Lung damage due to psoriasis. The first symptoms of psoriasis. Factors contributing to the development of the disease

(squamosal lichen) is a chronic non-contagious disease that affects the skin, nails and joints. It is characterized by the appearance of a monomorphic rash on the skin: bright pink nodules covered with silvery scales. Elements of the rash can merge into various configurations, reminiscent of a geographical map. Accompanied by moderate skin itching. Psoriasis worsens the appearance of the skin and causes psychological discomfort to the patient. When joints are damaged, psoriatic arthritis develops. Generalized pustular psoriasis in pregnant women is dangerous, leading to fetal damage and miscarriage.

General information

- a widespread chronic skin disease, characterized by a monomorphic rash of flat papules that tend to merge into large plaques, which very quickly become covered with loose silvery-white scales. Psoriasis has a wave-like course, the incidence is 2% of the entire population, and is diagnosed equally in both men and women.

Causes and pathogenesis of psoriasis

The etiology and pathogenesis of psoriasis are not fully understood, but research results suggest that a hereditary, infectious or neurogenic nature is most likely. The hereditary nature of psoriasis is confirmed by the facts that the incidence is higher in those families in which psoriasis has already been diagnosed; in addition, in monozygotic twins the incidence concentration is also higher than in other groups. The infectious etiology of psoriasis comes down to the presence of altered complexes and inclusions, as in a viral infection, but the virus has not yet been identified.

And, today, psoriasis is considered a multifactorial disease with a share of genetic and infectious components. The risk group for the incidence of psoriasis includes people with constant trauma to the skin, with the presence of chronic streptococcal skin infections, with disorders of the autonomic and central nervous system, with endocrine disorders; in addition, alcohol abuse increases the likelihood of psoriasis.

Clinical manifestations of psoriasis

The primary element of psoriasis is a single pink or red papule, which is covered with a large number of loose silvery-white scales. An important diagnostic sign is the triad of psoriasis: the phenomenon of stearin stain, terminal film and pinpoint bleeding when scraping off the scales.

During the development stage of psoriasis, there are few rashes, but their number gradually increases over the course of months and even years. Psoriasis very rarely debuts with intense and generalized rashes; this onset can be observed after acute infectious diseases, severe neuropsychic overload and after massive drug therapy. If psoriasis has such a beginning, then the rashes are swollen, have a bright red color and quickly spread throughout the body, psoriatic plaques are hyperemic, swollen and often itchy. Papules are localized on the flexor surfaces, especially in the area of ​​the knee and elbow joints, on the trunk and scalp.

The next stage of psoriasis is characterized by the appearance of new, already small elements at the sites of scratches, injuries and abrasions; this clinical feature is called the Koebner phenomenon. As a result of peripheral growth, newly emerged elements merge with existing ones and form symmetrical plaques or are arranged in the form of lines.

In the third stage of psoriasis, the intensity of the peripheral growth of plaques decreases, and their boundaries become clearer, the color of the affected skin acquires a bluish tint, and intense peeling is observed over the entire surface of the elements. After the final stop of the growth of psoriasis plaques, a pseudoatrophic rim is formed along their periphery - Voronov's rim. If psoriasis is left untreated, the plaques thicken, and sometimes papillomatous and warty growths can be observed.

In the regression stage, the symptoms of psoriasis begin to fade, while the normalization of the skin proceeds from the center of the affected surface to the periphery, first the peeling disappears, the color of the skin normalizes, and lastly, tissue infiltration disappears. With deep lesions of psoriasis and with lesions of thin and loose skin, temporary hypopigmentation can sometimes be observed after cleansing the skin of the rash.

Exudative psoriasis differs from normal psoriasis in the presence of crusty scales on the plaques, which are formed due to impregnation with exudate; there may be weeping in the folds of the body. The risk group for the incidence of exudative psoriasis includes patients with diabetes mellitus, people with hypofunction of the thyroid gland (hypothyroidism) and those who are overweight. Patients with this form of psoriasis note itching and burning in the affected areas.

Psoriasis of the seborrheic type is localized in areas prone to seborrhea. A large amount of dandruff does not allow psoriasis to be diagnosed in time, since it masks the psoriatic rash. Over time, areas of skin affected by psoriasis grow and spread to the skin of the forehead in the form of a “psoriatic crown.”

Psoriasis of the palms and soles is more common in people who engage in heavy physical labor. With this type of psoriasis, the main part of the rash is localized on the palms; only isolated areas of the rash are found on the body.

Pustular forms of psoriasis begin with one small vesicle, which quickly degenerates into a pustule, and when opened, forms a crust. Subsequently, the process spreads to healthy skin in the form of ordinary psoriatic plaques. In severe forms of generalized pustular psoriasis, intraepidermal small pustules may appear on infiltrated skin, which merge to form purulent lakes. Such pustules are not prone to opening and dry out into dense brown crusts. In pustular forms of psoriasis, the lesions are symmetrical, often involving the nail plates.

The arthropathic form of psoriasis is one of the severe ones; there is pain without joint deformation, but in some cases the joint is deformed, which leads to ankylosis. With psoriatic arthritis, symptoms of psoriasis from the skin can occur much later than arthralgic phenomena. The small interphalangeal joints are affected first, and later the large joints and spine are involved in the process. Due to gradually developing osteoporosis and joint destruction, the arthropathic form of psoriasis often ends in disability of patients.

In addition to skin rashes with psoriasis, vegetative dystonic and neuroendocrine disorders are observed; during exacerbations, patients note an increase in temperature. Some patients with psoriasis may have asthenic syndrome and muscle atrophy, dysfunction of internal organs and symptoms of immunodeficiency. If psoriasis progresses, then visceral disorders become more pronounced.

Psoriasis has a seasonal course, most relapses are observed in the cold season and very rarely psoriasis worsens in the summer. Although recently mixed forms of psoriasis, recurrent at any time of the year, are being diagnosed more and more often.

Diagnosis of psoriasis

The diagnosis is made by dermatologists based on external skin manifestations and patient complaints. Psoriasis is characterized by a psoriatic triad, which includes the phenomenon of stearin stain, the phenomenon of psoriatic film and the phenomenon of blood dew. When even smooth papules are scraped, peeling increases, and the surface resembles a stearin stain. With further scraping after complete removal of the scales, a thin, delicate translucent film is detached, which covers the entire element. If the exposure is continued, the terminal film is torn away and a moist surface is exposed, on which pinpoint bleeding occurs (a drop of blood resembling a drop of dew).

For atypical forms of psoriasis, it is necessary to carry out differential diagnosis with seborrheic eczema, papular form of syphilis and pityriasis rosea. Histological studies reveal hyperkeratosis and an almost complete absence of the granular layer of the dermis, the spinous layer of the dermis is swollen with foci of accumulation of neutrophilic granulocytes, as the volume of such a foci increases, it migrates under the stratum corneum of the dermis and forms microabscesses.

Treatment of psoriasis

Treatment of psoriasis should be comprehensive; local medications are used first, and a course of drug treatment is started if local treatment is ineffective. Compliance with work and rest schedules, a hypoallergenic diet, and avoidance of physical and emotional stress are of great importance in the treatment of psoriasis.

Sedatives, such as tincture of peony and valerian, relieve the nervous excitability of patients, thereby reducing the release of adrenaline into the blood. Taking new generation antihistamines reduces tissue swelling and prevents exudation. Tavegil, Fenistil, Claritidine, Telfast do not cause drowsiness and have a minimum of side effects, which allows patients with psoriasis to lead a normal lifestyle.

The use of light diuretics for the exudative form of psoriasis reduces exudation and, as a result, reduces the formation of extensive layered crusts. If there are lesions in the joints, then taking non-steroidal anti-inflammatory drugs to relieve pain is indicated - Ortofen, Naproxen and drugs containing ibuprofen as an active substance. If psoriatic disorders in the joints are more serious, then therapeutic punctures of the joints with intra-articular administration of betamethasone and triamcinolone are used.

For the pustular form of psoriasis, psoriatic lesions of the nails and erythrodermic psoriasis, aromatic retinoids prescribed for at least a month give a good effect. The use of corticosteroids is justified only during psoriasis crises; long-acting drugs, for example Dipropsan, followed by can quickly stop a psoriatic crisis.

Physiotherapeutic procedures such as paraffin baths and UV irradiation are indicated for various forms of psoriasis. In the progressive stage of psoriasis, anti-inflammatory ointments are used; if there is an infectious process, then antibiotic ointments are used. Laser treatment of psoriasis and phototherapy are effective. When psoriasis enters the stationary stage, keratolytic ointments and creams are indicated, for example salicylic, retinoic and Bensalitin. Cryotherapy is performed for psoriatic plaques. If psoriasis affects the scalp, then low-percentage sulfur-salicyol ointments are used, since with an increase in the content of salicylic acid, the ointment has a pronounced keratolytic effect.

In the stage of reverse development, reducing ointments are applied topically, gradually increasing their concentration. These are tar, ichthyol and naphthalan ointments or ointments containing these components. Local use of low-concentrated coricosteroid ointments is indicated at all stages of psoriasis. Drugs that modulate the proliferation and differentiation of keratinocytes are a promising direction in modern psoriasis therapy. During the rehabilitation period, sanatorium-resort treatment with sulfide and radon sources helps to achieve stable and long-term remission.

Prevention of psoriasis

There is no specific prevention of psoriasis, but after the onset of the disease, it is necessary to take sedatives, conduct courses of vitamin therapy and correct diseases that provoke relapses of psoriasis.

Timely treatment of psoriasis allows you to achieve long-term remission and is the prevention of complicated forms of the disease.

In this article we will describe in detail the causes of psoriasis. Knowing them is extremely important, since it is by getting rid of the causes of the disease that recovery can be achieved.

We will look at the causes of psoriasis, citing scientific evidence and medical research data. But we will be interested not only in the theoretical side of the issue. First of all, the practical applicability of this information is important to us.

Our goal is to help you determine the causes of psoriasis in your particular case. And, therefore, understand by influencing what factors you can achieve improvement and recovery.

