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Psoriasis – Symptoms – NHS
Main symptoms of psoriasis
Psoriasis typically causes patches of skin that are dry, red and covered in silver scales. Some people find their psoriasis causes itching or soreness.
There are several different types of psoriasis. Many people have only 1 form at a time, although 2 different types can occur together. One form may change into another or become more severe.
Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping.
You should see a GP if you think you may have psoriasis.
Common types of psoriasis
Plaque psoriasis (psoriasis vulgaris)
This is the most common form, accounting for about 80 to 90% of cases.
Its symptoms are dry red skin lesions, known as plaques, covered in silver scales.
They normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body.
The plaques can be itchy or sore, or both. In severe cases, the skin around your joints may crack and bleed.
This can occur on parts of your scalp or on the whole scalp. It causes red patches of skin covered in thick, silvery-white scales.
Some people find scalp psoriasis extremely itchy, while others have no discomfort.
In extreme cases, it can cause hair loss, although this is usually only temporary.
In about half of all people with psoriasis, the condition affects the nails.
Psoriasis can cause your nails to develop tiny dents or pits, become discoloured or grow abnormally.
Nails can often become loose and separate from the nail bed. In severe cases, nails may crumble.
Guttate psoriasis causes small (less than 1cm) drop-shaped sores on your chest, arms, legs and scalp.
There’s a good chance guttate psoriasis will disappear completely after a few weeks, but some people go on to develop plaque psoriasis.
This type of psoriasis sometimes occurs after a streptococcal throat infection and is more common among children and teenagers.
Inverse (flexural) psoriasis
This affects folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts.
It can cause large, smooth red patches in some or all these areas.
Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather.
Less common types of psoriasis
Pustular psoriasis is a rarer type of psoriasis that causes pus-filled blisters (pustules) to appear on your skin.
Different types of pustular psoriasis affect different parts of the body.
Generalised pustular psoriasis or von Zumbusch psoriasis
This causes pustules that develop very quickly on a wide area of skin. The pus consists of white blood cells and is not a sign of infection.
The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue.
This causes pustules to appear on the palms of your hands and the soles of your feet.
The pustules gradually develop into circular, brown, scaly spots that then peel off.
Pustules may reappear every few days or weeks.
This causes pustules to appear on your fingers and toes.
The pustules then burst, leaving bright red areas that may ooze or become scaly. These may lead to painful nail deformities.
Guttate psoriasis: Causes, symptoms, and treatment
Psoriasis is a chronic autoimmune disease that speeds up the natural growth cycle of the body’s skin cells and affects a range of systems in the body. Guttate psoriasis is a specific type of this condition, which causes tear-shaped, scaly patches to form on the skin.
Guttate psoriasis is the second most common type of psoriasis. According to the National Psoriasis Foundation, about 10% of people with psoriasis have guttate psoriasis.
This type of psoriasis can appear at any age, but it generally starts to develop in childhood or young adulthood.
In this article, learn all about guttate psoriasis, including its effects, possible causes, and how to treat it.
Share on PinterestGuttate psoriasis causes small, red, tear-shaped patches to form on the skin
The name guttate psoriasis comes from the Latin word guttate, which means “drop.”
The condition has this name because its characteristic small, red, scaly skin patches resemble tears or raindrops.
While the lesions in plaque psoriasis are large with a covering of thick, silvery scales, the patches in guttate psoriasis are much smaller and thinner.
Several hundred of these small, drop-shaped patches may appear on the arms, legs, torso, scalp, face, and ears.
Patches can appear almost anywhere on the body but often occur on the:
- lower back
- soles of the feet
Psoriasis can also affect the fingernails, toenails, and mouth. Guttate and plaque psoriasis might occur at the same time.
An outbreak of guttate psoriasis is usually manageable, but complications can arise if a person does not receive treatment.
Potential symptoms include pain, secondary skin infection, and itching.
The complications of guttate psoriasis include:
Doctors classify psoriasis according to its severity, which they determine by looking at how much of the body the symptoms are affecting.
- Mild: Lesions develop on up to 3% of the skin.
- Moderate: Lesions cover 3% to 10% of the skin.
- Severe: Psoriasis covers more than 10% of the skin.
Sometimes the rash resolves, but it may return later.
Share on PinterestA dermatologist will examine the skin to determine the presence of guttate psoriasis.
A doctor, usually a dermatologist, will typically diagnose guttate psoriasis by performing a physical examination of the skin. The dermatologist can determine whether pustules result from guttate psoriasis by their visual appearance.
The doctor or dermatologist may need to take a skin sample and perform a biopsy to confirm the diagnosis. Blood tests can rule out other possible diseases, such as eczema or dermatitis.
