Psoriasis or squamous lichenIt is a chronic disease that affects the skin and its appendages: nails and hair. It is characterized by periods of deterioration (relapses) and temporary well-being, when the manifestations of the disease decrease. This disease is not contagious and the patient is not dangerous to others. Because the appearance of psoriasis is not associated with microorganisms.
Psoriasis occurs most often between the ages of 15 and 45. Fair-skinned people are more susceptible. In developed countries, the number of patients with psoriasis reaches 2-4% of the population. Every twenty-five inhabitants of the earth on all continents suffers from it.
A large number of medical institutions are dealing with this problem. Therefore, psoriasis has been recognized as the most studied disease. But still, this disease is not fully understood. Officially, it is considered incurable and raises many questions.
Psoriasis is caused by the body's own immune cells. They rise from the lower layers of the skin to the upper ones, causing inflammation, proliferation of epidermal cells and the formation of small capillaries.
The manifestations of psoriasis on the skin are quite varied. Most often, the disease causes the appearance of red spots - psoriatic plaques. They are dry to the touch, rise above the surface of the skin, and are covered with a white coating.
Types of psoriasis
The disease is divided into two large groups: pustular and non-pustular psoriasis.
Nonpustular psoriasis
- ordinary (vulgar) or simple psoriasis (plaque psoriasis, chronic stable psoriasis)
- psoriatic erythroderma or erythrodermic psoriasis
Pustular psoriasis
- Von Tsumbusch pustular psoriasis or generalized pustular psoriasis
- palmoplantar psoriasis (pustular psoriasis of the extremities, chronic persistent palmoplantar pustulosis)
- annular pustular psoriasis
- palmoplantar psoriasis
- psoriatic impetigo herpetiformis
Also, these types of psoriasis are distinguished.
- seborrheic psoriasis
- psoriasis of flexor surfaces and skin folds
- Napkin psoriasis
- drug-induced psoriasis
Depending on the severity, such forms of psoriasis are distinguished.
- Mild: affects less than 3% of the skin.
- Moderate: between 3 and 10% of the skin is covered with psoriatic plaques.
- Severe: there are joint injuries or more than 10% of the skin is affected.
Causes of psoriasis
To date, there is no unequivocal answer to the question: "why does psoriasis appear? " Scientists have proposed various theories.
- Psoriasis is an autoimmune disease. It is based on a malfunction of the immune system. The immune cells of T-killers and T-helpers, whose function is to protect the body from viruses, bacteria and tumor cells, for some reason penetrate the upper layers of the skin. Here they produce inflammatory mediators, substances that "trigger" the inflammatory response. It results in further division of skin cells and their multiplication (proliferation).
- Psoriasis is a disease caused by poor growth, division, and maturation of epithelial cells - keratinocytes. The result of such skin changes is an attack by immune cells from T lymphocytes and macrophages to diseased skin cells.
Factors that contribute to the development of psoriasis.
Doctors have observed a number of factors that can lead to the onset of the disease. Of course, psoriasis occurs more often if several of these conditions act on the body at the same time.
- Hereditary predisposition.There is a version that the genes that are responsible for the immune system and T-lymphocyte function carry the disease. Therefore, parents with psoriasis are more likely to have children who develop the same symptoms.
- Fine and dry skin. . . It was observed that people with such skin characteristics get sick more often than those with oily and well-hydrated skin. This is probably due to the protective functions of sebum and the structural characteristics of the skin.
- External irritants. . . A high percentage of patients are among those people who are constantly in contact with alcoholic solutions, solvents, household chemicals, cosmetics (lotions, hand creams).
- Excessive hygiene- an excessive love of cleanliness also undermines the protective properties of the skin. Soaps, shower gels and wipes clean the natural protective barrier and leave microscopic wounds.
- Bad habits- Addiction to alcohol, smoking and drugs is harmful to the skin. His nutrition and blood supply are deteriorating.
- HIV- AIDS patients are more prone to psoriasis. Scientists cannot explain this phenomenon. The fact is that psoriasis is caused by increased activity of lymphocytes, and with AIDS their number decreases.
- Medicines- the intake of certain medicines can cause illness. Among them: beta-blockers, antidepressants, anticonvulsants and antimalarials, lithium carbonate.
- Infections (fungi and staph). . . Most often, there were cases when psoriasis appeared immediately after fungal infections or streptococcal diseases.
- Moving- a change in climate or even a season of the year, environmental degradation can be a trigger for this disease.
- Stress- Strong emotional disorder or physical stress (prolonged periods of hypothermia, overheating, accidents) precede the appearance of the first symptoms of psoriasis.
- Trauma- Constant effect on the skin: pressure, friction, scratching. Such regular trauma can cause the first psoriatic plaques to appear at this location.
