The pathological condition characterized by scaly and nodular changes of the skin and nails is called psoriasis. Dermatologists are involved in the diagnosis and treatment of diseases.
Psoriasis is a chronic skin and nail disorder in which pink nodules and silvery scales appear on the skin. Often the nodules coalesce into large plaques, and the surrounding skin is quickly covered with scales. As the disease progresses over time, joint damage is possible, along with impaired mobility and persistent pain. Different forms of psoriasis have different levels of skin damage: patients may have only fine spots on the scalp or large plaques on different parts of the body. The likelihood of developing psoriasis complications also depends on many factors. The disease is especially dangerous for pregnant women because the pustular form of the disease can cause miscarriage.
about disease
Psoriasis is one of the most common skin diseases. The first symptoms of skin changes usually occur between the ages of 18 and 35. Psoriasis often occurs in the context of cardiovascular disease, Crohn's disease, and depression. Joint damage (arthritis) develops in about 30% of patients. The underlying cause of psoriasis is impossible to eliminate, but symptomatic treatment can significantly slow down the course of the disease.
Types of Psoriasis
Depending on the main symptoms, several types of psoriasis can be distinguished:
- Plaque: characterized by a classic plaque covering the exterior with silvery scales; priority areas: elbows, knees, torso, scalp;
- Teardrop shape: mainly manifested as nodules, orange-pink nodules with a size of 1-10 mm;
- Nail psoriasis: the nail plate is mainly affected;
- plica plica psoriasis: rash occurs in areas of excessive friction such as armpits, neck folds, genitals; this form is more common in obese people;
- Scalp psoriasis: the scalp is affected;
- Articular psoriasis (psoriatic arthritis): The joints are affected;
- Pustular psoriasis: multiple pus-filled blisters appear on the patient's skin;
- Psoriatic erythroderma: In addition to the rash, the skin in the area of the rash becomes visibly reddened.
Symptoms of psoriasis
Most often, plaques appear on the forearms, calves, navel, and scalp. Pustular psoriasis is characterized by the formation of pus-filled blisters on the skin. During certain periods, many patients experience changes in nail color and structure. Damage to the scales of the skin can lead to needle bleeding. Patients also complain of itchy skin. Skin changes periodically disappear and reappear.
Other symptoms and signs:
- Red dots appear in areas of skin folds;
- Massive rashes after infectious diseases and stress;
- slightly elevated body temperature;
- a new rash in winter;
- joint pain;
- Impaired mobility in the affected joint area;
- Dry and irritated skin.
The resorption of the plaque usually starts from the central part, so the psoriatic component acquires a ring or rosette shape. Temporary depigmentation (pseudovitiligo) remains at the site of the subsided rash. During incomplete remission, individual "responsible" plaques may remain in certain areas of the skin (more commonly in the elbow and knee areas).
The most severe types of psoriasis are psoriatic erythroderma and arthritic psoriasis.
In psoriatic erythroderma, the entire (or nearly all) skin is involved in the pathological process. The skin is tight, rough, infiltrated, and red, with a large number of large and small layered peelings on the surface. Increased peripheral lymph nodes, low-grade fever develops, the general condition of the patient is disturbed, changes in the blood (leukocytosis, increased ESR), urine (proteinuria) are observed. In the advanced stage of psoriasis, irrational and irritating treatments promote the development of erythroderma.
The characteristic of arthritic psoriasis is that the lesions mainly occur in the small joints of the hands and feet, and the wrists, ankles, and intervertebral joints are less common, accompanied by severe pain and swelling of the joints, limited mobility and deformity. X-rays show osteolysis and joint changes in the distal phalanges of the fingers, resembling rheumatoid arthritis. Waaler-Rose and latex tests are usually negative. In the blood, leukocytosis, elevated erythrocyte sedimentation rate, hypergammaglobulinemia. Joint involvement may be associated with skin lesions or isolated over many years.
With all these forms of psoriasis, there is a possibility of damage to the nail in the form of a pierced nail plate ("thimble phenomenon"), their clouding or thickening until the nail bends. The course of the disease is chronic and undulating. The seasonality of the process is usually expressed as - worsening in winter, marked improvement in summer (winter type), less - vice versa (summer type).
causes of psoriasis
The exact mechanism by which psoriasis develops remains unclear. It's considered an autoimmune disorder in which the body's defenses mistakenly attack healthy tissue. The T cells and neutrophils needed to fight off pathogens start attacking skin cells and joint structures. In this condition, characteristic changes occur in the skin, including the formation of air bubbles with inflammatory fluid. Dilation of blood vessels in the area of inflammation is accompanied by redness of the skin. Autoimmune diseases can be caused by genetic factors.
Other risk factors:
- skin infection. First, these are bacterial infections caused by strep;
- Skin damage from cuts and burns;
- Chronic stress and traumatic factors;
- Alcohol and smoking;
- Vitamin D deficiency in the body;
- taking certain medicines, including lithium and beta blockers;
- Unfavorable family history. The discovery of psoriasis in close relatives of the patient indicates the possibility of a genetic predisposition to the disease;
- Impaired acquired or innate immunity. It could be HIV infection, AIDS, or another disease.
