Psoriasis (psoriasis) – a chronic contagious disease that affects the skin, nails and joints. It is characterized by the appearance on the skin monomorphic eruption nodules are bright pink, covered with silvery scales. Elements of the eruption can be combined in different configuration similar to a geographical map. Accompanied by moderate pruritus. Psoriasis affects the appearance of the skin, it delivers psychological discomfort to the patient. When the joint damage develops psoriatic arthritis. Threat generalized pustular psoriasis pregnant, which leads to fetal damage and miscarriage.
Psoriasis is a common chronic skin disease characterized by a monomorphic eruption of flat papules, which tend to merge into large plaques that are very quickly covered with loose silvery-white scales. Psoriasis has a course fluctuating, the incidence is 2% of the total population, is diagnosed equally in men and women.
The etiology and the pathogenesis of psoriasis is not fully understood, but the results of the research suggest that genetic, infectious or neurogenic nature more likely. Hereditary psoriasis, confirmed by the facts that the incidence is higher in those families in which psoriasis have already been diagnosed, except in monozygotic twins, the concentration of morbidity, is also higher than in the other groups. Infectious aetiology of psoriasis, is limited by the presence of the modifying complexes and inclusions, such as during viral infection, but to identify the virus, is not yet possible.
And, to date, psoriasis is considered a disease with a large number of factors of infection with a share genetic and infectious components. The risk of incidence of psoriasis are the people with constant trauma to the skin, with the presence of chronic streptococcal infections of the skin, disorders of the autonomic and the Central nervous system, endocrine disorders, in addition, the abuse of alcohol increases the risk of psoriasis.
The main element in psoriasis is a single papule is pink or red in color that is covered with a lot of loose silvery-white scales. An important diagnostic feature is the triad of psoriasis: the phenomenon of a stearin stain, a terminal film and the point of bleeding when trying to remove the scales.
In the stage of development of psoriasis rash a bit, slowly, for months and even years their number increases. Psoriasis very rarely will premiere an intense and widespread of the eruption, as a principle it can be observed that after acute infectious diseases, severe neuropsychiatric overloads and, after a massive drug therapy. If psoriasis is the beginning, the rash is swollen, have a bright red color and quickly spread throughout the body, psoriatic plaques hyperemic, swollen, and often itch. The papules are localized on the flexor surfaces, especially in the area of the knee and elbow joints, torso and the scalp.
For the next stage of the psoriasis, which is characterized by the appearance of new, small elements in the zones of streaks, injuries and abrasions, this clinical feature is called the phenomenon of the Kebner. In the result of peripheral growth, the emerging elements blend with the existing and the symmetrical shape of the plates or in the form of lines.
In the third stage of psoriasis, the intensity of the peripheral growth of the plates is reduced, and its boundaries to be more clear, the color of the affected skin acquires a tint bluish, there is intense peeling on the entire surface of the elements. After the final stop the growth of plaques of psoriasis at its periphery, formed pseudoatrophic mouth - mouth Voronova. In the absence of treatment of psoriasis plaques of thicken, sometimes you can see the papillomatous and warty growths.
In the stage of regression of the symptoms of psoriasis starts to disappear, while the normalization of the skin from the center of the surface affected in the periphery, the first disappears peeling, normal colour of the skin and finally disappear, the infiltration of the tissues. With the depth of the lesions of psoriasis and when the lesions are thin and loose skin, it can sometimes be a temporary hypopigmentation after cleaning the skin, rashes.
Exudative psoriasis differs from the usual presence of crusts scales and plates, which are formed due to absorb the exudate, in the folds of the body can be exuded. Risk Factors for the incidence of exudative psoriasis get with diabetes, people with hypofunctions of the thyroid gland (hypothyroidism) and have excess body weight. Patients with this form of psoriasis have noted itching and burning in the affected areas.
Psoriasis, that occur in the seborrheic type, is located in areas prone to seborrhea. A large amount of dandruff does not allow to diagnose psoriasis, because the masks of the eruption. With time, the patches of skin affected by psoriasis, grow and move on to the skin of the forehead in the form of "psoriatic crown".
The people who are engaged in heavy physical work, the most common of the psoriasis of the palms of the hands and the soles of the feet. In this type of psoriasis the main part of the rash localized on the palms, on the body there are only isolated areas of the eruption.