The doctor may ask about any recent bouts of strep throat or other infections, as these may act as a trigger for guttate psoriasis in children. They may also order a throat swab to test for infections.
The doctor will assess the severity of the breakout using the Physician Global Assessment (PGA) and the Psoriasis Area and Severity Index (PASI). They will also suggest the best ways to prevent future flares.
Several conditions have symptoms that are similar to the skin involvement of guttate psoriasis.
These conditions might occur alongside an outbreak of guttate psoriasis. An important part of diagnosis will be ruling out these alternative explanations for symptoms.
A doctor can treat early stage psoriasis effectively. Sometimes, the rash clears completely, but guttate psoriasis can cause further flares of skin symptoms in some people.
However, if a person does not seek medical treatment, symptoms may become severe. At this stage, guttate psoriasis becomes difficult to treat, and it may become a chronic health condition.
Guttate psoriasis can develop very quickly. It is not clear what makes the immune system overact, but a variety of different triggers can start flares.
- upper respiratory infections
- streptococcal infections
- injury to the skin
- certain drugs, including antimalarials and beta-blockers
- dysfunction of the nervous and endocrine systems
- hormonal disorders
- genetic predisposition
- environmental risks
- excessive alcohol consumption
Guttate psoriasis is not contagious, but a contagious infection, such as strep throat, is often responsible for flares of guttate psoriasis. Symptoms typically show 2–3 weeks after infection. It is the only type of psoriasis that progresses due to an acute viral or bacterial infection.
It is possible to have strep throat or another viral or bacterial infection without showing symptoms. For this reason, guttate psoriasis might seem to have a sudden, unexplained onset.
Guttate psoriasis might also have genetic causes. A person has a higher risk of developing the disease if it runs in their immediate family.
Treating guttate psoriasis can be challenging.
It is important to have appropriate treatment for guttate psoriasis to resolve ongoing discomfort and prevent complications.
People with mild guttate psoriasis should use topical medications as the first step. The direct application of topical medicines to the lesions can moisturize the area and relieve itching.
Topical treatments for guttate psoriasis include steroid creams, gels, ointments, and vitamin D treatments. People can purchase many of these over the counter (OTC) and use them at home.
Antidandruff shampoo can help with dryness and itching on the scalp.
Other treatment options may include:
- phototherapy, which uses ultraviolet light
- antibiotics to treat strep throat or any other infection
- drugs, either by mouth or injection
Some natural remedies may be beneficial:
Short monitored periods of sunlight can help minimize the severity of guttate psoriasis.
- Adding Epsom or Dead Sea salts to bathwater and soaking in it can help. These salts help reduce inflammation, remove built-up dead skin cells, provide hydration, and soothe the skin.
- People should avoid using soaps that contain perfumes, as these may irritate the skin.
- A daily exercise routine can help a person strengthen their muscles and tissues. Doing this can help regulate the body’s metabolic functions and reduce the risk of cardiovascular disease and metabolic syndrome, which can sometimes accompany psoriasis.
Guttate psoriasis is an autoimmune disorder. A person might not be able to prevent the disease if they have a family history of psoriasis. However, smoking and excessive alcohol consumption increase the likelihood of symptoms developing.
With proper treatment, individual outbreaks of lesions are likely to resolve in full. However, the skin involvement of guttate psoriasis may flare up later on, causing further symptoms.
If psoriasis makes a person feel self-conscious, they can try using clothing or makeup to cover lesions. A person with psoriasis might also benefit from counseling or psychotherapy to work through any feelings of depression or anxiety.
It is important to monitor for symptoms and any signs of relapse to ensure prompt treatment.
A healthful diet may help lessen the effects of guttate psoriasis. The results of a 2017 survey suggest that following certain diets, such as a vegan or Mediterranean diet, can help reduce the regularity and severity of flares.
Although no dietary measures directly relieve guttate psoriasis symptoms, some can help support active psoriasis treatment. These measures include:
- diet plans that promote weight loss
- gluten-free foods, as celiac disease is likely to develop alongside psoriasis
- foods that act against inflammation, such as oily fish
- good sources of antioxidants, such as leafy green vegetables
- sources of vitamin D
Here, learn more about dietary measures that can help people with psoriasis.
How do I reduce itching with guttate psoriasis?
Both guttate psoriasis and plaque psoriasis can cause itching, but it is likely to be on a larger scale if you have guttate psoriasis.
Often, a moisturizer, cold shower, or scale softening product will help relieve the itch. Identifying any triggers of your guttate psoriasis is key to helping reduce the itch because if you can avoid the trigger itself, there are more ways to reduce the flare-up and resulting itch.
