Psoriasis treatment. Symptoms, signs of the disease and effective treatments

The exact cause of the disease is not yet known. Currently, scientists distinguish several theories about the causes of psoriasis. These include:

• genetic predisposition;
• metabolic disorders;
• immunity disorders;
• focal chronic infection.

Several interrelated factors underlie the development of the disease. Often, even in people with a genetic predisposition to psoriasis, it may not be felt for many years. The impetus for the development of the disease can be:

• severe or prolonged stress
• alcohol;
• hormonal disorders;
• metabolic disorders;
• taking certain medications;
• infections;
• skin damage (burns, cuts, injuries);
• other factors.

In response to negative factors, foci of inflammation are formed in the skin, the processes of cell division and maturation are interrupted. The cells begin to actively divide, the skin thickens at the sites of inflammation, forming bright pink papules (nodules), which merge into so-called scale-covered psoriatic plaques. If left untreated, a significant surface of the skin is gradually affected, the inflammation spreads to the nails and joints.

In fact, the results of exposure to all causes of psoriasis can be combined into two groups: a violation of skin cell division and an alteration in the functioning of the immune system.

All external factors (environment, stress, trauma) only exacerbate the course of the disease, but cannot act as a single cause.

types of disease

There are a large number of psoriasis classifications, which are based on the severity of the condition, the nature of the rash, the location of the lesion, etc. Most often, the following types of diseases are distinguished:

• Plaque (common) psoriasis makes up the majority of all types of psoriasis. It is characterized by the appearance of traditional plates covered with grayish-white scales.
• Guttate psoriasis is manifested by numerous, small, scaly rashes over the entire surface of the body after suffering a cold or sore throat.
• The pustular variant is characterized by the formation of plaques with purulent inflammation.
• Seborrheic - is characterized by the presence of oily scales in the area of hair growth, nasolabial folds, chest and back. It differs from seborrhea by more distinct plate boundaries.
• With palmar-plantar psoriasis, the elements are located in the corresponding areas of the skin.
• The exudative variant is distinguished by the fact that the scales are saturated with a yellowish liquid - exudate. Due to this, they appear stuck together and change color. Often seen in obesity.
• Psoriatic erythroderma is a severe form of the disease, since almost the entire surface of the skin is affected and systemic reactions (fever, weakness, malaise, swollen lymph nodes, liver and kidney failure) occur.
• The arthropathic type causes joint damage, is observed in 3-5% of all psoriasis patients, often leads to disability.

According to the stages of the pathological process, progressive, stationary and regressive stages of lichen squamous are distinguished.

Signs and symptoms characteristic of psoriasis

Most often, with psoriasis, reddish-pink patches covered with grayish or white scales (psoriatic patches) appear on the surface of the skin. It is with this symptom that another name for the disease is associated - scaly lichen.

Bubble sizes can be various. The primary elements are considered small papules (nodules) from pink to bright red or burgundy. Over time, their size increases significantly and they also tend to merge.

In 90% of cases, the signs of psoriasis include the formation of patterned plaques, characterized by a triad of signs. This triad is detected by the doctor with a special diagnostic test - plaque scraping:

1. Stearin stain - characterized by scaling when the plaque is scraped and the separation of whitish-gray scales, resembling splinters from a candle in appearance.
2. If you continue to scrape the surface of the board, after all the scales have been removed, a thin, shiny film called a terminal will appear.
3. The blood dew symptom can be detected by removing the terminal film. At the same time, small droplets of blood appear on the surface.

Rashes can be found on various areas of the skin, but most often they are localized:

• on the extensor surfaces of the limbs (elbows, knees);
• along the hairline (the so-called "psoriatic crown");
• in the sacral region.

Also, psoriasis symptoms can get worse and go away depending on the season. For example, in the autumn-winter period, in most patients, the disease passes into an acute phase, while in the summer its symptoms decrease.

How to diagnose psoriasis?

Symptoms, stages and varieties of psoriasis

There are several stages in the course of the disease:

• Progressive. It is characterized by an active increase in the symptoms of psoriasis, proliferation of lesions, thickening of the skin plaques, an increase in the area of redness around them, as well as intense itching and peeling of the skin.
• Stationary. At this stage, the papules stop growing, the formation of new psoriatic plaques stops, while the redness around them subsides, the itching persists, and the scaling of the plaque intensifies.
• Regressive. Disease activity decreases, accompanied by a decrease in itching, psoriatic plaques, in their place there are areas of skin with impaired pigmentation. As a rule, even without exacerbation, a person suffering from psoriasis has 1-2 plaques that never go away - these are the so-called "duty plaques".

