: a phenomenon of a stearin spot, a terminal film and dot bleeding when scraping scales.
In a stage of development of psoriasis of rashes it is a little, gradually within months and even years their quantity increases. Psoriasis very seldom debuts intensive and generalized rashes, such beginning can be observed after acute infectious diseases, heavy psychological overloads and after massive medicamentous therapy. If psoriasis has such beginning, then rashes edematous, have bright red color and quickly extend on all body, psoriatichesky plaques are hyperemic, edematous and quite often itch. Papules are localized on sgibatelny surfaces, especially in knee and elbow joints, on a trunk and a hairy part of the head.
Emergence of new, already small elements on places is characteristic of the following stage of psoriasis having combed, injuries and attritions, this clinical feature is called Kebner's phenomenon. As a result of peripheral growth, again arisen elements merge with already available and form symmetric plaques or settle down in the form of lines.
In the third stage of psoriasis intensity of peripheral growth of plaques decreases, and their borders become more accurate, color of the affected skin gets a cyanotic shade, the intensive peeling on all surface of elements is observed. After a final stop of growth of plaques of psoriasis on their periphery the pseudo-atrophic rim - Voronov's rim is formed. In the absence of treatment of psoriasis of a plaque are thickened, sometimes it is possible to observe papillomatozny and warty growths.
In a regress stage the symptomatology of psoriasis begins to die away, at the same time normalization of skin goes from the center of the struck surface to the periphery, at first the peeling disappears, color of integuments is normalized and in the last turn infiltration of fabrics disappears. At deep defeats by psoriasis and at damages of thin and friable skin temporary hypopigmentation after clarification of skin from rashes can sometimes be observed.
Ekssudativny psoriasis differs from usual in existence of korko-scales on plaques which are formed due to treatment by exudate, pleated bodies can be moknuty. Patients with diabetes, people with hypofunctions of a thyroid gland (hypothyroidism) and having excess body weight get into risk group on incidence of ekssudativny psoriasis. Patients with such form of psoriasis note an itch and burning on affected areas.
The psoriasis proceeding on seboreyny type is localized on the sites inclined to seborrhea. A large number of dandruff does not allow to diagnose in time psoriasis as it masks psoriatichesky rash. Over time sites of the skin affected with psoriasis expand and pass to forehead skin in the form of "a psoriatichesky crown".
At people who are busy with hard physical work psoriasis of palms and soles meets more often. At such type of psoriasis the main part of rashes are localized on palms, on a body only single sites of rash meet.
Pustulous forms of psoriasis begin with one small bubble which quickly regenerates in a pustula, and when opening forms a crust. Further process extends to healthy skin in the form of usual psoriatichesky plaques. At severe forms of generalized pustulous psoriasis on infiltrirovanny skin there can be vnutriepidermalny small pustula which merging, form purulent lakes. Such pustula are not inclined to opening and dry up in brown dense crusts. At pustulous forms of psoriasis of defeat symmetric, often nail plates are involved in process.
The Artropatichesky form of psoriasis is one of heavy, pain without deformation of a joint is observed, but in certain cases the joint is deformed that leads to an anchylosis. At psoriatichesky arthritises the psoriasis symptomatology from skin can come much later, than the artralgichesky phenomena. First of all small interphalanx joints are surprised and already later large joints and a backbone are involved in process. Because of gradually developing osteoporosis and destruction of joints the artopatichesky form of psoriasis often comes to an end with an invalidization of patients.
Besides rashes on skin at psoriasis vegetodistonichesky and neuroendocrine frustration are observed, at the moments of aggravations patients note temperature increase. Some patients with psoriasis can have an asthenic syndrome and an atrophy of muscles, violations of work of internals and symptoms of immunodeficiencies. If psoriasis progresses, then visceral violations become more expressed.
Psoriasis has a seasonal current, the most part of a recurrence are observed in cold season and very seldom psoriasis becomes aggravated in the summer. Though recently the mixed psoriasis forms recuring at all seasons of the year diagnose even more often.
