Psoriasis — a chronic non-communicable diseases, dermatosis, affecting primarily the skin. Psoriasis usually causes the formation of excessively dry, red spots on the surface of the skin. However, some patients with psoriasis have no visible lesions.
Patches caused by psoriasis are called psoriatic plaques. These spots are areas of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin and excessive formation of new blood vessels (formation of new small capillaries) to submit to the layer of the skin. The excessive proliferation of keratinocytes in psoriatic plaques, and skin infiltration of lymphocytes and macrophages leads to the thickening of the skin in the affected areas, its elevation above the surface of the healthy skin and the formation of the characteristic pale, grey or silver points, it will seem to melt the wax or paraffin wax ("paraffin lakes").
Psoriatic plaques often first appear on exposed to the friction and pressure spheres — the one of the surfaces of elbow and knee bends, on the buttocks. However psoriatic plaques can occur and be located in any place of the skin, including the skin of the scalp, the surface of the hands, plantar surface of feet, external genitalia. In contrast to eczema rash, usually affecting the inner surface of the knees and elbows, psoriatic lesions often are located on the exterior of the extender surfaces of the joints.
Psoriasis is a chronic disease that is characterized by in general through the waves with periods of spontaneous or caused by various therapeutic effects of remission or of improvement and periods of spontaneous or provoked by adverse external influences (alcohol, intercurrent infections, stress) recurrences or exacerbations.
The severity of the disease may vary in different patients and even in the same patient during the periods of remission and exacerbation in a very wide range, from small local lesions to fully cover the entire body psoriatic plaques. Often there is a tendency to the progression of the disease over time (especially if untreated), to the weighting and the increase in the frequency of exacerbations, increase the area affected, and the involvement of new areas of the skin. In some patients, there is a continuous course of the disease without referring spontaneous, or even a continuous evolution. They also often affects the nails of the hands and/or feet (psoriatic onychodystrophy). Nail involvement may be isolated and observed in the absence of skin lesions. Psoriasis can also cause inflammation of the joints, called psoriatic arthropathy or psoriatic arthritis. From 10% to 15% of patients with psoriasis also suffer from psoriatic arthritis.
There are many different means and methods for the treatment of psoriasis, but because of the chronic recurrent nature of the disease itself, and often a tendency to advance in time, the psoriasis is quite difficult to treat the disease. Complete cure is not currently possible (that is to say, psoriasis is incurable at the current level of development of medical science), but possible, more or less long, more or less complete remission (including the life). However, it is always a risk of relapse.
People with disabilities function barrier of the skin (in particular, mechanical injury or irritation, friction and pressure on the skin, the excessive use of soap and detergents, contact with solvents, detergents, alcohol-containing solutions, the presence of infected lesions in the skin, or of skin, allergies, excessive dryness of the skin) also plays a role in the development of psoriasis.
Psoriasis is in large part idiosyncratic of diseases of the skin. The majority of patients experience suggests that psoriasis may improve spontaneously or worsens for no apparent reason. Studies of various factors associated with the onset, development or exacerbation of psoriasis tend to be based on the study of small, generally in the hospital (not outpatient), that is without a doubt more severe groups of patients with psoriasis. Therefore, these studies often suffer from lack of representativeness of the sample and the inability to identify causal relations in the presence of a large number of other (including as yet unknown) factors can influence the nature of psoriasis. Often, different studies found contradictory results. However, the first signs of psoriasis often appear after a trauma (physical or mental), damage to the skin in places of the first appearance of psoriatic lesions, and/or past streptococcal infection. Conditions, according to a number of sources that could contribute to the aggravation or worsening of psoriasis include acute and chronic infections, stress, climate change, and the change of seasons. Some medications, particularly lithium carbonate, beta blockers, antidepressants fluoxetine, paroxetine, antimalarial drugs chloroquine, hydroxychloroquine, anticonvulsants carbamazepine, valproate, according to several sources, are associated with worsening of psoriasis or may even cause its first appearance. The excessive consumption of alcohol, Smoking, overweight or obesity, poor diet can aggravate psoriasis or impede its treatment, cause the aggravation. The lacquer, some creams, and hand lotions, cosmetics and perfumes, household chemicals can also cause the exacerbation of psoriasis in some patients.
