According to the WHO, 2-4% of the world's population currently suffers from psoriasis. This disease affects patients of all ages, but is most common in young people (15-25 years old). Unfortunately, medicine today is not able to completely cure psoriasis, but timely professional treatment can significantly improve your quality of life. So if you notice the first symptoms, it is better to see a doctor immediately.
Psoriasis- It is a dermatosis that manifests itself in the form of scaly papules on the skin. Its distinguishing feature is that in addition to the skin, it can affect the joints and nail plates. Inherited factors in the pathogenesis of psoriasis can be clearly traced, and other irritants are only secondary causes of its occurrence.
As the disease gets worse, the natural processes of formation are interrupted - keratinocytes (cells that make up mainly human skin). There are also pronounced biochemical changes in the skin. In addition, physicians have recently been able to determine that nervous system function is abnormal in the acute phase of the disease. In general, the main cause of psoriasis is the presence of functional disorders in the immune system.
The spread of psoriasis
Psoriasis is common. Currently, the incidence statistics are approximately as follows:
- China - 0, 3%;
- USA - 1%;
- Denmark - 1-2, 3%;
- Northern Europe - 3%;
- Germany - 1-1, 3%.
Interestingly, the indigenous population of South America is not affected by the disease. At least so far, no such cases have been reported. Looking at the situation as a whole, the rate of psoriasis is about 6-8% of all skin diseases.
As already mentioned, psoriasis occurs at any age, but most often young people (up to 25 years old) continue to suffer and occur with the same frequency in both men and women.
Epidemiological situation
Based on the causes, psoriasis is a non-communicable disease with a pronounced genetic predisposition. People whose relatives also suffer from this disease are most at risk for the disease (in this case, we only think of the closest relatives). European researchers have certainly found that if one parent is ill, they are 14-25% more likely to pass it on to their child. If both parents are sick, this probability is already 41-60%.
According to the type of disease, psoriasis is divided into two groups:
- early;
- late.
This is evidence that there are two main types of psoriasis (e. g. , diabetes mellitus). It occurs in the first human at an early age (mean 16-22 years), is strictly hereditary, and is directly related to the HLA phenotype (HLA-Cw6). The course of the disease is often severe and over time the disease only progresses.
A II. The causes of this type of psoriasis are quite random, so this disease is sporadic. It is most common in older people (about 60 years old). It usually progresses fairly easily, but in some cases can be aggravated by damage to the joints and nails.
Factors provoking the appearance of psoriasis
Although psoriasis is usually inherited, it is usually multifactorial. Anything can trigger a fatal failure of the immune system. The provoking factors are thus divided into external and internal (or exogenously and endogenously in scientific terms) groups.
Exogenous factors
<1_img_rxx>These, in turn, are divided into physical and chemical parts. The former include the usual mechanical damage to the skin, such as household injuries, heat burns, abrasions, scars, tattoos, scratches, insects, and pet bites. Cases of psoriasis have also been recorded at the injection site. X-rays and ultraviolet radiation also play a significant role. In about 5% of cases, the disease occurs in the summer and 40% is due to sunburn.
Chemical factors are expressed by the dermal toxicity of harmful chemicals or other irritants. In addition, psoriasis is caused by other skin diseases, such as:
- dermatoses;
- fungal infections;
- infectious impetigo;
- acne;
- dyshidrosis;
- lichen;
- shingles;
- gangrenous pyoderma;
- allergic dermatitis of various natures.
Cases of the disease are known after performing basic diagnostic skin tests to reveal the body’s reaction to cosmetics, hygiene products, formalin, chromium, nickel and other chemicals.
Endogenous factors
The internal causes of psoriasis can be infectious diseases. Recent research in this area suggests that streptococcal infections and HIV are likely to be to blame. Moreover, often the symptoms do not occur during the disease but also after the usual vaccination. In these cases, psoriasis can often be difficult to treat.
Lithium supplements, beta-blockers, non-steroidal anti-inflammatory drugs, and ACE inhibitors are used to induce remission. Corticosteroids are contraindicated in this case.
Pregnancy and childbirth
Significant changes in hormonal levels caused by pregnancy can also become a provocative factor. A similar pattern is observed during puberty. It is also curious that women who already have psoriasis can improve their condition during pregnancy (40%). Deterioration occurs much less frequently (only in 14% of cases). True, most patients worsen again after delivery (54% of cases)
Diet and nutrition
These factors often have no noticeable effect on the course of the disease. It is only certain that alcohol and cigarette abuse significantly increases the chances of developing psoriasis and worsens its course.
