Psoriasis is an inflammatory disease of the skin. It occurs when the immune system malfunctions. The development of the disease is divided into clear stages: onset, progression, stabilization and regression. The different stages of psoriasis differ in the appearance of spots and rashes, painful itching, and extensive inflammation of the skin.
Why is it necessary to distinguish between the developmental stages of the disease and what are the characteristics of the course of psoriasis at the beginning of development and in the recovery process?
Why it is necessary to know the stages of psoriasis
Doctors use the division of psoriasis into stages for the correct choice of therapeutic methods. The complex of drugs and external agents that are prescribed for the treatment of inflammation depends on the stage of development of the disease. At the beginning of the manifestation of the disease, general therapy is needed: vitamin complexes, diet, external aseptic treatment of the rash, for example, a course of UV procedures. Medications that stimulate the cleansing of the intestines, blood vessels, liver are also prescribed. Make sure to perform a correction of the psycho-emotional state, by a neuropathologist or psychologist.
At the initial stage of the disease, they do not use powerful drugs that suppress the immune system, do not prescribe hormonal ointments. These drugs have a large list of side effects, so they are prescribed only when it is impossible to do without them.
Psoriasis: treatment in acute phase and in remission
In the case of an acute progressive course of the disease, various drugs of various actions are prescribed. Immunosuppressants and glucocorticosteroids are often used to relieve inflammation and reduce itching. External treatments are complemented with photochemical therapy, ultrasound and laser. Also, agents are prescribed for the antiseptic treatment of damaged skin.
In a stabilized state, they continue to take hormonal anti-inflammatory drugs, gradually reducing their dose. To restore damaged skin, ointments with a regenerating effect are prescribed.
In remission: support the body. Correct nutrition, take vitamin-mineral complexes to restore immunity.
Timeliness of treatment
The earlier treatment is started, the easier it will be to control psoriasis. Timely therapy limits the spread of skin inflammation, reduces its spread, and prevents subsequent relapses of flaking. Since psoriasis is often mistaken for an allergic rash at an early stage, it is necessary to know its initial signs so as not to miss the appearance of a skin disease.
Note: Doctors are still researching the causes of psoriasis. But it is definitely known that psoriatic skin inflammation is not contagious. You cannot get it from a sick person or an infection in case of injury. This is our own personal failure in the human body.
The cause of psoriasis is an immune failure, which can be caused by several factors. Severe stress, intoxication (including powerful drugs, industrial emissions, alcohol), previous infection.
Psoriasis is difficult to treat. The disease is prone to recurrence, relapse. And the therapy itself is symptomatic. It consists of preventing the appearance of new spots and alleviating existing skin itching.
What stage of psoriasis is called initial? How to distinguish early psoriasis from diathesis rash? And how will the disease develop in the future?
Psoriasis: initial stage
The first appearance of psoriasis on the skin looks like pimples. Most of the time, the rash appears on the curves of the elbows and knees, or in places where clothing is tight against the body (for example, below the belt at the waist). Rashes can also appear along the edge of the hair and under the hair, around the nails, and on the nail plates. Sometimes psoriasis occurs on the feet and palms.
Most of the time, psoriasis manifests itself symmetrically: on the elbows of both hands, on both sides of the lower back, or on two knees. The pimples themselves (in medical terminology, papules) in the initial stage have a modest appearance. They have:
- Pink or red;
- Sharp and blurry edge;
- Small size: the pimple at the base does not exceed 2mm;
- Flat shape: the small pinpoint grains at the beginning of the disease have almost no bumps, so they look like spots.
As the disease progresses, flakes of peeling skin appear on the pimples. They are gray or silver, against the background of a red grain they appear white.
The appearance of scales is accompanied by intense itching. If it does not resist and scratches, then the scales are removed, exposing the bright areas of pinkish young skin underneath. It is very thin, vulnerable, with prolonged scratching of the itchy papules; he's injured, he's bleeding.
The initial stage of psoriasis lasts up to 4 weeks.
Psoriasis: stage of progression
In the progressive stage, individual grains merge into a common place, forming so-called psoriatic plaques. They rise above the surface of the skin and are almost completely covered in flaking. At the edges of the psoriatic plaques, there is a pinkish-red border that does not flake.
The presence of a border is a sign of a progressive stage of the disease. The width of the rim is 1-2 mm. The skin is inflamed, its structure resembles parchment paper.
The border represents the expansion area of the place. This is skin that is already inflamed, but not yet peeled. After a while, it will also be covered in scales. And the patch will expand to cover new areas of the skin and form a new, wider border.
With the active development of the disease, adjacent points merge with each other. At some point, a large inflamed red spot can form on the human body.
