psoriasis

psoriasisIt is a systemic disease characterized by damage to the skin, musculoskeletal system, and functional and morphological disorders of other organs and systems. The main pathological symptoms are: nodular rash, congestion, and itching on the scalp, palms, feet, elbows, and knee extensor surfaces. The disease can be diagnosed with the naked eye, but in order to exclude the possibility of accompanying pathology, laboratory tests and instrumental diagnostic methods are required. Systemic treatment includes aromatic retinoic acid and cytostatics and glucocorticoids.

introduce

The disease's name comes from the Greek "psora" - "skin disease", "scab". In the Middle Ages, psoriasis was considered a form of leprosy (leprosy). The symptoms of psoriasis were first professionally described in 1808 by Robert Whelan in England. The term "psoriasis" was coined in 1841 by Viennese dermatologist Ferdinand Gebra. The pathology has been recorded from all latitudes worldwide with uneven frequency ranging from 0. 1% to 3%. Psoriasis occurs equally in men and women, but in children it is more common in girls, and in adults it is more common in men (60-65%).

reason

There are many theories about the origin of psoriasis. Mainly include parasitic, infectious, allergic, infectious allergies, autoimmune, neurogenic, endocrine, and hereditary. These theories are based on clinical observations and laboratory results.Most scientists focus on the genetic nature of psoriasis. They claim the disease is polygenic. If one parent has the disease, the child's risk is 8 percent, while the risk for both fathers and mothers is 41 percent.Factors leading to the occurrence of psoriasis are divided into external factors and internal factors.

• External factors include mechanical and chemical damage to the skin and dermatological diseases.
• Doctors include internal triggers: infections (strep and human immunodeficiency virus), medications (corticosteroids, nonsteroidal anti-inflammatory drugs), neurological stress.

onset

Today, doctors around the world recognize the involvement of the immune system in the pathogenesis of psoriasis. Cells of the immune system usually react to the antigen and begin attacking healthy cells, most commonly skin cells. Due to this process, cells in the epidermal layer divide faster than usual. They were not given time to mature, which is why a strong bond was not developed between them. Cells rise to the surface, forming prominent patches with silvery scales.

Classification

According to the International Statistical Classification of Diseases and Related Health Problems, there are many types of psoriasis.

1. Ordinary (vulgar). The most common form of lichen planus, without complications. This group includes plaque psoriasis and nummular psoriasis.
2. Generalized pustular psoriasis- A severe form of pathology complicated by secondary infections. It affects multiple areas simultaneously. Includes Zumbusch syndrome and impetigo herpetiformis.
3. Persistent acrodermatitis (Crocker's dermatitis, Seton's dermatitis)—Pustule contents are sterile and secondary infection is not present. The main areas affected are the fingers and nails.
4. Impetigo of the palms and soles of the hands (pustular bacteria)- Develops on feet and palms. It appears as pustules with sterile contents that gradually increase in size.
5. teardrop shape- Papules are distributed individually and do not merge into plaques. The most commonly affected areas are the calves, thighs, back, forearms, chest, and neck.
6. Arthropathy-The clinical course is similar to that of rheumatoid arthritis.
7. Other psoriasis (reverse)- Collections are concentrated in the armpits, groin and other natural folds. This type includes reflexor psoriasis.
8. unspecified psoriasis- Combines multiple pathological types and has a wide range of clinical manifestations.

Several types of psoriasis can be distinguished based on the seasonality of exacerbations:

• summer- Exacerbation of the condition due to skin exposure to sunlight;
• winter- Occurs due to the effects of extreme cold on the skin.

There are no remission periods for non-seasonal psoriasis; the disease occurs year-round. By affected skin area:

• localized psoriasis- Accounts for less than 20% of body skin;
• Common- more than 20%;
• Generalized-The entire skin is affected.

symptom

The clinical manifestations of psoriasis depend directly on the stage of disease development. There are 3 stages.

1. Advanced stage. It is characterized by papules, itching, peeling, peeling, and deformation of nails.
2. fixed stage. No new papules appear, the size of the old rash does not increase, and the peeling is moderate.
3. regression stage. The plaques heal and form white, depigmented spots in their place that no longer cause discomfort.

A rash is only an external symptom of psoriasis. In fact, this disease affects many organs and systems, as well as tendons and joints. As a result, patients complain of depression, persistent feelings of weakness, and chronic fatigue.

complication

Among the complications of psoriasis, psoriatic arthritis and psoriatic erythroderma are particularly important. Additionally, if psoriasis is not promptly diagnosed and effectively treated, the risk of developing serious chronic diseases increases: diabetes, arterial hypertension, and metabolic syndrome.

diagnosis

To identify pathology, laboratory and instrumental diagnostic methods are used.The patient was referred to:

• General clinical analysis of blood and urine;
• blood biochemistry;
• C-reactive protein blood test and rheumatology test;
• Coagulogram - Assessment of coagulation;
• Blood test for human leukocyte antigen.

In complex forms of psoriasis associated with damage to the musculoskeletal system and internal organs, radiographic examination of the joints, ultrasonography of the kidneys and urinary organs, and echocardiography are required.Some diseases have similar symptoms. Therefore, differential diagnosis is required. To do this, use the following method:

• Biopsy (removal of a piece of skin and further histological examination);
• Laboratory tests - used to differentiate between psoriasis and papular syphilis.

treat

Psoriasis responds well to symptomatic treatment. After understanding the pathogenesis, the doctor can individually choose a treatment method. Some are designed to reduce rashes, eliminate dryness and itching, and others are designed to suppress the immune system from "attacking" healthy cells.The treatment strategy depends directly on the severity of the disease and the location of the lesion.

External treatment

Topical corticosteroids are used as monotherapy or in combination with other medications to treat various forms of psoriasis. They come in dosage forms - ointments, creams or lotions.Medications containing vitamin D3 analogues. They are applied to the affected areas of skin if the psoriasis prevalence is no more than 30% of the body surface.Preparations containing active zinc pyrithione are available for use on the scalp in the form of aerosols, creams, and shampoos.

Phototherapy

For the treatment of this condition, medium wave phototherapy and PUVA therapy are used. PUVA therapy is a combination of UVA (320-400 nm) and a photosensitizer (8-methoxypsoralen). PUVA therapy is one of the most effective treatments for this disease; it is most commonly used to treat widespread forms of vulgaris and exudative psoriasis, persistent pathology, and severe infiltrates.

combination therapy

This treatment includes several treatment modalities, such as: phototherapy and topical corticosteroids; phototherapy and systemic tretinoin.

systemic treatment

For the treatment of moderate and severe psoriasis. Systemic therapeutic drugs are mainly used during disease progression.

biopharmaceuticals

These drugs are manufactured using genetic engineering methods. They are monoclonal antibodies, used for therapeutic purposes.

prognosis and prevention

Prompt diagnosis of pathology and effective treatment will result in a good prognosis. As a preventive measure, the following measures are usually taken: a diet rich in fish and vegetables, hydrotherapy, herbal treatments, health resort treatments and emollients (mainly between relapses - to restore the hydrolipidic layer).