There are different points of view on whether what is psoriasis. Anyway

Psoriasis occurs as a result of exposure to various external and internal causes.

The disease manifests itself if the combination of external factors and internal mechanisms exceeds a certain individual threshold. As a result, autoimmune processes (immune reaction against one’s own cells) are activated in the body and characteristic manifestations of the disease occur.

• External causes are lifestyle and environmental factors that provoke the occurrence of psoriasis or lead to its exacerbation.
• The main internal cause of psoriasis is genetic predisposition. These are the genes we inherited from our parents. Genes determine the innate properties of the body, which are also involved in the development of psoriasis. These include, for example, the characteristics of hormonal metabolism or the body’s immune system.

There is no single reason for the development of psoriasis. The disease occurs as a result of a combination of internal and many external causes.

Approaches to psoriasis: eliminate manifestations or causes?

Let's consider possible approaches to the problem of psoriasis.

Eliminating the internal causes of psoriasis is extremely difficult, since medicine has not yet learned to influence the patient’s genes.

At the same time, the external causes of psoriasis can be eliminated. It is thanks to the impact on them that it is possible to achieve stable remission. That's why it's so important to pay attention to them.

All external causes of psoriasis are united by two important factors:

• the influence of these external causes on the development of psoriasis has been scientifically confirmed;
• exposure to external causes is devoid of adverse effects and has many advantages.

Therefore, eliminating the external causes that led to the appearance of psoriasis is the most effective and at the same time safe way to get rid of the disease.

Benefits of working with external causes of psoriasis

Let's consider the benefits of influencing external factors leading to illness:

• sustainable result: by eliminating the external causes that caused psoriasis, a stable remission of the disease is achieved;
• no medications are used;
• there are no complications or side effects that arise from medications;
• there is no addiction to therapy, as happens in the case of medications, when in order to obtain a previously achieved effect it is necessary to increase their dosage;
• no need to go to hospital;
• no large financial costs are required, on the contrary, money and time are saved;
• a general healing effect occurs.

The key aspects of working with external causes are to identify the provocateurs in your particular case and eliminate them.

By eliminating the external causes of psoriasis, it is possible to achieve stable remission of the disease.

Problems of the medical approach to psoriasis

Official medicine primarily focuses not on eliminating the causes, but on quickly influencing the manifestations of the disease.

But, unfortunately, this approach has its drawbacks and only helps for a while. In addition, it often leads to side effects, and after cessation of exposure, psoriasis returns or even worsens.

Both doctors and patients often do not pay due attention to the external causes of illness.

Patients have their own reasons for this:

• Eliminating the external causes of psoriasis will require completely different efforts from the patient. After all, it is much easier to take a pill than to follow a diet, give up alcohol or quit smoking.
• Patients are not aware of all the disadvantages of medications.
• Patients do not understand that with the help of medications, only the external manifestations of the disease can be eliminated, and then only for a while.
• Patients are unaware of effective alternative methods.

Also, doctors have their own reasons for eliminating not the external causes of psoriasis, but only its external manifestations:

• Such an approach would require other efforts from the specialist. After all, it is much easier and faster for a doctor to write a prescription for hormonal ointment than to convince a patient to eat right, quit smoking and learn to cope with stress.
• Doctors are overloaded with work: they have a large flow of patients and limited time to see one patient.
• Doctors, as a rule, are not told about the external causes of psoriasis in universities and educational courses, focusing primarily on the use of tablets and hormonal ointments.

The approach of official medicine is aimed at eliminating external manifestations, and not the causes of psoriasis. However, this approach often leads to side effects, and cessation of therapy causes an exacerbation of the disease.

Thus, official medicine is still predominantly focused only on eliminating the external manifestations of psoriasis. Therefore, it is important for patients to independently take steps to deal with external causes.

Effects on external causes do not require medications. Therefore, it does not entail the difficulties that arise when trying to get rid of the manifestations of psoriasis with the help of medications. And at the same time, eliminating external causes can lead to stable remission.

Since it is important to deal with the external causes of psoriasis first, in this article we will focus on external triggers and only briefly look at internal ones.

IMPORTANT CONCLUSIONS and WHAT TO DO

• Psoriasis manifests itself as a result of exposure to internal and external causes.
• It is almost impossible to influence the internal causes of psoriasis.
• External causes of psoriasis can be eliminated.
• Working with external causes can lead to lasting remission of psoriasis.
• Impact on external causes has no disadvantages and has many advantages.
• The approach of official medicine allows only to temporarily eliminate the manifestations of psoriasis. However, this can lead to side effects, and after the treatment is stopped, psoriasis reappears.
• The best way to get rid of psoriasis is to identify its external causes in your particular case and eliminate them.

External causes of psoriasis

The main external causes leading to the occurrence of psoriasis include the following. Skin injuries, poor diet, stress, alcohol, tobacco, infections and the use of certain medications.

Some of the most common causes of psoriasis include: unhealthy diet, skin damage, alcohol, smoking, infectious diseases and certain medications.

Below we will look at each of these main external factors that provoke the occurrence or exacerbation of psoriasis.

Skin injuries

Psoriasis is directly related to skin damage.

Trauma can cause exacerbation or the appearance of new rashes where there were none before.

This phenomenon is called the Koebner reaction.

Any damage to the skin can cause this reaction. For example, cuts, insect bites, skin infections, surgery, tattoos.

Tattooing can lead to Koebner phenomenon and provoke psoriatic rashes on skin damaged by the needle.

IMPORTANT CONCLUSIONS and WHAT TO DO:
SKIN INJURIES

Take care and protect your skin!

• Use products to moisturize and nourish it.
• Be careful with household chemicals: always use gloves when working, especially if you suffer from allergies.
• Sunburn is also an injury; under no circumstances should you get sunburned.
• Deal with infectious skin problems. Maintain good hygiene.
• Don't tease cats and dogs; they may scratch or bite.
• Before getting a tattoo or piercing, weigh the pros and cons.

Nutrition, obesity and leaky gut

There are two points of view on the connection between the patient’s nutrition, the state of his gastrointestinal tract and psoriasis. One is the point of view of official medicine, the other is the point of view of alternative, or non-traditional, medicine.

The point of view of official medicine

Official medical science almost does not study the direct influence of nutrition and the state of the digestive system on the occurrence and development of psoriasis. And at the same time, he considers such a connection unproven. Few scientific articles have been published on this topic. This may be due to the prevailing practice in official medicine of solving problems with the help of drugs, rather than natural methods and prevention.

However, the relationship between excess weight and the severity and responsiveness of psoriasis to standard therapy has been widely studied.

Psoriasis is often accompanied by obesity

It was found that

Obesity is common among patients with psoriasis: 1.7 times more common than among people without psoriasis.

For example, in one clinical study among 10,000 patients with moderate to severe forms of psoriasis, the body mass index averaged 30.6 kg/m2 (grade 1 obesity starts at 30).

Also, the severity of psoriasis is directly related to the incidence of obesity:

• In mild forms of psoriasis - with lesions<2% кожи — ожирение встречалось у 14% больных.
• With moderate psoriasis - from 3 to 10% of the skin is affected - in 34% of patients.
• In severe psoriasis—>10% of the skin affected—obesity occurred in 66% of cases.

The more severe the form of psoriasis, the more often the patient suffers from obesity.

The same pattern was found in children: the more severe the psoriasis, the more common obesity is.

Interaction between obesity and psoriasis

There is a two-way relationship between psoriasis and excess weight.

On the one hand, obesity itself is a factor that increases the risk of developing psoriasis. For example, the relative risk of developing psoriasis in 18-year-old girls with a body mass index of more than 30 (1st degree obesity begins at 30) is 1.7 times higher than in girls of the same age with a body mass index of 21 to 22.9 (normal weight body).

On the other hand, psoriasis as a psychosocial problem can itself lead to weight gain due to the “seizing” of the problem.

Excess weight reduces the effectiveness of effects on psoriasis

Scientists found an inverse relationship between obesity and the result of standard and biological therapies: their effectiveness in obese patients was lower. For example, this was found with the use of ustekinumab.

And with weight loss, susceptibility, for example, to Cyclosporine, on the contrary, improved.

Low-calorie diet and weight loss improve psoriasis

Obesity provokes severe psoriasis, and weight loss improves the condition of patients

It is believed that increased permeability of the intestinal wall can also lead to the development of other diseases, including autoimmune diseases. For example, to rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, Crohn's disease, ulcerative colitis, diabetes, chronic fatigue syndrome, autism and others.

Official science recognizes the presence of such a pathology as increased intestinal permeability. However, the fact that “leaky gut syndrome” directly causes the diseases listed above is considered unproven. And he regards all discussions on this matter as a way to increase sales of probiotics, nutritional supplements, herbal remedies and the like, the effectiveness of which has not been studied and also not proven.

Causes of Leaky Gut Syndrome

The very occurrence of leaky gut syndrome is provoked by:

• irrational or unhealthy diet:
  • alcohol,
  • caffeinated drinks (coffee, tea, cola, energy drinks, etc.)
  • fast food and semi-finished products containing preservatives, dyes, flavoring additives, etc.,
  • foods high in sugar, fat, white flour, gluten and the like;
• certain types of products - nightshades, which include, for example, tomatoes and potatoes;
• dysbacteriosis, which occurs, among other things, due to the irrational use of antibiotics;
• insufficient water consumption (the norm for a person weighing 70 kg is at least 2 liters of clean water per day);
• chronic constipation;
• stress;
• heredity;
• diseases of the spine with displacement of the vertebrae and pinching of the nerves leading to the intestines.

How to repair leaky gut

The main method of recovery is to stop eating food containing potential.

Thanks to this, the intestinal barrier function will quickly restore.

Official medicine considers this method unproven. However, she also recognizes that normalizing your weight has a positive effect on your skin. A low-calorie, but nutritious diet is an important condition for defeating psoriasis.

