Psoriasis

Psoriasis (synonym psoriasis) - chronic relapsing papules-squamous skin disease. There are a number of theories of occurrence of psoriasis - virus, hereditary, neuroendocrine and others, none of which is not proven. A number of authors considers psoriasis is a disease polietiologic that can arise from various causes. The disease is common, non-contagious.
The clinical picture in typical cases is very distinctive. The disease occurs suddenly, without prodromal phenomena. The rash can either be limited to the election localization (the area of the elbow and knee joints), or common across the skin surface (Fig. 1-4). When irrational therapy, as well as under the influence of other factors rash may merge, capturing almost the entire skin,- psoriatic erythroderma.
The primary element rash, psoriasis is a papule rounded, pink covered with white-silvery scales. Expanding perifericheskie, papules assume the nature of plaques. For psoriatic rash characterized by three symptom, or phenomenon (the so-called psoriatic triad). 1. The phenomenon of a stearin stain. By poskablivanii elements rash scales are crushed and fall as fine silver pollen, as if poskablivanii stearic spots. 2. The phenomenon of terminal film. This film is visible after scraping from the surface of psoriatic element of all scales. 3. The phenomenon of blood dew, or the point of bleeding. After scraping a terminal film on the surface of psoriatic papules or plaques appear smallest drops of blood.

psoriasis photo
Fig. 1 - 5. Psoriasis: Fig. 1 - body; Fig. 2 - the elbow; Fig. 3 - soles; Fig. 4 - palm; Fig. 5 - opioidnye psoriasis.

There are several types of psoriasis, characterized by localization, morphological peculiarities of rash elements, the degree of prevalence of process and other clinical signs.
1. Acne psoriasis, clinically manifested by a rash of small follicular pink knots, scaly whitish, with no inclinations to peripheral growth. 2. Exudative psoriasis is characterized by the formation of scales-crust on the surface of the elements rash. 3. Psoriasis of the palms and soles is a more rare type of psoriasis is characterized by peculiar lesion localization. 4. Inverse psoriasis is one of the most difficult types of psoriasis. It affects the joints by type of arthralgia or (in more severe cases) arthropathy, accompanied by deformation of joints, sharp pain, expressed mainly in motion.
There are three stages of psoriasis: 1) acute stage, characterized by the appearance of new lesions, their intensive peripheral growth, a positive phenomenon, Cabrera (skin rash appears on the site of application scratches); 2) stationary phase, when the progression of the process was stopped symptoms inwalucia skin rash; 3) the stage of remission - all lesions are reverse, leaving depigmented spots. In the elbow and knee joints often remain so-called duty of psoriatic plaques.
The disease long, often throughout the life of the patient. Flare-UPS occur more frequently in autumn and winter. The most severe course differs inverse form of psoriasis and psoriatic erythroderma, often leading the patient to disability.
Diagnosis of psoriasis is usually simple. Differential diagnosis should be carried out with the parapsoriasis (see), secondary syphilis (see). The location of psoriatic items on the scalp conduct differential diagnosis seborrhoeic eczema (see).
Treatment. Diet - restriction of animal fats and carbohydrates, the exclusion of spicy dishes. At intensifying effective drugs bromine, intravenous infusion of 10% solution of calcium chloride, 30% of sodium hyposulphite, injections of vitamins B1 and B12, 1-2% mist sulfur in oil, of pyrogenal (contraindications - see Pyrotherapy); autohemotherapy. In the stationary phase psoriasis shown concentrate of vitamin a, vitamins B1, B6, B12, C, D2, folic acid, ultraviolet irradiation. When psoriatic the eritrodermii and inverse psoriasis shown corticosteroids (best effect has triamcinolone). When psoriatic arthropathy - ultrasound on the joints. External treatment: in the acute period indifferent ointments, ointments to steroid hormone (prednizolonovuyu, lookeren sinalar and others). In stationary phase psoriasis - 2-5% salicylic, 5-20% of the tar and naftalane ointment. Shows quarteria - hydrosulphuric baths, sea, river swimming, sunbathing.
Psoriasis patients should be under medical supervision, to get re-treatment courses. Prevention of psoriatic eritrodermii should not apply strongly irritating ointment in acute exudative form of psoriasis.



