For centuries, mankind has been trying to unravel all the secrets of this mysterious skin disease, but still much is unknown. According to statistics, psoriasis affects 4-7 percent of the population, and men and women are equally susceptible. Usually, the first signs of psoriasis appear in adulthood and can accompany a person throughout his life, sometimes decreasing and disappearing, sometimes intensifying.
Causes and risk factors of psoriasis
Psoriasisis a long-term inflammatory process of the skin (related to an allergic reaction to its tissues), which is considered an autoimmune disease. It is a chronic skin disease that affects the cells of the outer layer of the epidermis. The condition usually affects the legs, knees, back, chest, etc. appears in the form of red, silvery scaly skin. In most cases, psoriasis starts in small patches of skin, then it can spread to large areas of the body. There are many causes and risk factors that can contribute to the development of this disease, and there are several theories that explain its occurrence.
Autoimmune cause
Some studies suggest that psoriasis may be caused by a combination of genetic and environmental factors, such as infections, trauma, stress, and certain medications. These factors can cause a reaction from the immune system, which begins to fight the body's tissues, including the skin.
However, the processes underlying psoriasis are still not fully understood. It should be noted that psoriasis is a multiple disease that manifests itself differently in each patient. Studying the mechanisms underlying psoriasis may help develop more effective treatments, reduce the risk of complications, and improve patients' quality of life.
Effects on metabolism
Metabolic disorders significantly affect the condition and immunity of the skin in patients with psoriasis. Increased metabolism leads to the formation of toxins and free radicals, which contribute to inflammatory reactions. There is an imbalance in various metabolisms.
- In patients with psoriasis, the amount of albumin in the blood decreases and the amount of globulins increases due to the violation of protein metabolism, which increases their sensitivity.
- An increase in the content of lipids and cholesterol in the blood is observed during fat metabolism.
- Reducing calories and eating plant foods can reduce the activity of psoriatic inflammation.
- Disorders in carbohydrate metabolism almost always occur.
- The metabolism of vitamins and minerals is also disturbed, which is manifested by a decrease in the amount of vitamins C, A, B6, B12, iron, copper and zinc in the blood, but an increase in the amount of vitamin C.
Infectious cause
This theory was widespread in the last century. Psoriasis was believed to be caused by certain bacteria (streptococci), fungi, and viruses, but these hypotheses have not been scientifically proven. However, dermatologists note that any acute infectious process or chronic infection can cause psoriasis to recur. Special attention is paid to virus theory. Recent studies show that RNA viruses such as HIV and other retroviruses can affect the genetic apparatus and cause the appearance of genes that predispose to the development of psoriasis.
Genetic predisposition
Inherited predisposition to autoimmune reactions is a risk factor for psoriasis. If a person's close relatives suffer from this disease, then the probability of its development increases. Several genes may be associated with psoriasis, including the PSORS1-PSORS9 complexes, where PSORS1 is thought to be particularly active. It contains the genes HLA-C, HLA-Cw6, CCHCR1 and CDSN, which may contribute to the development of the disease. Genes affect metabolism, immunity and the development of autoimmune processes. However, the presence of these genes does not necessarily mean that a person will develop psoriasis. Other factors can cause the development of the disease.
Neurogenic cause
Excessive stress on the nervous system, prolonged stress and imbalance in the autonomic nervous system, which provides innervation of blood vessels and internal organs, can be risk factors for the development of psoriasis. These factors can cause an imbalance in the endocrine system, changes in metabolic processes and impaired immunological response, increased irritability or depression, constant fatigue, drowsiness and apathy, which in turn can lead to psoriasis.
Endocrine
Endocrine disorders that occur with psoriasis are quite common and can have a significant impact on the development of the disease. However, their relationship with psoriasis is not entirely clear and has not been proven. Experts believe that patients with psoriasis often suffer from dysfunction of the thyroid, pituitary and adrenal glands. Women may have problems with menstruation, and men may have problems with sexual function.
Symptoms and characteristics of psoriasis
Psoriasis manifests itself not only in skin rashes, but also in other symptoms. It often begins in childhood or adolescence and is associated with hormonal disorders, vegetative-vascular dystonia and stress.
First signstirednessAndmood swings. The main symptom is small pink bumps on the skin called papules covered with whitish scales. Papules are surrounded by a brighter ring.
Over time, the rash may coalesce into large, irregularly shaped plaques. Base of each papuleinflammatory infiltrate. The following types of rashes are distinguished:
- pinpoint (diameter no more than 1 mm);
- tear-shaped – (drop papules up to 2 mm in size);
- coin-shaped - (circular papules up to 5 mm in size - coins).
The rash also has its own characteristics:
- stearic stain - if you scrape the surface of the papule;
- terminal film - after cleaning papules from scales, you can see a transparent film;
- bloody dew (Auspitz phenomenon) - if the integrity of the film is broken, small bloody drops may appear.
Is psoriasis contagious?