The study was the subject of a single review study published in a scientific journal in 2017. According to this study, it is important to abandon foods that cause psoriasis. And at the same time, introduce plenty of fiber-rich fruits and vegetables into your diet, preferring organically grown products. Take probiotics, vitamin D, OMEGA-3 fatty acids and follow special diets.

Dr. John O.A. Pegano, osteopathic doctor, author of the book “Treating Psoriasis – The Natural Way”

Possible difficulties in repairing leaky gut

Resolving leaky gut syndrome can come with some challenges. However, they are mostly psychological in nature and are largely related to our reluctance to limit ourselves in our usual way of eating and change food preferences. In addition, you may encounter misunderstanding and lack of support from relatives, friends and doctors who are not familiar with or understand this approach.

In these cases, it is important to remember that avoiding unhealthy foods will go a long way toward solving your psoriasis problems. You can help yourself by developing the determination to follow your chosen diet until recovery.

IMPORTANT CONCLUSIONS and WHAT TO DO:
OBESITY, NUTRITION and LEAKY GUT

• What we eat is directly related to the condition of our skin.
• By following a therapeutic diet and some additional conditions, you can completely get rid of psoriasis.
• Not only getting rid of psoriasis, but also normalizing weight and metabolism will help a full-fledged low-calorie diet - vegan, paleo diet or Pegano diet.
• Avoid psoriasis-causing foods, processed foods, fast food, baked goods and sugary carbonated drinks.
• Make sure that there is no lack of vitamins and microelements; if necessary, take them additionally.
• Eat a lot more fruits and vegetables, drink more plain water.

Stress

The occurrence of psoriasis on nerves is confirmed by scientific data. Moreover, stress can become both a cause of the development of psoriasis and its consequence.

A holiday at the sea relieves stress: TV, the dollar exchange rate and junk food are left at home, the sun supplies vitamin D, and the seascape is calming in itself

Back in the 70s of the last century, it was found that stress preceded exacerbation of psoriasis in 40% of patients. Also, more than 60% of patients believe that stress was the main reason for its development.

In another study of 5,000 patients

40% of respondents reported that psoriasis first appeared due to anxiety. And 37% noted its aggravation against this background.

In children, relapse of psoriasis in 90% of cases is associated with stress suffered before it.

IMPORTANT CONCLUSIONS and WHAT TO DO:
STRESS

• Psoriasis is triggered by stress and itself creates stress.
• Find methods for relaxation and stress management that are effective for you.
• Give preference to natural ways to combat stress: yoga, meditation, cognitive behavioral therapy, walking and physical activity.
• To relieve stress, do not resort to various harmful substances, such as alcohol, tobacco, and excessive and unhealthy food. Firstly, they themselves can provoke psoriasis, and secondly, they lead to additional health problems.
• In case of severe depression, it is imperative to consult a doctor and strictly adhere to the medication prescribed by him.

Alcohol

A strong direct link has been proven between alcohol and the risk of developing psoriasis.

However, the mechanism of the relationship between psoriasis and alcohol is not fully understood. Alcohol increases the toxic load on the liver. Because of this, part of the function of removing toxins is taken over by the skin.

Alcohol also leads to metabolic disorders: insufficient absorption of proteins, vitamins and microelements. This deprives the body, including the skin, of its normal ability to recover.

Alcohol is a poison, under the influence of which psoriasis loses its seasonality and becomes more severe

Scientific evidence confirms that alcohol consumption is more common among people with psoriasis than among healthy people. Also, with alcohol abuse, psoriasis loses its seasonality and becomes more severe. At the same time, the area of ​​affected skin increases until the development of psoriatic erythroderma.

Psoriasis also often occurs in patients with alcoholic liver damage - hepatitis or cirrhosis.

IMPORTANT CONCLUSIONS and WHAT TO DO:
ALCOHOL

• The more often and in greater quantities the patient drinks alcohol, the more active and severe the manifestations of psoriasis.
• The best possible solution is to completely abstain from all types of alcohol.
• If it is not possible to completely give up alcohol, try to reduce its consumption to a minimum. However, it should be borne in mind that every use of alcohol can provoke an exacerbation.

Smoking

The greater prevalence of psoriasis among smokers compared to non-smokers is undeniable.

The risk of developing psoriasis and its severity in smokers is significantly higher than in non-smokers="">

The risk of developing psoriasis is significantly higher in smokers than in never smokers.

It has been proven that:

• For those who smoke 1 to 14 cigarettes per day, the risk increases 1.8 times;
• From 15 to 24 cigarettes per day - 2 times;
• From 25 cigarettes or more - 2.3 times.

Smoking also directly affects the severity of psoriasis and increases the risk of developing psoriatic arthritis.

Those who quit smoking have a 1.4 times higher risk of developing psoriasis than non-smokers. However, it decreases uniformly with increasing smoking cessation period. And after 20 years, the risks for those who quit and those who never smoked become equal.

IMPORTANT CONCLUSIONS and WHAT TO DO:
SMOKING

• Smoking and psoriasis are mutually supportive phenomena, because for some, smoking helps to cope with the psychological problems that accompany psoriasis.
• Unfortunately, quitting smoking is no less difficult than quitting alcohol. But scientific research data convinces us that this must be done.

Infections

Psoriasis is not an infectious disease and. However, infections often provoke the appearance of psoriasis or cause its exacerbation.

This has been confirmed by many studies.

Streptococcus

Streptococcus is a bacterium that lives in the mouth and nose. It is one of the most common causes of tonsillitis (inflammation of the tonsils or acute tonsillitis).

At the beginning of the twentieth century, a connection was established between guttate psoriasis and tonsillitis, confirmed by further research. Thus, 85% of patients with guttate psoriasis have antibodies (Antistreptolysin-O), produced by the immune system to fight streptococcus.

Streptococcus is believed to be responsible for the appearance of punctate (tear-shaped) rashes in patients with chronic plaque psoriasis. It also leads to exacerbation of other forms of psoriasis, including psoriatic arthritis.

In 63% of patients with psoriasis, previous streptococcal pharyngitis (sore throat) was identified.

And half of the children with psoriasis experienced an exacerbation of psoriatic rashes two weeks after pharyngitis.

Also, the connection between infection and psoriasis is confirmed by the presence of the same immune defense cells (T-lymphocytes) in the tonsils, psoriatic plaques and in the blood of patients with psoriasis.

Why does streptococcus provoke psoriasis?

This is what one of the provocateurs of psoriasis, streptococcus, looks like under an electron microscope.

Streptococci inside the tonsils are inaccessible to antibiotics and the defense mechanisms of the immune system. Streptococci produce M-protein, a protein similar to the protein of normal skin cells - keratinocytes. Cells of the immune system detect a protein similar to M protein on the surface of keratinocytes and trigger an immune reaction against their own cells - an autoimmune process.

There is information that removal of the tonsils (tonsillectomy) and the use of antibiotics can have a positive effect in the case of guttate psoriasis. But data from different studies is contradictory. Therefore, it is hardly possible to speak unequivocally about the positive effect of tonsil removal. It is better to solve problems with tonsils without surgical methods, for example, using yoga and lion pose or hardening.

HIV infection

An important causative agent of psoriasis is the human immunodeficiency virus (HIV; AIDS is the final stage of HIV infection). Among HIV carriers, psoriasis occurs in 5% of cases.

HIV can be suspected in a patient if psoriasis often worsens and is resistant to conventional or biological agents. Also, another signal can be the sudden onset of guttate psoriasis.

Other infections

Also, exacerbation of psoriasis can be provoked by other infections, for example:

• herpes simplex and chickenpox viruses,
• cytomegalovirus,
• parvovirus B19,
• staphylococci,
• candida,
• Helicobacter pylori,
• malassezia,
• Yersinia (can provoke psoriatic arthritis).

IMPORTANT CONCLUSIONS and WHAT TO DO:
INFECTIONS

• Don't catch a cold!
• Solve throat problems using preventative and natural methods, such as yoga.
• Protect yourself from potential sources of infection.
• Toughen up and move more!
• Live a healthy lifestyle, eat more fruits and vegetables and take a quality multivitamin.

Drug provocateurs

Medicines can cause psoriasis or make it worse.

Various medications, including drugs against psoriasis, can cause its exacerbation.

Most often, the following drugs can lead to this:

• non-steroidal anti-inflammatory drugs (NSAIDs) - used as painkillers, antipyretics and anti-inflammatory drugs;
• hormonal agents – used as anti-inflammatory and immunomodulatory agents;
• beta blockers and angiotensin-converting enzyme inhibitors (ACEIs) - to lower blood pressure;
• tetracyclines – broad-spectrum antibiotics;
• lithium preparations – used in psychiatry to stabilize mood;
• antimalarials - for the prevention and control of malaria;
• Interferon alpha (IF-alpha) is an antiviral agent;
• Tumor necrosis factor-alpha (TNF-alpha) inhibitors have anti-inflammatory, immune-suppressive effects. Used for autoimmune diseases such as rheumatoid arthritis and Crohn's disease.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world. Some studies have reported an association between them and exacerbation of psoriasis, for example with the use of indomethacin. Although this connection was not subsequently confirmed, caution should be exercised with drugs in this group.

Hormonal agents

The problem of using hormonal drugs deserves separate consideration. After all, they are often the first medications prescribed by a doctor for psoriasis.

In this article we will only briefly touch on some of the adverse effects.

For example, abrupt withdrawal of these drugs can provoke the development of a pustular form against the background of already existing plaque psoriasis.

Abrupt cessation of the use of corticosteroids - hormones produced by the adrenal cortex - can cause withdrawal syndrome: intensification of old or the emergence of new foci of psoriasis.

Long-term use of hormonal drugs is often accompanied by side effects

A rapid decrease in effect may also occur with repeated use of corticosteroids (tachyphylaxis).

Medicines for hypertension

An association between psoriasis and blood pressure-lowering drugs, such as beta blockers and angiotensin-converting enzyme inhibitors (ACEIs), has previously been reported. Although this information was later not confirmed, caution should be exercised.