- Allergic conditions- Allergic skin rashes and the processes that occur in this case, in all layers of the skin, also increase the risk of disease.
What are the signs and symptoms of psoriasis?
Psoriasis is a systemic disease that affects more than just the skin and nails. It affects the joints, tendons and spine, immune, nervous and endocrine systems.
But still, the main manifestations of the disease occur on the skin. The name squamous lichen quite accurately conveys the symptoms of psoriasis. The first manifestations are often bright pink or red papules of the correct rounded shape, covered with scales - psoriatic plaques. They are located symmetrically, mainly on the extensor surfaces, lumbar area and scalp. But they can affect any part of the skin and genital mucosa. Its size ranges from a few millimeters, in the initial stages, to ten centimeters or more.
Depending on the characteristics of the rash, suchforms of psoriasis:
- Psoriasis with bites - the size of the elements is less than the head of a pin.
- Guttate psoriasis: The papules are teardrop-shaped and reach the size of a lentil grain.
- Coin psoriasis - Plaques grow up to 3-5mm and have rounded edges.
They also distinguish the forms of the eruption, when its elements are in the form of rings, arches and garlands, geographical maps with uneven edges.
The papules are covered with a scaly coating that can be easily removed. It consists of keratinized cells of the epidermis. The psoriatic plaques begin to be covered with scales from the center, then the plaque spreads to the edges. Its loose and light appearance is due to the keratinized cells being infused with air-filled spaces. A pink ring can form around the elements; This is an area of inflammation, a zone of plaque growth. The skin around the elements of the rash does not change.
Scalp psoriasisrepresents psoriatic plaques that rise significantly above the surrounding skin. They are densely covered with dandruff-like scales. In this case, the hair is not affected. Rashes can occur not only under the hair, but also on smooth skin, on the neck, and behind the ears. These changes are explained by the active division of keratinocytes in the affected areas.
Psoriasis of feet and palmscauses a strong thickening of the stratum corneum of the skin in these areas of the body. The skin becomes thick, rough. Cracks often penetrate it. This is caused by intensive cell division, which multiplies 8 times faster than usual, but is not eliminated from the skin's surface in time.
Nail psoriasisdiffers in a variety of symptoms. But the most important are two main types of nail plate damage:
- By the type of "thimble". Small holes form in the nail plate, similar to needle stick marks.
- By type of onychomycosis. The lesions resemble nail fungus. Nails thicken, change color, peel off. A psoriatic papule surrounded by a red border is visible through the nail plate. It looks like an oil stain shining through the nail.
The symptoms and signs of psoriasis depend on the stage of the disease, which are replaced cyclically throughout the year. Therefore, most patients have a disease of the "winter" type, when the exacerbation occurs in the autumn-winter period. An improvement in the condition in summer is due to the fact that ultraviolet light from the sun has a therapeutic effect. But some patients suffer from the "summer" type.
There are such stages of the course of psoriasis:
- progressive - the appearance of new elements, the active growth of existing plaques, the implicity of the pink growth zone around it, intense peeling and itching.
- stationary - stops the growth of papules, absence of new eruptions, thin fold of the upper layer of the skin around the psoriatic plaques.
- returning: the absence of desquamation, the disappearance of the plaques and the appearance in their place of areas of pigmentation, indicate the attenuation of the process.
What do skin rashes look like with psoriasis?
Each organism is individual and reacts differently to disease. Therefore, the nature of the eruption can be very varied. This explains the variety of forms and types of psoriasis.
However, for most people, the symptoms of psoriasis are similar. These are red dots - psoriatic plaques that rise 1-3 mm above the level of healthy skin. Its appearance is due to the fact that the cells of the superficial layer of the skin, keratinocytes, divide very actively, without having time to mature into full-fledged epithelial cells. As a result of this increased pathological growth, certain areas of the skin become thicker. This is due to the fact that immune cells release chemicals that cause inflammation in the skin.
From above, the plates can be covered with a gray, silver or yellowish flower, which looks like paraffin. Therefore, they got the name - "paraffin lakes". These are keratinized epithelial cells, the rejection of which is affected and they accumulate on the surface of the affected skin area.
The spots are scaly, warmer than the rest of the skin, and can grow to a large size. Often times, the patient feels intense itching at this location. This is due to the fact that, against the background of the inflammatory process, a cascade of neuroreflex reactions and an allergic reaction occurs.
Another type of element is papules. These are small elements of a rash that resemble a tuber. The size is about 1mm. In the middle there is no cavity filled with content. They are often found in the knee and elbow joints. They remain even during periods when the disease regresses.