When diagnosing psoriasis, the doctor necessarily determines the stage, as the choice of treatment depends on it.

Depending on which part of the body is affected, symptoms of psoriasis can vary:

• On the scalp, plaques are formed, rising slightly above the main surface. From above, they are covered with small scales, visually similar to dandruff. The hair structure remains intact. In addition to the plaques being located on the scalp, often with the progression of the disease, they go beyond its borders, affecting the skin of the forehead, neck and the region behind the auricle.
• On the skin of the feet and palms of the hands, psoriasis is manifested by a noticeable thickening, the skin becomes rough, its thickness increases. Often, cracks and ulcers visible on external examination are formed at the sites of injury. This feature is explained by the fact that the cells of the epidermis divide with high intensity, the skin simply does not have time to get rid of dead particles, as they accumulate and compress, remaining on the surface.
• On the nail plate, psoriatic lesions manifest themselves in a completely different way. Here options are possible: the surface of the nail is covered with small shallow holes - the nails acquire the so-called "thimble" appearance. Or the second option - there is a thickening of the nail plate, its color changes, it begins to flake off in places. At the same time, characteristic papules with red edges can be seen through the nail. This form is sometimes confused with a fungal nail infection.

Recommendations to eliminate the symptoms of the disease

Effective treatment of psoriasis is only possible with an integrated approach. Observance of maximum precautions is of great importance to reduce the risk of disease exacerbation. Therefore, it is recommended:

• avoid skin injuries;
• avoid hypothermia;
• refuse bad habits;
• avoid stressful situations;
• timely treat concomitant infections and illnesses;
• avoid prolonged exposure to direct sunlight.

Patients with psoriasis must take special care to comply with personal hygiene requirements. If you take a bath or shower, then:

• use products without dyes and fragrances;
• choose a mild shampoo;
• avoid the use of thick cloths, creams, gels with abrasive particles;
• Avoid harsh soaps as they dry out the skin.
• adjust the water temperature so that it is warm;
• stay in the water for no more than 10-15 minutes;
• use a soft towel, do not rub or comb the skin.

After bathing and bathing, it is recommended to use special moisturizers for the body. Try to comb your hair as little as possible so you don't irritate the surface of your head again. The same applies to drying with a dryer. If you can't do without it, choose a hot or cold jet.

Choose lightweight clothing made from natural fabrics that cut freely so that it doesn't restrict movement and doesn't rub.

In summer, don't sunbathe for a long time. To protect your skin from UV rays, use high SPF sunscreen.

Psoriasis treatment

Several important aspects determine the choice of approaches and methods for the treatment of psoriasis.

The systemic nature of the disease predetermines a comprehensive approach to its treatment, which includes both drugs (sedatives, antihistamines, vitamin complexes, sorbents), as well as physiotherapy, diet, balneotherapy. Special attention is paid to external therapy with ointments and creams, daily skin care.

The chronic course with numerous relapses throughout life forces the patient and his/her attending physician to seek prevention methods that can prolong remission periods and improve the patient's quality of life.

Basic approaches to treating psoriasis

Treatment of a disease such as psoriasis should begin with establishing the causes of the exacerbation of the disease. If you systematically eliminate the factors that contribute to the exacerbation of this pathology, then it will be possible to keep the course of the disease under control. Methods of treatment of psoriasis are selected taking into account several aspects:

• the complexity of the disease course;
• the presence of concomitant pathology;
• location and size of psoriatic plaques;
• the patient's ability to comply with medical recommendations.