Tetracycline antibiotics

These antibiotics are used for streptococcal infection, one of the factors that provoke psoriasis. Information about the possibility of antibiotics themselves to provoke psoriasis is contradictory. However, for example, the concentration of tetracycline in the area of ​​psoriatic rashes is higher than in intact skin. Tetracycline also has a photosensitizing effect, that is, it increases the skin's sensitivity to ultraviolet radiation. And this can lead to the occurrence of the Koebner phenomenon and the appearance of psoriatic plaques.

Lithium preparations

Lithium salts have been used in psychiatry since the middle of the last century for the prevention and elimination of bipolar disorders and severe depression that is resistant to conventional therapy. It is believed that lithium disrupts the maturation (in medical language - differentiation) of skin cells - keratinocytes, which can provoke psoriasis or cause its exacerbation.

Antimalarial drugs

These drugs interfere with the immune system, which can cause an exacerbation of psoriasis or its initial appearance. Due to the side effects of antimalarial drugs - chloroquine and hydroxychloroquine - inflammation of the skin (dermatitis), discoloration of the skin and mucous membranes, and hair loss may develop. With the use of hydroxychloroquine, the development of psoriatic erythroderma, affecting more than 90% of the skin, has been reported.

Interferon-alpha

Exacerbation of psoriasis has been frequently reported with the use of interferon-alpha in patients with hepatitis C and multiple sclerosis. Such exacerbations usually respond to conventional medical treatments against psoriasis and do not require discontinuation of interferon.

Tumor necrosis factor-alpha inhibitors

Tumor necrosis factor inhibitors - the drugs Remicade, Enbrel and Humira - are also prescribed for psoriasis. However, scientific articles describe cases where their use, on the contrary, led to an exacerbation of psoriasis or the appearance of new lesions on previously unaffected skin.

IMPORTANT CONCLUSIONS and WHAT TO DO:
MEDICATIONS

And the sun too?!! Photosensitive summer psoriasis

The sun is necessary for health. For example, for the synthesis of vitamin D, the deficiency of which is associated with the development of depression in the northern hemisphere.

Most patients with psoriasis improve their skin condition when exposed to sunlight.

With photosensitivity psoriasis, the skin condition worsens under the influence of sunlight - a source of broadband ultraviolet type A

However, in 5-20% of cases there is so-called photosensitivity psoriasis, the condition of which worsens under exposure to the sun.

The disease usually occurs at an early age in families with an existing history of psoriasis and a clear genetic predisposition - this is the so-called type 1 psoriasis. It usually affects women.

This type of psoriasis is also called summer psoriasis, since it appears primarily in the summer and subsides in the fall and winter. It was associated with the development of the Koebner effect after sunburn, but this assumption was not confirmed.

Summer psoriasis occurs only when the skin is exposed to broadband ultraviolet type A. Moreover, it takes several days after exposure to sunlight for external manifestations of psoriasis to appear. Apparently, under the influence of ultraviolet radiation, previously hidden disorders of sensitivity to the sun appear.

IMPORTANT CONCLUSIONS and WHAT TO DO:
SUN

• Tan carefully without getting burned.
• The UV light in commercial tanning beds is not the type of UV light needed for psoriasis. Although it can improve the condition of the skin.

Internal causes of psoriasis

Internal causes of psoriasis include genetic predisposition. Genes, in turn, determine the characteristics of immunity and hormonal metabolism, which also influence the occurrence of psoriasis.

We will dwell in detail on the genetic and immune causes of psoriasis in separate articles, but here we will talk about them only briefly.

Genetic predisposition

Genetic predisposition is changes in genes that are observed in psoriasis or contribute to its development.

In 70% of cases of psoriasis in children, it is possible to detect a family history of the disease, that is, the mother or father of the child suffers from psoriasis.

If in a pair of identical twins with the same genes (monozygotic twins) one suffers from psoriasis, then the risk of developing the disease in the second is 70%. If twins share half the same genes (dizygotic), the risk is 23%.

No single mutation has been found that would lead to psoriasis in 100% of cases. However, in the 1970s, Finnish researchers first discovered a region on the sixth chromosome (locus) called PSORS1.

This locus was found in 73% of cases of guttate psoriasis and 46% of ordinary (vulgar) psoriasis. The locus contains several genes associated with the immune system. These genes encode proteins, the increased content of which is found in the skin with psoriasis.

Prospects and problems of the genetic approach

Perhaps in the future, modification of “wrong” genes will be used for psoriasis

Studying genes should help in understanding the causes of psoriasis and choosing therapy. Thus, pharmacogenomics, a discipline at the intersection of genetics and pharmacology, explains the difference in the results of using the same methods of therapy in different patients.

This has been proven using coal tar, vitamin D3, ultraviolet radiation, and immune suppressants. The results of this study revealed that patients with different genes responded differently to the same drugs.

However, genetic testing explains only 20% of psoriasis cases. Moreover, each of the many genes found is only partially responsible for the risk of developing the disease.

In total, more than 50 chromosome regions (loci) have been identified that are associated with an increased risk of developing psoriasis.

However, the mechanism of influence of genes on the development of psoriasis remains unknown.

Since the connection between genes and psoriasis was established statistically by processing a large number of genetic studies of patients with psoriasis.

Unfortunately, there is not yet enough verified information for the real application of pharmacogenomics, and the research results are contradictory. In addition, genetic research methods are still too expensive.

Perhaps in the future, selecting the “right” methods for a particular patient and turning off the “wrong” genes will become commonplace. But for now, this approach is more applicable in scientific research.

Immune pathways for the development of psoriasis

The immune system is a system of organs and cells to protect the body from external pathogens (for example, bacteria, viruses or helminths), as well as from its own cells that have mutated into tumor cells.

Simply explaining how autoimmune inflammation develops in psoriasis is hardly a feasible task. Indeed, this process involves many different types of cells of the immune system (T and B lymphocytes and their many varieties, dendritic cells, etc.), skin cells (keratinocytes) and chemicals that transmit signals between cells (cytokines).

If very briefly, then

in response to external provoking factors, excessive activation of the immune system occurs, which ultimately leads to the development of psoriasis.

An excessive reaction of the immune system, designed to protect the body from external and internal threats, can cause the development of psoriasis.

It happens like this. Immune cells migrate to the area affected by the provoking factor, and inflammation develops there. The most numerous skin cells - keratinocytes - respond to stimulating signals from the immune system by accelerating division with the formation of psoriatic plaques. Keratinocytes also produce cytokines, which in turn further stimulate the immune system. In the area of ​​inflammation and thickening of the skin, new blood vessels begin to form. A vicious circle of self-sustaining inflammation is formed. All this leads to the appearance of reddish plaques raised above the skin and covered with silvery-white scales - the main manifestation of psoriasis on the skin.

Influence of the hormonal system

Psoriasis can be triggered by changes in the hormonal system of women.

Proof of this is the frequent appearance of the first manifestations of psoriasis during puberty in girls.

Female sex hormones - estrogens - provocateurs or protectors?

In some women, an increase in the level of female sex hormones - estrogens - provokes the development of psoriasis. This is confirmed by research data on the occurrence of psoriasis at a certain time:

• during puberty in girls due to increased estrogen activity,
• when using estrogens as medicines,
• during certain phases of the menstrual cycle when estrogen levels rise.

Other studies have found that in some women, psoriasis, on the contrary, worsens with the onset of menopause, that is, with a decrease in hormonal activity and a drop in estrogen levels.

Thus, the connection between the level of female sex hormones and psoriasis can be traced, but is not entirely clear. Psoriasis can worsen both when estrogen levels increase and when they decrease.

Pregnancy and psoriasis

The behavior of psoriasis during pregnancy is impossible to predict.

Two thirds of women reported improved skin condition during pregnancy

About a third of pregnant women complain of exacerbation of psoriasis. However, twice as many women experienced improvement in their skin condition during pregnancy. Why skin condition may improve during pregnancy is not fully understood, but scientists believe it is due to the effects of anti-inflammatory cytokines.

Unfortunately, psoriasis usually returns to its previous state after childbirth.

CONCLUSION and CONCLUSIONS

• In the fight against psoriasis, special attention should be paid to eliminating its external causes.
• Compared with drugs that suppress the internal mechanisms of psoriasis, targeting external causes has no adverse effects and has many advantages.
• It is not necessary to influence all causes at once. Study the main causes of psoriasis, evaluate which of them are especially important in your case and start by eliminating them. But remember that the most positive result will come from eliminating all external causes.

WHAT TO DO

• Follow your diet and drinking regime. Give preference to vegetables and fruits, avoiding processed foods, caffeine-containing drinks, as well as fatty, starchy and sweet foods.
• Protect your skin from injury.
• Stop smoking and alcohol.
• Do not abuse medications.
• Support your immune system and prevent infections.
• Find stress management methods that work for you.

Your recovery is in your hands!

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  And in the comments to the article you can share your experience and thereby help other readers.
  Thanks a lot! We appreciate your attention!

There are a huge number of dermatological diseases. One of the most common skin diseases is psoriasis. Treatment of psoriasis is a very hot topic in modern medicine. Thousands of pharmaceutical companies are releasing new products every day to get rid of this pathology, but today there is no medicine that can get rid of the disease once and for all. In this article we will find out everything about psoriasis and its treatment, and also try to answer such common questions as what to do with psoriasis, how to get rid of psoriasis, and whether it is possible to cure psoriasis once and for all.

What is psoriasis

This disease is classified as a non-infectious pathology that cannot be transmitted through household, sexual, airborne or any other means. Many patients believe that this disease affects only the skin, but this is not the case. The disease has several types, which can manifest themselves not only on the skin, but also have a negative effect on nails, joints and some internal organs.

So, what is psoriasis? In a person with healthy skin, the cycle of maturation and division of skin cells is from 28 to 30 days, but with psoriasis, this period is reduced tenfold and is only 4-6 days. Because of this, unripe cells begin to divide and die, resulting in the formation of unpleasant white or grayish scales on the skin. Scientists around the world still cannot figure out the exact reasons why this process occurs. Only a few provoking factors are known that can cause relapse and exacerbation of the pathology.

