Psoriasis is a chronic inflammatory disease of a multifactorial nature that affects the skin and nails and is often accompanied by pathology of the musculoskeletal system.
If you are concerned about red, dry patches of various shapes and sizes on your skin that are scaly and itchy, make an appointment with a dermatologist.
Our doctors treat psoriasis using an integrated approach - using both medical treatment methods (ointments, gels, aerosols, tablets and drug injections) and the well-proven excimer light treatment using an Italian laser device.
Causes of psoriasis
Doctors indicate several reasons for the development of psoriasis:
- Genetic predisposition - scientists have described a number of genes, the presence of which predisposes to the appearance of the disease;
- Malfunctions of the endocrine, immune and nervous systems;
- Negative effects of certain environmental factors.
There are also provoking factors, which include:
- Chronic infectious diseases (most often caused by streptococci);
- Alcohol abuse, chronic alcoholism;
- Weather conditions (dry or cold climate);
- Skin trauma (scratches, insect bites, sunburn);
- Frequent emotional stress;
- Taking certain medications (eg, lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
- Abrupt withdrawal of systemic hormonal drugs.
You should not believe the myths that dry skin and excessive hygiene can cause psoriasis - this is absolutely not true!
Stages of psoriasis
Currently, doctors distinguish 3 stages of the disease:
- Progressive - characterized by an increase in the number of rash elements, fusion of papules and the appearance of new elements in the damaged areas. The plaques are bright pink and covered with scales. The rate of cell division in new lesions increases 10-fold;
- Stationary - no fresh elements are observed, the plaques are stagnant-red in color, there is practically no flaking, the itching hardly bothers;
- Regressive - weakening of the intensity of the color of the rash, the elements of the rash are pale, new ones do not appear, there is no peeling, there are no subjective signs. White pseudoatrophic edges form around the plaques, and healthy skin appears in the center of the large plaques. Colorless spots remain at the site of the rash.
In some cases, patients have skin elements at different stages of development at the same time.
Symptoms of the disease
The dermatovenerologist first of all pays attention to the presence of the psoriatic triad. These are spot bleeding, terminal film symptoms and stearin spot.
When you scratch the plaques, a "stearin spot" appears - you can observe increased peeling, and the surface of the papules becomes similar to a broken drop of stearin.
The so-called terminal film can be seen if the scales are completely removed - a wet, thin, shiny film will appear on the surface.
Spot bleeding (Auspitz's symptom) - exposed on the skin when the scale is removed.
Dermatologists also emphasize the Koebner phenomenon - the appearance of psoriatic rashes at the site of skin trauma (scratches, injuries).
The symptoms of psoriasis depend on its type, but there are common points:
- Rashes – they are always present in one form or another;
- Sensation of tightening of the skin at the site of the psoriatic elements;
- Itching of varying intensity.
Plaques in psoriasis appear in different places, but there are also areas with typical localization:
- Scalp (with this placement of the plaques we are talking about seborrheic psoriasis);
- Knees and elbows;
- Skin folds and flexor surfaces - elbow, knee joints, groin, armpit area, under the chest (this localization allows us to talk about reverse psoriasis);
- Lumbar, sacrum;
- Palms and feet - respectively in case of palmoplantar psoriasis;
- Psoriasis of the nails - indentations on the nail plates, subungual hemorrhages, separation of the nail from the nail bed (onycholysis).
In addition to skin manifestations, psoriasis also causes other symptoms. For example, in an arthropathic form, it will be pain in the joints, their swelling (most often these manifestations are localized on the legs, hands, ankles and knee joints).
Types of psoriasis
Dermatologists distinguish several types of disease:
Vulgar(plaque, common) is the most common and accounts for 90% of all cases of psoriasis. In this type of disease, flat inflammatory elements (papules) of red-pink color stand out above the surface of the skin and have clear borders.
They tend to merge and form plaques of various sizes covered with silvery scales. In appearance it resembles a garland or a geographical map.
Psoriatic elements are found mainly on the scalp, on the extensor surface of the elbows and knees, on the skin of the lower back and sacrum, but can also be found in other places.
Psoriasis of the elbow is treated as a special case (there is a permanent plaque on the elbow, and when it is injured, it starts to get worse).
Exudative- occurs more often in patients with endocrine diseases (obesity, diabetes, etc. ). There is exudation in the lesions, as well as yellowish-gray crusts.
teardrop shaped- as the name suggests, numerous papules in the form of bright red droplets are observed on the skin, peeling and infiltration are insignificant. It occurs mainly in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis degenerates into simple psoriasis.
Seborrhoeicdiffers in its localization - elements are found in the back and nasolabial folds, on the chest, in the interscapular region, on the scalp. The color of the scales is yellowish, sometimes they spread to the skin of the forehead and a "psoriatic ring" is formed.