Psoriatic plaques are very itchy, give a person unpleasant sensations, interrupt work, rest and sleep. They grow, occupy a large area, and form a new rash on clean, healthy skin.
The main sign of the progressive stage is the appearance of new eruptions. As soon as new pimples and spots stop appearing, the next stage of psoriasis begins: stationary. This is not yet a complete victory, but it is already a turn towards recovery.
In the progression stage, psoriasis is almost always accompanied by weakness, fatigue, weakness. Depression is common. Possible temperature.
The duration of the progressive stage of psoriasis can be prolonged, several months.
Psoriasis: stationary stage
The main sign of the stationary stage is the cessation of the appearance of new spots and eruptions. At the same time, the itching also subsides, it becomes more bearable. The rash loses its bright color, becomes discolored, becomes invisible. This is also one of the signs that the process is stabilizing.
The pink edges around the plates disappear when the inflammation stops spreading. Active exfoliation and healing begins, regeneration of new healthy skin.
With the naked eye, it can be seen that flaking increases in the stationary stage. The scales completely cover the entire surface of the psoriatic spot, leaving no space for the tires. Psoriasis takes on the characteristic scaly appearance that is commonly recognized by the general public.
Extensive peeling in the stationary stage is not dangerous. When all the dead cells come off the surface of the psoriatic spot, the healthy skin with a slight light hue will remain in place.
Other signs of progression or stabilization
In addition to the appearance of the rash, the spots and the peeling, there are other signs that can be used to judge the development of the disease. This is the nature of the sensations of itching (strong or tolerable), general state, depressed mood. And also the presence of temperature.
In the initial stage, the itching is variable and the rash is incomprehensible. Also, the itching intensifies every day. In the acute stage of psoriasis, it becomes intolerable. Disrupts sleep, rest, interferes with work. The person becomes irritated because the itching sensations do not give him a chance to rest.
In the stationary stage, the itch subsides. Every day a person feels better. The general state of the psyche changes, negativity and depressive moods weaken. The duration of the stationary stage is several weeks, from 2 to 5.
Psoriasis in attenuation stage
The fading stage of psoriasis is the almost complete disappearance of plaques, spots, redness, inflammation and itching. At this stage of the disease, psoriasis is only reminiscent of different skin pigmentations. Instead of the old psoriatic spots, it seems lighter. The surface of healthy skin is darker in tone.
In some cases, the so-called hyperpigmentation is formed. The skin at the site of psoriasis spots does not become lighter, but darker. In either case, differences in skin pigmentation will be visible for another month or two.
Psoriasis after recovery: possibility of relapse
The possibility of recurrence of psoriasis is determined by the person's lifestyle, diet, allergic mood, and general body condition. It is also determined by the amount of toxins in your body, blood, liver. You can reduce the likelihood of repeated skin inflammation by strengthening the immune system and cleansing the body of toxins in the liver, blood vessels, and intestines.
Seasonal relapses of psoriasis are usually rare after cleansing. A person remains susceptible to the disease, but the likelihood of it occurring is markedly reduced.
Cleansing the body of toxins and taking vitamin-mineral complexes helps boost immunity. This is especially important if immunosuppressants were used during treatment, in the progressive stage of psoriasis. Its need was due to the work of inflammatory mediators. After suppressing the autoimmune defense, it is necessary to restore the immune system.
Clinical manifestations
Psoriasis is characterized by monomorphic eruptions in the form of papules (nodules) of various sizes, when they fuse, plaques form that can spread over the skin.
At the onset of the disease, in most cases, the rash is limited and is represented by unique plaques in the places of its favorite location (scalp, extensor surface of the elbow, knee joints, sacral region, etc. ).
The plaques are clearly differentiated from healthy skin, bright pink or deep red, covered with loose silvery-white scales, when scraped, a triad of phenomena characteristic of psoriasis can be obtained: "stearin stain", " terminal film ", " blood spray ". . . .
There are 3 clinical stages of psoriasis: progressive, stationary, and regressive.
Classification
Depending on the degree of the inflammatory process, the predominant location of the eruptions, the severity of the patient's condition and other clinical signs, there are common plaque, exudative, arthropathic, pustular psoriasis, psoriatic erythroderma, fold psoriasis, psoriasis ofpalms and soles. It should be noted that different clinical variants may exist simultaneously in a patient.
Exudative psoriasis is characterized by a pronounced inflammatory reaction of the skin, manifested by the presence of lamellar scaly crusts on the surface of the plates, sometimes multilayered, resembling a puff pastry cake (insuch cases, this form of psoriasis is called rupioid). When scale crusts are removed, a watery surface is exposed.
Arthropathic psoriasis in the clinical picture has, in addition to the usual plaque eruptions, joint lesions, often small, distal, less often large.
