Psoriasis is a pathology in which the human immune system mistakenly attacks healthy skin cells. As a result, flaky plaques appear on its surface, which can be very itchy and even painful. Sometimes this disease is also 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 is not contagious - it is an autoimmune disease, not an infectious disease.
Psoriasis is characterized by inflammation of the skin, as well as the rapid growth and exfoliation of abnormal cells (keratinocytes) that make up the stratum corneum - the epidermis. Usually, it is completely renewed within a month, but in people with psoriasis this process is accelerated several times and occurs on average in 3-4 days.
In addition to skin damage, the disease causes joint inflammation (in about 30% of cases). A little less often - in 10% of cases - psoriasis leads to inflammation of the uvea (uveitis).
Prevalence of psoriasis
Psoriasis most often affects people aged 15-35, but in general the disease can appear at any age. The first peak of the onset of pathology occurs at 15-20 years, the second at 55-60.
On average, psoriasis affects about 1-2% of people worldwide. In our country, according to the clinical recommendations of the Ministry of Health, in 2021 the prevalence of the disease is 243. 7 cases per 100, 000 inhabitants.
Types of psoriasis
Like most chronic diseases, psoriasis is distinguished by stage, severity, and form of manifestation.
By stage
Psoriasis has three stages: progressive stage, stationary stage and regression (remission).
INSIDEprogressive stagered spots appear on the skin. Joined, they form a large scaly plaque with a clear red line around the edge - it is called Erythema Erythematous Redness of the skin caused by dilation of capillaries and blood flow. corolla, or corolla. New plaque is very itchy and can hurt.
Traumatized skin areas are particularly prone to the appearance of new spots: psoriatic plaques can develop quickly in places of friction (for example, on clothing), as well as in areas of scratches or scratches. Doctors call this phenomenon the Koebner phenomenon.
This phenomenon, also known as "isomorphic reaction", was discovered by the German dermatologist Heinrich Koebner in 1872. Doctors noticed that in some patients with psoriasis, new plaques appeared on the skin in places of trauma, for example after scratches, injections or bruises.
Stationary stage- stabilization phase. Plaque stops growing, but continues to irritate and peel. New rashes and spots usually do not appear.
Regression stageoccurs when psoriasis symptoms begin to disappear. Exfoliation disappears, the plaque becomes brighter and smoother. Symptoms decrease in this phase.
By severity
To assess the severity of psoriasis, doctors use the PASI system (Psoriasis Area and Severity Index) - an index to assess the severity and prevalence of psoriasis. It requires a professional analysis of parameters such as severity of erythema, infiltration, peeling, and calculation of the skin area affected by the rash.
Depending on the results of the examination, the doctor distinguishes between mild, moderate and severe disease.
By shape
According to the clinical picture of manifestations, several main forms of psoriasis are distinguished: abrasive, inverse, seborrheic, exudative, guttate, pustular, psoriasis of the palms and soles and psoriatic erythroderma.
Abusive psoriasis (common).- one of the most common forms, accounting for about 90% of all cases of the disease. First, red spots appear on the skin, which in a few days turn into convex, scaly plaques. As the plaques develop, they coalesce into large, itchy, scaly lesions. Then the situation enters the stage of stabilization and regression: the manifestations of the disease recede temporarily and the person's well-being improves.
The most common places where psoriasis vulgaris appears are the extensor (outer) skin of the elbows and knees. Lesions also appear on the body and scalp.
Psoriasis vulgaris on the outside of the elbow
inverse ("inverted") psoriasis.run the same way as usual. The only difference is in the location of the lesions: they do not appear on the extensor (outer) side of the knee and elbow, but on the flexor (inner) side - that is, below the knee, under the armpit and at the elbow. area, as well as in the neck, eyelids, navel, inguinal folds. The skin in this place is smoother, moister and rubs more often on clothes. Because of this, it may be more itchy than the usual form of the disease, but peeling in these places is less noticeable.