Most scientists are inclined to argue that psoriatic disease is an incurable disease and no one has yet been able to get rid of it. It has also long been known that it is impossible to cure psoriasis with any of the treatment methods. Sooner or later, the disease returns with renewed vigor.

The disease can occur in men, women and even children. According to some statistics, it is known that people living in countries with cold and humid climates are more prone to the disease. Also at risk are young people aged 18 to 25 years and older patients after 45-50 years of both sexes. Children get sick somewhat less and their pathology can occur in an atypical form, that is, without symptoms characteristic of psoriasis, for example, such as scales, itching and flaking.

How dangerous is the disease?

You should not assume that, apart from being an aesthetic problem, psoriasis is not capable of causing serious harm to the body. Symptoms such as itching, redness, peeling are only a small part of what can provoke this disease. Experts say that many patients often develop a form of the disease called psoriatic arthritis. This is a serious damage to joints and cartilage, which can even lead to disability. Also, complications of psoriasis include the following manifestations:

1. Damage and deformation of nails.
2. Damage to the mucous membrane. It can also be diseases of the bladder and urethra.
3. Against the background of pathology, serious diseases of the gastric mucosa can develop.
4. The liver often suffers, it increases in size and ceases to perform its functions.
5. In addition, patients often experience complications such as epileptic seizures, depression, delirium, polyneuritis and many other psychological disorders.
6. Common complications include constant muscle and joint pain and severe weight loss.
7. There are known cases of myocardial infarction, strokes, heart failure and other diseases.
8. Lymph nodes often become enlarged, especially in the groin and thigh areas.

These are just some of the consequences that the disease can lead to. The list goes on and on, but even without this it is obvious that psoriasis is a serious disease that requires serious and timely treatment.

Important! In order to avoid complications, you should not let the disease take its course. Timely contact with a specialist will help to avoid many complications and side effects.

Reasons for the development of the disease

At the present stage of research into psoriasis, scientists and doctors have not been able to agree on the exact causes of the development of the disease. Representatives of different theories adhere to points of view that explain the possible reasons for the appearance of pathologically rapid division of skin cells. Next, we will consider the most popular theories of the development of the disease.

Immune

This is one of the main and most reliable causes of the disease. Immunity is a person’s natural defense that can cope with many diseases. Sometimes, under the influence of various factors, the immune system malfunctions. Representatives of this theory believe that psoriasis occurs as a result of an incorrect immune response to dermal cells. In other words, immune cells begin to attack skin cells, perceiving them as aggressors. As a result, severe itching, redness and inflammation occurs.

Genetic

Another point of view is the genetic theory. Its supporters believe that psoriasis is inherited. According to medical statistics, in more than 50% of all patients with pathology, one of the parents suffered from the disease. In addition, if the mother or father suffers from the disease, the risk of developing psoriasis in the child increases by 25%, but if both parents suffer from the pathology, the risk increases by more than 50%.

Endocrine

The hormonal background of the body plays a very important role. The endocrine system, consisting of organs such as the thyroid, pancreas and pituitary gland, is entirely responsible for the balance of hormones. Diseases and malfunctions of these organs can lead to hormonal imbalance, which, according to supporters of the endocrine theory, leads to the development of unhealthy cell division in the dermis.

Also, imbalance can often occur during puberty, the menstrual cycle and menopause, as well as treatment with hormonal drugs and under the influence of some other reasons.

It is important to note that in the context of modern research, the influence of hormones on the occurrence of psoriasis has not been proven, so this theory remains only an assumption.

Neurogenic

This is one of the young theories, whose representatives believe that the appearance of the disease can occur against the background of severe stress and psychosomatic disorders. The theory has also not been proven; its proponents continue to conduct research to this day.

The neurogenic theory explains the appearance of the disease by the development of vasomotor neurosis in the walls and muscles of blood vessels. This process can cause a narrowing of the vascular walls, resulting in a significant reduction in blood circulation.

The theory has also not been proven, however, numerous studies confirm the fact that in most patients psoriasis worsened or arose for the first time after strong emotional stress and experiences.

Viral

It is immediately worth noting that a direct connection between viruses and psoriasis has not been identified. It is only confirmed that after suffering from certain diseases caused by the action of various viruses, psoriasis can worsen. Experts attribute this not to the viral origin of the pathology, but rather to the appearance of the disease against the background of a strong complication of the immune system.

Exchange

Scientists have identified the following abnormalities in almost all patients with psoriasis:

1. The general body temperature of patients with pathology is slightly lower than that of healthy people. This indicates a slow metabolic process.
2. Another factor that unites all patients is an increase in blood cholesterol levels. As is known, the presence of cholesterol in the blood in large quantities can reduce the level of lipid metabolism. This is what can provoke the appearance on human skin of the keratinized dermal membranes characteristic of the disease.
3. Another unifying factor is a significant decrease in vitamins in the body in all patients. Most patients had a lack of B vitamins, however, interestingly, in the layers of the dermis, vitamin C was present even in excess.

Important! None of the theories has been officially approved or scientifically proven to date. All of them are just assumptions without supporting factors.

What can trigger the development of the disease

The disease psoriasis and its treatment is a very complex process, which is often complicated by many provoking factors. These can be both external and internal influences that can provoke an exacerbation of the pathology or its primary appearance. So, factors that can lead to the disease include:

1. Psychosomatic disorders. Every day many people experience a lot of stress and emotional tension. These could be problems at work, quarrels with family, loss of loved ones and much more. When answering the question of how to deal with psoriasis, doctors unanimously repeat - try to avoid stress and nervous experiences.
2. Another cause of the disease is the patient’s transmission of infectious diseases, as well as chronic inflammatory processes as a result of advanced diseases. The use of certain medications can also trigger pathological processes in the skin.
3. Often the first rashes, as well as relapses, appear due to mechanical damage to the skin. Even a simple abrasion or scratch can lead to serious skin problems.
4. Hormonal imbalance is another serious reason that can provoke the disease.
5. Treatment for psoriasis is impossible without giving up bad habits. Smoking and alcohol can cause rashes.
6. Psoriasis can also be cured with a diet that excludes allergenic foods, as well as foods containing large amounts of fat and carbohydrates.

Treatment for psoriasis consists primarily of eliminating factors that can aggravate the disease. If the cause is not eliminated, psoriasis is almost impossible to cure.

Main types and symptoms of psoriasis

Symptoms of psoriasis can be very diverse. Its manifestations depend on the type of disease. Forms of psoriasis in medical practice are divided into the following types.

Psoriasis of the scalp

This is one of the most common types. Many patients have encountered this problem and know how unpleasant this pathology is. Can scalp psoriasis be cured? Definitely not, like its other types. The disease manifests itself differently in each patient. These may be minor rashes in the area of ​​the hairline, accompanied by flaking and dandruff, or the disease may manifest as large plaques with rough crusts and significant redness of the skin.

It is necessary to treat psoriasis of this type; it is strictly undesirable to let the disease take its course.

Nail psoriasis

Faced with this type of disease, patients are concerned about whether nail psoriasis can be treated. After all, pathology not only significantly spoils the aesthetic appearance of the nail plates, but also leads to their severe distortion, detachment and even complete loss. This type of illness most often develops against the background of other types of illness and requires comprehensive and proper treatment.

The fight against nail psoriasis often involves an integrated approach and fairly long-term treatment. The patient must be patient to achieve positive results.

Hand psoriasis

Hands, namely palms, are highly susceptible to various mechanical damage and friction. Often this type of disease occurs in both men and women. The main manifestations of psoriasis on the hands are calloused formations with peeling, itching and redness. The disease is aggravated by frequent skin injuries, since the palms are very mobile.

Psoriasis on the face

The appearance of rashes on the face is very unpleasant, since this area is constantly in sight. Patients are puzzled by how to overcome facial psoriasis. After all, ugly flaky plaques not only cause severe discomfort on a physical level, but also a significant deterioration in the emotional state. This type of disease can occur on any area of ​​the face: cheeks, nose, lips, forehead and chin. Treatment of scaly lichen on the face (as psoriasis is often called) is a complex and troublesome process.

Psoriasis on legs

The course is very similar to the disease on the hands. This form can affect the inner surface of the thighs, knee joints, and less commonly the feet. Characteristic signs are itching, flaking and inflammation.

Elbow psoriasis

A common type of pathology, it occurs in many patients of different age groups. Affects the outer surface of the elbows. Externally, the disease resembles the appearance of a whitish or grayish film on the skin in the form of a so-called shell. Elbow psoriasis is not difficult to treat and often has a favorable prognosis for patients.

Vulgar psoriasis

The mildest form of the disease. In this case, single plaques appear on the patient’s skin, which do not cause much discomfort for the patient. Psoriasis vulgaris can be treated with topical treatments and simple preventive measures.

Disease of the genital organs is quite rare. In almost 99% of cases it is not an independent disease. The disease is often confused with many sexually transmitted pathologies, and patients are in no hurry to consult a dermatologist. In men, the head of the penis is affected; in women, the disease spreads to the labia.

Seborrheic

Very similar to seborrheic dermatitis. This type is characterized by redness and peeling of the skin. Found on the head, scalp and ears.

teardrop-shaped

Often develops after exposure to viral and infectious diseases. Outwardly it resembles small red drops, which are framed by a whitish border. Often there is no peeling at all. The disease spreads to all parts of the body; it can be a single rash or a large number of rashes.

Important! You should not try to make a diagnosis on your own. Often one form of psoriasis turns into another. Only a doctor can make a diagnosis and prescribe treatment.

Treatment methods for psoriasis

Most patients faced with this disease have no idea how to get rid of psoriasis. In addition, people simply do not know whether this pathology can be treated or not. Further in the article we will try to understand what methods of treating the disease exist and what are the features of treating psoriasis.

Before starting treatment, every patient should remember that psoriasis is incurable. Treatment is always aimed solely at eliminating symptoms, strengthening the immune system, and achieving stable remission.