widespread psoriasis psoriasis vulgaris
Widespread psoriasis

Psoriasis (from the Greek. psoriasis - itching, scabies; synonym: psoriasis vulgaris, a psoriasis) - chronic, usually long-flowing, relapsing, non-contagious skin disease, the main element of which is the papules, covered with silvery-white scales.
The frequency of disease psoriasis in different countries, on average it is about 4-6% of all skin diseases. The incidence among men and women is about the same. Psoriasis occurs at the age of 16-25 years old, in children less common (up to 2% of the total number of cases), even less often after age 70. A. P. Jordan and others pointed to the frequent cases of so-called family of psoriasis (17%). Anula and Novotny (J. Janula, E. Novotny) believe that it is 31.3% of cases.
The cause of psoriasis is unknown. Known the importance of heredity. It includes the dominant nature of inheritance. Marked the inheritance of psoriasis in several generations. Some researchers tried to explain the cause of the disease effect of various infections. However, as a result of thorough research etiological role spirohet, pyococcal, epidermofitony, monili and actinomycetes was rejected. Some researchers (among domestic dermatologists A. F. Ukhin with al., A.M. with Krichevsky al. and others) believe viral etiology of psoriasis most likely, others do not confirm it, since there is still no convincing evidence of infection from one person to another.
Known value is allergic theory, from the point of view which psoriasis is treated as an allergic reaction to the action of bacterial toxins circulating in the blood and act as antigens. Such statements also did not find widespread support.
A special role in the etiology of psoriasis is given to the nervous system. A. G. Polotebnov, P. C. Nicholas, Brock (L. Brocq), Balser (F. Balzer), Lutz (S. Lutz), Degas (R. Degos) and others have reported a large number of cases of psoriasis that developed after various mental and nerve injuries. Changes from the nervous system can be functional and organic nature. Recent studies showed a significant disturbances in metabolism of the skin in patients with psoriasis. So, Uhlmann (K. Ullmann), Kuta (A. Kuta) observed increased activity dehydrogenase in the epidermis, the Braun-Falco, O. Braun-Falco) indicates the appearance of functional changes in sulfhydryl groups, phospholipids, polysaccharides and hydrolytic enzymes, but thought there was specific for psoriasis. Several authors indicate infringement of water balance, electrolyte and some microelements in the skin of psoriasis patients. These and other biochemical changes in the skin associated with impairments of metabolic processes in the body, primarily with changes in the lipid metabolism [B. S. Ablenet, Grotz, Burger (O. Griitz, M. Biirger) and others]. There are many reports of violation of nitrogen and carbohydrate metabolism; any specific for psoriasis changes in the proteins of blood cannot be found.
Histopathological changes, as a rule characteristic of psoriasis. They are reduced to the parakeratosis, acanthosis with intracellular edema in minisoccer areas, congestion in the stratum corneum of neutrophils - microabscess Munro, rarely to the formation of the so-called spongiform pustules Cogoa. Due to the presence of air between the plates of the stratum corneum peeling has a silver-white color. Derma papillae lengthened, swollen, especially in the upper part, capillaries on top of their extended maleyeva network over them thinned, and therefore in low poskablivanii capillaries easily ranada and occurs dotted haemorrhage, a phenomenon of Auspice, papillary and podarochnom layers - perivascular infiltration of lymphocytes and histiocytes. From the nervous fibers, according to the majority of the authors, the changes are not specific. Histological changes depend on the form of psoriasis and severity of the current process. Some authors believe that the process actually begins in the skin, because the change is mainly distributed in the capillaries papillary and podmoskovnogo skin layers (isomorphic response - the phenomenon of Cabrera); the other, based on significant histological and biochemical disturbances in the epidermis, the beginning of the process explain from the point of view of the theory of primary epidermal proliferation. Skin changes are detected and on the sites of apparently healthy skin near the lesions. Similar changes in the skin are found in some healthy individuals of the same kinship with patients with psoriasis. Because of this there was the idea of latent psoriasis.
The clinical picture. At first appear spot the size of a pinhead, which quickly formed in papules; they are usually pink in color (symptom M. S. Pylnova), covered with silvery-white scales. The number of eruptions is growing rapidly, they increase in size, becoming typical papular infiltrates with growing peeling. Psoriasis is characterized following triad: 1) the phenomenon of a stearin stain - surface papules after scraping reminds of a stearin stain, and 2) the phenomenon of terminal film with the full scraping scales found shiny surface papules; 3) the phenomenon of Auspice, or the phenomenon of blood dew A. G. Protassova is the most superficial trauma terminal film leads to the point of bleeding. A characteristic of psoriasis isomorphic response of Cabrera: the appearance of the skin fresh rash in the areas of mechanical, chemical and other skin irritations.