Patients suffering from HIV or AIDS often suffer from psoriasis. This seems paradoxical for researchers of psoriasis, such as treatment with the aim of reducing the number of T cells or their activity as a whole contributes to the treatment of psoriasis, and HIV infection or AIDS is accompanied by a decrease in the number of cells T. however, over time with the progression of HIV infection or AIDS by increasing viral load and a decrease in the number of circulating CD4+ T cells, psoriasis in HIV-infected patients or AIDS patients deteriorates or escalates. In addition to this mystery, the HIV infection is usually accompanied by a strong shift of the cytokine profile towards Th2, whereas psoriasis vulgaris of uninfected patients is characterized by a strong shift of the cytokine profile towards Th1. According to the currently accepted hypothesis is that a reduction of the amount and pathologically modified activity of the CD4+ T-lymphocytes in patients with HIV infection or AIDS due to hyperactivation of the cd8+ T-lymphocytes, which are responsible for the development or exacerbation of psoriasis in HIV-infected or AIDS patients. However, it is important to know that most of the psoriasis patients in relation to healthy carriers of HIV, and HIV is responsible for less than 1% of cases of psoriasis. On the other hand, psoriasis in HIV-positive occurs, according to different sources, with a frequency of 1 to 6 %, which is approximately 3 times greater than the prevalence of psoriasis in the General population. Psoriasis in patients with HIV infection and AIDS, in particular, often occurs very hard and responds little or not at all amenable to standard therapies.
Psoriasis most often develops in patients initially dry, sensitive skin patients with oily skin, and is much more common in women than in men. A patient psoriasis often first appears in areas more dry or more thin skin than in areas of oily skin and most often appears in the places of damage of the integrity of the skin, including scratches, scuffs, abrasions, scratches, cuts, in places exposed to friction, pressure or contact with aggressive chemicals, detergents, solvents (this is called the phenomenon Kebner). It is assumed that this phenomenon lesions of psoriasis mainly dry, delicate or injured skin associated with the infection, because the infection (probably the most common Streptococcus) penetrates easily into the skin with a minimum of secretion of sebum (which, in other circumstances, protects the skin from infections) or skin damage. The most favourable conditions for the development of psoriasis, therefore, faced with the most favorable conditions for a fungal infection of the feet (the so-called "athlete's foot") or the armpits, groin area. For the development of fungal infections is more favorable, wet, wet to the skin, for psoriasis, on the contrary, dry. Penetration in dry skin infection causing dry chronic inflammation, which, in turn, causes the characteristic symptoms of psoriasis, such as itching and increased proliferation of the cells of the skin. This, in turn, leads to a further increase of the dryness of the skin due to inflammation and increased proliferation of keratinocytes, and due to the fact that the infection consumes the moisture, which otherwise would serve to moisturize the skin. To avoid excessive dryness of the skin and reduce the symptoms of psoriasis patients with psoriasis is not advisable to use washcloths and scrub, especially difficult, as it not only harms the skin, leaving microscopic scratches, but scraping the skin of the upper protective stratum corneum and sebum, normally protects the skin from drying and from penetration of microorganisms. It is also recommended to use talc or baby powder after washing or bathing to absorb excess moisture from the skin, which is another way of "reaching" of the infection. In addition, we recommend the use of the funds, moisturize and nourish the skin, lotions that improves the function of the sebaceous glands. It is not recommended to abuse of soap, detergents. Should try to avoid skin contact with solvents, household chemicals.
It has been shown that psoriasis can harm the quality of life of the patients in the same degree as other severe chronic illnesses, such as depression, myocardial infarction, hypertension, cardiac insufficiency or diabetes mellitus of the 2nd type. Depending on the severity and location of psoriatic lesions, patients with psoriasis may experience significant physical and/or psychological distress, difficulty with social and professional adaptation and even need disability. Strong itching or pain can interfere with performing basic life functions, such as self-care, walking, sleep. Psoriatic plaques on the exposed parts of the hands or feet can prevent the patient to work in certain jobs, to do some sport, take care of family members, Pets or home. Psoriatic plaques on the scalp often pose to patients with special mental problems and caused a considerable distress and even social phobia, as pale plaques on the scalp, can be confused with other people for the dandruff or result of the presence of lice. Another big problem psychological gives rise to the presence of psoriatic lesions on the face, the earlobes. Psoriasis treatment can be expensive and take away from the patient a large amount of time and effort, interfering with work and/or study, the socialization of the patient, the device personal life.
Patients with psoriasis can also be (and often are excessively concerned about their appearance, attach too much importance (sometimes to the point of being obsessed, almost body dysmorphic disorder), suffer from a low self-esteem, which is related to the fear of rejection, a public rejection, or fear of not finding a sexual partner because of problems of appearance. Psychological distress combined with pain, itching and immunopathological disorders (increased production of inflammatory cytokines) can lead to the development of serious depression, anxiety or social phobia, is an important social isolation and maladjustment of the patient. It should also be noted that the comorbidity (combination) psoriasis and depression as well as psoriasis and social phobia, occurs with greater frequency, even in patients who do not experience subjective psychological discomfort of the presence of psoriasis. It seems likely that the genetic factors that influence the predisposition to psoriasis and the predisposition to depressions, anxiety States, social phobia in a large part of overlap. It is also possible that in the pathogenesis of both psoriasis and depression play a role in common immunopathological and/or endocrine factors (for example, with depression also show elevated levels of inflammatory cytokines, increase of the cytotoxic activity of glial).