Hypocalcaemia and hypokalaemia
These factors may trigger the appearance of generalized pustular psoriasis. The chances of a favorable outcome in this case are very small.
Pustular psoriasis.
Psychogenic factors
Their role today is considered quite controversial. Some researchers claim that the presence of traumatic psychogenic factors provokes psoriasis in 60% of cases. However, it is only certain that they can only aggravate the course of the disease and reduce the effectiveness of the therapy.
Classification
Currently, several different types of psoriasis have been identified. They differ significantly from the clinical picture and the extent of the effect on the body, so in order to get a picture of the stakes, it is better to look at the World Wide Web and study the psoriasis photos carefully. various etiologies as well as familiarize yourself with the description.
Vulgar psoriasis
Vulgar or common psoriasis occurs in most cases. This disease manifests itself as a copious rash of tiny, bright red papules (from the match head to the peas). After their appearance, they grow quickly, with silver-white scales appearing on their surface. In the future, the papules will transform into plaques that will merge into a major lesion. Very often there are clear boundaries that separate them from healthy skin.
When you try to comb or remove the papula, the peeling increases first. This phenomenon is called the "stearin stain symptom, " and once all the scales have been removed, a shiny, smooth surface, the "terminal film symptom, " is found. If you continue scraping, the capillaries will be damaged and blood droplets will be released. This symptom is known as "blood dew. "
The development of psoriasis is divided into three main periods:
- progressive (acute);
- stationary;
- resolution period.
The success of the treatment here depends mostly on the correct choice of the methods of therapy, as their effectiveness varies significantly depending on the period.
Advanced period. This stage is characterized by the abundant appearance of a particular rash. In the exacerbation phase, parts of the patient's body are covered with tiny papules that actively peel. Peeling in this case is strictly localized and does not affect healthy skin. It is easy to identify acute psoriasis based on the characteristic red or pink border that limits the papule.
The most common symptoms at this stage are the presence of itching and the so-called Koebner symptom. The latter manifests itself in the fact that psoriatic papules appear at the site of all skin lesions (minor burns, scratches, injections, scratches, etc. ). This phenomenon occurs on average two weeks after injury and occurs in 38-76% of all patients.
It is also extremely curious that (much less often) the opposite effect can also be observed. Scientists believe that in some patients' blood serum is caused by special factors that inhibit Koebner's syndrome.
Stationary period. On average, 2-3 months after the onset of the first rash, the formation of new papules stops. Plaque growth also stops. At this stage, their entire surface is already covered by scales. This period can last for months or even years. However, the latter is relatively rare.
The resolution period. This period is also called the regression period, as a gradual decrease in plaque is observed in the meantime. At first, they stop peeling and then gradually smooth out until they completely disappear. If the disease is mild, this phenomenon occurs spontaneously. The treatment only speeds up the onset. Often, the site of plaque placement in the background of healthy skin areas is characterized by depigmentation, or, somewhat less frequently, hyperpigmentation. In psoriasis vulgaris, the rash can occur almost anywhere and is usually symmetrically localized (the extensor surfaces of the elbow and knee). It can also appear on the head, sacrum, hands, palms, soles, groin, and armpits. In addition, in many cases, the nail plates are also affected (appearance, loosening, thickening of point-like pits). These symptoms are very similar to those that occur when infected with a fungus, so the final diagnosis is made only after a special laboratory test has given a negative reaction to the fungal spores. Psoriasis vulgaris as a whole has no overall negative effect on the patient's body, its course is chronic. Periods of exacerbation occur in autumn or winter, while in summer exacerbations occur on the contrary, much less frequently. The main incentive for active treatment is that without proper therapy, psoriasis plaques can cover the body for years, while proper treatment causes improvement after a few months.
Psoriatic erythroderma
Psoriasis erythroderma is one of the most unpleasant forms of the disease. On average, a similar reaction is observed in approximately 2% of patients, both spontaneously and as a result of inadequately selected treatment. Although, of course, if the medications used irritate the skin or are exposed to ultraviolet radiation, the risk of psoriasis erythroderma is much higher. Most often, psoriasis erythroderma suddenly appears in the first stage of psoriasis. It can be combined with arthritis and generalized pustular psoriasis, and exposure to factors such as streptococcal infections or hypocalcemia significantly increases the likelihood of such complications. Abrupt withdrawal of corticosteroids can also worsen the condition. The appearance of erythroderma completely eliminates the clinical symptoms of psoriasis, which are replaced by diffuse redness of the skin, severe itching, and lamellar exfoliation.