Treatment methods for psoriasis are quite varied and involve the use of the following techniques:

1. Drug treatment.
2. Physiotherapeutic procedures.
3. Non-traditional alternative treatment.
4. Application of traditional medicine methods.

Important! How and with what to treat psoriasis is decided exclusively by a qualified specialist. Only a doctor can choose the right method of therapy, taking into account the individual characteristics of each patient.

Drug treatment

Psoriasis and its treatment is a complex and lengthy process. In medical practice, a step-by-step approach is used to ensure the achievement of the desired result, which lasts for a long time. This approach includes the following steps:

1. Emergency help. It is carried out at the acute stage of the disease and involves the use of drugs for both external and internal application. Here, doctors can prescribe steroids and immunosuppressants.
2. Transition period. Here, drugs that have a strong systemic effect are gradually introduced.
3. Maintenance treatment. This stage lasts until the patient’s skin is completely clear of plaques and papules.

The doctor selects medications depending on the severity of the patient’s condition, as well as the characteristics of the course of the disease.

If the disease worsens, the doctor may recommend the patient a certain type of cyclic therapy. It consists of using one medicine over a long period in order to prevent serious complications and side effects. The treatment regimen for psoriasis may look like this:

• for 2 years the patient has been attending herbal medicine sessions;
• After this, the doctor prescribes one or more strong drugs. The patient also takes medications for 1.5-2 years.

In most cases, after cyclic therapy, long-awaited relief and stable remission occurs.

Preparations for external use for psoriasis

Very often, in medical practice, to relieve itching, inflammation, redness and other symptoms of the disease, products intended for external application are used. This group includes medications produced in the form of ointments, gels, lotions, sprays, shampoos, foams and others.

The use of such drugs is indicated for mild to moderate forms of pathology. In cases of severe disease, such drugs are most often prescribed in combination with stronger drugs.

The specialist selects the medicine taking into account the severity of the disease and the individual characteristics of the patient. Treatment methods for psoriasis using external medications can be used in patients of different age groups and provide minimal side effects.

Use of corticosteroids

One of the common groups of medications for this disease are corticosteroids. They are fundamental in treatment and are used in most modern countries of the world. These drugs have the following effects:

• reduction of inflammation;
• slowing down the growth and division of dermal cells;
• eliminating itching.

Corticosteroids can have strong and moderate effects. For severe degrees of the disease, the specialist prescribes medications with a stronger effect; for milder forms, medications that have a mild effect.

Based on their biological activity, drugs in this group can be divided into:

• low activity;
• average;
• strong activity;
• very strong.

Steroid drugs include the following:

• flucinar;
• cortisone;
• hydrocortisone;
• prednisolone ointment.

Despite the fairly good effectiveness of steroids, their use for most patients is insufficient. Doctors are forced to prescribe complex treatment, including the use of other medications.

Side effects of corticosteroids

When prescribing strong drugs belonging to this group, the specialist must take into account the risk of side effects. Negative manifestations include:

• the appearance of acne;
• feeling of burning and itching;
• the walls of blood vessels may expand;
• the appearance of dry skin;
• irritation and sensitivity of the skin.

Another serious disadvantage of steroids is the addictive effect. With prolonged use, the drug ceases to have the necessary effect and loss of effectiveness occurs. That is why doctors do not recommend that patients immediately take strong medications.

Vitamin therapy

Many patients wonder how to cure psoriasis and do vitamins play a role in treatment? The answer to this question is clearly positive. Taking vitamins during illness is extremely necessary. Vitamin D3 is especially indicated for people suffering from pathology. Research into the use of medications based on vitamin D3 has proven the good effectiveness of such drugs and a minimal number of side effects. These drugs include:

• Daivonex;
• maxacalcitol;
• calcitriene;
• tacalcitol and others.

Such agents are able to stop the excessively rapid division of dermal cells and have an anti-inflammatory effect. Their main distinguishing feature from corticosteroids is that the drugs are not addictive and do not cause severe side effects. The combination of steroids and products with vitamin D3 reduces the risk of complications, as they allow you to limit the concentration of the active substances of steroid drugs. Quite good results are obtained from treatment using ointments with vitamin D3, as well as herbal medicine.

Side effects of vitamin D3

Comprehensive treatment of psoriasis with vitamin D3 may also cause some side effects. These include:

• decreased vitamin D levels. This can interfere with normal bone growth, especially in children;
• increase in calcium in the blood;
• skin irritation.

The medications should be taken strictly according to the regimen prescribed by a specialist. This will help avoid many complications and unwanted side effects.

Use of retinoids

Medicines in this group contain vitamin A and are used to treat many skin diseases. So, we will consider further how to treat psoriasis with the help of retinoids. One of the first remedies that has proven itself for psoriasis is tazarotene. It is used for mild to moderate forms of pathology. The drug is available in the form of products for external use, such as creams and gels.

Products containing vitamin A do not cause tolerance. Apply the product to the affected areas in small quantities. One of the contraindications is applying the cream to the genital area and eyelids.

Retinoids in combination with corticosteroids are quite effective.

Side effects

Long-term use of tazarotene can cause dryness of healthy skin. To prevent this, it is necessary to treat healthy skin with emollients after applying the medicine.

If severe irritation occurs after treatment with retinoids, the concentration of the active substances of the drug can be reduced by diluting the medicine with petroleum jelly.

The drug is also contraindicated during pregnancy. The components of the drug can negatively affect the development of the fetus and cause congenital anomalies.

Treatment with systemic drugs

It has long been known that psoriasis cannot be completely cured. However, comprehensive and correct therapy can save a person from the disease for many years. One of the groups of drugs are systemic drugs. These are very serious medications that are often used to treat severe autoimmune diseases, arthritis and oncology.

Such drugs are administered mainly orally or by injection. They are used mainly for particularly severe forms of psoriasis, since systemic drugs have a number of serious side effects. Next, we will consider the most effective means. Systemic drugs include the following drugs:

• cyclosporine;
• methotrexate;
• psoralen.

Also, to get rid of psoriasis, products intended to treat diseases such as cancer, acne and others are often used. It can be:

• hydrea;
• sulfasalazine;
• isotretinoin and others.

Side effects

If these drugs are used incorrectly, the following complications may occur:

• frequent headaches;
• anemia;
• hair loss may occur;
• muscle pain;
• weakness;
• rashes;
• vomiting, dizziness.

Methotrexate is strictly contraindicated for people suffering from anemia and other blood diseases, patients with alcohol dependence, patients with impaired renal function, weak immunity and some others.

Important! When treating a disease with medications, you should never reduce or increase the dose on your own, or terminate therapy prematurely without the doctor’s permission. Self-medication and non-prescription often lead to many negative consequences.

Physiotherapy as a method of combating psoriasis

One of the most effective methods of physiotherapy today is light treatment. Various methods are used in this area. The most popular procedures are:

Photochemotherapy (PUVA)

As you know, the disease can become more complicated in the cold season, as well as in the summer months. Winter psoriasis, which is often treated with light, responds quite well to treatment with PUVA. Photochemotherapy is one of the most effective modern methods. Thanks to this method, success can be achieved in more than 95% of cases. The action involves the use of long-wave ultraviolet treatment, as well as the introduction of photosensitizers into the body.

The use of PUVA is very effective for such types of pathology as exudative, vulgar, palmoplantar psoriasis, as well as disease of the scalp. Photochemotherapy has proven itself very well in the treatment of such severe forms as pustular and erythrodermic psoriasis. Answering the question: is it possible to cure psoriasis using light therapy alone, it is impossible to give a definite answer. In most cases, treatment with physiotherapeutic methods still requires drug therapy.

Selective phototherapy (SPT)

Using this method, exudative and vulgar forms of psoriasis are often treated. However, SFT is often used for progressive forms. Procedures are prescribed 5-6 times a week. The initial radiation doses are low, the doctor can increase them if the patient tolerates the treatment well and no complications arise. The course of selective therapy averages 25-30 sessions.

Narrow wave therapy (UVB)

No less effective than PUVA, gives excellent results in practice. The disadvantage is the high cost and inaccessibility of treatment, since today there is a shortage of equipment with which UVB can be performed. The patient is given 3-5 sessions per week, the total course is from 20 to 30 days.

Like other therapies, phototherapy has a number of side effects. These include:

• erythrema;
• dry skin;
• irritation;
• itching and redness.

Some time after using the light, side effects such as age spots may occur. Light therapy should also be used very carefully due to frequent eye injuries.

Important! Despite its great effectiveness, almost every light treatment method can increase the risk of malignant formations on the skin.

Alternative Treatments for Psoriasis

In addition to traditional therapy, there are alternative treatment methods. Very often in practice, the use of unconventional treatment gives the most unexpected results. So, we will consider further how psoriasis is treated with alternative methods.

Ichthyotherapy

This is a relatively new method using small Garra rufa fish. This type of therapy is carried out in sanatoriums where there are springs. The session is very simple. A person dives into water with fish, and they, in turn, cleanse the body of rough skin particles and scales, without affecting healthy areas at all.

Treatment with clay and mud

Therapeutic mud cleanses the skin of plaques very well. Often they use, for example, mud obtained from Lake Sivash. It can be purchased at a pharmacy. For application, the mud is heated to a temperature of 38-39 degrees and applied in a thin layer to the affected areas. After 30-40 minutes, the mask is washed off with warm water and a softening cream is applied to the skin.

Using massage

Massage for psoriasis is another effective method. Acupuncture is also often used in conjunction with acupressure. Massage for psoriasis has the following goals:

1. General relaxation of the patient, improvement of the psychosomatic state.
2. Increased blood flow.
3. Establishing metabolic processes of the skin.
4. Restoring skin integrity.

Important! The main feature of massage for psoriasis is the complete avoidance of any chemical and cosmetic products. Medicines in the form of creams and ointments are applied only after the session.

