Psoriasis is a chronic inflammatory disease of a multifactorial nature that affects the skin and nails and is often associated with pathology of the musculoskeletal system.
If you are concerned about red, dry patches of various shapes and sizes on your skin that are scaly and itchy, make an appointment with a dermatologist.
Our doctors treat psoriasis using an integrated approach - using both medicinal treatment methods (ointments, gels, aerosols, tablets and medication injections) and the well-proven excimer light treatment using an Italian laser device.
Causes of psoriasis
Doctors mention several reasons for the development of psoriasis:
- Genetic predisposition – scientists have described a number of genes, the presence of which predisposes to the appearance of the disease;
- Endocrine, immune and nervous system dysfunctions;
- Negative effects of some environmental factors.
There are also provoking factors, which include:
- Chronic infectious diseases (most often caused by streptococcus);
- Alcohol abuse, chronic alcoholism;
- Weather conditions (dry or cold climate);
- Skin traumatization (scratches, insect bites, sunburn);
- Frequent emotional stress;
- Taking certain medications (for example, lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
- Immediate withdrawal of systemic hormonal drugs.
You should not believe the myths that dry skin and excessive hygiene can cause psoriasis - this is absolutely not true!
Stages of psoriasis
Currently, doctors distinguish 3 stages of the disease:
- Progressive - characterized by an increase in the number of elements of the rash, melting of the papules and the appearance of new elements in the damaged areas. The plates are bright pink and covered with scales. The rate of cell division in new lesions increases 10 times;
- Stationary - fresh elements are not observed, the plaques are dull-red in color, there is practically no skin, itching is almost not bothersome;
- Regressive - weakening of the intensity of the color of the rash, the elements of the rash are pale, new ones do not appear, there is no skin, no subjective signs are observed. White pseudoatrophic rims form around the plaques and healthy skin appears in the center of the large plaques. Colorless spots remain at the site of the rash.
In some cases, patients have skin elements in different stages of development at the same time.
Symptoms of the disease
The dermatovenerologist first of all pays attention to the presence of the psoriatic triad. These are marked bleeding, terminal film symptoms and stearin stain.
A "stearin spot" appears when you scratch the plaques - you can notice increased skin and the surface of the papules becomes similar to a crushed drop of stearin.
The so-called terminal film can be seen if the scales are completely removed - a wet, thin and shiny film will appear on the surface.
Pinpoint bleeding (Auspitz symptom) - exposed on the skin when the scales are removed.
Dermatologists also emphasize the Koebner phenomenon - the appearance of psoriatic rashes at the site of skin trauma (scratches, injuries).
The symptoms of psoriasis depend on its type, but there are common points:
- Rashes - they are always present in one form or another;
- The feeling of tightness of the skin at the location of psoriatic elements;
- Itching of varying intensity.
Plaques in psoriasis appear in different places, but there are also areas with typical localization:
- Scalp (with this arrangement of plaques we are talking about seborrheic psoriasis);
- Knees and elbows;
- Skin folds and flexural surfaces - elbow, knee joint, groin, armpit area, under the breast (this localization allows us to talk about inverse psoriasis);
- Lumbar, sacrum;
- Palms and feet - respectively, with palmoplantar psoriasis;
- Nail psoriasis – pitting in the nail plates, subungual haemorrhage, separation of the nail from the nail bed (onycholysis).
In addition to skin manifestations, psoriasis also causes other symptoms. For example, in the arthropathic form there will be pain in the joints, their swelling (more often these manifestations are localized in the feet, hands, ankles and knees).
Types of psoriasis
Dermatologists distinguish several types of diseases:
vulgar(plaque, common) is the most common and accounts for 90% of all cases of psoriasis. With this type of disease, flat inflammatory elements (papules) of red-pink color appear on the surface of the skin and have clear borders.
They tend to merge and form plates of different sizes, covered with silver scales. It looks like a crown or a geographical map.
Psoriatic elements are found mainly on the scalp, on the extensor surface of the elbows and knees, on the skin of the lower back and sacrum, but can also be found in other places.
Psoriasis of the elbow is treated as a special case (on the elbow there is a permanent plaque and when it is injured it starts to get worse).
Exudative- appears more often in patients with endocrine diseases (obesity, diabetes, etc. ). In the lesions there is exudation, as well as yellow-gray crusts.
teardrop shaped- as the name implies, numerous papules in the form of bright red dots are observed on the skin, peeling and infiltration are small. It occurs mainly in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis degenerates into regular psoriasis.
Seborrheicit differs in its localization - the elements are found in the folds behind the ear and nasolabial, on the chest, in the interscapular region, on the scalp. The color of the scales is yellow, sometimes they spread to the skin of the forehead and a "psoriatic crown" is formed.
