Psoriasis (psoriasis) - an inflammatory skin disease characterized by diverse manifestations. It occurs with equal frequency in men and women.
Risk factors
- Mechanical trauma and irritation of the skin
- Infection (Streptococcus)
- Stress
- endocrine disorders
- Medications (hormones, anti-malarial drugs, interferon)
- alcohol abuse
psoriasis manifestations
Psoriasis is characterized by having a homogeneous rash as plaques with a diameter of 3.1 mm to 2.3 cm, pink-red, seated loosely covered with silvery white scales. As a result, growth of boundary elements may coalesce into plaques of various sizes and shapes, sometimes occupy extensive areas of skin. Plaques are commonly found on the skin of the extensor surface of the extremities, especially the elbows and knees, trunk and scalp.
Photo: site of the Department of dermatology Tomsk Military Medical Institute
The appearance of fresh elements characteristic of local injuries, raschosov. When poskablivanii psoriatic plaques detected characteristic signs of the disease: the peeling poskablivanii amplified, causing the association with tallow candles; after removing the scales appear shiny wet surface; drip bleeding appears at the further poskablivanii. The hair is not affected.
There are the following kinds of psoriasis:
- normal,
- exudative,
- arthropathic,
- pustular,
- psoriatic erythroderma
The usual form (vulgar psoriasis) characterized by precipitation flat plaques pinkish-red color in the size of 0.5 cm or more, covered with silvery white scales.
Exudative form is distinguished by the fact that in the psoriatic plaques formed grayish-yellow Cork scales due to their impregnation with effusion, in large folds sometimes defined Moisture.
The most severe forms of psoriasis - pustular, and erythrodermic psoriasis arthropathic - they can develop From the very onset of the disease or in the later stages due to the influence of adverse factors or irrational treatment.
When artropaticheskom struck the small joints of the hands and feet, but possibly defeat the other or all of the joints. Sometimes articular manifestations preceded by eruptions on the skin. When erythrodermic psoriasis in the painful process involved the entire skin, symptoms of intoxication are developing (nausea, weakness, headache). Pustular psoriasis manifests superficial pustular elements.
For all forms of the disease is characterized by the defeat of nails in the form of a thickening of the nail plate, point depressions on the surface or the appearance of reddish spots under the nail plate.
The diagnosis is carried out dermatologists via laboratory and instrumental methods of research:
- Analysis of total blood
- skin biopsy
psoriasis treatment
Psoriasis treatment is aimed at suppressing the inflammatory reaction of the skin. Therapy is prescribed with regard to the shape, phase, spread of the process, the presence of concomitant diseases, age and sex of the patient.
In milder forms in a number of cases it is sufficient destination external therapy as salicylic ointment preparations naphthalan, tar, hormonal ointments. Severe psoriasis require complex treatment with drugs of different groups, physiotherapeutic therapies and other external preparations.
Treatment is carried out with regard to the stage of psoriasis.
Therapy advanced stage requires special attention and caution. In this period are assigned gemodez intravenously 2-3 times a week, 30% sodium thiosulfate solution intravenously, 10% calcium gluconate solution was 10 mL, the various chelators. With concomitant increase in blood pressure is expedient intramuscular injection of a 25% solution of magnesium sulfate. Externally used emollient creams or 1-2% salicylic ointment cent.
At an advanced stage of psoriasis therapy is contraindicated for outdoor application of preparations containing tar, irritating and highly concentrated agents. Physical therapy procedures appropriate to apply after decrease inflammation.
At stages stable and can be used to abate the flow naftalan ointments, tar, salicylic acid.
One of the most effective methods of treatment recognized as PUVA therapy or photochemotherapy.
Photochemotherapy - a combined use of the ultraviolet radiation (wavelength from 320 to 420 nm) with the ingestion of drugs that increase sensitivity to light. The use of photosensitizers based on their ability to increase the skin's sensitivity to UV and stimulate the formation of skin pigment - melanin. Dose picked individually, taking into account the patient's weight. Procedures are carried out 3-4 times a week, administered 20-25 sessions per course. PUVA therapy is contraindicated in acute infectious diseases, exacerbation of chronic diseases, cardiovascular decompensation, cancer, severe diabetes diabetes, Severe liver disease and kidney.
External treatment of psoriasis in order to eliminate inflammation, peeling, itching, skin softening is assigned to all patients. For this purpose, commonly used agents, which include salicylic acid, hormones. Especially popular are preparations containing hormones and salicylic acid (Diprosalik, belosalik in the form of an ointment, lotion; Ointment Lorinden A Elokim advantan, latikort, lokoid et al.).
Creams are assigned in the absence of pronounced inflammation during exacerbation, in the presence of rash on the face; lotions - with lesions of the scalp; ointment for psoriasis drugs most commonly used, especially on the surface of plaques. You should not use products containing hormones for a long time and over large areas of skin.
An effective means is activated zinc pyrithione (skin-cap) which is available as a cream, aerosol and shampoo.
Dayvoneks used in the form of an ointment, and lotion. The drug normalizes the cell growth. Maximum efficiency is achieved when the long, multi-week application of the agent in patients. In severe forms of psoriasis dayvobet shown. Grounded stage treatment when the therapy is started with application dayvobeta then prescribe combination therapy and subsequently transferred to the treatment Dayvoneks. To prevent the development of withdrawal symptoms the first and second stages should have the same duration.
Acitretin - used to treat severe psoriasis, is usually administered in a dose of from 10 to 30 mg per day - depending on the severity of the skin process (process than acute, the lower the dose acitretin). Especially effective drug in combination with PUVA therapy. During the drug necessary to control the function of the liver, concentration cholesterol and triglycerides; children need to monitor the performance of growth and development of bones. In the appointment of acitretin women of childbearing age should use reliable last contraceptives in 4 weeks before starting treatment, during treatment and for 2 years after the end - because of the crippling fruit of action the drug.
Methotrexate is used in the case of persistent currents in psoriatic arthropathy and the presence of contraindications to other therapies. The drug is very toxic. It applied under the strict control of blood parameters, bilirubin transaminases and serum.
Cyclosporin A (Sandimmune Neoral) is assigned if severe, widespread psoriasis resistant to other therapies. The drug is administered at the rate of 5 mg per 1 kg of body weight per day in 2 divided doses. Contraindications for application of cyclosporin A are infectious disease, renal failure and arterial hypertension. Treatment should only be performed in specialized hospitals. During therapy shows systematic control indicators creatinine, uric acid, bilirubin, liver enzymes, determination of potassium concentration, and serum lipids, control of blood pressure.
In severe, resistant to treatment and disabling forms shown infliximab (Remicade). The drug is available in vials of 20 ml containing 100 mg of powder.
Diet plays a role in the development and treatment of psoriasis. A diet of fresh fruits and vegetables and low in proteins, many experts considered to be useful. On the other hand, a diet - a strictly personal matter. Allergy and sensitivity to the products play a role in some patients, contributing to the deterioration of the disease. The use of dietary supplements (eg, fish oil) is considered to be beneficial for many patients.
Read more about food in psoriasis principles, lists of permitted and prohibited products can be found in our separate article.
Course and prognosis
Psoriasis has a fluctuating course with periods of exacerbation and subsided. Exacerbations are more often in the fall and winter (autumn-winter form), at least - in the summer (summer form). The prognosis for patients with widespread psoriasis favorable for severe forms (pustular, arthropathic, erythroderma) possible disability.
Pregnancy may exert unpredictable effects on psoriasis. If pregnancy should avoid application of ointments containing tar or hormones, as well as systemic therapy.
