Psoriasis is a pathology in which the human immune system mistakenly attacks healthy skin cells. As a result, scaly plaques appear on its surface, which can be very itchy and even painful. Sometimes the disease is accompanied by inflammation of the joints and eyes.
What is Psoriasis?
Psoriasis is a chronic autoimmune disease that causes red, scaly patches to appear on the surface of the skin. They are often called plaques.
Psoriasis cannot be contracted - it is not an infectious disease, but an autoimmune one.
Psoriasis is characterized by inflammation of the skin, as well as abnormal rapid growth and erosion of the cells (keratinocytes) that make up the stratum corneum - the epidermis. Normally, it is completely renewed within a month, but in people with psoriasis, this process is accelerated many times and occurs in an average of 3-4 days.
In addition to skin damage, the disease causes inflammation of the joints (about 30% of cases). A little less - in 10% of cases - psoriasis causes inflammation of the uvea (uveitis).
The prevalence of psoriasis
Psoriasis most often affects people between the ages of 15 and 35, but in general, the disease can appear at any age. The first peak of the pathological onset occurs at the age of 15-20, and the second at the age of 55-60.
On average, psoriasis affects about 1-2% of people worldwide. According to the clinical recommendations of the Ministry of Health in our country, the prevalence of the disease in 2021 was 243. 7 cases per 100, 000 people.
Types of psoriasis
Like many chronic diseases, psoriasis differs in its stages, severity and form of manifestation.
By stage
Psoriasis consists of three stages: progressive, stationary and regressive stage (remission).
INprogressive stagered spots appear on the skin. Together, they form large scaly plaques with a clear red outline around the edges - this is called erythematous erythema. corolla or corolla. New plaques are very itchy and can hurt.
Damaged areas of the skin are especially sensitive to the appearance of new spots: psoriatic plaque can quickly develop in the place of friction (for example, on clothes), as well as in the area of a scratch or scratch. Doctors call this phenomenon the Koebner phenomenon.
This phenomenon, also known as "isomorphic reaction", was discovered in 1872 by the German dermatologist Heinrich Koebner. The doctor noted that in some patients with psoriasis, new plaques appear on the skin in places of trauma, for example, after scratches, needles or bruises.
Stationary stage- stabilization phase. Plaques stop growing, but continue to bother and peel. New rashes and spots usually do not appear.
Regression stageoccurs when the psoriasis symptoms begin to disappear. Peeling goes on, plaques lighten and flatten. At this stage, the symptoms decrease.
Because of its intensity
To assess the severity of psoriasis, doctors use the PASI (Psoriasis Area and Severity Index) system - an index to assess the severity and spread of psoriasis. Erythema severity requires professional analysis of parameters such as infiltration, peeling, and calculation of the area of skin affected by rashes.
Based on the results of the examination, doctors distinguish mild, moderate and severe degrees of the disease.
According to the form
According to the clinical picture of manifestations, several main forms of psoriasis are distinguished: vulgar, inverse, seborrheic, exudative, guttate, pustular, psoriasis of palms and feet and psoriatic erythroderma.
Vulgar (ordinary) psoriasis- one of the most common forms, accounting for about 90% of all cases of the disease. First, red spots appear on the skin, which after a few days turn into raised, scaly plaques. As the plaques develop, they coalesce into large, itchy, scaly lesions. Then the condition goes to the stage of stabilization and regression: the manifestations of the disease temporarily decrease and the person's well-being improves.
The most common places where psoriasis vulgaris appears are the extensor (external) part of the skin of the elbow and knee. Lesions also appear on the body and scalp.
Psoriasis vulgaris on the outside of the elbow
Reverse ("opposite") psoriasiscontinues as usual. The difference is only in the location of the lesions: they appear not in the extensor (external) part of the knees and elbows, but in the flexor (internal) part - that is, under the knee, under the armpit and at the elbow. in the region, as well as in the neck, eyelids, navel, inguinal folds. In these places, the skin is more delicate, moisturized and rubs on clothes more quickly. Therefore, there may be more itching than in the usual form of the disease, but the peeling is less pronounced in these places.
Seborrheic psoriasisit continues in the same way as normal, but its foci are located in areas with a large number of sebaceous glands. This is the scalp, the folds behind the ears, the cheeks and the nasolabial region of the face, forehead, chest and back (mainly the upper part).