In this regard, when choosing methods of treating psoriasis, doctors are guided by the solution of the following tasks:

• the maximum possible cleaning of the skin of the lesions;
• obtaining results in the shortest possible time;
• relief of the main symptoms of the disease;
• reducing the likelihood of recurrence or worsening of the course of the disease.

general scheme of therapy

Typically, patients with this pathology receive the following treatments for psoriasis:

• Glucocorticosteroids - they give a good effect, help to stop the exacerbation, but they have a lot of contraindications. With improper use, there may be a decrease in the effectiveness of the drug, skin atrophy, the so-called "withdrawal dermatitis".
• Vitamin D3 analogues - these drugs are used to control psoriasis in the remission and exacerbation phase, however, they cannot be used for extensive skin lesions, they are contraindicated in children under 18 and elderly over 65 years, and also not are recommended for patients with impaired calcium exchange.
• Means with salicylic acid - provide an exfoliating and anti-inflammatory effect, are recommended for use in the stationary stage of the disease and with severe peeling. Particularly impressive treatment results can be obtained with a combination of salicylic acid and corticosteroids.
• Birch tar - despite the abundance of contraindications and side effects, preparations containing this substance are still prescribed to patients with psoriasis. Therefore, they should be used with caution as coal tar can cause skin irritation.
• Means for the treatment of psoriasis containing activated zinc pyrithione. They are included in modern clinical guidelines for the treatment of psoriasis and are prescribed to hasten the regression of rashes.

As a rule, experts recommend using several drugs at the same time. This approach helps to get a pronounced effect and keep the disease under control.

systemic treatment

In severe cases of psoriasis, systemic therapy is used. It includes the use of standard immunosuppressive therapy as well as genetically modified biological drugs. Retinoids and systemic glucocorticosteroids can be used.

external treatment

Special attention in the treatment of psoriasis is given to the choice of external medications, as among patients, there is a predominance of people with a mild and moderate course of the disease, characterized mainly by cutaneous manifestations.

These remedies are designed to deal with skin symptoms:

• reduce and eliminate itching;
• relieve inflammation;
• reduce the volume of lesions;
• promote plaque regression;
• reduce skin peeling;
• moisturize dry areas.

Activated zinc pyrithione in the treatment of psoriasis

Zinc pyrithione is a complex compound of zinc with sulfur and oxygen. Used in the treatment of various skin conditions including psoriasis.

Recently, activated zinc pyrithione-based preparations have become especially in demand. The relevance of its use is due to the fact that it helps to fight the exacerbation of psoriasis, being in some cases an alternative to drugs with external hormones for the treatment of skin diseases. The activated zinc pyrithione molecule is 50 times more stable than standard zinc pyrithione.

Benefits of using activated zinc pyrothione in the treatment of psoriasis:

• Pathogenetically based treatment of cutaneous psoriasis as it has pronounced anti-inflammatory, antibacterial and antifungal properties
• Long-term control of psoriasis, does not cause skin atrophy even with prolonged use (up to 6 weeks)
• With no restrictions on the location of the lesions, it can be used for the treatment of psoriasis on the face, scalp and anogenital region.

Treatment of psoriasis with activated zinc pyrithione-based drugs

Especially many difficulties arise in the treatment of psoriasis on the head. This is because many preparations are difficult to use in this area, they can remain in the hair and not reach the surface of the skin. The way out of the situation can be the use of preparations based on activated zinc pyrithione.

A gentle shampoo specifically designed for psoriasis patients. It is applied to damp hair with light massaging movements, washed, washed again with shampoo and left for five minutes for the active ingredients to act, then washed off with warm water. The shampoo has a light and discreet aroma, the substances contained in it fight inflammation, preventing skin irritation. And the menthol in the composition cools the scalp and helps to reduce itching. For medicinal purposes, shampoo is used 2-3 times a week, and for preventive purposes - 1-2 times a week.

With severe damage to the scalp, an aerosol can be used in addition to shampoo. It is convenient to apply on the scalp with a special nozzle.

If the disease has spread to smooth skin, psoriatic patches have appeared behind the ears, on the neck, or on other parts of the body, then an activated zinc pyrithione-based cream or spray can be applied to the affected areas. Do this twice a day for four to six weeks.

Patients with severe psoriasis are often prescribed glucocorticosteroids. Activated zinc pyrithione-based preparations are recommended as a second stage of treatment. When it is possible to reduce the severity of the process, they can be used to further control psoriasis.