During exacerbations, the elements of the rash gradually grow in width and merge with neighboring plaques. During periods of improvement (remission), the spots begin to lighten from the middle. Gradually they take the shape of a ring and can dissolve completely. After the plaques, a trace remains on the body - pigmentation. It can be significantly lighter or darker than the surrounding skin. After a person tans, the skin tone usually evens out.
What do nail lesions look like in psoriasis?
Nail psoriasis is similar to a fungal infection of the nail plate. For a correct diagnosis, a laboratory analysis is necessary. The changes can affect only one nail or all at once and are very diverse. They occur in 10-15% of patients. Nail damage is often accompanied by joint pain caused by psoriasis. In this case, it is possible that there are no skin rashes.
Nail psoriasis has several stages:
- depressed spots - thimble nail
- longitudinal depressed grooves
- transverse compression in the center of the nail, these first signs are associated with damage to the nail root - the nail matrix
- Irregularly shaped "oil spots" pink spots that show through the nail: this is the accumulation of serous fluid under the nail
- the nail becomes dull, cloudy, yellow, and thickened due to circulatory disorders
- the nail plate takes on the appearance of a bird's claw, which is accompanied by pain. This is due to the fact that the process captures the nerve endings.
Nail lesions start from the edge and gradually move towards the root, covering the entire surface. Microcirculation disorders cause clouding of the nail and a change in its color from yellow to bluish.
If you find similar symptoms in yourself, do not diagnose yourself. Similar changes may be due to other reasons: fungus, trauma, and poor blood supply.
Is psoriasis contagious?
This question is often asked by those who have just been diagnosed with the disease and by acquaintances of the patient. Scientists give you an unequivocal answer. Psoriasis is not contagious and a sick person is absolutely safe for others. This is because psoriasis is not caused by a virus or bacteria, but by aggressive white blood cells. These own immune cells, for unknown reasons, attack skin cells and cause skin inflammation. The result of this process is rashes and thickening of the skin in some places (psoriatic plaques).
How is psoriasis treated?
Treatment of psoriasis depends on the form and stage of the disease and on the sensitivity to drugs. Traditional medicine focuses on the use of drugs. Treatment begins with local preparations that act on the affected skin. Thus, they try to avoid the side effects that occur when taking oral medications. More details on the use of local remedies are described below. Let's stop now on pills and capsules.
There is a technique in which the patient is offered milder medications with the fewest side effects in the first place. If they are not effective, they are replaced by more powerful ones, and so on. Even if the treatment is suitable for the patient, after a while it is changed. The fact is that the body gradually gets used to the drug, and its effect decreases.
Oral systemic drugs are very effective. They are prescribed for the moderate and severe stages of the disease. They help even those patients for whom treatment with other means has not given a positive result. However, they have significant disadvantages: they can cause serious side effects, and after the abolition of these funds, the condition worsens again.
| Drug group | Dosage form and effect of the drug on the body |
| Retinoids: derivatives of vitamin A | It influences the maturation of the superficial layer of the skin and eliminates the alterations in this process caused by psoriasis. Release form - capsules. Dosage according to the scheme, depending on the stage, 30-75 mg / day. Reduces the rate of division of keratinocytes, promotes normal maturation and differentiation of cells. Available in capsules. The daily dose is 25 to 50 mg. |
| Immunosuppressants: drugs that reduce the activity of the immune system. | It reduces the activity of T lymphocytes, which cause further division of skin cells. Sterilized solution in ampoules. The initial dose when administered into a vein is 3-5 mg / kg per day, for oral administration - 10-15 mg / kg per day. |
| Medicines for the treatment of malignant neoplasms (cytostatics). | Inhibits the excessive growth and reproduction of atypical cells of the epidermis. Available in tablets. Assign 2. 5-5. 0 mg orally, 2-3 times a day, once a week. |
Physiotherapy treatments for psoriasis are very effective. They bring significant relief to patients, stop disease progression, and in some cases serve as a safe substitute for medications.