Pustular psoriasis
It is also a severe form of psoriasis. It is characterized by the appearance of abscesses, which often remain the only symptom. It is much less commonly combined with the classic symptoms of psoriasis. Pustular psoriasis is common and localized. The second differs only in that the abscesses in this case are concentrated only in the palm or plantar area.
Psoriatic arthritis
Currently, psoriasis arthritis alone is considered an autoimmune disease. It is expressed in bone and muscle damage in patients who already have psoriasis or who have a high family history of the disease. Very often, arthritis of psoriasis is combined with classic psoriasis as well as psoriasis nail lesions. This disease is diagnosed by the occurrence of back pain, which is accompanied by the following conditions:
- lack of a clearly stated reason for the appearance;
- the patient is over 40 years of age;
- unreasonable deep pain in the lower back or buttocks;
- vague localization of pain;
- reducing pain after exercise;
- pain or stiffness felt early in the morning or at night;
- the presence of pain with an excellent general condition of the musculoskeletal system.
The nail plates are psoriasis
Very often, psoriasis of psoriasis is accompanied by nail damage. In this case, their pronounced dystrophy and symptoms characteristic of fungal infections are observed. It is a common companion to arthritis of psoriasis. Considering that about 4% of the world’s population suffers from psoriasis, 30-50% of them also suffer from nail psoriasis.
Treat psoriasis
Unfortunately, at present, medicine is still unable to cure psoriasis, as this requires a much deeper understanding of the specifics of the work of the basic mechanisms of the human immune system. Because this type of research is fairly slow and the disease itself does not pose a particular threat to life, symptomatic therapy is currently a priority. Before starting treatment, the patient needs a thorough examination, as each organism contains different factors that affect the course of the disease. Gender, age, occupation, general health, type of psoriasis - all should be considered when prescribing therapeutic therapy. The nature of the course of the disease, the individual's sensitivity to drugs, and the current stage of the disease also play an important role.
General activities
First, the doctor must determine the patient's mental and physical condition, assess the general condition of his body, and know how tolerant he is of the disease. The best prerequisites for effective treatment are good rest, staying in a calm environment, switching to a less intensive work mode, or short-term hospital treatment. Various methods of psychotherapy (rehabilitation in marine resorts using cognitive-behavioral therapy, etc. ) have also proved quite well. It is also very important that the patient knows that the healing process is going as it should, because without a quick effect, about 40% of patients lose faith in the effectiveness of the therapy and ignore it. It is important to remember that psoriasis is a chronic disease, so the safety of therapy should be considered. Many drugs are toxic and can accumulate in the body, becoming a timed bomb. An addictive effect is also possible, so it is better to save the most effective medications until the really dangerous symptoms appear.
Disease course and long-term prognosis
The course of psoriasis is often unpredictable. For modern doctors, this has been virtually unsuccessful, which is why, as before, psoriasis is still an unpleasant and uncontrollable disease. In each case, it is entirely individual, so any attempt to predict the course of the disease and the duration of the phases of exacerbation and remission is doomed to failure. I only like one thing - despite the difficulty of treatment, it rarely poses a real threat to a patient’s life. As for arthritis of psoriasis, this disease is much milder than rheumatoid arthritis, and the deterioration in patients' quality of life is very insignificant compared to the latter. Statistics show that with proper treatment, the majority of patients with psoriasis arthritis remain functional and can live a full life. If the required therapy is lacking or the disease is associated with complications, joint deformities may develop with the further development of severe pathologies. However, such complications occur in very few patients with psoriasis. Most patients can expect a gradual stabilization of the condition and the appearance of long-term remissions (more than two years). In very rare cases, the disease occurs mainly in the active phase, but in this case it can be effectively localized. Effective treatment for psoriasis is available today in any major city. And although, as you know, ultimate healing is not achievable, diet, special medications, and procedures do their job quickly. In addition, you will not need long-term treatment in a hospital. The doctor’s job is only to quickly bypass the first two stages of psoriasis and get the person into remission. After that, the patient can only take care of themselves, follow the instructions, and forget about the disease for a long time.