Plasmapheresis

As is already known, one of the main causes of psoriasis is a violation of the body's metabolic processes. Due to metabolic imbalance, negative products such as waste, toxins, and radicals accumulate in the body. These components have a very negative effect on the entire body, poisoning it from the inside. Blood transfusion for psoriasis is one of the methods of combating the disease. For these purposes, a centrifuge (plasmapheresis) is used. Using this method, you can cleanse the patient’s blood of harmful substances, as well as pathogenic viruses and fungi. Thanks to plasmapheresis, the following goals can be achieved:

• blood purification;
• improvement of microcirculation;
• elimination of inflammation;
• elimination of decomposition products and other harmful components.

Traditional methods of treating the disease

Cleansing the body with psoriasis is often carried out using folk remedies. For these purposes, various products of natural origin, as well as herbs, are used. So, we’ll figure out how to treat psoriasis using traditional methods later in the article.

All treatment methods can be divided into drugs for internal use, as well as drugs for external use.

Prescription medications for oral use

To cleanse the skin and eliminate the main symptoms of psoriasis, the following recipes are recommended:

1. Using flax seeds. To prepare the product, pour a tablespoon of seeds into a glass of boiling water and mix thoroughly. The product must infuse for at least 12 hours. It is better to leave the medicine overnight. Take the infusion in the morning on an empty stomach.
2. Bay decoction. A decoction of bay leaves has a good effect. To do this, add 10-15 medium-sized leaves to a liter of boiling water and let the product simmer for 15-20 minutes over low heat. At the end, strain the broth and cool. Take 1 tbsp. l. three times a day for 20-30 days.
3. Dill seeds. Plant seeds in the amount of 2 tbsp. l. pour a glass of boiling water and leave for 2-3 hours. Afterwards, the medicine should be strained and taken half a glass 2-3 times a day.
4. Tincture of celandine herb. Celandine can be purchased at a pharmacy. To prepare the product 2 tbsp. l. the herbs are poured with 500 g of alcohol and left in a dark room for 10-12 days. Afterwards, the product must be filtered and taken 20 g three times a day.

Products for external use

To get rid of plaques and cleanse the skin, use the following recipes:

1. Treatment of lesions with linseed oil. You can apply the oil 5-6 times a day.
2. Ointment based on tar and propolis. To prepare, you need to take 50 g of tar and 30 g of propolis. The products must be heated in a water bath and mixed thoroughly. After cooling, apply the ointment to the plaques 3-4 times a day.
3. Fish oil in its pure form cleanses the skin very well. It is applied to the affected areas in a thin layer and left for 30-40 minutes.
4. Egg ointment. To prepare it you need to take 2 chicken eggs and beat well. Then add a spoonful of sesame or sea buckthorn oil and 40 g of vinegar. The ointment is applied to the plaques 3-4 times throughout the day.

Psoriasis is a disease that is very difficult to treat. It is impossible to completely get rid of the disease. For quite a long time...

Many people have heard about psoriasis, but not everyone knows what psoriasis is and how to treat it? This disease is manifested by skin rashes and other very...

Today, psoriasis is one of the most common types of all dermatitis. The disease occurs in patients of different age...

Psoriasis, or lichen planus, is a chronic multifactorial systemic disease manifested by epidermal-dermal papular rashes. It occurs with equal frequency among males and females and lasts for years with alternating periods of relapses and remissions. This is one of the most common, difficult to treat and often severe dermatoses. Effective treatment of psoriasis requires considerable effort, but in many cases it fails.

The relevance of this medical and social problem is related to:

• significant prevalence;
• unpredictability, originality and inconstancy of the flow;
• the appearance of the first clinical signs mainly at a young age;
• the increase in incidence in the last 10-15 years among young people;
• an increase in the percentage of severe forms of the disease accompanied by serious psychological disorders and sleep disorders;
• deterioration in the quality of life of patients;
• difficulty of treatment;
• a significant increase in the number of patients with loss of ability to work, both on sick leave and due to disability, especially among young men.

According to various sources, the disease is registered in 2-7% of the world's population. In the structure of skin diseases, psoriasis accounts for 3-5%, and among patients in dermatological hospitals - up to 25%. For some reasons, these data are incomplete: the difficulty of identifying severe forms, for example, psoriatic arthritis, rare visits to medical institutions by patients with mild forms, etc.

Causes of psoriasis and its pathogenesis

Despite the advantage of local skin manifestations in most forms of the disease, due to its causes and the nature of disorders in the body, the disease is systemic in nature. The disease process involves joints, blood vessels, kidneys, and liver. There is also a high risk of diabetes, obesity and hypertension in people suffering from psoriasis, especially women.

20-30% of patients subsequently develop a syndrome of metabolic disorders with an increased content of triglycerides in the blood, obesity mainly in the abdominal area, and psoriatic arthritis. Also recently, a number of biological markers have been identified that indicate a direct connection between psoriasis and Crohn’s disease, rheumatoid arthritis, cardiovascular diseases, angina pectoris and increased mortality due to myocardial infarction. For these and other reasons, an increasing number of researchers are inclined to systematically define dermatosis as a “psoriatic disease” rather than simply “psoriasis.”

Is psoriasis inherited?

Despite the presence of a large number of hypotheses and studies conducted to date, it remains difficult to answer the question of whether psoriasis is inherited. However, it is generally accepted that the disease is genetically determined. In the absence of the disease in both parents, it occurs in only 4.7% of children. If one of the parents gets sick, the risk of the child getting sick increases to 15-17%, and for both parents - up to 41%.

The onset of psoriatic disease can occur at any age, but in most cases the peak is observed at the ages of 16-25 years (type I psoriasis) and 50-60 years (type II psoriasis). In type I psoriasis, the hereditary nature of the disease, joint lesions and the prevalence of plaque rashes are more often traced. In type II, the disease has a more favorable course.

Mechanism of development (pathogenesis)

The main link in the pathogenesis (mechanism of development) of the disease, leading to the occurrence of skin rashes, is an increase in mitotic (cell division) activity and accelerated proliferation (proliferation) of epidermal cells. As a result, the cells of the epidermis, without having time to keratinize, are pushed out by the cells of the underlying layers of the skin. This phenomenon is accompanied by excessive peeling and is called hyperkeratosis.

Is psoriasis contagious?

Is free communication and contact with sick people possible, that is, is it possible to become infected? All studies related to this disease refute this assumption. The disease is not transmitted to other people either through airborne droplets or through direct contact.

The realization of a genetic predisposition to the disease (in accordance with the genetic theory of psoriasis) is possible in the event of a disorder of the regulatory mechanisms of the following systems:

1. Psychoneurological. Mental instability contributes to disorders of the autonomic nervous system. The latter is one of the reflex links in the implementation of certain emotional factors of influence through alpha and beta receptors on the vascular system of the skin, and therefore on its general condition.

   Mental trauma plays a significant (if not primary) role in the mechanism of disease development, as well as in the frequency and duration of relapses. At the same time, dermatosis itself causes disturbances in the functional state of the psyche.

2. Endocrine. Psoriatic disease is a manifestation of a violation of adaptation mechanisms, the main role of which is played by the endocrine glands (hypothalamus, pituitary gland, adrenal glands), the regulation of which is carried out not only by the humoral route (through the blood), but also with the participation of the nervous system. /In order to adapt the body, the hypothalamic-pituitary-adrenal system is the first to turn on (in response to environmental changes, extreme and stress factors) by increasing or decreasing the release of hormones, as a result of which cellular metabolism changes.
3. Immune. The mechanism of implementation of genetic predisposition to psoriasis with the participation of the immune system occurs through genes that control the cellular immune response and the immune interaction of cells among themselves (HLA system). The immune system in psoriasis is also altered either genetically or under the influence of internal or external factors, which is confirmed by a violation of all links of skin immune regulation.

   Genetically determined disorders of cellular metabolism lead to accelerated growth and proliferation of immature epidermal cells, which leads to the release of biologically active substances (BAS) by lymphocytes, immature skin cells, activated keratinocytes and macrophages. The latter are mediators of inflammation and immune response.

   These substances include proteases, protein information molecules called cytokines (tumor necrosis factor, interleukins, interferons, various subtypes of lymphocytes), polyamines (hydrocarbon radicals). Mediators, in turn, stimulate the proliferation of defective epidermal cells, changes in the walls of small vessels and the occurrence of inflammation. The whole process is accompanied by the accumulation of single- and multicellular leukocytes in the epidermis and papillary layer of the dermis.

Predisposing and provoking factors

The key pathological manifestation of psoriasis is the excessive proliferation of defective epidermal cells. Therefore, the fundamental point in elucidating the mechanism of development of the disease and deciding how to treat psoriasis is to establish trigger factors. The main ones:

1. Psychological - the influence of short-term severe stress, as well as unexpressed, but long-term or frequently repeated negative psychological effects, moral dissatisfaction, sleep disturbances, depressive states.
2. Metabolic disorders in the body, dysfunction of the digestive organs, especially the liver and exocrine function of the pancreas.
3. Disease or dysfunction of the endocrine glands (hypothalamus, thyroid, parathyroid and thymus glands, endocrine activity of the pancreas).
4. Immune system disorders (allergic reactions and immune diseases).
5. The presence of chronic foci of infection in the body (tonsillitis, rhinosinusitis, otitis, etc.). Pathogenic and opportunistic microorganisms, especially Staphylococcus aureus, streptococci and yeast-like fungi, their toxins, skin cells damaged by these microorganisms, are powerful antigens that can provoke the immune system to aggression against them, altered and healthy cells of the body.
6. Mechanical and chemical damage to the skin, long-term use of antibiotics or glucocorticoids for any disease, hyperinsolation, smoking and alcohol abuse, acute infectious diseases (respiratory viral infection, influenza, sore throat, etc.).

Symptoms and types of psoriasis

There is no generally accepted clinical classification of psoriatic disease, but the most common clinical forms are traditionally identified. In some cases, they are so different from each other that they are regarded as separate diseases.

There are three stages in the development of the disease:

1. Progression of the process in which rashes up to 1-2 mm in size appear in large numbers in new areas. Subsequently, they transform into typical psoriatic plaques.
2. Stationary stage - absence of the appearance of “fresh” elements, preservation of the size and appearance of existing plaques, completely covered with exfoliating epidermis.
3. The regression stage is a reduction and flattening of plaques, a decrease in the severity of peeling and the disappearance of elements, the resorption of which begins in the center. After their complete disappearance, foci of depigmentation usually remain.