Seborrheic psoriasis of the scalp
Exudative psoriasis- a type of disease in which, in addition to peeling, exudate is also visible in the lesion. It is a fluid that contains protein, some blood cells, and other substances. During inflammation, exudate can come out of the capillaries.
In the exudative form of the disease, the crust on the surface of the plaques is usually dense, gray-yellow, sometimes slightly wet. This type of psoriasis is most often seen in people with endocrine diseases: thyroid pathologies, type 2 diabetes mellitus or obesity.
Guttate psoriasisIt appears on the skin not as a plaque, but as multiple papules - bright red swollen spots with peeling in the center. The size of the papules can vary from about 1 to 10 mm. They mainly cover the torso, arms and legs.
Guttate psoriasis usually occurs in children after streptococcal infections (eg, tonsillitis). Compared to other types of psoriasis, it is somewhat better treated, but in some cases it can turn into a common (vulgar) form.
Pustular psoriasischaracterized by the appearance of numerous pustules on a red erythematous background. Pustules are formations very similar to acne. Such psoriasis can be the result of infectious diseases, stress, hormonal imbalance, improper use of drugs or inadequate use of ointments. At first, many pustules appear on the red spots. Then they merge into one large pus spot (or "pus lake").
The generalized form of pustular psoriasis is difficult to tolerate: with episodes of fever, weakness, and severe pain and burning of the skin. In parallel, changes in the nails and pain in the joints can be observed.
Psoriasis of palms and feet- typical psoriatic rashes appear on the palms and soles, less often in the form of localized pustular psoriasis. It can also affect and deform the nails - they become thicker, cloudy and uneven.
Psoriasis on palm
Erythrodermic psoriasisThis is extremely rare and is considered an extremely severe form of the disease. About 90% of the body has redness, severe itching and pain appear, the skin swells and peels. The temperature often rises and the lymph nodes become inflamed.
Typically, this type of psoriasis is the result of an exacerbation of another form of the disease due to improper treatment or adverse environmental factors (for example, sunburn in advanced psoriasis vulgaris, inadequate use of irritating external agents or intravenous administration of glucocorticosteroids).
Symptoms of psoriasis
The manifestations of psoriasis vary depending on the type and severity of the disease.
Common symptoms and signs of psoriasis:
- red, raised, scaly patches on the skin;
- itching in the area of inflammation and peeling;
- changes in the nails: accurately determine the impressions, thickening and collapse of the plate, its separation;
- joint pain (sometimes).
For an accurate diagnosis, you should contact a special specialist - a dermatologist.
Mechanism of development of psoriasis
Psoriasis is an autoimmune disease.
All autoimmune pathologies are associated with an error in the work of the immune system. Normally, it "scans" the body day and night, looking for pathogenic cells by foreign protein molecules that distinguish them from the body's own "normal" cells.
As soon as foreign protein molecules are detected, the immune system activates special immune cells - T-lymphocytes - which should destroy the enemy.
However, for some people, the friend-foe recognition system may be impaired. As a result, the immune system begins to attack the healthy cells of individual organs or tissues, inciting inflammation in their places and causing all sorts of damage to the body that it is supposed to protect.
This is what happens with psoriasis: the immune system attacks the skin. It activates T-lymphocytes and "puts" them on skin cells. After reaching the target, T-lymphocytes release substances that cause inflammation - cytokines. They provoke the first symptoms: redness, swelling, itching and pain.
With psoriasis, skin cells divide several times faster, resulting in the formation of scales and crusts.
Under the influence of cytokines, an inflammatory process develops and skin cells begin to divide actively - thus active peeling occurs and a convex plate is formed.
Since the cell renewal process is accelerated almost ten times, the main cells of the epidermis (keratinocytes) do not have time to form properly. And that's why they can't act as a barrier.
As a result, the stratum corneum becomes permeable and stops protecting the deeper layers of the skin from the environment and moisture loss. All this leads to more inflammation.
Until the immune system calms down, the disease will progress and the symptoms will increase.
Causes of psoriasis
The exact causes of the development of psoriasis are not yet fully understood. However, many studies agree that the development of psoriasis is related to genetics, as well as lifestyle, comorbidities, and adverse environmental factors.
Genetics
The disease is often inherited from parents to children. Psoriasis is mainly associated with the HLA-C gene. It codes for a protein that allows the immune system to recognize its own (harmless) cells.