Pustular forms of psoriasis started with a small bubble, which soon degenerates into a pustule, and in open form a crust. In the future, the process extends to the health of the skin in the usual form of psoriatic plaques. In severe forms of generalized pustular psoriasis infiltrated into the skin can cause intraepithelial small pustules that merge to form purulent the lake. Such pustules are not prone to Stripping, and dry to a brown crisp crust. In pustular forms of psoriasis lesions are symmetrical, often, the process involves the plate of the nail.
Arthropathy psoriasis is a serious, no pain without deformation of the joint, but in some cases the joint is deformed, which leads to ankylosis. When psoriatic arthritis symptoms of psoriasis, the skin may produce much later than arthralgic phenomenon. Mainly affects the small joints later, the process of large joints and the spine. Due to slowly the development of osteoporosis and destruction of the joints arthopathic form of psoriasis, often the results of the disability of the patients.
In addition to the skin rash in psoriasis is observed vegeto-dystonic and neuroendocrine disorders, exacerbations of patients reported fever. Some patients with psoriasis can be asthenic syndrome, and muscle atrophy, disorders of the internal organs and symptoms of deficiencies of the immune system. If the psoriasis progresses, the visceral disorders was more pronounced.
Psoriasis has a period of the season, the majority of relapses are observed in the cold season and very rarely psoriasis is exacerbated in the summer. Although in recent years mixed forms of psoriasis, recurring at any time of the year, is diagnosed with more frequency.
The diagnosis is made by dermatologists on the basis of the appearance of manifestations skin and the complaints of the patient. For psoriasis typical psoriatic triad, which includes the phenomenon of stearin site, the phenomenon of the psoriatic film and the phenomenon of blood dew. When poskablivanii papules smooth and even reinforced by the shell, and the surface adopts the similarity with stearic place. With further poskablivanii after the complete removal of flake detachment and a subtle, delicate, translucent film that covers the entire element. In the case of continuing the action, the terminal film rejected and exposed wet surface where there is a point of bleeding (a drop of blood, looks like a drop of morning dew).
When atypical forms of psoriasis it is necessary to perform a differential diagnosis with eczema, papular form of syphilis, and pink ringworm. Histological studies revealed hyperkeratosis, and almost total absence of the layer of granular of the dermis, spiny layer of the dermis edematous with a central axis of the accumulation of neutrophils, the increase in the volume of this approach, migrates to the bottom of the Horny layer of the dermis and forms microabscesses.
Psoriasis treatment should be complex, first apply local medication, and exchange drug treatment are connected with the ineffectiveness of local treatment. Adherence to work and rest, hypoallergenic diet, avoiding physical and emotional stress are of great importance in the treatment of psoriasis.
Sedatives, such as tincture of Valerian, peony, and relieve nervous irritability of patients, thus reducing the release of adrenaline in the blood. Take antihistamines of new generation, which reduces the inflammation of the tissues and prevents exudation.
The use of diuretics lung with exudative form of psoriasis reduces exudation and as a consequence, reduces the formation of extensive layers of scabs. If there are injuries of the joints, that is shown in the taking of nonsteroidal anti-inflammatory drugs for the relief of pain. If psoriatic disorders in the joints more severe use therapeutic puncture of joints, with the introduction within the joints, betamethasone and triamcinolone.
When pustular form of psoriasis, psoriatic nail lesions and erythrodermic psoriasis aromatic retinoids are appointed for a period of not less than one month give a good effect. The use of corticosteroids is justified only when the crisis of the psoriasis drug action prolonged, followed by plasmaphoresis allows to quickly arrest psoriatic crisis.
Physiotherapy treatments such as paraffin baths, irradiation with UV is shown in different forms of psoriasis. In an advanced stage of psoriasis apply anti-inflammatory ointment if there is infection, then ointment with an antibiotic. Effective laser treatment of psoriasis and phototherapy. In the transition of psoriasis in a phase stationary displays keratolytic ointments and creams. Is cryotherapy psoriatic plaques.
In the stage of reverse development of the reduction applied locally in ointments, to gradually increase their concentration. Local application of low concentrated corycosteroids ointments demonstrated in all stages of psoriasis. Drugs that modulate the proliferation and differentiation of keratinocytes this is a perspective direction in the modern treatment of psoriasis. During the period of rehabilitation of sanatorium-resort treatment with sulfide and radon sources to help achieve the persistent and prolonged remission.