Pustulous- manifested as limited (on palms and soles) or extensive rashes represented by superficial pustules.
Barber's palmoplantar psoriasis, in which the pustules cover the feet and palms, stands out among the pustular types. It is characterized by severe itching, coalescence of pustules with the formation of crusts. The disease often also affects the nails.
Pustules also occur in generalized Tsumbusch psoriasis. This type of disease is characterized by bright erythema (redness) and the appearance of superficial pustules. There is burning and soreness in the areas of the rash. The lesions grow rapidly, coalesce and cover larger areas of the skin. In Tsumbusha psoriasis, the epidermis (the top layer of the skin) peels off and the so-called "pus lakes" are formed. Patients experience a general malaise, they are tormented by fever, burning and numbness in the affected areas.
Psoriatic erythroderma
Doctors focus specifically on this type of psoriasis, psoriatic erythroderma. In this case, the pathological inflammatory process covers all or almost all of the skin. It becomes rough, tight, covered with scaly elements, the skin turns red.
Many of our patients complain of a rise in temperature to subfebrile levels and malaise. There is an increase in peripheral lymph nodes. Erythroderma can develop due to improper treatment of psoriasis (bathing, too intense tanning, high concentration of medical ointments, etc. ). In other cases, the process develops in healthy people, if psoriasis has just begun and progresses rapidly.
If psoriatic erythroderma exists for a long time, patients may experience nail damage and hair loss.
Psoriatic arthritis
This pathology is also called arthropathic psoriasis. Joint damage can develop in parallel with rashes, and in some cases it begins even earlier and is a harbinger of psoriasis.
The small joints of the feet and hands are mainly affected, but sometimes the wrists and ankle joints are also involved in the inflammatory process. Patients are concerned about joint pain, swelling, deformity and limited mobility.
Diagnosis
The main task of diagnostics is to determine the percentage of skin lesions throughout the body. This is necessary to assess the effectiveness of the treatment in a particular patient.
There is an opinion that in order to make a diagnosis, you need to pass a large number of tests. But in most cases this is not the case, and a thorough examination of the rash by a dermatovenerologist is sufficient. Psoriasis has characteristic manifestations, so visual diagnosis is not difficult.
In typical cases, this is the psoriatic triad: punctate bleeding, terminal film symptoms, and stearin spot. Very often, patients are worried about itching of varying degrees of intensity. The presence of psoriasis in relatives is also important.
However, there are skin symptoms that must be distinguished when diagnosing the disease. For example, a similar picture is observed in papular syphilis. In this case, the doctor will carry out a differential diagnosis, including serological tests.
Scalp psoriasis is sometimes confused with seborrheic dermatitis. In psoriasis, the doctor finds that there is a papule on the skin - that is, a seal that rises above the level of the skin and is covered with scales.
In the arthropathic form of psoriasis (when there are no skin rashes), the dermatologist must make sure that it is psoriasis and not rheumatoid arthritis.
Psoriasis often occurs together with other diseases, then doctors talk about concomitant diseases. For example, psoriasis can be combined with coronary heart disease, diabetes, depression or gastrointestinal pathologies.
If a dermatologist diagnoses psoriasis, he will certainly refer the patient for a consultation with a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And these specialists will prescribe a thorough examination (for each disease there is a standard list of tests, in particular blood tests).
The diagnostic base of the modern clinic is represented by the most modern apparatus and devices. This will allow you to undergo a comprehensive examination for various diseases.
Laboratory tests are carried out with the help of modern biochemical and hematological analyzers. Ultrasound doctors examine patients using modern ultrasound machines.
In the radiology department, equipped with the latest medical technology, you can undergo x-rays and mammography. In the clinic, you can also have an MRI or CT scan of any organ.
Doctors of the functional diagnostics department have the opportunity to conduct all the necessary tests: ECG, EEG, echoencephalography, daily ECG monitoring, daily blood pressure monitoring, determination of the function of external breathing and other vital indicators.
The widest range of diagnostic tests presented in our clinic allows doctors to identify diseases at almost any stage of development.
Treatment
The main goal of treatment is to control the disease and put it in remission (weakening or disappearance of symptoms). In the treatment of psoriasis, doctors simultaneously use several directions: drugs (ointments and other medicinal forms for external use, as well as tablets for systemic therapy) and phototherapy with excimer light.
External means include creams, ointments, gels, emulsions and sprays containing hormonal drugs. Glucocorticosteroids suppress the immune system and relieve inflammation. They are presented in numerous dosage forms, in each specific case the doctor will choose an individual treatment scheme for you.
Moisturizers and emollients are used to reduce itching and dryness of the skin.