In patients with psoriasis, doctors detect a special genetic marker in the HLA-C gene more often than in other people - HLA-Cw6. However, its presence only indicates a predisposition to the disease. Not all people with the HLA-Cw6 marker have psoriasis, and not all patients diagnosed with the disease have this genetic change.
Lifestyle
Permanent damage to the skin, frequent friction, sunburn and hypothermia are believed to be triggers for the development of the disease. Especially if there is a hereditary predisposition in the form of the genetic marker HLA-Cw6 or close relatives suffering from psoriasis.
Other risk factors include constant stress, alcohol abuse and smoking - all of which have a detrimental effect on metabolism, internal organs and the immune system.
Mixed pathologies
Some types of psoriasis, such as guttate psoriasis, can appear after a streptococcal infection.
Also, the risk of developing pathology increases in people with autoimmune diseases. These include, for example, type 1 diabetes, Crohn's disease, systemic lupus erythematosus, and rheumatoid arthritis.
During such diseases, the general mechanism of the immune system is disturbed: it perceives part of its own cells as something foreign, reacts with inflammation and destroys them. Accordingly, the risk of accidentally adding other cells to the "black list" increases.
Complications of psoriasis
Psoriasis is caused by a malfunction of the immune system and chronic systemic inflammation. It develops as a result of continuous aggression of immune cells to healthy tissues.
Autoimmune processes differ in their ability to spread: the immune system can at any time include other healthy cells in the list of "enemies".
For example, in the background of psoriasis, if the immune system mistakenly attacks the tissues of the gastrointestinal tract, Crohn's disease or ulcerative colitis can develop.
In addition to autoimmune diseases, people with psoriasis are susceptible to various endocrine pathologies (metabolic syndrome, obesity, type 2 diabetes), cardiovascular diseases (hypertension, heart attack) and other dysfunctions of internal organs. All this is associated with a chronic inflammatory process that affects hormonal levels and interferes with normal metabolism.
A separate complication is psoriatic arthritis. It occurs in about 30% of people with psoriasis.
In psoriatic arthritis, the immune system attacks the connective tissue, most commonly affecting the joints of the lower extremities. Inflammation of the joint structures develops, the skin in the affected area may turn red, swelling appears, and pain and / or stiffness appear when trying to bend or straighten the joint.
In 10% of people with psoriasis, the pathology spreads to the eyes and develops uveitis. The choroid of the eye becomes inflamed, which causes reduced vision and discomfort.
In addition to the physiological complications, psoriasis can affect a person's mental health. Changes in appearance, poor skin condition, and unbearable itching can cause self-doubt and lead to a depressive disorder.
Diagnosis of psoriasis
A dermatologist diagnoses skin diseases, including psoriasis.
At the time of admission, the doctor will ask about the symptoms and how long ago they appeared. Then he will ask his closest relatives: parents, siblings about skin diseases. Family history allows a specialist to immediately recognize diseases that may be hereditary - psoriasis is one of them.
The doctor will also ask about conditions that provoke the appearance of new rashes and worsening symptoms. For example, new psoriatic lesions may appear after taking a hot bath or prolonged exposure to the sun. In some patients, plaques appear at the injection sites, scratches or after rubbing the skin on clothes - this is how the Koebner phenomenon, which is characteristic of psoriasis, manifests itself.
An important point in making the diagnosis is the examination of the rash. If the description of the disease is not enough, a specialist can observe the rash over time and prescribe a histological examination of the skin (biopsy).
If the doctor is not sure that the plaques on the skin are psoriasis, he will order a biopsy and histological examination of the skin.
Histological examination of skin and subcutaneous neoplasms
The study allows identifying malignant changes in the tissues of skin tumors (moles, papillomas, warts, age spots). Material obtained during biopsy or surgery is used for analysis.
In some cases, a specialist can check the psoriatic triad, which are the main diagnostic signs of psoriasis.
First, the dermatologist will take a glass slide or scalpel and begin to gently scrape the surface of the plaque. Light peeling of whitish scales from the surface or stearin stain phenomenon is the first sign of triad.
After all the peels are peeled off, the surface of the board is smooth, shiny and slightly moist. This is the second sign of the triad - the terminal film.
If the doctor continues to scratch the spot, there will be definite bleeding on its surface, which is called bloody dew, the third sign of Auspitz syndrome or the psoriatic triad.
