Skin is the organ that protects us from the penetration into the body of foreign substances and pathogens. Unfortunately, the skin is also susceptible to various diseases, and psoriasis is among the most difficult to treat. In addition, the disease gives the patients a lot of trouble.
What is psoriasis
The word "psora" in Greek means "itch, mange". This title reflects the main symptom of the disease. Sometimes psoriasis called scaly ringworm, for his external form. From a scientific point of view, psoriasis is among the skin diseases – dermatoses. The disease changes the appearance of the skin, causing the patient suffering, which are expressed, first and foremost, a strong itch.
About psoriasis was known in ancient times, but then it often was confused with other skin diseases. As an independent skin disease medicine recognized him in 1799 At the present time doctors tend to treat psoriasis probably not even as a skin disease but as a systemic disease because it affects not only the skin but also the immune, nervous and endocrine system.
The mechanism of development of psoriasis
Psoriasis is a violation of the process of cell regeneration of the top layer of skin (epidermis). If the normal epidermal cells (keratocytes) are updated every month or every three weeks, in psoriasis, this process takes much less time is only 3-6 days. It is also important that the cells of the stratum corneum of the skin in this are undeveloped and are not able to perform its functions. The result is intercellular communication is lost, the skin does not have time correctly to emerge and take root. The result is psoriatic of education on the skin – papules, pustules, and plaques. They observed excessive angiogenesis, that is, produced a lot of small blood vessels. Lower layers of the skin unaffected. The mechanism of occurrence of pathological formations on the skin are also cells of the immune system – T lymphocytes.
Some features of the flow and the occurrence of psoriasis
Psoriatic lesions on the skin are often formed in places where the skin was wounded, in places of burns, blisters, abrasions and even injections. This phenomenon is called the Koebner phenomenon , after the German dermatologist, Heinrich Köbner, who described this phenomenon for the first time in 1872. The Koebner phenomenon is characteristic of psoriasis about half of cases and 90% of cases of severe psoriasis.
For psoriasis is characteristic seasonal for. The majority of patients during the cold period of the year of infection on the skin become more visible. Some patients, on the contrary, the heat contributes to the progress of the disease.
How does psoriasis?
According to modern concepts, this skin disease is not contagious, it means that it is not transmitted by contact with another person, even if the affected area of the skin touches the skin of a healthy person. No recorded disease transmission through blood. Also you cannot get psoriasis by contact with animals or catch a disease from the environment. The cause of the disease lies solely in the patient, although some adverse external factors can also exert influence.
Who suffers from psoriasis
Several psoriasis often affects women. The disease develops mainly in young age (before 25 years). The most dangerous period of 16 to 20 years, in that time the symptoms appear in 70% of patients. Although unable to get sick and elderly. But usually old age the symptoms are not so clear. On the other hand, in children (under 16 years), the disease is also uncommon (about 4% of patients). There are racial differences in incidence. Most common in whites, and some groups, for example, the Indians of South America, the disease does not occur.
Reasons
Despite the undoubted medical advances, science still has no answers to many questions. This applies mainly to the reasons for the development of many pathologies. This applies to psoriasis. Interest in this case is not academic. After all, if you understand the origin of this skin disorders, you can find, and how it full treatment. And because clarity in the etiology of psoriasis the scientists there, it remains incurable. In this case it only means that the patient is not able to get rid of skin psoriasis until death. Although in most cases psoriasis is not a direct cause of death. Treatments can inhibit the development of psoriasis and prevent complications.
There are several theories that explain the emergence of this skin disease, but none of them fully satisfies scientists:
- autoimmune,
- genetic,
- hormonal,
- viral
- neurogenic,
- metabolic.
Factors that contribute to the development of the disease
This category should also include phenomena that directly can't be the cause of psoriasis. However, if you have a predisposition, e.g. genetic predisposition, these factors can become the trigger that starts the pathological mechanism. In particular, it is seen that ill more often than people with thin, dry and sensitive skin. This is due to the insufficient production of sebum, making the stimuli, in particular, Streptococcus can penetrate deep into the skin tissue.
Factors that contribute to psoriasis, quite a lot:
- Smoking;
- alcoholism;
- wounds, injuries and cuts of the skin;
- skin burns, including solar;
- the bites of insects or other animals;
- stress;
- improper diet, plenty of fatty foods, sweet, lack of fruits and vegetables, high intake of caffeine-containing beverages;
- diabetes mellitus;
- taking some medicines, primarily antibiotics, NSAIDs, antihypertensive drugs, vitamin complexes, antidepressants, antimalarial, and anticonvulsant drugs;
- the medication lithium (lithium disrupts the synthesis of keratocytes);
- the lack of vitamins in the body;
- infectious skin diseases (fungus, ringworm, dermatitis, furunculosis, herpes, acne);
- systemic infection or infection of the respiratory system (influenza, acute respiratory infections);
- infection with Helicobacter pylori, staphylococci;
- vaccination;
- moving to other climatic zones;
- hypothermia or cold climate;
- food poisoning;
- immunosuppression, including AIDS;
- the exposure of the skin to harsh chemicals, including detergents, cosmetics, perfumes;
- too frequent washing of the skin, destroys beneficial microflora;
- disruption of the gastrointestinal tract, dysbacteriosis.
Most of these factors is external in nature. This means that any person able to prevent their effects on the body, to avoid developing the disease.
Types
The most common type of psoriasis is psoriasis vulgaris. It is about 90% of cases.
Few people know that psoriasis can not only affect the skin, joints and nails. Many patients with psoriasis is also psoriasis of the nails (psoriatic onihodistrofiya) or psoriatic arthritis (a joint disease).
Psoriatic arthritis usually affects the small joints of the hands and feet. However, the pathology can spread to large warehouses, will affect the spine. It threatens the patient with disabilities.