| Physiotherapy method | Effects on the body |
| PUVA therapy or photochemotherapy | Combination of long wave UV irradiation and an internal photosensitizer. The course is 20-30 procedures. The method is based on the fact that UV rays penetrate deep into the skin. The photosensitizer inhibits the synthesis of DNA in skin cells and the speed of their division. Special facilities or cabins are used for the treatment. |
| Selective phototherapy (S. F. T) | Irradiation of the skin with ultraviolet rays with a wavelength of 280-320 nm. The course is 15 to 35 procedures. A special cabin is required for therapy. |
| Monochromatic UV treatment | Exposure to each spotlight separately with a laser or UV source lamp. It allows to irradiate bulbs even in places that are difficult to access, without affecting healthy skin. It is prescribed in cases where less than 10% of the skin is affected. The course of treatment is from 15 to 30 procedures. |
| Laser therapy | Laser radiation with different wavelengths is used to treat rashes. The laser promotes the rapid resorption of psoriatic plaques, protects against the appearance of scars in their place. The doctor determines the number of procedures individually for each patient. |
| Electrosleep | The procedure is carried out in a device that relies on a mild effect on the brain with weak electrical impulses. Duration 20-60 minutes. The number of procedures is 10 to 12. Electrosleep has a calming effect. As a result, the activity of the nervous system is normalized, the plaques begin to dissolve, and a period of well-being begins faster. |
| Magnetotherapy | Treatment with magnetic fields has a beneficial effect on the general condition. Reduces itching and inflammation of the skin, swelling and pain in the joints, improves the psycho-emotional state. The Betatron apparatus is used for treatment. The duration of the procedure is 20 minutes. Number per course 10-15. |
| Ultrasound therapy | It is used as an analgesic, antipruritic and decongestant. It favors the reabsorption of scars. The procedure can be combined with the administration of medications (phonophoresis). The duration of exposure to one area is 15 minutes. To obtain a therapeutic effect, 7-14 sessions are required. |
| Hyperthermia | Heat fabrics to a temperature of 40 degrees using special pillows with a thermal mix. This effect on the body normalizes the functioning of the immune system and reduces the attack on the skin. The duration of the procedure is approximately 2 hours. Their number is determined by the doctor. |
| Bee venom treatment | The substance is introduced into the body by an electrophoresis or ultrasound device. An anti-inflammatory, absorbable and antipruritic effect is achieved. The metabolism is normalized. The minimum number of procedures is 10. |
It is very important for people with scaly lichens to follow a diet. Eating disorders can aggravate the disease. The menu should be rich in vitamins and at the same time simple. It should give rest to the intestines and liver, and not allergies the body.
| Allowed products | Forbidden food |
| Vegetables (pumpkin, watermelon, beet, carrot, potato, radish) | Animal fats |
| Fruits (apricots, peaches, apples), juices | Alcohol |
| Berries (except red fruits: strawberries, raspberries, red currants) | Fatty meat (pork, duck) |
| Fresh herbs | Smoked meats |
| Lean meat (beef, veal, rabbit, turkey) no more than 200 g per day | red fish |
| Cheese, cottage cheese, dairy products. | Carbonated drinks and coffee. |
| Walnuts | Eggs |
| Low-fat varieties of fish | Ice cream and shakes |
| Seaweed | Minimum amount of confectionery and sugar. |
| Wholemeal bread | Butter and puff pastry |
To cleanse the body of toxins and metabolic products, it is necessary to perform fasting days twice a week. They recommend kefir, apple, vegetables.
What ointments are effective in treating psoriasis?
The use of ointments for psoriasis brings the greatest effect compared to other external preparations. The components of the ointment do not remain on the surface of the plaque, but rather soften the scales and penetrate the skin.
There are a large number of ointments available to treat psoriasis. In the early stages, namenon-hormonal ointments.
In the event that the treatment has not given the expected effect, prescribehormonal ointments. . . Treatment begins with lighter medications that have minimal side effects. If improvement has not been achieved, stronger glucocorticosteroid ointments are prescribed.
| Name of the ointment | Pharmacological action | Side effects |
| Weak ointments | Suppresses the increased activity of leukocytes, prevents their movement towards the skin, eliminates the sensation of tightness and itching. | Swelling of the skin, itching, redness. |
| Moderate ointments | It has anti-inflammatory, antiallergic, antiedematous, antipruritic effects. Indicated for patients with exudative forms of psoriasis, it reduces bleeding. Apply in a thin layer in limited areas 2-3 times a day. Treatment lasts 10-14 days. | Steroid acne, skin atrophy and tightening, burning, itching, hypopigmentation. |
| Strong ointments | Local anti-inflammatory, antipruritic and antiallergic agent. Reduces moisture from the skin. Apply to the affected area 2-3 times a day for up to two weeks. It is used during an exacerbation. | Skin atrophy |
| Very strong ointments | It has a strong antipruritic and antiallergic effect. It slows down the processes of cell division and keratinization. Apply 1-2 times a day for no more than two weeks per course. | Acne, hair loss, skin atrophy. Do not use for disseminated pustular and plaque psoriasis. |
Pharmaceutical companies produce many drugs in the form of ointments. The doctor individually selects the drug for the patient and, if necessary, changes it to a stronger one.
Do not forget that in no case with psoriasis you should ignore visits to the doctor. After all, this disease can hide the initial stage of skin cancer.
Choosing a treatment regimen for psoriasis is a long process that involves a lot of trial and error. Don't despair if you can't find "your" medicine right away. Remember that many people achieve lasting improvement when the disease does not return for years. You can do it too!