Risk factors that cause the development of the disease

In the medical environment, there are usually several characteristic factors that can start the process. In addition, the risk of developing the disease increases if there is a combination of several triggering factors at the same time. These include:

• genetic predisposition. Scientists put forward the theory that the carriers of the disease are certain types of genes that affect the functioning of the immune system and immune cells of T lymphocytes. For this reason, parents who suffer from psoriasis are more likely to have a child who also will be susceptible to this disease.
• Dry and thin skin. In the course of numerous studies, a link has been established between skin characteristics and the risk of developing psoriasis. It has been found that people with thin and dry skin are more likely to suffer from this disease. The reason, according to the researchers, lies in the insufficient production of sebum, which acts as a natural moisturizer on the body surface, as well as in the structural characteristics of the cells of the epidermis.
• The impact of the external environment. A significant role in increasing the number of people suffering from this disease can be played by the use of various cosmetic products, household chemicals, which often contain alcohols, solvents, surfactants and other aggressive components. These substances disrupt the skin's natural functions, can cause irritation and exacerbate psoriasis.
• Excessive body hygiene. The pathological obsession with cleanliness also plays a cruel joke on people. The more actively, intensively and often you cleanse your skin, the more damage you can do to it. Due to the frequent use of soap when bathing or showering, the protective lipid layer of the skin is destroyed, which leads to the formation of microdamage on the surface, which can subsequently provoke an exacerbation or worsening of the course of psoriasis.
• Unhealthy lifestyle. Alcohol, smoking, constant stress, unbalanced and poor quality nutrition, lack of normal rest and sleep - all these inevitably affect human health. It has been observed that certain foods such as tomatoes and eggplant, as well as alcohol and tobacco, can make psoriasis worse.
• Immunodeficiencies. Reduced immunity, especially in HIV-positive patients, causes skin problems and exacerbates the symptoms of psoriasis.
• Medical therapy. Taking certain medications can trigger the development of the disease. With special care, you should use drugs from the group of beta-blockers, antidepressants, as well as drugs against malaria and seizures.
• associated infections. In medical practice, many cases are described when signs of psoriasis develop in patients after injury to the skin by a fungus or as a result of a streptococcal infection.
• Change in usual living conditions. Climate change, changes in time zones, seasons all have a negative impact on people's general well-being. During the period of changing living conditions, the environment, the body weakens, which paves the way for the development of various diseases.
• The impact of stress. Emotional and nervous tension, physical activity, violation of the work and rest regime are among the factors that provoke the appearance of the first symptoms of psoriasis.
• Skin injury. Prolonged scratching, friction, pressure on the skin can cause microdamage and injury. In certain situations, they can turn into characteristic psoriatic plaques.

Is it possible to get psoriasis from someone else?

If we consider a disease like psoriasis, what is it, what treatment and drugs to use to relieve symptoms, a related question arises - is psoriasis contagious, and is it possible to get this disease from someone else? How safe is it for relatives, close people to stay or live near the patient? Is it possible to get psoriasis through household contacts, personal items, touch or blood?

Scientists unequivocally state that psoriasis is not contagious to other people. It is not a virus or bacteria that can be transmitted from person to person in a variety of ways. Psoriasis is not transmitted from person to person, it is an autoimmune disease resulting from an inadequate response of the immune system to external factors (the body attacks itself).

Another thing is when it comes to heredity. Therefore, if there is psoriasis in the family or close relatives, in such a situation one should control the skin condition and try to exclude or minimize factors that could trigger the onset of the disease in advance.

Table. How to distinguish psoriasis from dermatitis

Redness of the skin at the site of inflammation

Lichenification (thickening of the skin)

diagnostic criteria	contact dermatitis	atopic dermatitis	Seborrheic dermatitis	Psoriasis
typical signs	Inflammation requires skin contact with an irritating agent.	intense itching	Peeling of the skin with formation of scales in the location of the sebaceous glands	The presence of characteristic psoriatic plaques, as a rule, there is a plaque on call that never completely disappears
		Dry skin
		Association with allergens
Flow	acute/chronic course	Chronic course with relapses	Chronic course with relapses	chronic progressive course
Localization	Any location at the site of skin contact with an irritant	Depends on age:	- face	- elbows, knees
		- flexion, extensor surfaces of the limbs	- scalp	- folds
		- face	- upper chest	- scalp
		- neck	- axillary region	- sacral region
The nature of the eruption	For acute stroke:	Depends on stage of rash and age of patient	Well-defined areas of redness with pinkish papules covered in yellow scales and crusts	Pinkish-red plaques covered in silvery scales (psoriatic plaques)
	Hyperemia (bright redness with increased temperature of the skin area)	Papules (raised skin) / Vesicles (skin blisters up to 5 mm)
	Edema	Edema
	Pain in the affected area	thickening
	Later there is peeling	Redness
	For chronic course: congestive hyperemia	Peel/Wet
	hyperpigmentation	traces of scratches