The disease affects all areas of the skin, but often places subject to pressure and irritation. Favourite localization psoriasis - extensor surfaces of the limbs, mainly the area of the elbow (printing. Fig. 2). Clinical picture of lesions of psoriasis on the trunk and extremities extremely diverse in sizes of elements and their distribution (psoriasis punctata, guttata, nummularis). Lesions increase in size, acquire different shape (psoriasis anularis, gyrata, geographica). Gradually, they can apply to the entire skin (printing. table). Psoriasis rarely occurs with pigmentations, often with discoloration in the form of leukoderma (psoriatic Leucoderma).
The usual clinical course of the disease can worsen, and then develop the most severe psoriasis. Among them psoriatic erythroderma, rubioideae (printing. Fig. 5), warty and pustular form (sterile pustules); the latter form is a variant of exudative psoriasis, often it is accompanied by the affected joints. Among the rare forms of psoriasis is inverse, in some cases kombineras with other forms. Along with lesions of the joints, but sometimes without marked bone changes, often in the form of osteoporosis.
To atypical localization of psoriasis include large-scale folds (inverse psoriasis). Usually psoriasis is located symmetrically, rarely - sided. On the face and the chest yellowish lesions covered with thick greasy scales (psoriasis in seborrhoica) (printing. Fig. 1).
On the genitals, especially in the area of the glans penis, found atypical little scaly papules yellow-reddish color. There is an isolated disease of the hands and feet (palms and soles) (printing. Fig. 3 and 4).
In half of the cases, especially with generalized forms of psoriasis, it is the defeat of the scalp. Psoriasis mucous membranes occurs rarely. Meet the defeat nails (10-12%), which can develop in isolation, but more often in the presence of the disease in other parts of the skin. There are psoriatic onykii, in some cases in combination with periodicity. Clinic of nail lesions of psoriasis diverse, particularly characteristic punctulata istinnost nail plate, the so-called naperedodni nails, there oniholizis, leukonychia.
Your psoriasis is usually long, periods of relapse and remission different. Sometimes there may come a spontaneous cure disease. In most patients with favorable course is observed in the warm season, exacerbation - in autumn and winter months (psoriasis hiemalis), some patients with exacerbation may come in the summer months (psoriasis aestivalis).
Differential diagnosis of psoriasis is often done with teardrop and a plaque parapsoriasis (see), seborrheic eczema (see), red pityriasis hair deprive Diverge (see Zoster), various forms of reticulata, erythroderma Wilson - Brock and, most importantly, erythrodermic forms of mycosis fungoides (see the mushroom Avium).
Treatment. General measures: vitamin - vitamins B1 and B12, C, D2. In severe forms, accompanied by itching, insomnia, it is useful to designate a sedative and neurologiske drugs (bromine, andaxin, nanophyn, chlorpromazine, sulphate of magnesia, novocaine and others); at the widespread and acute, especially in bone and joint complications it is advisable to use aspirin, phenylbutazone, salitsilovaya sodium.
In severe forms of psoriasis, not susceptible to treatment with these drugs can be recommended in the hospital, aminopterin, but in small doses (not more than 1 mg per day), because it causes severe complications (stomatitis, hematological and other symptoms).
Drugs arsenic (especially long-term use and large doses) recommend rare. In severe and widespread forms of psoriasis appoint corticosteroids (prednisone, triamcinolone, dexamethasone). Drugs adrenocorticotropic hormone (ACTH) is ineffective. Apply pyrogenic therapy (A. A. Sudnitsyn, A. A. Stein and others). Number of patients, mainly in winter, it is useful ultraviolet irradiation. In the absence of contraindications appropriate treatment on resorts of Pyatigorsk, Sochi-Matsesta, Sernovodsk, Kemeri, Tskaltubo, and on resorts of southern coast of Crimea. Patients with acute, erythrodermic and pustular psoriasis be sent to the resorts carefully.
Local treatment prescribed with caution (avoiding eritrodermii).
When hardly proceeding, rapidly progressing form of psoriasis useful indifferent ointment 1-2% salicylic ointment, etc. When stationary or regressing forms shown sulfur-tar ointment (2-5-10%), psoriasis and antipsoriatics and ointment containing 2 -10% chitravina. These potent ointment can cause some patients the disease, so their use in the beginning should be limited. Some patients it is expedient to prescribe ointments containing corticosteroids (hydrocortisone and others). With the defeat of the scalp effective ointment containing 2-5% white sediment mercury and 1% salicylic acid. Not recommended rays Bucky tray or x-rays.
Forecast for psoriasis largely depends on the course of the process. He favorable for uncomplicated and limited forms, less favorable when erythrodermic, inverse, exudative. The importance of timely treatment of disease recurrence. All patients with psoriasis should be under the supervision of clinic.