Many people believe that psoriasis is contagious, so they try to avoid contact with people who suffer from it. This can cause the patient to withdraw from others and lead to serious psychological problems. However, studies have shown that psoriasis is not transmitted through person-to-person contact. If all family members suffer from this disease, this only indicates the presence of a genetic factor in the development of the pathology.
Classification and development stages of psoriasis
Currently, there are three main stages of psoriasis development:
- A progressive stage characterized by the constant formation of new skin rashes accompanied by severe itching.
- The stationary stage, when new formations stop appearing and existing ones begin to heal.
- The color of the skin affected by the rash darkens due to the regressive phase, in which the edges appear around the rash, and due to the increase in pigmentation.
In addition, the pathology has several degrees of severity:
- Mild degree when more than 3% of the skin surface is affected.
- Moderate grade characterized by 3-10% skin damage.
- Severe degree in which the disease affects more than 10%.
Types of psoriasis
PsoriasisIt is a chronic skin disease that can manifest itself in different forms. Rashes, their location and damage to other systems and organs can be different. Depending on these characteristics, different forms of psoriasis are distinguished.
Simple (vulgar, board)
Plaque psoriasis is the most common form of this disease. Its symptoms include the appearance of bright pink papules covered with white scales.
Elbow psoriasis
This is a typical manifestation of mild plaque psoriasis. A characteristic feature of psoriasis on the elbows is the presence of one or more permanent "post" plaques on the extensor side of the elbow joints. If these elements are traumatized, exacerbation occurs.
Guttate psoriasis
Associated with bacterial (mostly streptococcal) and viral infections, this type of psoriasis can cause inflammation. This condition often occurs in children and begins with the appearance of small, red, lachrymatory papules on the skin of the limbs, body or face. Papules have a scaly surface and can become erosions and ulcers, increasing the risk of infection.
This condition can develop quickly or gradually become chronic, followed by periods of exacerbation and remission of symptoms. In rare cases, psoriasis may be more severe.
Palmoplantar psoriasis
This type of psoriasis often develops in people who do manual labor and is often accompanied by severe itching and can cause nail complications. Several subtypes of this type of psoriasis include:
- Plaque fan-shaped: large elements with white scales on the palmar and plantar surfaces, merging into fan-shaped plaques. This subtype is most common in the hands.
- Circular: ring-shaped scaly elements on palmar and plantar surfaces.
- Callosal: growth of rough epithelium with callus formation.
- Pustular: This is a distinct subtype of psoriasis on the palms and soles of the barber. Purulent blisters and pustules form in the areas under the big toes, which cause severe itching. Ulcers coalesce, then dry and form crusts. Elements characteristic of psoriasis are also seen in other parts of the body.
Psoriasis on the legs can be associated with varicose veins and is mainly seen on the lower legs.
Nail psoriasis
It can occur as a separate disease or as a complication of another type of psoriasis. The main symptom is small holes with different depths on the nail plate. These pits are usually more noticeable and painful when compressed than with other types of dermatitis. In addition, symptoms include spontaneous separation of the nail, subungual bleeding (especially when wearing tight shoes), changes in nail color and surface, such as trachyonychia and koilonychia.
Psoriasis of the scalp
It can manifest itself as an independent disease or as part of a general pathological process. One of the characteristic features is weeping and the formation of crusts on part or the entire surface of the head. In this case, hair growth is not disturbed, because the function of the hair follicles is not disturbed. However, moisture poses a risk of infection, which can damage the hair follicles.
Seborrheic psoriasis
It occurs as a result of disruption of the skin glands that produce viscous sebum, causing skin irritation and promoting inflammation - dermatitis. This condition quickly spreads over the entire head, covering it like a cap and is accompanied by severe itching. Sometimes weeping develops in the areas behind the ears and infection may develop. A scalp covered with dandruff and crusts can look like a psoriatic crown.
Psoriasis on the face
It usually appears in the area of the nasolabial triangle, on the eyelids, above the eyebrows and in the areas behind the ears. Rashes can coalesce, forming large areas of redness and swelling. If the activity of the sebaceous glands is disturbed, the process may be accompanied by weeping, the formation of crusts and an increased risk of infection.
Genital psoriasis
Psoriasis affecting the genitals is a concomitant process that is usually accompanied by characteristic psoriasis rashes all over the body, which makes it easier to diagnose.
Psoriatic rashes on the penis in men, labia majora and surrounding skin areas in women are oval in shape and slightly raised above the surface of the skin. They are pink and crusty. It is practically not accompanied by itching. Sometimes the lesion process spreads to the mucous membranes and can take the form of vulvovaginitis in women and balanoposthitis in men.
In obese people, atypical psoriatic rashes can be observed in folds located near the genitals (inguinal, intergluteal). In these areas, intense red areas appear, which have a mirror-like surface and do not peel off due to constant moisture.
Why is psoriasis dangerous?
