According to WHO, 2 to 4 percent of the world's population has psoriasis. This disease affects patients of all ages, however, it is most common in young people (15-25 years). Unfortunately, today's medicine cannot completely cure psoriasis, but prompt professional treatment greatly improves quality of life. Therefore, in the event of detecting the first symptoms, it is better to immediately consult a doctor.
Psoriasis- This is a dermatological disease, manifesting as scaly papules on the skin. Its distinguishing feature is that in addition to the skin, it has the ability to affect joints and nail plates. In the pathogenesis of psoriasis, genetic factors are clearly traced, and other irritants are only secondary causes of its occurrence.
During an exacerbation of the disease, the natural processes of formation are disrupted - keratinocytes (cells of which human skin is mainly composed). There are also marked biochemical changes in the skin. In addition, recently, doctors were able to determine that in the acute phase of the disease, the functioning of the nervous system is also different from normal. In general, the main reason for the appearance of psoriasis is the presence of a malfunction in the functioning of the immune system.
The incidence of psoriasis
Psoriasis is common. Currently, the prevalence statistics are approximately as follows:
- China - 0. 3%;
- United States - 1%;
- Denmark - 1-2, 3%;
- Nordic - 3%;
- Germany - 1-1, 3%.
It is curious that the indigenous population of South America is not affected by this disease. At least no such case has been reported so far. Overall, the prevalence of psoriasis is approximately 6-8% of all skin diseases.
With that said, psoriasis manifests at any age, but often young people (up to age 25) still have it, and in both men and women, it occurs with equal frequency.
Epidemiological situation
Based on the cause of appearance, psoriasis is a non-communicable disease with a pronounced genetic predisposition. The people most at risk of the disease are those whose relatives also have the disease (in this case only the closest relatives are meant). European researchers have determined that if one of the parents is sick, the probability of passing the disease on to the child is 14-25%. If both parents have the disease, the probability is 41-60%.
According to the form of development of the disease, psoriasis is divided into two groups:
- Soon;
- late.
This is evidence that there are two main types of psoriasis (like diabetes). The first occurs in humans at an early age (median age 16-22 years), which is strictly heritable and is directly related to the HLA phenotype (HLA-Cw6). The course of the disease is usually severe and over time the disease only gets worse.
The causes of type II psoriasis are quite random, so the disease is sporadic. It occurs most often in older people (about 60 years of age). In general, it is fairly easy, however, in some cases, it can be aggravated by damage to the joints and nails.
Factors that provoke the appearance of psoriasis
Although psoriasis tends to be hereditary, it is generally a multifactorial disease. Anything can cause a fatal malfunction of the immune system. Thus, stimuli are divided into extrinsic and intrinsic (or in scientific terms, exogenous and endogenous).
Exogenous factors
They are, in turn, divided into physical and chemical. Causes include common mechanical injuries to the skin, such as domestic wounds, thermal burns, abrasions, scars, tattoos, scrapes, insect and pet bites. Cases of psoriasis at injection sites have also been reported. X-ray and ultraviolet radiation also play an important role. In about 5% of all cases, the disease occurs in the summer, and 40% of them are caused by sunburn.
The chemical factor is expressed in the toxic effect of harmful chemicals or other irritants on the skin. In addition, psoriasis is caused by other skin diseases, such as:
- Dermatology;
- fungal infections;
- contagious impetigo;
- acne;
- digestive disorders;
- lichens;
- herpes zoster;
- necrotizing pyoderma;
- atopic dermatitis of different natures.
There are known cases of the disease after preliminary diagnostic skin tests are performed to find out how the body reacts to cosmetics, hygiene products, formalin, chromium, nickel and other chemicals.
Endogenous factors
The internal causes of psoriasis can be infectious diseases. The latest research in this area suggests that streptococcal infections and HIV are most likely the cause. Furthermore, symptoms usually do not appear during illness but even after routine vaccination. In these cases, psoriasis is often difficult to treat.
For remission, lithium preparations, beta-blockers, non-steroidal anti-inflammatory drugs and ACE inhibitors are used. Corticosteroids are contraindicated in this case.
Pregnancy and childbirth
Significant changes in hormone levels due to pregnancy can also become a trigger. A similar pattern is also observed in puberty. It is also curious that women who already have psoriasis can improve their condition during pregnancy (40%). Functional impairment is much less common (in only 14% of cases). Yes, after childbirth in most patients, the condition worsens again (in 54% of cases)
Diet and nutrition
These factors usually have no noticeable effect on the course of the disease. It is only known for certain that alcohol and tobacco abuse significantly increases the risk of psoriasis and worsens the course of the disease.