For example, if stress triggers your symptoms, you can try practicing meditation. If the itch is too overwhelming, prescription steroids or antihistamines can help you control the urge to scratch.
Debra Sullivan, PhD, MSN, RN, CNE, COIAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Guttate Psoriasis — Causes, Symptoms, Treatment, and Complications
What Causes Guttate Psoriasis?
The term “guttate” comes from the Latin word “gutta,” meaning drop; the red spots in guttate psoriasis can look like droplets.
Very often, guttate psoriasis comes on suddenly. Strep throat is a common trigger, says Jeffrey Sugarman, MD, PhD, an associate clinical professor in the departments of dermatology and family medicine at the University of California in San Francisco, and a medical director at Redwood Family Dermatology in Santa Rosa.
The environment seems to play a more important role in guttate psoriasis than in other types of the disease.
Guttate psoriasis can also be triggered by:
- An upper respiratory infection
- An injury to the skin such as a burn, cut, or scrape
- Some medications such as beta-blockers, which are used to treat heart conditions, and drugs that treat malaria
These triggers can unmask psoriasis in people who may have a family history or other risk factor for the disease.
Shurlow doesn’t know what triggered her guttate psoriasis. She can’t recall anything in particular, but she was sick a lot as a kid. “I had asthma, and from when I was 4 until about 10, I got bronchitis a lot,” she recalls.
Shurlow does know that when she’s under stress, her guttate psoriasis symptoms can be worse. Also, two or three days before she has any symptoms of a cold or other illness, she’ll notice more spots. “I find it kind of strange,” she says. “It’s like a warning sign that I’m going to get sick.”
How Is Guttate Psoriasis Diagnosed?
Dermatologists diagnose guttate psoriasis much as they do plaque psoriasis: mostly from the distinct appearance of the rash, says Dr. Sugarman.
As with plaque psoriasis, guttate psoriasis appears most often on the trunk and limbs, says Sugarman. But instead of the thick red lesions you get from plaque psoriasis, you get tiny red spots — “and it can be hundreds,” he adds.
As part of the diagnosis, your doctor will also ask whether you’ve had strep throat or another infection, and may do a skin biopsy and a throat culture to confirm the diagnosis — though this isn’t often necessary. Your doctor may also ask whether you’ve been taking any new medications or supplements.
Most people get guttate psoriasis as children or young adults. In older adults, it can often be the initial presentation of the more chronic plaque psoriasis, and it often runs in families. But Shurlow says that in her family, only a cousin is also living with guttate psoriasis.
Guttate psoriasis’s teardrop-shaped rash can break out almost anywhere on your body. The red spots can be covered with silver, flaky scales, similar to plaque psoriasis.
Guttate psoriasis may go away on its own in a few weeks or months. If it doesn’t, it can be treated with topical medications, although applying creams and ointments to the hundreds of tiny drops on your skin can be tedious. “I’ve done numerous steroid creams over the years,” Shurlow says. Dandruff shampoos and moisturizers may help, too.
Phototherapy is often an effective treatment for guttate psoriasis. “Light therapy helped a lot,” says Shurlow.
If you have a severe case, your doctor might prescribe oral or injectable medications to dampen your inflammatory response. Shurlow has been on a biologic for about five years, and it’s helped clear her skin. “I feel very fortunate that insurance has covered most of the cost,” she says. “I still have a copay, but it’s reasonable.”
Can There Be Complications from Guttate Psoriasis?
As with any type of psoriasis, guttate psoriasis may lead to complications.
“Some people can have one episode of guttate psoriasis when they are 12 years old and never have it again,” Sugarman says. “Others wind up with chronic psoriasis and some lipid abnormalities: high blood cholesterol and triglycerides.”
It’s also possible to develop the more common plaque psoriasis.
Guttate psoriasis can cause severe itching and, less frequently, serious skin infections. About 10 percent of people living with guttate psoriasis develop psoriatic arthritis, which causes chronic joint inflammation.
Work closely with your doctor to find the best treatment for you, and the condition will be easier to manage.
