It is known that up to 80% of patients with psoriasis have a greater or lesser extent of skin lesions of the scalp. In some cases, the scalp is the only localization of psoriatic lesions. Given the special "social significance" of the scalp, the presence of chronic diseases in this area substantially violates the quality of life for 80% of patients.
A recent study noted the impact of psoriasis on patients (n=723), 97% noted a violation of a daily lifestyle. 28% of patients with psoriasis who participated in the study in 2005, noted the problems with getting services in beauty salons. Patients with psoriasis low self esteem, which is reflected negatively on their social relationships. According to one study psoriasis is significantly correlated with mental health (p < 0.01).
Specific features that may contribute to the susceptibility to PWCG
- Along with the presence of long terminal hairs and a high level of production of sebum the scalp is characterized by enhanced desquamation of keratinized anuclear cells. The high concentration of follicles, lack of sunlight, which limits the influence of UV, which usually reduces the development of psoriatic lesions.
- Causing the inflammation the bacteria (in patients with PWCG was isolated fungus type Malassezia globosa, and the assumption on the relationship with disease severity).
- Repetitive friction and damage to the scalp (the Koebner phenomenon) when combing or application of devices for installation).
Clinic psoriasis of the scalp
Psoriasis of the scalp is accompanied by the appearance on the skin characteristic rash presents with spots, or more plaques from pale pink to brown-red. In most cases, the lesions infiltrated from the minimally palpable palpable elevation above the level of healthy skin to severe infiltration of more than 1 mm.
Dubitandum questions:
- psoriasis and/or seborrheic dermatitis;
- psoriasis and hair loss;
- psoriasis and scarring;
- psoriasis and hair growth;
- psoriasis – inverse Koebner phenomenon or Reinbek
Psoriasis and/or seborrheic dermatitis (SD)
In the diagnosis may occur some difficulties in the localization of the pathological process exclusively on the scalp. Many patients with psoriasis, initially was diagnosed with diabetes.
Differential-diagnostic signs of psoriasis and diabetes:
- for psoriasis, unlike DM, is characterized by more severe infiltration of lesions due to the acanthosis and Hyper-proliferation of the epidermis;
- the rash of psoriasis often go beyond the hairy portion of the scalp, on the forehead (the so-called "psoriatic crown"), on the neck, the ear;
- flaking in psoriasis dry, while SD scales more fat;
- more intense itching is observed in DM;
- you must also carefully examine and question the patient on the subject of lesions of the nails and joints, which can speak in favor of the psoriasis also significantly impact the future treatment tactics.
Despite some differences in the clinic, is not always clinically possible to distinguish between these two diseases. A great help in providing dermatoscopy.
Characteristics of the clinical picture and treatment of nail psoriasis?
This is a useful tool for the assessment of psoriasis of the scalp, especially in its mild and moderate forms are difficult clinical assessment. Dermatoscopy helps in the early detection, differential diagnosis, follow-up and screening. It takes into account the area of scalp affected by psoriasis, the presence and morphology of vascular pattern, erythema, and peeling.
Dermatologically psoriatic lesions without peeling are characterized by the appearance of "red dots", which are loops of blood vessels of the papillary dermis, dilated on the background of acanthosis and inflammation psoriatic.
You should also remember about the possibility of a combination of psoriasis and diabetes in the same patient, some authors even combine such a General term as "sebopsoriasis". In some cases, diabetes may be preceded by psoriasis or these States can coexist. The appearance of psoriasis can also occur as a result of the Koebner phenomenon against the background of the skin lesions of SD.
Psoriasis scalp and hair loss
A common complaint in patients with psoriasis of the scalp is hair loss, but cause of most of these cases is the loss of hair, triggered by trauma caused by itching of the lesions (traction alopecia).
So, we have analyzed the status of 47 patients with psoriatic alopecia: the period of follow-up, 41 patients was 7 years, 34 patients (83%) were observed to restore growth of hair for elimination of psoriatic lesions. Reports of telogen effluvium is not directly associated with psoriasis.
Dermatological status:
- observed decrease in density and thinning hair with areas of alopecia, more pronounced in the Central-parietal region of the scalp;
- the lack of follicular mouths;
- erythematous-infiltrative lesions with peeling.
Dermatoscopic signs of psoriatic scarring alopecia are usually the following: is the presence of interfollicular twisted red loops characteristic of PWCG, in the absence of follicular openings. Postolatii or growth of the hair bundles was not observed.
Horizontal slices of the biopsy sample when PWCG show:
- sebaceous glands were not visualized, however, had separate and the muscle lifting the hair, and also were observed perifollicular fibrosis;
- analysis of vertical slice showed epidermal changes compatible with psoriasis, and mild chronic inflammatory infiltrate around blood vessels and sweat glands, which is accompanied by the formation of fibrous bundles;
- at dermal-epidermal level, any inter-layer changes or lesions of the follicular epithelium was not observed.
- The obtained results of the biopsy when PWCG consistent with scarring alopecia, which is accompanied by psoriasiform epidermal changes.
Psoriasis and secondary cicatricial alopecia
The most common factors associated with the development of psoriatic scarring alopecia, are high, the duration of the disease and severity of psoriasis.
