Psoriasis

Psoriasisis a systemic disease characterized by damage to the skin, musculoskeletal system, functional and morphological disorders of other organs and systems. The main symptoms of the pathology: nodular rashes on the scalp, palms, feet, extensor surfaces of the elbows and knees, hyperemia, itching. The disease can be diagnosed visually, but in order to exclude the possibility of the development of concomitant pathologies, laboratory tests and instrumental diagnostic methods are prescribed. Systemic therapy includes taking aromatic retinoids and cytostatic drugs, glucocorticosteroids.

Introduction

The name of the disease comes from the Greek "psora" - "skin disease", "scab". In the Middle Ages, psoriasis was considered a form of leprosy (leprosy). The signs of psoriasis were first described from a professional point of view in 1808 by RobertWhelan in Great Britain. The term "psoriasis" was introduced by the Viennese dermatologist Ferdinand Gebra in 1841. The pathology is registered in all geographical latitudes of the globe with an uneven frequency of 0. 1 to 3%. Psoriasis develops equally in men and women, butin children it is more common in girls, and in adults - in men (60-65%).

reasons

There are different theories about the origin of psoriasis. The main ones are parasitic, infectious, allergic, infectious-allergic, autoimmune, neurogenic, endocrine, hereditary. Each of these theories is based on clinical observations and laboratory results.

Most scientists pay attention to the genetic nature of psoriasis. They claim that this disease has a polygenic heredity. If one of the parents is sick, the risk of developing pathology in the child is 8%, if the father and mother are 41%.

The factors that contribute to the development of psoriasis are divided into external and internal.

• External factors include mechanical and chemical damage to the skin, as well as dermatoses.
• Doctors include internal provoking factors: infections (streptococci and human immunodeficiency virus), drugs (corticosteroids, nonsteroidal anti-inflammatory drugs), nervous stress.

Pathogenesis

Today, doctors around the world recognize the involvement of the immune system in the pathogenesis of psoriasis. Immune system cells that normally respond to antigens begin to attack healthy cells, most commonly skin cells. As a result of this process, the cells of the epidermal layer divide faster than usual. They do not have time to mature, which is why strong bonds are not established between them. The cells, coming to the surface, form raised plaques 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 commonly recorded form of lichen planus, in which there are no complications. This group includes plaque and coin psoriasis.
2. Generalized pustular psoriasis- severe form of pathology complicated by secondary infection. It affects several areas at the same time. Includes Zumbusch syndrome and impetigo herpetiformis.
3. Persistent acrodermatitis (Crocker's dermatitis, Seton's dermatitis)— the contents of the pustules are sterile, there is no secondary infection. The main affected areas are the fingers and nails.
4. Palmar and plantar pustulosis (pustular bacteriosis)- develops on the soles and palms. It appears as pustules with sterile contents that gradually increase in area.
5. teardrop shaped- separately located papules that do not merge into plaques. The most commonly affected areas are the legs, thighs, back, forearms, chest and neck.
6. Arthropathic- the clinical course resembles the rheumatic form of arthritis.
7. Other psoriasis (inverse)- conglomerates are located in the armpits, inguinal and other natural folds. This type includes inverse flexor psoriasis.
8. Unspecified psoriasis- combines several types of pathology, the clinical picture is quite broad.

Depending on the seasonality of the exacerbation, several types of psoriasis are distinguished:

• the summer- exacerbation occurs as a result of exposure of the skin to sunlight;
• the winter- occurs due to severe cold affecting the skin.

In non-seasonal psoriasis, there are no periods of remission, the disease manifests itself throughout the year.

On the affected area of the skin:

• limited psoriasis- occupies less than 20% of the skin of the body;
• Common— more than 20%;
• generalized- all skin is affected.

Symptoms

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

1. Progressive stage. It is characterized by the appearance of papules, itching, the beginning of peeling, peeling and deformation of the nails.
2. Stationary stage. New papules do not appear, the old rash does not increase, and peeling is moderate.
3. Regressive stage. The plaques heal, and white depigmented spots form in their places, which no longer cause discomfort.

Skin rashes are only external signs of psoriasis. In fact, the disease affects multiple organs and systems, as well as tendons and joints. For this reason, patients complain of depression, a constant feeling of weakness and chronic fatigue.

Complications

Among the complications of psoriasis, psoriatic arthritis and psoriatic erythroderma are particularly important. Also, in the absence of timely diagnosis and effective treatment of psoriasis, the risk of developing severe chronic pathologies increases: diabetes mellitus, arterial hypertension and metabolic syndrome.

Diagnosis

To identify the pathology, laboratory and instrumental diagnostic methods are used.

The patient is referred for:

• general clinical analysis of blood and urine;
• blood biochemistry;
• blood test for C-reactive protein and rheumatic tests;
• coagulogram - assessment of blood clotting;
• blood test for human leukocyte antigen.

In complex forms of psoriasis, which are associated with damage to the musculoskeletal system and internal organs, radiography of the joints, ultrasound examination of the kidneys and organs of the urinary system, and echocardiography are prescribed.

There are diseases that have similar symptoms. As a result, there is a need for a differential diagnosis. To do this, use methods such as:

• biopsy (excision of a piece of skin with further histological examination);
• laboratory tests - used to distinguish psoriasis from papular syphilis.

Treatment

Psoriasis responds well to symptomatic treatment. Knowing the pathogenesis, the doctor can individually choose a treatment method. Some of them are aimed at reducing skin rashes, eliminating dryness and itching, others - at limiting the immune system from "attacking" healthy cells.

Therapeutic tactics directly depend on the severity of the disease and the location of the lesions.

External therapy

Topical glucocorticosteroids are used in various forms of psoriasis as monotherapy or in combination with other drugs. They exist in the form of medicinal forms - ointments, creams or lotions.

Medicines that contain analogues of vitamin D3. They are applied to the affected areas of the skin if the spread of psoriasis does not exceed 30% of the body surface.

Preparations that contain activated zinc pyrithione are used in the form of an aerosol, cream, and shampoo for the scalp.

Phototherapy

For treatment in this case, medium wave phototherapy and PUVA therapy methods are used. PUVA therapy is the combined use of long-wave ultraviolet rays (UVA) (320-400 nm) and a photosensitizer (8-methoxypsoral). PUVA therapy is one of the most effective ways to treat the disease, it is most often prescribed for widespread vulgar and exudative psoriasis, persistent pathology, severe infiltration.

Combined therapy

Such treatment includes several therapeutic modalities, for example: phototherapy and topical corticosteroids; phototherapy and systemic retinoids.

Systemic therapy

It is prescribed for moderate and severe forms of psoriasis. Medicines for systemic therapy are mainly prescribed during the progression of the disease.

Biological drugs

These drugs are created using genetic engineering methods. They are monoclonal antibodies and are used for therapeutic purposes.

Prognosis and prevention

With timely diagnosis of the pathology and effective treatment, the prognosis is quite favorable. As preventive measures, the following are often prescribed: a diet enriched with fish and vegetables, hydrotherapy, a course of herbal medicine, sanatorium-resort treatment and emollients (mainly in the period between relapses - to restore the hydrolipidic layer).