Guttate Psoriasis – an overview
PSORIASIS AS AN AUTOIMMUNE DISEASE: INTEGRATING GENETICS AND IMMUNOLOGY
Acute guttate psoriasis is often self-limiting and may reflect an abnormal immune reaction to streptococcal throat infection. Chronic plaque psoriasis, however, behaves like most autoimmune diseases, being characterized by a chronic but fluctuating inflammatory process. Given that the major role of MHC molecules is to present antigens to T cells, the discovery of HLA-Cw6 as the major disease allele at PSORS132 provides a major new impetus to focus research efforts on understanding precisely how the immune system is dysregulated in psoriasis. The predominance of oligoclonal CD8+ T cells in lesional epidermis64 suggest that specific antigens rather than superantigens drive the pathogenic process. HLA-Cw6 seems well suited for a role in this process, as HLA-C presents peptide antigens to CD8+ T cells and CD8+ T cells constitute at least 80% of the T cells in the epidermis of psoriatic lesions.117 HLA-Cw6 homozygotes have a 2.5-fold higher risk of psoriasis than heterozygotes without having more severe disease. This outcome would be expected if the density of HLA-Cw6 molecules on the surface of antigen-presenting cells (APCs/DCs) determined, together with the local concentration of relevant neoantigen, the probability of exceeding the threshold for breakage of tolerance leading to an “all or none” process of T-cell activation.117 Furthermore, the CD4+ T cells in stable psoriasis lesions are also likely to be oligoclonal,61–64 further supporting the concept that chronic psoriasis is an antigen-driven disease.
Psoriasis (particularly its guttate variant) has long been known to be triggered by streptococcal pharyngitis,28 and associations between guttate psoriasis and HLA-Cw6 are extremely strong.118 Streptococcal tonsillitis is the only infection shown to trigger psoriasis in a prospective cohort study.28 Interestingly, streptococcal skin infections such as erysipelas, impetigo, and cellulitis generally do not seem to trigger psoriasis, suggesting a critical role for the tonsils. The tonsils are a part of the mucosal lymphoid system but have several unique features. It is the only mucosal lymphoid organ that is lined by stratified squamous epithelium, it does not have any afferent lymphatics, and skin-homing T cells have been identified and isolated from the tonsils.119 Thus, this lymphoid tissue can be thought of as being on the boundary of the cutaneous and mucosal surfaces and can probably function as a generator of skin-homing cross-reactive T cells in psoriasis.
It has been postulated that psoriasis is mediated by T cells that cross-react with epitopes that are common to streptococcal M proteins and the keratins that are upregulated in psoriatic lesions (keratin 16 [K16] and keratin 17 [K17]).65 M proteins are a virulence factor of α-hemolytic streptococci and over 80 serotypes are known, reflecting considerable variability in the protein sequence of these proteins.120 In contrast to findings in rheumatic fever, no specific M protein is associated with guttate psoriasis. However, all M proteins have a conserved amino acid sequence, and this conserved region has considerable homology to keratins, particularly K16 and K17.121–123 These keratins are usually expressed only at low levels or not at all in normal skin but are upregulated during inflammation or trauma. Consistent with this hypothesis, skin-homing (cutaneous lymphocyte antigen–positive, CLA+) CD8+ T cells in HLA-Cw6–positive patients have been shown to respond to peptide sequences present in both K16 and K17 keratins and M proteins, but nonpsoriatic HLA-Cw6–positive control subjects responded only to peptides from the M protein.124 These data strongly support the concept that psoriasis is an autoimmune disease, even though there is little evidence for immune-mediated tissue damage (with the exception of joint disease in PsA). Instead, a major consequence of autoimmunity in psoriasis appears to be activation of the epidermal regenerative maturation program.
With influx of these cross-reactive cells into the skin, they are able to recognize cross-reactive antigens in the binding pocket of HLA-Cw6 on the keratinocytes themselves and induce local release of cytokines with subsequent local inflammation. This response would be more characteristic for the skin lesions we know of as guttate psoriasis rather than chronic plaque psoriasis. For the lesions to evolve into classical chronic plaque lesions, generation of a self-sustaining number of autoreactive T cells probably needs to occur (Fig. 6-2). As keratins are intracellular proteins expressed by keratinocytes and as keratinocytes are not effective antigen-presenting cells for naïve or even resting memory T cells,125 this model necessitates that the putative autoantigens derived from K16 and K17 must be taken up by dendritic cells in order to trigger T-cell responses. It has been recognized for many years that psoriatic lesions are characterized by a large increase in the number and activation levels of dendritic cells.126 Dendritic cells have been shown to “sample” intracellular proteins from adjacent living cells in a process known as cross-presentation.83 Dendritic cells are particularly efficient in their ability to cross-present antigens and are the only cells that can cross-present antigens to CD8+ T cells.127 Because this cross-priming event is dependent upon support of activated CD4+ T cells,128 the model posits that presentation of self-peptides to activated CD4 T cells in the context of HLA class II is also important for the functional maturation of cross-presenting dendritic cells. Indeed, epitopes of K17 predicted to bind to HLA-DRB1*07 (which is often found in cis to HLA-Cw6 on extended MHC haplotypes) were found to stimulate proliferation and IFN-γ production in T cells from psoriatic patients but not from control subjects.129 CD4+ T-cell support is also necessary for maintaining CD8+ effector T-cell function.130