Arthropathy can occur in the presence of skin lesions or precede them. Psoriatic arthritis is manifested by pain, swelling, limited mobility in affected joints of varying degrees of intensity, from minor arthralgia of individual joints to generalized injuries and disability of patients. The possibility of arthropathic psoriasis is higher in patients with severe skin manifestations (psoriatic erythroderma, pustular psoriasis), but a combination of severe joint damage with relatively limited skin eruptions is possible.
Pustular psoriasis can be generalized (Tsumbusha) and limited, affecting the palms and soles (Barbera). Stressful situations, infections, irrational general or local therapy contribute to the appearance of this severe form of psoriasis.
Generalized pustular psoriasis presents with fever, leukocytosis, increased ESR, and a severe general condition. Suddenly, against the background of a bright erythema, small superficial pustules appear, accompanied by burning, pain, which can be located in the area of common plates and on the skin previously unchanged. New paroxysmal pustular foci appear, occupying large areas of the skin. The fused pustules provoke the detachment of the epidermis in the form of "purulent lakes", erythroderma may develop.
Limited pustular psoriasis is more common, the rash is located mainly on the palms and soles of the feet in the form of pustules in the context of erythema and skin infiltration. The course, compared to generalized, is milder, with a satisfactory general condition, but persistent, with frequent relapses. An irritating local therapy is a provoking factor.
Psoriatic erythroderma is a severe form of psoriasis that develops with a gradual progression of the psoriatic process and the fusion of plaque elements until the defeat of the entire skin, characterized by acute hyperemia, edema, cutaneous infiltration with abundantsmall and large laminar scaling, less commonly pityriasis. Subjective: severe itching is often noted. The disease can begin with erythroderma. The general condition worsens (fever, weakness, reaction of the lymph nodes, heart failure, deterioration of liver and kidney function, changes in blood tests, hair loss, etc. ).
Fold psoriasis is more common in children and the elderly, especially in patients with diabetes mellitus. The lesions are located in the armpits, under the mammary glands, in the perineum, inguinal-femoral folds, in the navel and are characterized by marked contours, saturated red color and slight scaling.
Psoriasis of the palms of the hands and soles of the feet can exist in isolation or simultaneously with damage to other areas of the skin; The characteristic psoriatic triad is difficult to evoke.
Three clinical stages of psoriasis
Progressive stage. Under the influence of provoking factors (trauma, psycho-emotional stress, infectious diseases, improper treatment methods, etc. ), an exacerbation of the disease may develop with the appearance of abundant small nodules prone to peripheral growth and the formation of plaques of various sizes. and forms, which can be isolated or occupy large areas of the skin up to universal skin lesions.
In the progressive stage, a symptom of an isomorphic reaction (Kebner phenomenon) is characteristic, characterized by the fact that typical psoriatic eruptions appear at the site of a lesion, albeit mild.
Stationary stage. In the stationary stage, the appearance of new elements ceases and the tendency to peripheral growth of the existing plates disappears.
Regressive stage. The regressive stage is characterized by a decrease in the intensity of the color of the plaques, their flattening, a decrease in desquamation, infiltration, reabsorption of elements with the subsequent formation of hypo- or hyperpigmentation foci at the site of previous eruptions.
Treatment
The treatment of psoriasis is aimed at suppressing the proliferation of epithelial cells and eliminating the inflammatory process and is prescribed taking into account the anamnestic data, the form, the stage, the prevalence of the process, the concomitant diseases, age andthe sex of the patient, contraindications to a certain method of treatment or drug.
For mild and limited manifestations of psoriasis, local external therapy in the form of salicylic ointment, naphthalan preparations, tar or emollient ointments is sufficient. Severe forms of the disease require complex systemic treatment with the use of detoxification, desensitization, anti-inflammatory drugs of different groups, physiotherapy methods of therapy, external drugs, etc.
This section will present the most modern and available effective methods and means for the treatment of psoriasis.
Systemic therapy
There are peculiarities in the management of patients at different stages of the psoriatic process. Treatment of the advanced stage requires special care. During this period, hemodez is prescribed by intravenous drip, 30 percent. sodium thiosulfate solution i. v. , 10% calcium gluconate solution, with concomitant hypertension, it is advisable to introduce a magnesium sulfate solution; Emollient creams or 1-2 percent are used externally. salicylic ointment.
Aromatic retinoids.Acitretin (neotigazone): a representative of the second generation of monoaromatic retinoids, it is used to treat severe psoriasis at a dose of 10 to 20-30 mg per day, depending on the severity of the skin process. The mechanism of action of acitretin is to inhibit the proliferation of epidermal cells, to normalize the keratinization processes. The drug is especially effective in combination with PUVA therapy. When prescribing acitretin, its teratogenic effect should not be forgotten.