Psoriasis vulgaris (ordinary, common)

It manifests itself as monomorphic (homogeneous) rashes in the form of plaques or papules - reddish or pink nodules that rise above the surface of the skin. Papules are clearly demarcated from healthy areas and covered with silver-white scales. Their diameter can range from 1-3 mm to 20 mm or more. They are characterized by three phenomena that occur after scraping on their surface:

• symptom of “stearin stain” - increased peeling after light scraping, as a result of which the surface of the papules becomes similar to a drop of ground stearin; this is explained by parakeratosis (thickening of the epithelium), hyperkeratosis (thickening of the stratum corneum of the skin, i.e., layering of scales), accumulation of fats and fat-like components in the outer layers of the epidermis;
• symptom of “terminal film” - from under the removed scales a mucous epidermal layer appears in the form of a thin, velvety, shiny, moist surface;
• the symptom of “blood dew”, or the Auspitz-Polotebnov phenomenon - droplets of blood in the form of dew that do not merge with each other, which appear on a shiny surface after lightly scraping it; this is explained by injury to the plethoric dermal papillae.

The favorite places for localization of the rash are the scalp, symmetrical location on the extensor surfaces in the area of ​​large joints - elbows, knees. The localization of plaques can be limited to only these areas for a long time. That’s why they are called “watchmen” or “on duty”. Less commonly affected are nails, skin in the area of ​​other joints, genitals, face, soles and palms, and large folds.

Another characteristic symptom is the appearance of a psoriatic rash in areas of mechanical or chemical damage to the skin (Koebner phenomenon). Such injuries can be scratching, cuts, chemical irritation with acids or alkalis.

Depending on the localization of the elements and the clinical course, vulgar psoriasis is divided into several types:

• Seborrheic.
• Palmoplantar.
• Teardrop-shaped.
• Intertriginous.
• Nail psoriasis.

Seborrheic psoriasis. It occurs in areas of the skin with a large number of sebaceous glands - on the forehead, scalp, behind the ear, in areas of the facial folds (nasolabial and nasolabial), between the shoulder blades and in the upper parts of the anterior surface of the chest. If on the face, back and chest the rash has the character of red papules, which are covered with flaky large plates of silvery-white color, then behind the ears it looks like a rash complicated by an attached infection.

The surface of seborrheic spots and papules behind the ears is brighter and swollen compared to other areas. It is covered with yellowish-white or grayish-white scales and a serous-purulent crust (due to oozing), which adheres tightly to the skin. Almost always the rash is accompanied by severe itching.

This type of seborrhea behind the ears and on other parts of the body, which is accompanied by weeping of the surface and bleeding when removing the crust-scales, is classified by some authors as an independent form - exudative psoriasis (“exudate” - effusion). Despite the significant similarity with seborrheic dermatitis, these diseases are based on different causes and mechanisms of development, which means that a different approach to their treatment is required.

Palmoplantar psoriasis occurs quite often. Diagnosis of the disease is not difficult if the rash on the palms and soles is part of a common form of psoriasis. But in recent years, in some patients, especially in women in the pre- and menopausal periods, the first localization of psoriatic rash is observed in isolation (only in these areas), resembling acquired dermatosis or keratoderma of other etiologies. In the plantar area, rashes characteristic of psoriasis are often combined with fungal ones, which requires careful diagnosis and combined treatment.

In practical dermatology, three forms of palmoplantar psoriasis are distinguished:

1. Papular-plaque, characterized by dense rashes with clear boundaries with a diameter of 2-5 to 25 mm, almost not rising above the skin surface. They are reddish in color and covered with silvery-whitish scales, which are difficult to separate, unlike other localizations.

   The characteristic psoriatic triad of symptoms is often difficult to identify due to the structural features of the skin in these areas. The rashes are often localized on the marginal areas of the palms and feet. In these places, it is quite easy to diagnose the triad and collect material for microscopic examination.

   The rashes are accompanied by pronounced keratosis and edema, which gradually leads to the formation of deep cracks, pain, and decreased ability to work and quality of life. In addition, these cracks are good conditions for infection and the occurrence of often worsening erysipelas.

2. Horny, or “psoriatic calluses”, in which rounded dense foci of growths of keratinized epidermis of a yellowish color, difficult to peel off, predominate. Redness of the skin in these areas is slight. The diameter of the lesions can range from a few millimeters to 2-3 cm. They look like calluses or lesions on the feet and palms of secondary syphilis. Large psoriatic papules sometimes coalesce and cover the entire surface of the palms and soles, resembling fungal and other forms of keratoderma.
3. Vesicular-pustular- a relatively rare form of the disease. It can manifest as single blisters with serous-purulent contents against a background of erythema (redness) with blurred boundaries, or tense pustules (purulent blisters) up to 2 mm in diameter, located on typical psoriatic papules and plaques. Typically, these pustules are located symmetrically on the elevations of the palms and feet, as well as in the area of ​​the periungual fold, rarely on the tips of the fingers. Sometimes they tend to merge and form large areas of purulent areas (“purulent lakes”).

Many experts classify it as severe forms. It is observed in 2% of patients with this disease. The teardrop shape is more common in adults under 30 years of age and children. In the latter, this is the most common type of psoriatic disease. The clinical features of guttate psoriasis are the sudden appearance of rashes after a streptococcal infection of the upper respiratory tract (in 80%), for example, acute pharyngitis, tonsillitis, tonsillitis.

Orange-pink scaly papules with a diameter of 1-10 mm have the appearance of droplets and are often accompanied by slight itching. Localization of papules is the trunk, shoulder and femoral extremities, less often - the scalp and ears. It is extremely rare that elements may appear in the area of ​​the palms and soles, while damage to the nail plates is often absent.

Over the course of 1 month, new elements may appear and remain unchanged for 2 months. Sometimes small abscesses form from them. Regression of elements occurs with the formation of areas of increased pigmentation or depigmentation without the formation of scars. In 68% of cases, the disease becomes chronic with exacerbations in winter and remission in summer.

Intertriginous psoriasis more common in people who are obese, have cardiovascular disease, or have diabetes. A large, sharply painful psoriatic rash in the form of plaques with clear boundaries is localized in large skin folds - between the buttocks, under the mammary glands, in the skin folds on the abdomen, in the axillary and groin areas. The skin surface in these places becomes wet, acquires an unpleasant odor, and cracks may form on it. Thus, all favorable conditions are created for the accession and reproduction of pathogenic microorganisms.

Changes in the general condition are expressed in high temperature (up to 38 - 40 0), nausea, soreness in muscles and joints, headache, enlargement of peripheral lymph nodes, pain in the affected areas. As the pustular rash disappears, the temperature decreases and the general condition improves. Erythema and the usual symptoms of psoriasis after the end of the acute period persist for a long time.

1. Localized or palmoplantar pustular psoriasis of Barber

In contrast to the palmoplantar psoriasis described above, the rashes are predominantly pustular (with purulent contents) in nature.

Arthropathic form

Consists of inflammation of the distal joints, mainly small ones. It can have varying degrees of severity, affect one or more asymmetrically located joints, and precede or accompany skin manifestations. Arthritis can occur even with minor pain, especially at the initial stage. In the future, the process often generalizes with the appearance of swelling in the joint area, accompanied by severe pain, limitation of movements, the formation of articular ankylosis (immobility) and dislocations. This form most often leads to disability.

Therapy of psoriasis (general principles)

In recent years, a group of experts from 19 European countries have proposed 3 main principles on which effective treatment of psoriasis should be based:

1. Strict adherence to complex therapeutic treatment algorithms.
2. Constant monitoring by a specialist dermatologist of the disease’s response to the medications prescribed to the sick patient.
3. Timely modification of therapy in case of ineffectiveness.

The choice of drugs and treatment methods is directly dependent on the severity of the manifestations of the disease - in mild and moderate cases it is possible to limit it to local agents, in severe forms it is necessary to use systemic therapy.

Approximate local treatment plans

They are selected depending on the stage of the process:

1. Stage of progression:

• Unna cream, the components of which are olive oil, lanolin and distilled water;
• salicylic ointment 1-2%;
• lotions, creams or ointments containing corticosteroids - Fluorocort, Flucinar, Lorinden, Elokom, Okoid, Laticort, Advantan;
• Beclomethasone, which has anti-allergic, anti-inflammatory and anti-edematous effects, in combination with calcipotriol (an analogue of vitamin D 3, accelerating the maturation of keratinocytes and inhibiting their proliferation;
• modern, highly effective, pathogenetically based ointment for psoriasis “Daivobet”, recommended for its various clinical forms. It is a combination of the glucocorticoid betamethasone with calcipotriol;
• the drug "Skin-Cap" (zinc pyrithione, zinocap) in the form of a cream, ointment, spray or emulsion, which has anti-inflammatory, antibacterial and antifungal activity;
• Detoxification and antiallergic drugs are prescribed intravenously.

2. Stationary stage:

• salicylic ointment 3-5%;
• sulfur-tar - 5-10%;
• naftalan - 10-20%;
• calcipotriol, Daivobet ointment, Skin-Cap;
• and other types of phototherapy in winter and spring.

3. Regression stage- the same means as in the previous stage.

For nail psoriasis, injections of Triamsinolone (glucocorticoid) into the nail folds are additionally used; the systemic retinoid acitretin, which regulates the maturation and keratinization of epithelial cells, and local PUVA therapy are prescribed orally.

In severe forms, in addition to external tar and corticosteroid drugs, synthetic retinoids, cytostatics Cyclosporine and Methotrexate are added, which have powerful immunosuppressive (immune suppression) activity, intravenous detoxification, anti-inflammatory, antipyretic, cardiovascular and other intensive care agents.

It should be remembered that each form of psoriasis at each stage requires a specific individual selection of drugs for local and general effects under the supervision of an experienced dermatologist.