Once activated, the CD8+ T cells induce further maturation and Th2 polarization of the dendritic cell population.131 Thus, a self-sustained cycle continuously generating new autoreactive T cells is established (Fig. 6-3). These keratin-reactive CD8+ T cells would then directly recognize keratin peptides on the surface of keratinocytes in the context of HLA-Cw6. Consistent with this model, at least 80% of epidermal T cells in psoriatic lesions are CD8+ and most of these are in contact with keratinocytes. In contrast, CD4+ T cells are found in contact with dendritic cells.65 Although the classical outcome of such an interaction in the context of viral infection would be cytolysis of virus-infected keratinocytes by cytotoxic T cells, frank cytolysis is not a prominent feature of the psoriatic epidermal response. Nickoloff and colleagues have suggested that the psoriatic keratinocyte is resistant to apoptosis because of precocious differentiation in the context of the regenerative maturation program.132 Alternatively, it is not clear whether epidermal CD8+ T cells possess the full complement of cytotoxic effectors. Thus, lesional psoriatic skin manifested less perforin and granzyme B than lesional atopic epidermis,133 although levels of these cytotoxic effectors were higher in psoriatic than in normal epidermis.133,134 Krueger and colleagues have proposed that epidermal hyperplasia may be triggered by sublethal injury of keratinocytes by αEα7-positive CD8+ T cells that recognize E-cadherin.135 Whatever the mechanism, interaction of CD8+ T cells and keratinocytes would lead to production of growth factors, chemokines, and cytokines by keratinocytes and dendritic cells, promoting keratinocyte proliferation, angiogenesis, and further chemotaxis of inflammatory and immune cells into the epidermis.
It is interesting that guttate psoriasis is a self-limited process and only one third to one half of these patients later develop chronic plaque psoriasis.136 This indicates that there are potent mechanisms to prevent generation of autoreactive T cells. It has been shown that the generation of autoreactive T cells requires persistently high expression of the target antigen in order to overcome the network of regulatory events that normally lead to cessation of immune responses when the pathogen has been cleared.137,138 Dysfunction of T-reg cells, as mentioned earlier, would significantly lower that threshold. Clearly, K16 and K17 fulfill this requirement, as they are strongly overexpressed in psoriatic lesions as well as in healing wounds8,139–141 but not in normal skin, thereby meeting the definition of neoantigens. K16 and K17 have long been recognized as two components of the regenerative maturation response, which is activated in wound healing140 and in psoriasis.142 However, these keratins need not be the only neoantigens relevant to psoriasis. Interestingly, many of the genes undergoing upregulation in regenerative maturation of the skin are located in the epidermal differentiation complex (PSORS4, 1q21.3), where linkage and disease association with psoriasis have been reported.19,143–145 Many of these genes are among the most highly overexpressed genes in psoriasis, as assessed by global gene expression analysis.146 Perhaps peptides derived from proteins other than K16 and K17 will prove to interact with HLA alleles other than HLA-C, thereby providing an explanation for the approximately one third of white psoriatics and two thirds of Asian psoriatics who do not carry HLA-Cw6.
This model integrates the genetic finding of direct involvement of HLA-Cw6 in psoriasis32 with immunologic evidence for increased reactivity to K17 peptides in Cw6-positive psoriatic patients. However, it is important to keep in mind that this model envisions the interaction of HLA-Cw6 with keratin peptides as one way to trigger a complex and multifaceted response, which could have a multiplicity of additional genetic and environmental inputs. Whether this model can eventually account for most or all psoriasis, rather than just its guttate variant and its evolution into chronic plaque disease, remains to be determined.
Psoriasis | Psoriasis Treatment Options
What is Psoriasis?
Psoriasis is an inflammation in the skin that is driven by the body’s own immune system. The inflammation in the skin causes the skin and creates red, itchy, and scaly lesions mainly around the elbows, knees and scalp. The chronic condition can appear as early as childhood. While it’s not contagious, psoriasis is a condition that is important to seek the help of a dermatologist.
What Are the Symptoms of Psoriasis?
Psoriasis typically affects larger parts of the skin. It tends to present with redness, scaling, and thick, itchy raised areas of skin known as plaques. It most commonly appears on the elbows and knees, but it can show up any place on the body including the trunk (particularly around the belly button), scalp, genitals, and underarms. Occasionally, it affects the face, hands, feet, or even just the nails.
It has a variety of skin presentations and types which include:
Inverse psoriasis appears in the armpits, groin, genital area, behind the knees, or underneath the breasts. Affected areas are moist, shiny, smooth and often an irritated red color. Hard to diagnose, inverse psoriasis can look like allergic reaction or a fungal infection.