To alleviate the manifestations of psoriasis on the scalp, the use of special shampoos is prescribed.
Calcipotriol (analogue of vitamin D) is also prescribed for local treatment.
In systemic therapy, doctors prescribe immunosuppressive drugs. These drugs are often given in small doses (once a week) to treat hard-to-treat common types of psoriasis. Similar schemes are used in patients with rheumatoid arthritis. Administration is oral, intravenous, intramuscular or subcutaneous.
Doctors also prescribe retinoids (drugs with biological properties similar to vitamin A).
Systemic glucocorticosteroids are used very rarely and only in particularly difficult cases.
As the process subsides, the frequency of use of external means and oral drugs changes to decrease.
Keep in mind that some drugs have a negative effect on the development of the fetus (for example, selective immunosuppressants), so they are contraindicated in pregnant women.
No alternative treatment leads to positive results. You should not experiment and trust your health to folk healers and methods with unproven effectiveness.
Our doctors urge you not to self-medicate and not to stop (prescribe) various drugs, as this can only worsen the situation and cause an increase in rashes!
Treatment of psoriasis with a laser device
The dermatovenerology center offers you an effective method of treating the disease using an excimer laser system. It is the main physiotherapy treatment for psoriasis and some other skin diseases with proven effectiveness.
The excimer lamp works with xenon-chlorine compounds and emits light in the UV range. Only rays of a certain length penetrate the skin and reduce inflammation in the skin. Plaque thickness decreases.
The rays affect only the "diseased" cells without affecting the healthy skin. This therapy reduces the population of T-lymphocytes in the areas of the skin covered with plaques. In this way, a stable remission is achieved and in many cases excimer light treatment allows to abandonhormonal drugs.
This method allows you to forget about the torment that seasonal exacerbation brings to patients with psoriasis.
The dermatovenerologist first identifies indications and contraindications for phototherapeutic treatment with monochromatic excimer light.
Indications include:
- psoriasis;
- vitiligo;
- Atopic dermatitis;
- Patchy baldness (alopecia);
- Change in the color of the scars;
- Eczema.
There are very few contraindications for the procedure, they include:
- Pregnancy;
- Oncological diseases;
- Severe general condition.
Why you should pay attention to systemic treatment
Dermatovenerologists note a number of undeniable advantages of excimer light treatment:
- The action is local, only on psoriatic plaques, the rays do not affect the whole body;
- In mild cases, it is enough to prescribe only phototherapy and photosensitizers to achieve a stable remission;
- It is prescribed to patients of any age (from 3 years);
- Treatment with a laser system does not require a hospital stay, it easily fits into any work schedule;
- Effective in various forms of psoriasis;
- Minimum restrictions.
How is the treatment procedure carried out?
At your first visit, the doctor will perform an examination, during which he will determine your skin phototype and determine the minimum dose of ultraviolet radiation.
The next day, you come to an appointment where the doctor determines the most appropriate test result. That is, the doctor will individually choose the radiation power that is suitable specifically for your skin.
During treatment there are no restrictions, you will only be advised to limit spicy and fatty foods and drink plenty of fluids.
The effect of phototherapy occurs after only a few procedures, and about 5-10 procedures (in some cases 15) are needed for a stable remission.
The duration of one procedure is 10-20 minutes, depending on the treatment area and the number of affected areas.
Psychological help
We always encourage you to remember that psoriasis is not contagious! And yet, patients are often worried not so much about the discomfort of the presence of rashes, but about the reaction of others. This is especially painful for women and children.
Children can be cruel to a sick child. That is why it is very important to prescribe timely treatment, including consultation with a psychologist or even a psychotherapist.
The benefits of treating psoriasis in a clinic
Patients choose to treat psoriasis for a number of reasons:
- Experienced, qualified dermatologists and cosmetologists;
- Simultaneous removal of dermatological and cosmetic problems;
- Innovative methods of treatment, in particular the use of a laser system;
- State-of-the-art diagnostic methods;
- Possibility of consultation with doctors of various specialties.
If you are worried about plaques, itching and peeling of the skin, contact the clinic. You can always get qualified medical help.
Prevention of psoriasis
The main task of dermatovenerologists is to prevent the exacerbation of psoriasis. To this end, they prescribe preventive measures:
- Preventing stress;
- Prevention of colds;
- Control of outbreaks of chronic infection;
- Rejection of rough, tight clothes that hurt the skin.
Thanks to preventive measures and timely treatment of psoriasis, doctors are able to quickly reduce the severity of the disease and achieve the disappearance of many symptoms of the disease.
What happens if the disease is not treated?
If left untreated, the rash will spread and fill more and more of the skin. A transition to the erythrodermic type is possible, which is much more difficult to treat.