Diagnosis of psoriasis
The diagnosis is made by dermatologists on the basis of external skin manifestations and complaints of the patient. The psoriatichesky triad which enter a phenomenon of a stearin spot, a phenomenon of a psoriatichesky film and a phenomenon of blood dew is characteristic of psoriasis. At a poskablivaniye even of smooth papules the peeling amplifies, and a surface accepts similarity to a stearin spot. At a further poskablivaniye after full removal of scales there is an otsloyka of the thinnest gentle translucent film which covers all element. If to continue influence, then the terminal film is torn away and the damp surface on which there is dot bleeding (the blood droplet reminding a dew drop) is bared.
At atypical forms of psoriasis it is necessary to carry out differential diagnostics with seboreyny eczema, a papular form of syphilis and pink it is deprived. At histologic researches comes to light and almost total absence of a granular layer terms, a shipovaty layer terms it is edematous with the centers of congestions of neytrofilny granulocytes, in process of increase in volume of such center, it migrates under a horn layer terms and forms microabscesses.
Treatment of psoriasis
Treatment of psoriasis has to be complex, local medicines are applied in the beginning, and connect course drug treatment at inefficiency of local treatment. Observance of an operating mode and rest, a hypoallergenic diet, avoiding of physical and emotional activities are of great importance in therapy of psoriasis.
Sedative medicines, such as tincture of a peony and valerian remove nervous excitability of patients, thereby reducing emission in adrenaline blood. Reception of antihistaminic medicines of new generation reduces puffiness of fabrics and interferes with an ekssudation. Tavegil, Fenistil, Klaritidin, Telfast do not cause drowsiness and have a minimum of side effects that allows to lead sick psoriasis a habitual life.
Use of light diuretics at an ekssudativny form of psoriasis reduces an ekssudation and as a result reduces formation of extensive layered crusts. If there are defeats from joints, then reception of nonsteroid anti-inflammatory medicines for knocking over of a pain syndrome – Ortofen, Naproksen and the medicines containing an ibuprofen as active agent is shown. If psoriatichesky violations in joints more serious, then use medical punctures of joints with intra articulate introduction a beta metazone and a triamtsinolona.
At a pustulous form of psoriasis, psoriatichesky damages of nails and at eritrodermichesky psoriasis aromatic retinoida the appointed not less than a month give good effect. Application of corticosteroids is justified only at psoriasis crises, medicines of the prolonged action, for example Dipropsan with the subsequent plazmoforez allow to stop psoriatichesky crisis quickly.
Such physiotherapeutic procedures as paraffin applications, UF-radiation are shown at different forms of psoriasis. In the progressing stage of psoriasis apply anti-inflammatory ointments if there is an infectious process, then ointments with an antibiotic. Effectively laser treatment of psoriasis and phototherapy. Upon transition of psoriasis to a stationary stage keratolitichesky ointments and creams, for example salicylic, retinoyevy and Bensalitin are shown. Cryotherapy of psoriatichesky plaques is carried out. If psoriasis struck a hairy part of the head, then apply low-percentage sulfur- ointments as at increase in content of salicylic acid ointment renders pronounced keratolitichesky effect.
In a stage of the return development locally apply the reducing ointments, gradually increasing their concentration. These are the tar, ikhtiolovy and naftalanovy ointments or ointments containing these components. Local use of low concentrated korikosteroidny ointments are shown at all stages of psoriasis. Medicines which modulate proliferation and a differentiation of keratinotsit are the perspective direction in modern therapy of psoriasis. During rehabilitation sanatorium treatment with sulphidic and radonic sources help to achieve permanent and long remission.
Prevention of psoriasis
Specific prevention of psoriasis does not exist, but after a disease debut, it is necessary to accept sedative medicines, to conduct courses of vitamin therapy and correction of diseases which provoke a psoriasis recurrence.
Timely therapy of psoriasis allows to achieve long remission and is prevention of the complicated disease forms.