The most common type of psoriasis causes red, raised patches of skin, often covered with a white, plaque-like scale. These patches appear primarily on the knees, elbows, and scalp.
Often appearing on the legs, arms, torso, face and scalp, guttate psoriasis consists of small red, scaly, teardrop spots that appear suddenly.
Symptoms of pustular psoriasis are small pustules — blisters containing pus — in specific areas of the body or widespread throughout. This is a severe type of psoriasis and often appears quickly and in cycles.
The most severe and rarest form of psoriasis, erythrodermic creates fiery red skin that sheds in large pieces. This type of psoriasis destabilizes body temperature and can be life-threatening. If you believe you have erythrodermic psoriasis, seek medical attention immediately.
What Causes Psoriasis?
Caused by an overreaction of the immune system, psoriasis is a disease in which the body has been tricked into thinking an infection exists in the skin. A combination of genetic and environmental factors, the specific triggers of psoriasis vary for every individual.
When the immune system tries to treat the infection with the acceleration of skin cells, itchy plaques or other marks appear on the skin. While it may not be an aesthetically pleasing experience, psoriasis isn’t contagious and can be managed.
There are genetic links to psoriasis, and while it’s not 100% hereditary, it does tend to run in families. Typically, it’s a combination of these factors that causes psoriasis to appear. If you get it, you’re likely genetically predisposed to psoriasis and experiencing a stressor (emotional, physical, mental, or food-related) that triggered a reaction.
What Are the Treatment Options for Psoriasis?
Topical steroids are a mainstay treatment for psoriasis. We have a variety of classes of topical steroids and tend to choose medium- or high-potency topical steroids for intermittent use. For mild psoriasis, topical steroids may be all you need to clear up your condition.
Often topical steroids can be used with other topical or systemic therapies to boost their effect. We cannot use oral or topical steroids without breaks — they end up causing problems and do not work as well over time. However, by strategically adding medications between steroid pulses, we are able to continue treating the problem without over-medicating.
Oral & Injectable Medication
Oral and injectable medications are systemic treatments for psoriasis. These systemic medications are typically the most effective therapies for clearing psoriasis. Systemic medications are prescribed to treat moderate-to-severe psoriasis. When 3-5% of the body’s surface area is covered by psoriasis, dermatologists typically consider systemic medications.
Dermatologists have a large number of options to consider when selecting a systemic treatment. Oral medications tend to target the inflammation caused by the immune system.
Acitretin is one of the most commonly used oral, systemic therapies. This tried and true medication is similar to Accutane but milder and more sustainable over longer periods of time. With regular use, it causes the skin to grow smoother. Acitretin has a low side-effect profile and doesn’t decrease the immune system.
Methotrexate is a low-dose oral chemotherapy option proven relatively safe and predictable. While this mild systemic therapy is still considered effective, it has been mostly supplanted by newer biologic therapies.
Injectable or biologic drugs target the pathways the body’s immune system uses that lead to inflammation. Biologic drugs selectively suppress the immune system in a very specific way to block the inflammation that leads to psoriasis. Most patients do not experience increased colds, but these medications do increase the risk of upper respiratory problems and other health problems. Patients need to follow up with their dermatologist every six months for regular health checks. When the side effects are managed, these medications are very helpful for managing psoriasis and completely clear plaques for many patients.
Phototherapy treatment isn’t exclusively for psoriasis, but for some patients it’s especially effective. UVB phototherapy uses a machine with a specific light bulb to create a wavelength of light that reduces inflammation and improves the skin condition as it refracts off the skin.
These units can be used in clinics or prescribed for home use. For patients who want to avoid internal medication, phototherapy has the distinct advantage of being drug free.
FAQs About Psoriasis
Is psoriasis contagious?
No. you cannot contract or spread it through physical contact.
My psoriasis improves after I’ve been in the sun. Can I use a tanning bed for treatment?
Before we understood the causes of skin cancer, doctors exposed patients to UV light to treat their psoriasis. Symptoms improved as the light calmed the immune system. However, we have more effective treatments and can avoid exposing patients to harmful UV rays.
Is there a difference between eczema and psoriasis?
Even though both conditions appear as red, scaly patches, eczema and psoriasis are not the same. Eczema can be found in the folds of the skin, like behind the knees and elbows, while psoriasis appears on the outside of those same areas.
Eczema patches have exaggerated skin lines, and the scales are thin with possible blisters. Cracking and weeping of the skin are more common in these areas.
Psoriasis, on the other hand, appears as well-defined plaques. The scales are thicker, stacked on top of each other, and turn extremely red. Occasionally, they’ll crack and bleed.