Seborrheic psoriasisproceeds in the same way as usual, but the focus is located in places with a large number of glands that secrete sebum. These are the scalp, folds behind the ears, cheeks and nasolabial areas of the face, forehead, chest and back (especially the upper part).
Seborrheic psoriasis of the scalp
Exudative psoriasis- a kind of disease in which, in addition to peeling, exudate also appears in the lesions. It is a fluid that contains proteins, some blood cells and other substances. Exudates can be released from capillaries during inflammation.
The crust on the surface of the plaque in the exudative form of the disease is usually dense, yellow-gray, and sometimes slightly moist. This type of psoriasis most often appears in people with endocrine disorders: thyroid pathology, type 2 diabetes mellitus or obesity.
Guttate PsoriasisIt does not appear as a plaque on the skin, but as many papules - bright red swollen spots with peeling in the middle. The size of the papules can vary from about 1 to 10 mm. They mainly cover the body, arms and legs.
Guttate psoriasis usually occurs in children after a streptococcal infection (for example, tonsillitis). It is treated somewhat better than other types of psoriasis, but in some cases it can turn into a normal (abusive) form.
Pustular psoriasischaracterized by the appearance of multiple pustules on a red erythematous background. Pustules are formations that look very similar to acne. Such psoriasis can be the result of an infectious disease, stress, hormonal imbalance, improper use of medication or insufficient use of ointments. At first, many pustules appear on red spots. They then merge into one large purulent spot (or "purulent lake").
The general form of pustular psoriasis is difficult to tolerate: with episodes of fever, weakness, as well as severe pain and burning of the skin. In parallel, changes in the nails and pain in the joints may be observed.
Psoriasis of the palms and soles- a typical psoriatic rash appears on the palms and soles, less often it occurs in the form of localized pustular psoriasis. It can also affect and change the shape of the nail - it becomes thicker, cloudy and uneven.
Psoriasis on the palms
Erythrodermic psoriasisIt is quite rare and is considered a very severe form of the disease. There is redness on about 90% of the body, severe itching and pain appear, the skin swells and peels. The temperature often rises and the lymph nodes become inflamed.
Usually, this type of psoriasis is the result of the aggravation of other forms of the disease due to improper treatment or adverse environmental factors (for example, sunburn in advanced psoriasis vulgaris, insufficient use of external irritants or intravenous administration of glucocorticosteroids).
Symptoms of psoriasis
Manifestations of psoriasis vary depending on the type of disease and its severity.
Common psoriasis symptoms and signs:
- red, raised, scaly patches on the skin;
- itching in the area of inflammation and peeling;
- changes in the nail: precise effects, thickening and collapse of the plate, its separation;
- joint pain (sometimes).
For an accurate diagnosis, you need to contact a specialist - a dermatologist.
Mechanisms of psoriasis development
Psoriasis is an autoimmune disease.
All autoimmune pathologies are associated with errors in the functioning of the immune system. Normally, it "scans" the body all the time and looks for pathogenic cells by foreign protein molecules that distinguish them from the "normal" cells that exist in the body.
As soon as foreign protein molecules are detected, the immune system activates special immune cells - T-lymphocytes, which must destroy the enemy.
But for some, the friend-foe recognition system may be broken. As a result, the immune system begins to attack the healthy cells of individual organs or tissues, causing inflammation in their location and in every possible way harming the body, which, in fact, it should protect.
This is what happens with psoriasis: the immune system attacks the skin. It activates T-lymphocytes and "fixes" them on skin cells. After reaching the target, T lymphocytes release substances that cause inflammation - cytokines. They trigger the first symptoms: redness, swelling, itching and pain.
With psoriasis, skin cells divide several times faster, resulting in scales and peeling.
Under the influence of cytokines, the inflammatory process develops, and skin cells begin to divide actively - this is how active exfoliation occurs and convex plaques are formed.
