Guttate psoriasis – a type of psoriasis, distinctive features of which are the absence of lesions of the nail plate and spontaneous unpredictable distribution of skin lesions associated with the presence of infection in the body. The primary item is a pink teardrop-shaped plaque. The appearance of papules accompanied by itching. Initially, the rash is localized on the trunk and extremities, but later spreading throughout the skin, except the palms and soles. The disease is diagnosed clinically in the detection of psoriatic triad, using the data of histology. The most effective methods of treatment are PUVA therapy and plasmapheresis.
General information
Guttate psoriasis is a rare form of autoimmune scaly depriving painting with chronic. Dermatosis has no gender or racial differences, has no clear seasonality and regularity. Often guttate psoriasis diagnosed in school-age children, young men and women. In the world more than 4% of the population suffer from psoriasis, the share of the teardrop is about 2 million. Guttate psoriasis has an organic specificity, often combined with somatic diseases, acute or chronic infection, which worsened. It is assumed that such combinations due to a violation of the protective properties of the skin and not easy penetration into the body of infectious agents, which are one of the main triggers in the starting mechanism of development of disease.
It is believed that disseminated guttate psoriasis shortens a woman's life for 3 years, men and 1.5 years. The reason for reducing the period of life become autoimmune disorders. On the development of guttate psoriasis adversely affected by bad habits, especially Smoking and high atherogenic profile power. Smoking packs of cigarettes a day increases the risk of developing guttate psoriasis 2 times. Eating large amounts of fish (a natural source of polyunsaturated fatty acids) reduces the risk of diseases 3 times. The urgency of the problems associated with severe psoriasis significantly impairs the quality of life of patients.
Causes of guttate psoriasis
The vast majority of dermatologists considered the main reason for the development of guttate psoriasis transferred the infection of any etiology: influenza, sore throat, pneumonia, acute respiratory disease of the upper respiratory tract, candidiasis of the mucous membranes. In favor of the infectious theory shows the presence of pathogens in scrapings with a drop of plaque. Infectious disease or leads to the debut of the pathology, or aggravates other forms of psoriasis and stimulates their transformation into guttate psoriasis. Background of the pathological changes is stress, fatigue, decreased immunity, genetic predisposition or combination of these factors. Despite the fact that the scabs of plaques is determined by a pathogenic agent, guttate psoriasis is not contagious, not infectious.
In the pathogenesis of guttate psoriasis, the leading role belongs to the autoimmune reactions. The presence of an infection activates genes responsible for disease development, stress affects the neuropeptides are able to stimulate keratinocytes, which, in turn, secrete cytokines. Cytokines activate the immune system lymphocytes and histiocytes connective tissue component of skin that attracts eosinophils. There are three stages of development of guttate psoriasis: sensitization, latent existence, and effector. In the first phase, starts the mechanism of the reaction antigen-antibody, where the antigen are pathogenic microorganisms that enter the skin, and antibodies – cells of the immune and reticuloendothelial system. In the second phase there is a latent accumulation of antibodies that are produced by dermal cells and lymphocytes of the immune system. Antibodies due to excess is associated not only foreign particles, but also endogenous structure of the skin.
Finally, in the third phase, begins primary rash elements on the skin surface. The start time for the final phase it is impossible to predict, because the duration of the latent period depends on the virulence of the pathogen or other pathogenic cytotoxicity beginning, its amount and resistance. It should be noted that in the case of guttate psoriasis a genetic predisposition does not play a decisive role, since genes responsible for the development of guttate psoriasis, a lot, and the genetic transmission of any form of psoriasis is not subject to the laws of Mendel. Believes guttate psoriasis is genetic disease it is impossible, you can only talk about genetically heterogeneous disease.
Classification of guttate psoriasis
In dermatology to classify, guttate psoriasis severity in view of the prevalence of lesions of the skin. Distinguish:
- Mild guttate psoriasis is a rash a single of the primary elements in the square, which is less than 3% of the skin. The features appear sharply 2-3 weeks after infection and require immediate treatment to the doctor. Localized on the trunk and extremities, regress with symptoms of hyperpigmentation.
- Mild guttate psoriasis – multiple lesions, prone to peripheral growth, lose skin from 3% to 10%. Overall condition is violated, marked pruritus, a patient needs hospital care. Elements of the rash may be addressed alone or be transformed into disseminirovanne form.
- Severe guttate psoriasis – widespread rashes that cover more than 10% of the skin of the skin. Localized everywhere seriously disrupt the patient's condition require medical intervention in a specialized hospital and treatment according to the individual program to a complete regression of primary psoriatic cells.
The symptoms of guttate psoriasis
The disease has a fluctuating course, in place of the remission come recurrence, particularly frequent in autumn and winter. Clinical manifestations of guttate psoriasis occur spontaneously. The primary element is the bright red papules teardrop shape from 3 to 10 mm in diameter, covered with silvery scales. The papules grow on the periphery, merge and turn into plaque. In the injury elements are prone to ulceration and transformation in exudative psoriasis. Rash accompanied by itching. The rash is on the trunk and limbs is the typical localization of primary cells guttate psoriasis. The face almost always remains free, the nail plate is not surprised. The rash may be addressed alone or be transformed into a more severe kind of psoriasis. The disappearance of the rash is not a guarantee of recovery.
Diagnosis guttate psoriasis
When the diagnosis of "guttate psoriasis" take into account the information about recent infection, complaints and the presence of specific diagnostic triad: stearin spot terminal film, bleeding "drops of dew". The KLA is defined by elevated erythrocyte sedimentation rate and leukocytosis, according to biochemistry revealed the presence of rheumatoid factor. Children who suffered a strep infection, conduct serological tests, take the swab from the nasopharynx with a bacteriological study of hemolytic Streptococcus.
Histology typical drip psoriasis, morphological changes testify to the immaturity of the epidermal cells, the finding in the biopsy material of T-lymphocytes and symptoms of hyperkeratosis. Disease differencebut with other varieties of the psoriasis pink ringworm, secondary syphilis, drug intoxication, dermatitis, and viral exanthema.
Treatment guttate psoriasis
Dermatosis resistant to therapy, and requires patience from the patient and the dermatologist. Treatment is complex, depending on the severity of the process is carried out in an outpatient or inpatient. First of all, conduct sanitation of foci of chronic infection, treat residual symptoms of acute ARI and ARI, adjusting concomitant somatic pathology. A dermatologist picks up an individual program anti atherogenic profile the power consumption of polyunsaturated fatty acids. At the same time, symptomatic therapy. With this most effective psoriasis PUVA therapy, which is administered in small doses under medical supervision. The use of plasmapheresis allows to reduce the frequency of recurrence.
Drugs with this type of psoriasis are used for different purposes and according to different therapeutic schemes. For example, hormonal ointments, taking into account the area affected of the skin, use only short courses; antibacterial therapy against hemolytic Streptococcus is carried out with purpose of long cycles of antibiotic therapy with the use of cephalosporins. The longest is receiving immunomodulators.
Shown vitamin (A, D, C, E, b group) and monoclonal antibodies. If expansion of the primary elements are significant and continue to progress, apply retinoids inside and calcitriol ointment in appearance. Prescribed sedative, antihistamine therapy and medications against itching. Good effect is given a bath with bran. The relatively favorable prognosis given the ripple current guttate psoriasis and reduce the quality of life of patients.