Psoriatic arthritis refers to severe psoriasis regardless of what percentage of the skin affected in this case. This form is observed in 15% of patients.
The most severe type of psoriasis is psoriatic erythroderma (2% of cases). Also severe form is pustular (1% of cases). Nail psoriasis occurs a quarter of patients. This type of psoriasis may not be accompanied by the appearance of lesions on the skin.
Guttate psoriasis usually occurs after infections (ARI, influenza). In 85% of patients with psoriasis teardrop in the blood are detected antibodies to the Streptococcus responsible for the development of angina, and 63% of patients with this type of psoriasis just before the aggravation of suffer from pharyngitis. Pustular psoriasis is usually common among people with overweight.
Also there is a scale for assessing the severity of psoriasis. This index takes into account the various manifestations of the disease:
- redness of the skin,
- skin itching,
- thickening of the skin,
- skin redness,
- peeling,
- the affected area of the skin.
Complications
Psoriasis is not fatal pathology. The main danger is the accession of bacterial and fungal infections of the skin. Also, in some cases, psoriasis can make generalized and affect the entire skin surface. Especially dangerous are the types of generalized skin lesions, as psoriatic erythroderma and generalized pustular form of the disease. Psoriatic arthritis can affect not only the small joints but also the spine. The joints and spine can be deformed, which leads to disability of the patient.
Less often taken into consideration the difficulties that brings with it the psoriasis – problems of the psychological plan. Pathology has a negative effect on quality of life approximately the same way as hypertension and diabetes.
Approximately 71% of patients consider psoriasis to be a serious problem of his life. People, especially the young, having psoriatic plaques in prominent parts of the body, primarily the face, may experience difficulties in communication, resulting in poor social adjustment, inability to engage in certain work or to arrange a personal life. And this, in turn, leads to psychological problems, neurosis, depression, alcoholism. That, in turn, further worsens the patient's condition. It is a vicious circle, escape from which is not easy.
Diagnosis
Usually, the pathology is easily diagnosed by a doctor during examination. Plaque psoriasis on the skin have a characteristic appearance and difficult to confuse with symptoms of other pathologies of the skin, including allergic nature. Psoriasis is usually not present swellings on the skin, but when allergic dermatitis is common.
Except in severe forms of the disease, there is no specific system parameters, for example, in blood tests, which could be a definite diagnosis. In severe psoriasis in the blood changes are observed, characteristic of an intense inflammatory process (leukocytosis, increased erythrocyte sedimentation rate and t.. d).
May be a skin biopsy to rule out other dermatological pathologies. If the biopsy is fixed the immaturity of keratocytes, increased content in the skin, T-lymphocytes and macrophages. In the affected areas there is increased vascular fragility syndrome (Auspitz).
Also note that there are forms of psoriasis, not like the vulgar, such as drip, pustular and erythroderma. The patient often can take them for Allergy symptoms on the skin and treated properly. Nail psoriasis may be confused with fungal infections.
Psoriatic arthritis resembles rheumatoid arthritis. However, in the diagnosis of rheumatoid arthritis made special tests, so if the result was negative, then there is reason to suspect psoriatic arthritis.
During the diagnosis of psoriasis the doctor shows signs of the presence of psoriatic triad:
- stearic spots
- terminal film,
- point of bleeding.
This means that the surface of the skin plaques on the touch is thick and similar to stearin. After removing plaque under it there is a thin and smooth film on the surface which are small drops of blood ("blood dew").
Treatment
The methods of complete recovery from psoriasis is still not developed. This is due largely to the fact that so far there is no generally accepted theory of the etiology of the disease. Therefore, treatment is mainly symptomatic.
It has two main strategies – the struggle with getting into the skin T-lymphocytes and the suppression of cytokines and other mediators of inflammation. When treating ordinary psoriasis the most effective recognized treatment designed to compensate for a lack of vitamin D in the body. In particular, the use of cholecalciferol (vitamin D3) is able to transfer the disease in remission in 70% of patients.
Treatment includes both medications and non-drug methods.
The main methods of treatment of psoriasis
| The name of the method of treatment | The principle of operation | Application method in the treatment of psoriasis | Stage of psoriasis, the treatment of which method is used |
| Non-hormonal anti-inflammatory drugs | fighting inflammation in the skin | applied to the skin | easy, medium |
| Moisturizing ointments | moisturize the skin, helps to remove flakes | applied to the skin | easy, medium |
| Corticosteroids | fighting inflammation in the skin | applied to the skin, are accepted inside | medium, heavy |
| Immunosuppressants | reduce the activity of immune system cells in the skin tissues | are accepted inside | heavy |
| Cytostatics | regulate skin cell division | are accepted inside | heavy |
| Antidepressants, tranquilizers | improve emotional state | are accepted inside | medium, heavy |
| Ultraviolet irradiation | the treatment of inflammation, increase in the concentration of vitamin D in the skin | remote effect on the skin | easy, medium |
Prevention
Psoriasis can affect anybody. However, the exact causes of psoriasis no one knows. Does this mean that to protect yourself from it impossible? Of course not. First and foremost, the danger should pay attention to those who have relatives who have psoriasis. Such people are at risk. Also the risk group includes smokers, people who suffer with diabetes who have excessively dry skin.
People who are at risk are advised to monitor their health and condition of the skin, to avoid wounding the skin or injury. Because the pathology can develop even after applying the tattoo in the tattoo parlor. It is also important to observe the principles of good nutrition to fight infections.
Secondary prevention is prevention of recurrence. This kind of prevention is necessary in order to minimize measures for the treatment of exacerbations. Secondary prevention includes skin care, balanced diet, dealing with stress. To combat anxiety and depression, it is recommended to visit a therapist.