Since the process of cell renewal accelerates almost tenfold, the main cells of the epidermis (keratinocytes) do not have time to form properly. Therefore, they cannot perform their barrier function.
As a result, the stratum corneum becomes permeable and stops protecting the deeper layers of the skin from the environment and moisture loss. All of this leads to more inflammation.
Until the immune system calms down, disease will develop and symptoms will increase.
Causes of psoriasis
The exact reason why psoriasis develops is still not fully understood. However, many studies agree that the development of psoriasis is linked to genetics, as well as lifestyle, co-morbidities and adverse environmental factors.
Genetics
This disease is often inherited from parents to children. Psoriasis is mainly associated with the HLA-C gene. It encodes 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 everyone with the HLA-Cw6 marker necessarily has psoriasis, and not all patients diagnosed with the disease have this genetic change.
Lifestyle
It is believed that continuous damage to the skin, frequent friction, sunburn and hypothermia can be triggers for the development of this disease. Especially if there is a hereditary predisposition in the form of the HLA-Cw6 genetic marker or a close relative who suffers from psoriasis.
Other risk factors include constant stress, alcohol abuse and smoking - all of which have adverse effects on metabolism, internal organ function and the immune system.
Concomitant pathology
Some types of psoriasis, such as guttate psoriasis, may 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.
In such diseases, the general mechanism of the immune system is disturbed: it considers some of its own cells as something foreign, reacts with inflammation and destroys them. Therefore, the risk that he will mistakenly add another cell to the "black list" increases.
Complications of psoriasis
Psoriasis is caused by immune system damage and chronic systemic inflammation. It develops due to the continuous invasion of immune cells against healthy tissue.
Autoimmune processes are distinguished by the fact that they can spread: the immune system can include other healthy cells in the list of "enemies" at any time.
For example, against the background of psoriasis, Crohn's disease or ulcerative colitis can develop if the immune system mistakenly attacks the tissue of the gastrointestinal tract.
In addition to autoimmune diseases, people with psoriasis are prone to various endocrine pathologies (metabolic syndrome, obesity, type 2 diabetes), cardiovascular diseases (hypertension, heart attack) and other internal organ dysfunction. All of this is associated with a chronic inflammatory process, which affects hormone levels and disrupts 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 often affecting the lower leg joints. Inflammation of the joint structure develops, the skin in the affected area may turn red, swelling appears, and pain and/or stiffness when trying to bend or straighten the joint.
In 10% of people with psoriasis, the pathology spreads to the eye and develops uveitis. The choroid of the eye becomes inflamed, which leads to decreased vision and discomfort.
In addition to physiological complications, psoriasis can affect a person's mental health. Changes in appearance, poor skin conditions and unbearable itching can cause self-doubt and lead to depressive disorders.
Diagnosis of psoriasis
Dermatologists diagnose skin diseases, including psoriasis.
At the appointment, the doctor will ask about the symptoms and how long they appeared. Then he will ask his closest relatives: parents, brothers and sisters about skin diseases. Family history allows experts to immediately consider hereditary diseases - psoriasis is one of them.
The doctor will also ask about the situation that led to the appearance of new rashes and worsening symptoms. For example, new psoriatic lesions may appear after a hot shower or prolonged exposure to the sun. In some patients, plaques appear at the injection site, scratches, or after rubbing the skin on clothes - this is how Koebner's phenomenon, characteristic of psoriasis, manifests itself.
The important thing in making a diagnosis is the examination of the rash. If the picture of the disease is not enough, the specialist can observe the rash over time and prescribe a histological examination of the skin (biopsy).
If the doctor is not sure that the plaque on the skin is psoriasis, they will prescribe a biopsy and a histological examination of the skin.
Histological examination of skin and subcutaneous neoplasms
The study allows us to identify malignant changes in skin tumor tissue (moles, papillomas, warts, age spots). For analysis, material obtained through biopsy or during surgery is used.