Cytostatics.Methotrexate is used in cases of persistent psoriasis and in the presence of contraindications to other treatment methods, being an antagonist of folic acid, it acts mainly on cells in active proliferation. Very toxicThere are many methods of application, preferably intramuscular administration once a week under strict laboratory control.
Immunosuppressants.Cyclosporine-A is prescribed in cases of severe, generalized psoriasis resistant to other therapies. This drug has an immunosuppressive action, has an inhibitory effect on cell growth processes, suppresses the secretion of activated cytokine lymphocytes and the expression of receptors for interleukin-1 in immunocompetent cells. With psoriasis, it is prescribed at the rate of 5 mg per 1 kg of body weight per day.
Non-steroidal anti-inflammatory drugsare prescribed for arthropathic psoriasis, as well as for the reduction of acute inflammation in exudative psoriasis and erythroderma. The daily doses of drugs and the duration of treatment depend on the intensity of the pain syndrome, the degree of inflammation and individual tolerance.
The use of systemic corticosteroids in the treatment of psoriasis is considered inappropriate, it leads to the development of torpid forms of the disease, resistant to various types of therapy. In severe arthropathic psoriasis, prolonged intra-articular corticosteroid administration is possible; The dose and duration of treatment depend on the size of the affected joint and the degree of inflammation.
Physiotherapy treatments. One of the most effective treatment methods is PUVA therapy or photochemotherapy (PCT). PCT is a combination application of long-wave ultraviolet radiation (wavelength 320 to 420 nm) and photosensitizing furocoumarin drugs. The use of photosensitizers is due to their ability to increase the sensitivity of the skin to ultraviolet rays and stimulate the formation of melanin. PUVA therapy leads to the inhibition of cell proliferation, the suppression of pathological keratinization, affects the metabolism of prostaglandins, the permeability of cell membranes. The peak of the photosensitizing effect occurs 1-3 hours after taking 8-methoxypsoralen. The dose of the drug is selected taking into account the weight of the patient. Procedures are published 3-4 times a week, during a course of 20-25 sessions.
Local PCT is also used with external photosensitizers.
The combined use of PUVA and retinoid therapy is called Re-PUVA therapy. It has the greatest clinical effect in cases of severe psoriasis.
Selective phototherapy (SFT): UV irradiation in the medium wave spectrum (wavelength 280-320 nm) without taking photosensitizers. SFT is used for less pronounced manifestations of the disease, the presence of contraindications to the appointment of PUVA therapy.
How to recognize psoriasis at an early stage
Treatment of psoriasis is most effective at the earliest stage. That is why it is so important to make a diagnosis on time. Only a dermatologist can tell you if you have psoriasis or some other skin condition. However, you yourself can recognize this disease in yourself by several characteristic signs:
- Most often, psoriasis first manifests itself in the folds of the arms and legs, on the hairline, or where clothing is in close contact with the body or rubs, under the belt of pants, various elastic bands or straps.
- At the onset of the disease, a very itchy rash appears, covered with gray or silver scales of skin that are easily removed.
- If you remove the scale, you will see thin, shiny, slightly moist skin underneath.
- If you scrape the plate with something like a spatula, removing the scales, then blood will appear on the stain in the form of small drops. However, it is better not to use the latter method for self-determination of psoriasis; it is very easy to infect it.
In order to have complete confidence, you should consult a doctor, since psoriasis themselves often confuse psoriasis with various types of lichen or allergic dermatitis and use inappropriate drugs for treatment.
What to do if you find early-stage psoriasis symptoms?
Psoriasis cannot be cured once and for all, so the main goal of therapy is to achieve a stable remission as long as possible. You should know that without proper treatment, psoriasis quickly becomes chronic: exacerbations can occur up to 9 times a year, lasting up to 15 days.
What to do if you suspect you have psoriasis? Often people, discovering the signs of this disease, make a big mistake and resort to "heavy artillery" - hormonal ointments (so-called topical glucocorticosteroids or THCS), without consulting a doctor. Usually, patients explain that step by the fact that they allegedly heard from friends that such funds help quickly. This is a big mistake!
What is the danger of such self-medication? Hormonal ointments for psoriasis have many side effects and contraindications. It is highly undesirable to use them without the strict recommendation of a doctor regarding the duration of use, the frequency, the area of application on the body and also without taking into account the individual characteristics of your body.
For effective treatment of early psoriasis, non-hormonal agents such as zinc pyrithione should be used. Zinc pyrithione, or active zinc, is a very effective remedy for the treatment of psoriasis, which has a complex effect:
- suppresses excess proliferation and inflammation of skin cells, reducing the formation of scaling and psoriatic plaque;
- relieves itching;
- protects damaged skin from bacterial and fungal infections;
- restores the lipid layer and the protective functions of the skin.