Hypocalcemia and hypokalemia
These factors can trigger the appearance of systemic pustular psoriasis. The chance of a favorable outcome in this case is very small.
Pustular psoriasis.
Psychological factors
Their role today is considered quite controversial. Some researchers state that the presence of traumatic factors causes psoriasis in 60% of all cases. However, it is only known for certain that they can only aggravate the course of the disease and reduce the effectiveness of treatment.
Classify
Currently, several distinct types of psoriasis have been identified. They differ markedly in the clinical picture and the degree of effect on the body, therefore, to get an idea of what is at stake, it is better to look at the World Wide Web and carefully study the photos ofpsoriasis of various etiologies, as well as familiarize yourself with the description.
Psoriasis
Pustular or disseminated psoriasis occurs in most cases. This disease presents as a rash of many small, bright red papules (from the tip of a matchstick to a pea). Once appearing, they rapidly grow and appear silvery-white scales on their surface. In the future, papules turn into plaques, merging into one large lesion. Very often they have clear boundaries separating them from healthy skin.
When you try to comb or remove the papilloma, the flaking will increase first. This phenomenon is known as the "stearin spot symptom", and once all the scabs have been removed, the smooth surface, which can be found, the "terminal membrane symptom", can be found. If you continue to scrape, the capillaries will be injured and blood droplets will be released. This symptom is called "blood fog".
The development of psoriasis is divided into three main periods:
- progressive (acute);
- freeze;
- settlement period.
The success of treatment here largely depends on how correctly the treatment methods are selected, since their effectiveness varies considerably from period to period.
Progression stage. A feature of this stage is the profuse appearance of specific rashes. During an exacerbation, some parts of the patient's body are covered with small papules, which are actively sloughing off. Peeling in this case is strictly atopic and does not affect healthy skin. Acute psoriasis can be easily recognized by the characteristic red or pink border, limited to papules.
The most characteristic symptoms at this stage are itching and the presence of the so-called Koebner's symptoms. The second is manifested in the presence of psoriatic papules at the site of skin injury (slight burn, abrasion, injection, scratching, etc. ). This phenomenon occurs an average of two weeks after injury and occurs in 38-76% of all patients.
It is also extremely curious that (much less often) the opposite effect is also observed. Scientists believe that the cause is because in the serum of some patients there is a specific factor that inhibits Koebner's syndrome.
Sedentary period. On average, 2-3 months after the appearance of the first nodules, the formation of new papules stops. The growth of the arrays also stopped. At this stage, their entire surface is covered with scales. This period can last for months or even years. However, the latter is relatively rare.
Resolution period. This stage is also known as the receding phase, as the gradual reduction of plaques is observed during that time. At first, they stop flaking, then they gradually smooth until they disappear completely. If the disease is mild, this phenomenon occurs spontaneously. Treatment only speeds up its onset. Usually, the location of the patches is prominent against the background of healthy skin areas by hypopigmentation or less frequently by hyperpigmentation. With psoriasis vulgaris, rashes can occur almost anywhere, and they are usually symmetrically localized (extended surfaces of the elbows and knees). May also appear on the head, sacrum, hands, palms, soles, groin, and armpits. In addition, in many cases, nail plates are also affected (pitting, peeling, thickening). These symptoms are very similar to those that occur with a fungal infection, so a final diagnosis is made only after receiving a negative test for fungal spores in a special laboratory study. Psoriasis in general does not have a general negative effect on the patient's body, and its course is chronic. Exacerbations occur in the fall or winter, while summer exacerbations, by contrast, are much less common. The main motivation for aggressive treatment lies in the fact that without proper therapy, psoriasis plaques can cover the body for years, while adequate treatment improves after a few months.
Erythema psoriatic
Erythema psoriasis is one of the most unpleasant forms of this disease. On average, a similar reaction is observed in about 2% of patients and it occurs spontaneously and as a result of improperly selected treatment. Of course, if the medications used cause skin irritation or exposure to UV radiation, the risk of erythrodermic psoriasis is much higher. Usually, psoriatic erythema occurs suddenly in the early stages of psoriasis. It can be associated with arthritis and systemic pustular psoriasis, and exposure to factors such as streptococcal infection or hypocalcemia greatly increases the likelihood of complications. Abrupt discontinuation of corticosteroids can also worsen the condition. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, replacing it with diffuse redness, intense itching and patchy peeling.