After examination and anamnesis, the doctor will prescribe laboratory tests. In general, it is recommended to undergo a clinical blood test - it reflects the general state of health. The patient is also sent for blood biochemistry. This allows us to evaluate the work of internal organs and metabolism - with a long course, psoriasis can lead to pathologies of the cardiovascular and endocrine systems.
A general urine test is also often prescribed. Disorders related to the urinary system may interfere with the prescription of certain medications.
General urine test includes physical and chemical examination of urine (color, density, composition) and microscopic examination of its sediment. A general urine test is prescribed to check the condition of the body, identify pathologies of the urinary system, gastrointestinal tract, endocrine, infectious and inflammatory diseases.
For the same reason, according to clinical recommendations, tests for HIV and hepatitis are prescribed. Against the background of these infections, the disease can be more severe.
Also, when preparing for treatment, women should undergo a pregnancy test - for example, take a blood test for beta-hCG. The fact is that many of the most prescribed and effective systemic drugs for the treatment of psoriasis are contraindicated during pregnancy.
The research makes it possible to make a diagnosis in the early stages of pregnancy and identify its complications. It is used to evaluate the effectiveness of the procedure in induced abortion. In oncology - for the diagnosis of hormone-producing tumors.
If you complain of joint pain, your doctor will send you for an MRI, CT or X-ray to confirm or rule out psoriatic arthritis. If joint inflammation is confirmed, the dermatologist will recommend an examination by a rheumatologist.
Treatment of psoriasis
If the affected skin area is small, patients are prescribed topical corticosteroid creams or ointments. They suppress inflammation and reduce disease manifestations.
In addition, the doctor can prescribe local analogues of vitamin A or vitamin D. Such preparations eliminate inflammation, accelerate the erosion of the stratum corneum of the skin and slow down the growth of psoriatic plaques. It is also recommended to use skin moisturizers from Aptek dermatocosmetics lines.
Mild psoriasis is often treated with topical ointments and creams.
Systemic treatment may be required for moderate and severe psoriasis - classic immunosuppressive and genetically engineered biological drugs in the form of tablets or subcutaneous injections. They have an obvious effect, but a careful examination is required before use.
Systemic glucocorticosteroids for psoriasis are contraindicated and can be prescribed by a doctor only in certain (extremely difficult) situations and in hospital settings. Otherwise, such treatment can significantly worsen the condition.
Psoriasis is also treated with phototherapy: ultraviolet light of a certain spectrum is directed at the plaques. Many physiotherapy offices have special lamps for this type of treatment.
The most modern and effective way to treat psoriasis is monoclonal antibodies (genetic engineering biological therapy). These drugs can block some stages of the inflammatory response, such as certain cytokines Cytokines Proteins produced by the immune system's protective cells, which trigger inflammation and plaque growth in psoriasis.
Prevention of psoriasis
There is no specific prevention that can prevent the development of psoriasis.
In general, it is recommended to lead a healthy lifestyle: give up alcohol and smoking, do sports, and eat a healthy and balanced diet.
People with relatives with psoriasis should be more careful with their skin: moisturize it regularly, avoid hypothermia, prolonged exposure to the sun, and visiting solariums. Tattoos are not recommended if you have a hereditary predisposition to psoriasis.
Forecast
Psoriasis is a chronic pathology like all autoimmune diseases. Psoriasis cannot be completely cured.
However, timely and correctly selected treatment can allow the patient to achieve long-term remission - an asymptomatic disease period.
Frequently asked questions
How is psoriasis transmitted?
Psoriasis cannot be contracted. It's an autoimmune disease - it occurs when a person's immune system malfunctions and mistakenly attacks skin cells. The disease has a hereditary (genetic) tendency, that is, it can be hereditary.
How does psoriasis manifest itself?
In most cases of psoriasis, large red, scaly plaques appear on the surface of the skin. They can be very itchy and even painful. Most often, psoriatic patches appear on the elbows, knees, trunk and scalp.
Which doctor treats psoriasis?
A dermatologist treats psoriasis.
Can people with psoriasis be accepted into the army?
With a mild form of psoriasis, they can be assigned category B - "limitedly suitable". A conscript with moderate or severe psoriasis may be considered unfit for military service. In each specific case, the decision is made individually during the medical examination.