Pustular– manifests as limited (on the palms and soles) or enlarged rashes, represented by superficial pustules.
Among the pustular types, Barber's palmoplantar psoriasis is distinguished, in which the pustules cover the soles and palms. It is characterized by severe itching, the melting of pustules with the formation of a crust. The disease often also affects the nails.
Pustules are also found in generalized Tsumbusch psoriasis. This type of disease is characterized by bright erythema (redness) and the appearance of superficial pustules. There is burning and pain in the rash areas. The lesions grow quickly, coalesce and cover larger areas of the skin. With Tsumbusha psoriasis, detachment of the epidermis (top layer of skin) occurs and so-called "purulent lakes" are formed. Patients experience general malaise, they suffer from fever, burning and tingling in the affected areas.
Psoriatic erythroderma
Doctors focus specifically on this type of psoriasis, psoriatic erythroderma. In this case, the pathological inflammatory process involves all or almost all of the skin. It becomes rough, tight, covered with rounded elements and the skin becomes red.
Many of our patients complain of rising temperature to subfebrile levels and not feeling well. There is an increase in peripheral lymph nodes. Erythroderma can develop due to improper treatment of psoriasis (washing, very intense tanning, high concentration of medicinal ointments, etc. ). In other cases, the process develops in healthy people if psoriasis has just begun and progresses rapidly.
If psoriatic erythroderma exists for a long time, patients may experience nail damage and hair loss.
Psoriatic arthritis
This pathology is also called arthritic psoriasis. Joint damage can develop in parallel with the rash, and in some cases it starts even earlier and is a warning sign of psoriasis.
Small joints of the feet and hands are mainly affected, but sometimes the joints of the wrist and ankle are also involved in the inflammatory process. Patients are concerned about joint pain, swelling, deformity and limited mobility.
Diagnosing
The main task of the diagnosis is to determine the percentage of skin lesions in the whole body. This is necessary to assess the effectiveness of treatment in a particular patient.
There is an opinion that to make a diagnosis you need to undergo a large number of tests. But in most cases this is not the case and a complete examination of the rash by a dermatovenerologist is enough. Psoriasis has characteristic manifestations, so visual diagnosis is not difficult.
In typical cases, this is the psoriatic triad: pinpoint bleeding, terminal film symptoms, and stearin spots. Very often, patients are bothered by itching of various degrees of intensity. The presence of psoriasis in relatives is also important.
However, there are skin symptoms that must be differentiated when diagnosing the disease. For example, with papular syphilis, a similar picture is observed. In this case, the doctor will perform a differential diagnosis, including serological studies.
Scalp psoriasis is sometimes confused with seborrheic dermatitis. With psoriasis, the doctor determines that there is a papule on the skin - that is, a lump that rises above the level of the skin and is covered with scales.
In the arthropathic form of psoriasis (when there is no skin rash), the dermatologist must make sure that it is psoriasis and not rheumatoid arthritis.
Often psoriasis appears together with other diseases, then doctors talk about comorbid diseases. For example, psoriasis can be combined with coronary heart disease, diabetes, depression or gastrointestinal pathologies.
If a dermatologist diagnoses psoriasis, he will probably refer the patient for consultation with a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And these specialists will prescribe an extensive examination (for each disease there is a standard list of tests, in particular blood tests).
The diagnostic base of the modern clinic is represented by the most modern equipment and devices. This will allow you to undergo a comprehensive examination for various diseases.
Laboratory studies are performed using modern biochemical and hematological analyzers. Ultrasound diagnostic doctors examine patients using advanced ultrasound machines.
In the radiology department, equipped with the latest medical technology, you can undergo radiography and mammography. In the clinic you can also do an MRI or CT of any organ.
Doctors of the functional diagnostics department have the opportunity to perform all the necessary studies: ECG, EEG, echoencephalography, daily monitoring of the ECG, daily monitoring of blood pressure, determine the function of external breathing and other vital indicators.
The widest range of diagnostic tests presented in our clinic allows doctors to identify diseases at almost any stage of development.
Treatment
The main goal of treatment is to control the disease and put it in remission (weakening or disappearance of symptoms). In the treatment of psoriasis, doctors use several directions at once: medications (ointments and other dosage forms for external use, as well as tablets for systemic therapy) and phototherapy using excimer light.
External remedies include creams, ointments, gels, emulsions and sprays containing hormonal drugs. Glucocorticosteroids suppress the immune system and relieve inflammation. They are presented in multiple dosage forms in each specific case, the doctor will choose an individual treatment regimen for you.
Moisturizers and emollients are used to reduce itching and dry skin.