Can psoriasis be cured?
Research is constantly advancing around treatment for psoriasis, but currently, there is no known cure. However, with the assistance of your dermatologist, steroidal, non-steroidal and oral medication, psoriasis can be managed.
Do I Have Psoriasis or Seborrheic Dermatitis?
It’s easy to confuse these two scalp conditions. Sometimes they overlap, and they’re often treated similarly. But the causes and severity of the conditions differ.
Seborrheic dermatitis flares up because of a yeast that lives on the oils in the skin. The yeast causes mild irritation, redness, flaking, and itching. Usually, it occurs at the back of the scalp. (If it’s all over the scalp, it’s dandruff.) Other times, seborrheic dermatitis shows up as red, scaly areas in the eyebrows, around the nose, in the ear, or behind the ears.
Seborrheic dermatitis responds well to treatment and heals temporarily. But the yeast never goes away completely, and the oil your skin produces is unchangeable. So when it eventually comes back, you have to treat it again.
Psoriasis is more severe. You’ll notice similar, yet more intense, symptoms such as red, irritated, dry, flaky, itching skin.
Since no one treatment is effective for everyone, find a dermatologist that will work to find the best solution to your psoriasis symptoms. Whether it’s a pill or topical medication, there’s a treatment that will work for you.
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A Look at the Types of Psoriasis
Psoriasis is an autoimmune skin disease that typically results in raised, red, and flaky patches of skin. Most individuals will be affected by just one type of psoriasis; however, in rare circumstances, it is possible to be affected by more than one form of this condition.
As the most common type of psoriasis, plaque psoriasis affects as much as 80-90% of psoriasis sufferers. The unique symptoms of plaque psoriasis include thick, red patches that are covered with silvery, flaky scales. Most plaque psoriasis sufferers are affected on the elbows, knees, lower back, and scalp.
Guttate psoriasis is the second most common form of psoriasis and is characterized by small pink-red patches on the skin that are the size of water drops. Typically, guttate psoriasis affects the torso and limbs. Guttate psoriasis often first appears in childhood or in early adulthood. The symptoms of guttate psoriasis may come on quickly and can be triggered in several ways.
Typified by bright red, smooth, and sometimes shiny patches of skin, inverse psoriasis often affects the groin, armpits, and areas of overlapping skin. Sweating and rubbing can aggravate the areas affected by inverse psoriasis due to the location of the patches of affected skin.
Pustular psoriasis presents as white blisters of non-infected pus, surrounded by irritated, red skin. Initially, red areas appear and are then followed by pustules and scaling. Pustular psoriasis can be brought on by a wide array of triggers, from pregnancy to the use of systemic medications.
As the most serious form of psoriasis, erythrodermic psoriasis should be evaluated by a physician immediately. Erythrodermic psoriasis is typified by inflammatory, fiery redness that affects most of the body. When the patches shed, they do so in sheets as opposed to flakes. In addition, symptoms of a flare-up may include itching and pain, increased heart rate, and swings in body temperature.
If you are showing signs of psoriasis in Arlington Heights, call Arlington Dermatology to schedule an appointment with one of our physicians today at 847-392-5440. Our dermatologists and staff utilize the newest technology and techniques to satisfy your skin care needs.
Psoriasis | Advanced Dermatology
Psoriasis is a chronic, red, scaly rash that affects people of all ages. Psoriasis tends to run in families because of its genetic predisposition; however, you can not get it from another person – it is not contagious. Psoriasis affects about 2% of the population or 7.5 million people in the United States. Psoriasis occurs more often in Caucasian people. About 15% of those with psoriasis will also develop joint pain which may involve one or more joints. This is known as psoriatic arthritis.
A person’s genetics and immune system plays a role in the disease. Not everyone with the gene associated with the disease will get it. Sometimes psoriasis is triggered and begins after an event such as an illness, skin injury, severe sunburn, stressful life event, certain medications or exposure to cold or dry weather.
There are several types of psoriasis:
- Plaque psoriasis or psoriasis vulgaris appears as red, scaly, raised patches on the skin. The patches can vary in size and often itch. Knees and elbows are common places for the patches to occur. Also, nails may become brittle, discolored, and can lift off the nail bed.
- Inverse psoriasis, also known as flexural psoriasis, involve smooth red patches that appear raw. Common areas include the inguinal folds and armpits. This type of psoriasis is most common in infants and young children.
- Guttate psoriasis involves small, red spots most commonly on the arms, legs and trunk. Sometimes this occurs after an illness such as strep throat or after a dental procedure. This may clear up on its own. Guttate psoriasis is most common in infants and young children.