Assuming that these changes in varying degrees, are common to all of lymphocytic cicatricial alopecia, we have reason to believe that psoriatic alopecia is a secondary clinical change to a primary process and is not unique histopathological condition.
The high incidence of this complication, while it is not known, therefore, to prevent the progression to the development of scarring alopecia, the necessary optimal control of psoriatic inflammation.
Psoriasis and hair growth
Observations show that the sequence of events in psoriasis correlated with the activation of anagenic hair growth. Seen a striking analogy between the kinetics of epidermal cells in psoriasis and proliferation of keratinocytes of the hair matrix during the anagen phase.
The analogy between Koebner phenomenon and restoration of anagenic growth, g Zn. the wound healing process. Two phenomena can have the same "triggers" mechanism.
A unique method of psoriasis treatment laser?
It is seen that clinically active psoriasis inhibits alopecia alopecia (GO). The large-scale spread of psoriasis on the scalp stops at the border of the hearth ST. The concomitant growth of hair and psoriasis on the head can occur after contact immunotherapy with TH. The phenomenon Reinbek showing normal hair growth in psoriatic lesions with concomitant HA.
The factors that determine the choice of therapy for psoriasis
- age;
- type of psoriasis;
- the degree of damage, the nature and localization of lesions;
- prior therapy;
- comorbidities.
Group of drugs for topical therapy of psoriasis:
- topical glucocorticoids;
- analogues of vitamin D3;
- topical calcineurin inhibitors;
- keratolytic;
- others (retinoids, herbal preparations of tar, a combination of drugs).
Treatment of psoriasis of the scalp
With the defeat of the skin of the scalp is assigned to the lotion 1 time per day, which has anti-inflammatory, exfoliating action.
At moderate manifestations of inflammatory and slight peeling recommended shampoo and lotion 1-2 times a day until disappearance of clinical manifestations.
Psychosomatics: psoriasis is a physical reflection of mental problems?
At the moment the most widely used in the treatment of psoriasis received phototherapy methods with the use of ultraviolet (UV) B spectrum (280-320 nm). The effect of the application of phototherapy is based on its anti-inflammatory, immunomodulatory and antiproliferative actions.
Phototherapy is combined with topical remedies, and also can be used as monotherapy or supportive treatment.
For the most effective use of phototherapy on the skin of the scalp, there are devices optimized for the zone. Such devices equipped with a comb or optical fiber, which facilitate the smooth penetration of UV rays to the scalp.
The algorithm phototherapy PWCG
Before the course of phototherapy it is recommended to prepare scalp with the use of keratolytic as rich peeling may significantly reduce the effectiveness of therapy.
It is important to remember that emollients can not be used immediately prior to phototherapy, because they hinder the access of rays to the skin. However, they can and should be used after each session of phototherapy because UV rays additionally dry the skin.
Phototherapy UVB 311 nm is assigned 2-4 times per week, 20-30 procedures for the course.
After intensive treatment, in some cases, the appropriate use of supportive therapy 1 time a week.
The role of basic skin care in patients with PWCG:
- preparing for the treatment;
- improving the efficiency of therapy;
- reduction of duration of treatment and the requirements of "active therapy", including the use of TKS;
- the extension of periods of remission, reducing the number of exacerbations per year;
- the improvement of the skin and prognosis in General.
Therapy optimization can be achieved by the use of keratolytic, emollients, antifungals.
- Keratolytic is an important step in the treatment of psoriasis. This is the correct preparation of the skin for therapeutic treatments. The composition of the keratolytic remedies usually include: urea (10-30%), salicylic acid (2-5%), lactic, glycolic acid and other organic acids, alpha-hydroxy acids and their derivatives (cloimid).
- Emollients are able to restructure water lipidnuu the mantle and the epidermal barrier, these substances necessary in the therapy for continuous use keratolytic remedies.
- Antifungals - used to readjustment of the scalp (shampoos and lotions ketoconazole, zinc compounds, etc.
In the treatment of psoriasis can be a successful anti-psoriatic herbal medicine. Its success, usually based on a combination of sensitive methods of desquamation, hydration and rehabilitation of the scalp.
Given the peculiarity of the disease-specific keratolytic treatments can be conducted in a mode of 2-3 times per week to one time use per month.
On the backdrop of a crisis symptoms, the intensity of the keratolytic therapy can be reduced.
From moisturizers which can also be used on the skin of the scalp, it is better to give preference to gel formulations or emulsions.
For the scalp the commonly used forms sensitive shampoos (shampoo), oil and nourishing masks, balms, oils, hair lotions which have a low acidity (less than 5.5).
Justified tactics use moisturising masks after shampooing.
Systemic therapy PWCG
The indication for systemic therapy in psoriasis is an ineffective topical treatments and phototherapy, as well as the involvement of critical anatomical areas. The need for systemic therapy when localization of the pathological process only on the scalp occurs rarely.
But, despite the availability of effective modern methods of topical treatment and phototherapy is not always possible to achieve the desired therapeutic effect.
Given the very significant effect of the lesion of the scalp on the quality of life in the torpid cases of psoriasis, consider systemic therapy, discussing with the patient the expected benefits and possible risks.
Systemic medications for psoriasis include the following groups:
- retinoids;
- cytotoxic drugs;
- immunobiological preparations.