Psoriasis can be very serious when the rash covers more than 10% of the skin. This condition is difficult and prone to recurrence, and the rash can be sensitive to moisture, wetness and infection. Only timely and effective treatment of psoriasis can prevent the spread of the disease.
In some cases, psoriasis can be complicated by inflammation of the joints and the development of psoriatic polyarthritis, which can lead to joint dysfunction. In addition, the systemic autoimmune process caused by psoriasis can lead to the development of other autoimmune diseases, serious cardiovascular and digestive pathologies, and neurological reactions.
Ignoring the timely treatment of psoriasis can lead to complications such as psoriatic erythroderma, which can occur as a result of improper treatment of psoriasis or exposure to various irritating factors on the skin. With psoriatic erythroderma, the skin is deep pink, with a clear distinction between affected areas and healthy ones, as well as between small and large crusts. This condition requires immediate medical attention.
Complications of psoriasis
Lack of timely and adequate treatment of psoriasis can seriously damage vital organs and systems of the body, such as joints, heart, kidneys and nervous system. These consequences can lead to disability and even death.
Diagnostics
Typically, the diagnosis of psoriasis is made based on the typical symptoms of skin lesions and their localization. In some complicated cases, additional tests may be required to rule out other skin conditions.
Laboratory tests may include:
- A complete blood count can reveal leukocytosis and anemia in psoriasis.
- Rheumatoid factor (RF) is a protein whose levels can be elevated in systemic inflammatory diseases with joint damage, but its levels are usually normal in psoriasis.
- The erythrocyte sedimentation rate (ESR) is also usually normal, except in pustular psoriasis and psoriatic erythroderma.
- In psoriasis, uric acid levels can be elevated, which can be confused with gout.
- Antibodies to the human immunodeficiency virus (HIV) may be detected with the sudden onset of psoriasis.
Other tests, such as x-rays of the joints and skin biopsies, may be used in more complex cases to assess the severity of joint damage and differentiate psoriasis from other skin conditions.
Treatment
Treatment of psoriasis requires a comprehensive approach, including local treatment of skin lesions, medications, light therapy, and prevention of exposure to aggravating factors. The choice of treatment method depends on the type and severity of psoriasis. Treatment may include:
- external preparations (external ointments, petroleum jelly, paraffin, vegetable oils and creams with anti-inflammatory effects, their amount depends on the nature of the lesion and is used daily);
- lotions and shampoos based on salicylic acid, as well as photosensitizers;
- drugs for oral administration (retinoids, vitamin D preparations, etc. );
- physiotherapeutic procedures;
- Daily baths with bath oil, oatmeal infusion, or sea salt can help soften the skin and reduce the inflammation that occurs with psoriasis. It is important to avoid hot water and scrubs, and to use a moisturizer after bathing;
- light therapy, which involves exposing the skin to ultraviolet rays, may also be helpful (avoid burns);
- photochemotherapy using medium wave radiation;
- compliance with a special diet and general regimen.
When preparing the treatment program, the gender and age of the patient, the presence of concomitant diseases, general health and the influence of external factors are taken into account. Sometimes it is enough to change your lifestyle to treat it, and in other cases, several courses of treatment are prescribed.
In addition to traditional methods, the treatment of psoriasis can include the use of modern laser technologies. Laser therapy can reduce the symptoms of pathology, achieve long-term remission and relieve the patient from unpleasant rashes and related problems. The special feature of laser therapy is that the special excimer laser affects only the affected areas of the skin without affecting the healthy ones, which ensures rapid recovery without side effects. Laser therapy is safe and painless, requires no preparation and can be used regularly so that the patient can live without limitations.
The effectiveness of treatment depends on many factors, including hereditary predisposition, provoking factors, the stage of the disease and the specificity of the lesion, so it is recommended to consult a specialist first and prescribe treatment measures based on clinical recommendations.
Prevention
Psoriasis is a disease that can be successfully treated if you consult a doctor in time and get qualified help. In the simple form of psoriasis, the patient can work without any restrictions, except for work in chemical plants, where being at work can be dangerous.
However, psoriasis can cause complications such as psoriatic arthritis, which can limit work performance and cause disability.
Prevention of psoriasis is an important part of treatment. After recovery, patients should revise their lifestyle, get rid of bad habits, treat other chronic diseases, control their diet and increase physical activity, spend more time outdoors and do sports.
Nutrition for psoriasis
Diet for psoriasis is not strict, proper nutrition plays an important role in complex treatment. When giving nutritional advice, patients are advised to:
- Avoid foods that the body is overly sensitive to and eliminate them from the diet.
- Give preference to fresh fruits, vegetables, berries, meat cooked or boiled without fat and drink more.
- Avoid the following foods: onions, garlic, radishes, condensed tea, coffee, alcohol, sweets, salty and sour foods, as well as foods that can cause an allergic reaction, such as orange fruits, honey, nuts, cocoa and eggs.
- Avoid fatty foods of animal origin.