Pustular psoriasis
Also a severe form of psoriasis. It is characterized by the appearance of an abscess, which often remains the only symptom. Less often they are associated with the classic symptoms of psoriasis. Pustular psoriasis is generalized and localized. The second only differs in that the abscesses in this case are only concentrated in the palm or soles of the feet.
Psoriatic arthritis
Currently, psoriatic arthritis is classified as an autoimmune disease in its own right. It is manifested by bone and muscle damage in patients who already have psoriasis or are at high risk for the disease from a family history. Psoriatic arthritis is very often associated with classical psoriasis, as well as psoriatic lesions of the nails. This disease is diagnosed when back pain occurs, accompanied by the following conditions:
- lack of a clear reason for the appearance;
- the patient's age is over 40;
- unexplained deep pain in the lower back or buttocks;
- indistinct localization of pain;
- pain relief after exercise;
- feeling pain or stiffness early in the morning or at night;
- the presence of pain with an excellent general condition of the musculoskeletal system.
Psoriasis of the nail plates
Very often, psoriasis vulgaris is accompanied by nail lesions. In this case, we observe pronounced dystrophy, as well as symptoms characteristic of fungal infections. It is a frequent companion of psoriatic arthritis. Considering that about 4% of the world's population suffers from common psoriasis, then 30-50% of them also have nail psoriasis.
Treatment of psoriasis
Unfortunately, at present, medicine is still unable to cure psoriasis, as this requires a deeper knowledge of the specifics of the functioning of the basic mechanisms of the human immune system. Because this type of research is progressing fairly slowly and the disease itself is not specifically life-threatening, symptomatic therapy is currently the priority. Before starting treatment, the patient should be thoroughly examined, since each organ contains a distinct group of factors that affect the course of the disease. Gender, age, occupation, general health, type of psoriasis - all these must be taken into account when prescribing therapy. An important role is also played by determining the nature of the disease process, the individual's susceptibility to the drug and the current stage of the disease.
General activities
First of all, the doctor needs to determine the mental and physical condition of the patient, assess the general condition of the body, and find out the patient's tolerance. The best prerequisites for effective treatment are good rest, being in a quiet environment, switching to a less intense work mode, or being hospitalized for short periods of time. Various psychotherapeutic approaches (rehabilitation at beach resorts with the use of cognitive-behavioral therapy, etc. ) have also been shown to be quite good. It is very important for the patient to know that the healing process is going on as normal, because, if the effect is not received quickly, about 40% of the patients lose confidence in the effectiveness of the therapy and begin treatment. ignore it. It is important not to forget that psoriasis is a chronic disease, so the safety of therapy must be taken into account. Many drugs are toxic and can build up in the body, turning into time bombs. Addictive effects can also occur, so it's better to save the strongest drugs until really dangerous symptoms appear.
Disease progression and long-term prognosis
The course of psoriasis is often unpredictable. Modern doctors have practically failed to do this, therefore, as before, psoriasis remains an unpleasant and uncontrollable disease. In each case, it proceeds completely individually, so that any attempt to predict the course of the disease, as well as the duration of the exacerbation and remission periods, fails first. There is only one gratification - although difficult to treat, it is rarely truly life-threatening. Psoriatic arthritis is much more susceptible than rheumatoid arthritis, and the reduction in quality of life compared to the latter is very insignificant. Statistics show that with proper treatment, most patients with psoriatic arthritis can still function normally and can lead a full life. Without the necessary therapy, or the disease progresses with complications, joint deformities may develop with the further development of serious pathologies. However, such complications are seen in only a very small number of patients with psoriasis. Most patients can count on gradual stabilization of the condition and the emergence of long periods of remission (more than two years). In some very rare cases, the disease is primarily progressive in the active phase, however, in this case it can be effectively localized. An effective treatment for psoriasis today can be obtained in any major city. And, although, as you know, it is impossible to achieve final recovery, the diet, special drugs and procedures will quickly do their job. In addition, you will not need long-term treatment in the hospital. The doctor's job is just to quickly bypass the first two stages of psoriasis and bring the patient into remission. After that, the patient can only take care of themselves, follow the instructions and forget the disease for a long time.