In some cases, the specialist can check for the psoriatic triad, the main diagnostic sign of psoriasis.
First, the dermatologist will take a glass slide or a scalpel and begin to gently scrape the surface of the plaque. Light exfoliation of whitish scales from its surface, or the phenomenon of stearin staining, is the first sign of the triad.
After all scabs are peeled off, the surface of the plaque becomes smooth, shiny and slightly moist. This is the second sign of the triad - the terminal film.
If the doctor continues to scratch the spot, accurate bleeding will appear on its surface, which is called Auspitz syndrome, or bloody dew, the third sign of the psoriatic triad.
After examination and medical history, the doctor will prescribe laboratory tests. It is generally recommended to take a clinical blood test - it reflects the general state of health. Patients are also referred for blood biochemistry. It allows you to evaluate the function of internal organs and metabolism - with a long course, psoriasis can trigger pathologies of the cardiovascular and endocrine systems.
A general urine test is also often prescribed. Problems with the urinary system may interfere with the use of certain medications.
General urinalysis 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, to 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 this infection, the disease can become worse.
Also, in preparation for treatment, women should take a pregnancy test - for example, take a blood test for beta-hCG. The fact is that many systemic drugs, which are most often prescribed for the treatment of psoriasis and have a good effect, are contraindicated during pregnancy.
This study allows you to diagnose pregnancy at an early stage and identify its complications. In a consequential abortion, it is used to evaluate the effectiveness of the procedure. In oncology - for the diagnosis of hormone-producing tumors.
If you complain of joint pain, the doctor will also refer the patient for an MRI, CT scan 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, the patient is given a topical corticosteroid cream or ointment. They block inflammation and reduce disease manifestations.
In addition, the doctor may prescribe a local analogue of vitamin A or vitamin D. Such drugs relieve inflammation, accelerate the exfoliation of the stratum corneum of the skin and slow down the growth of psoriatic plaques. It is also recommended to use skin moisturizers from the pharmacy dermatocosmetics line.
Mild psoriasis is often treated with ointments and creams for external use.
For moderate to severe psoriasis, systemic treatment may be required - in the form of classical immunosuppressive biological drugs and genetic engineering in the form of tablets or subcutaneous injections. They have a clear effect, but require careful inspection before use.
Systemic glucocorticosteroids for psoriasis are contraindicated and can only be prescribed by a doctor in specific (very difficult) situations and in a hospital setting. Otherwise, such treatment can lead to a significant deterioration of the condition.
Psoriasis is also treated with phototherapy: ultraviolet light of a certain spectrum is directed at the plaque. Many physical therapy offices have special lights for this type of treatment.
The most modern and effective way to treat psoriasis is monoclonal antibodies (genetically engineered biological therapy). These drugs can block some stages of the inflammatory response, for example, certain cytokines CytokinesProteins, produced mainly by the protective cells of the immune system, 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: stop alcohol and smoking, exercise, and eat a healthy and balanced diet.
People whose relatives have psoriasis should be more careful about their skin: moisturize it often, avoid hypothermia, prolonged exposure to the sun, and also avoid visiting the solarium. Tattoos are not recommended if you have a hereditary predisposition to psoriasis.
Forecast
Psoriasis is a chronic pathology, like all autoimmune diseases. It is impossible to cure psoriasis completely.
However, timely and correctly selected treatment can allow patients to achieve long-term remission - a period of disease without symptoms.
Common questions
How is psoriasis transmitted?
Psoriasis is not contagious. It is an autoimmune disease—it occurs when a person's immune system malfunctions and mistakenly attacks skin cells. The disease has a hereditary (genetic) tendency, which means that it can be inherited.
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 spots appear on the elbows, knees, trunk and scalp.
Which doctor treats psoriasis?
Dermatologists treat psoriasis.
Can people with psoriasis be accepted into the army?
With a mild form of psoriasis, they can be assigned category B - "suitably limited". Service members 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.