To alleviate the manifestations of psoriasis on the scalp, the use of special shampoos is prescribed.
Calcipotriol (a vitamin D analogue) is also prescribed for local treatment.
In systemic therapy, doctors prescribe immunosuppressive drugs. These drugs are often given in small doses (once a week) to treat common, hard-to-treat types of psoriasis. Similar regimens are used in patients with rheumatoid arthritis. Administration is oral, intravenous, intramuscular or subcutaneous.
Doctors also prescribe retinoids (drugs with biological properties similar to vitamin A).
Systemic glucocorticosteroids are used very rarely and only in particularly difficult cases.
With the reduction of the process, the frequency of use of external agents and oral medications changes towards decrease.
Note that some drugs have a negative effect on the development of the fetus (for example, selective immunosuppressants), so they are contraindicated in pregnant women.
No alternative treatment leads to positive results. You should not experiment and trust your health to healers and traditional methods with unproven effectiveness.
Our doctors urge you not to self-medicate and not stop (prescribe) various medications, as this can only worsen the situation and cause an increase in rashes!
Treatment of psoriasis using a laser device
The Center for Dermatovenereology offers you an effective method of treating the disease using an excimer laser system. This is the main physiotherapeutic treatment for psoriasis and some other skin diseases with proven effectiveness.
An excimer lamp operates on a xenon-chlorine compound and emits light in the UV range. Only rays of a certain length penetrate the skin and reduce inflammation in the skin. The thickness of the plates decreases.
The rays affect only the "diseased" cells without affecting the healthy skin. This therapy reduces the population of T lymphocytes in areas of the skin covered with plaques. In this way, stable remission is achieved, and in many cases excimer light treatment makes it possible to abandon hormonal drugs.
This method allows you to forget about the torment that seasonal aggravation brings to patients with psoriasis.
The dermatovenereologist first identifies the indications and contraindications for phototherapy treatment with monochromatic excimer light.
Indications include:
- Psoriasis;
- Vitiligo;
- Atopic dermatitis;
- Spotted baldness (alopecia);
- Change in the color of the wounds;
- Eczema.
There are very few contraindications for the procedure, these include:
- Pregnancy;
- Oncological diseases;
- Serious general condition.
Why you should pay attention to system handling
Dermatovenereologists note a number of undeniable advantages of excimer light treatment:
- The effect is local, only on psoriatic plaques, the rays do not affect the whole body;
- In mild cases, it is enough to prescribe only phototherapy and photosensitizers to achieve lasting remission;
- They are prescribed for patients of any age (starting from 3 years old);
- Treatment with the laser system does not require a stay in the hospital, it is easily adapted to any work schedule;
- Effective for various forms of psoriasis;
- Minimum restrictions.
How is the treatment procedure performed?
At your first appointment, the doctor will perform a test for you, during which he will determine the phototype of your skin and determine the minimum dose of ultraviolet radiation.
The next day you come for an appointment, where the doctor determines the most appropriate result of the analysis. This means, the doctor will choose the power of radiation individually, which is especially suitable for your skin.
There are no restrictions during treatment;
The effect of phototherapy occurs after only a few procedures, and for stable remission you will need about 5-10 procedures (in some cases 15).
The duration of a procedure is from 10-20 minutes, it depends on the treatment area and the number of affected areas.
Psychological help
We always encourage you to remember that psoriasis is not contagious! And yet, patients often worry not so much about the discomfort of the presence of rashes, as about the reaction of others. This is especially painful for women and children.
Children can be cruel to a sick child. Therefore, it is very important to prescribe treatment at the right time, including consultation with a psychologist or even a psychotherapist.
Benefits of treating psoriasis in a clinic
Patients choose to treat psoriasis for a number of reasons:
- Experienced, qualified dermatologists and cosmetologists;
- Elimination of dermatological and cosmetic problems at the same time;
- Innovative treatment methods, especially using a laser system;
- The most modern diagnostic methods;
- Possibility of consultation with doctors of various specialties.
If you are concerned about the plaques, itching and redness of the skin, contact the clinic. You can always get qualified medical care.
Prevention of psoriasis
The main task of dermatovenerologists is to prevent the worsening of psoriasis. For this purpose, they prescribe preventive measures:
- Prevention of stress;
- Prevention of colds;
- Control over foci of chronic infection;
- Rejection of tight and tight clothing that damages the skin.
Thanks to preventive measures and timely treatment of psoriasis, doctors are able to quickly reduce the severity of the disease and achieve the disappearance of many symptoms of the disease.
What happens if the disease is not treated?
If left untreated, the rash will spread and fill more and more of the skin. A transition to the erythrodermic type is possible, which is much more difficult to treat.