Despite the discovery of the so-called immunopathological cause of psoriasis, the disease remains poorly understood. There are a large number of disease and lifestyle traits that contribute to the manifestation of hidden factors of susceptibility to this disease.
Psoriasis Diagnosis
If skin changes occur, you should consult a dermatologist. Doctors at our clinic begin with a comprehensive skin examination to assess the nature of the rash. A soft scrape allows you to detect the thin film beneath peeling papules and nodules. Under the film, a moist skin surface is found, prone to small bleeding. At the same time, psoriasis has atypical signs similar to other diseases, so doctors need instrumental and laboratory diagnosis.
- blood analysis. A dermatologist will prescribe a venous blood test to rule out other conditions and detect signs of psoriasis. In the treatment room, the nurse used disinfectant to treat the skin of the patient's cubital fossa, tied a tourniquet, and drew blood with a syringe. In our laboratory, specialists first rule out the presence of rheumatoid factors. In pustular psoriasis, an increased erythrocyte sedimentation rate is often found. Elevated uric acid levels are detected;
- Examine pustular fluid. The doctor collects the fluid in a sterile container and sends the material to the laboratory. Microbiological examination revealed no bacterial cultures but an increased number of neutrophils characteristic of psoriasis;
- Skin biopsy. Dermatologists prescribed the study to make an accurate diagnosis of the atypical rash. During the procedure, the doctor treats the skin with an antiseptic, anesthetizes it, and removes a small piece of skin with a scalpel. Tissue material is studied using a microscope in our clinic's laboratory. The results could elucidate the cellular composition of the nodule;
- X-rays of affected joints. Doctors prescribe this study to determine the type of arthritis. In addition, in severe complications of arthropathic psoriasis, diagnostic X-rays of the bones are required;
- Scrape the skin to get rid of fungus. The doctor cleans the surface of the skin and uses a special scraper to collect several scales for microbiological examination. This analysis is mainly necessary if the rash occurs only in the foot and nail area.
If necessary, a rheumatologist will be consulted.
Expert Opinion
Psoriasis is a disease with many manifestations. It can be nearly invisible, or it can cause serious health problems. The most dangerous complication of psoriasis is joint damage, which can lead to disability. In addition, the disease can lead to autoimmune diseases, especially Crohn's disease and ulcerative colitis, metabolic pathologies, erectile dysfunction in men. Women with psoriasis may experience infertility and miscarriage. In order to prevent these complications, it is necessary to consult a doctor as soon as suspicious signs appear, and carefully follow all the recommendations of specialists in the case of a confirmed diagnosis.
Psoriasis Treatment
The main goal of psoriasis treatment is symptomatic treatment. Patients need medications that reduce inflammation and prevent the rash from forming. In addition to medication, the dermatologists in our clinic have to prescribe special diets for their patients. Normalization of lifestyle and elimination of stressors can reduce the severity of psoriasis symptoms.
Depending on the situation, a dermatologist may use different methods to treat the condition.
- Administration of corticosteroids. Dermatologists prescribe creams that contain these medications. The beneficial effects of corticosteroids include reducing tissue inflammation and eliminating itching;
- Vitamin D supplements. The synthetic form of this vitamin slows the growth of skin cells, thus preventing the formation of scales and nodules;
- Treatment with medicines containing vitamin A derivatives. Dermatologists prescribe retinoid-based creams to reduce inflammation and itching. These medicines increase the skin's sensitivity to light, so sunscreen must be used;
- Use of calcineurin inhibitors. These are immunosuppressants that reduce inflammation. A dermatologist will prescribe a topical medication, such as tacrolimus. These medicines are used for a short period of time to prevent side effects and complications;
- Treat the skin with salicylic acid to remove dead cells. Dermatologists use this medication with corticosteroids in complex skin treatments;
- Use moisturizers to combat dry and itchy skin;
- The skin is irradiated with ultraviolet light. This safe form of physical therapy improves local immune function. Doctors choose individual radiation doses for patients;
- Phototherapy. This method involves irradiation of the skin with special equipment. Phototherapy combines the techniques of laser therapy and photochemotherapy;
- Joint aspiration in severe psoriasis. The doctor treats the skin at the puncture site with an antiseptic, numbs the tissue, and inserts the needle. With the help of a syringe, the drug is injected into the joint cavity to reduce the inflammatory process.
Dermatologists control all stages of treatment to achieve optimal results and prevent complications. Corticosteroids, retinoids, and calcineurin inhibitors are used strictly under the supervision of a specialist.
Psoriasis Prevention
Advice from our clinic dermatologist will help reduce the severity of the rash and ease its course.
To prevent the exacerbation of psoriasis:
- Relieve anxiety and stress by improving sleep, avoiding coffee, and taking prescription sedatives;
- Excluding foods containing allergens from the diet;
- Treat contagious skin diseases promptly.
recovery
Psoriasis is a chronic disease with no cure. Rehabilitation measures are aimed at preventing relapse. Depending on the form of the disease, physical therapy, hydrotherapy, mud therapy, therapeutic baths and other procedures may be prescribed.
questions and answers
Is it possible to treat psoriasis with folk remedies?
There is no proven method. It is important not to trust dubious types of treatment, but to follow the advice of the attending physician.
Does Stress Affect the Course of Psoriasis?
Yes, stressful situations can exacerbate the disease process.