- Erythrodermic psoriasis, also known as exfoliative psoriasis, causes the skin to look as if it has been burned. The skin turns bright red and cannot maintain its normal temperature. This can cause intense pain and itching as well as a rapid heartbeat. Anyone affected should seek medical treatment immediately.
- Pustular psoriasis causes pus filled bumps on the palms or soles.
There are several ways to treat psoriasis including topical (applied to the skin) and injectable medications. The injectable medications are known as biologics. Some of the most common biologics include Enbrel, Humira, Cosentyx and Stelara. Oral medications include Otezla, Methotrexate, Soriatane and Cyclosporine. These drugs work by suppressing the part of the immune system that is critical for psoriasis to develop. Use of these medications requires us to draw blood work on a regular basis. Not everyone responds to the same medications. If we decide to treat your psoriasis with a biologic, we will work with you to determine which medication is best for you.
Another method of treating psoriasis is with phototherapy. Phototherapy has been used for years and is a safe method of treating psoriasis. With phototherapy, ultraviolet (UV) light pushes the inflammation away from the skin cells. We offer both full body narrow band UVB or UVA treatments as well as XTRAC laser for those patients who do not have as much skin involvement. Treatments are usually done 2-3 times per week. Our will trained staff will make sure you are comfortable during your treatment.
90,000 Treatment of guttate psoriasis in Moscow
Treatment of psoriasis is individual, a regimen that is suitable for one patient may not be useful for another. Therefore, when a rash appears, you must definitely go to a dermatologist. Do not self-medicate. Although psoriasis is not considered a dangerous disease, it has several complications that lead to serious consequences.
Typically, the patient is prescribed antihistamines to relieve itching and a gentle diet.In the diet, the content of fats and carbohydrates is reduced, alcohol, spicy and salty foods are completely prohibited.
Ultraviolet treatment is one of the most effective methods. The most common treatment is PUVA (UVA) therapy, in which patients have to take photosensitizers that have harmful effects on the liver. In addition, the entire body is exposed to UV light, which increases the risk of skin cancer.
In the most severe cases, doctors have to use cytostatics – drugs that stop the multiplication of skin cells.However, this treatment has too many side effects. Cytostatics cause nausea, vomiting, ulcers on the oral mucosa, liver and kidney damage.
We use UVB radiation to treat psoriasis. Its use does not require the use of photosensitizers. In addition, this radiation does not have a carcinogenic effect, penetrates deeper into the skin and has a more pronounced effect.
Vitamins A, E and B6 are also prescribed to the patient. To improve liver function, hepatoprotectors are prescribed: Essentiale forte.
The method of treatment with UVB radiation allows, in most cases, to abandon the use of hormonal ointments, or to minimize their use. They are included in the state standard for the treatment of psoriasis. Hormonal ointments are guaranteed to relieve itching and accelerate the disappearance of plaques. Unfortunately, the effect of their use is short-lived and when the use is stopped, psoriasis quickly returns to its position.
90,000 why is psoriasis and how does it manifest?
Psoriasis is a disease that is manifested by the appearance of a rash in the form of pink plaques with silvery scales, often accompanied by itching.However, this is just the tip of the iceberg. The disease is based on not fully understood processes.
Psoriasis is a mysterious enemy
With psoriasis, skin cells begin to divide 6-10 times faster than they should. This leads to chronic skin inflammation and flaking.
Scientists have been researching psoriasis for many decades, but an unambiguous answer to the question “Why does psoriasis appear?” modern science still does not. This disease is not contagious, but it can be inherited.Exacerbations can be provoked by a variety of external and internal factors: stress, skin trauma, the use of certain medications (more often antibiotics), alcohol abuse, infectious diseases (caused by streptococcus, viruses), etc. different parts of the body can be affected. Some patients have knees and elbows, others have palms and soles, and still others have large folds of skin or mucous membranes or nail plates.Sometimes psoriasis affects a very large area of the body, sometimes it is localized only in limited areas and never spreads further.
It is no exaggeration to say that psoriasis is one of the most mysterious diseases. Scientists have already figured out what exactly happens in the body of a patient with psoriasis and how to alleviate his condition, but it remains unclear what is the cause of these pathological changes and how they can be prevented.
Winston Churchill struggled with psoriasis all his life and promised to erect a golden monument to a doctor who will solve the riddle of this disease and find an effective treatment.Alas, the award never found its owner.
Why does psoriasis appear?
Science does not know the exact reasons, however, over the years of studying the problem, several hypotheses have been formed:
- Autoimmune theory . It’s all about the increased concentration of T-lymphocytes, which leads to constant inflammation of the affected area of the skin. The body seems to begin to perceive its own skin as an aggressor.
- Hereditary theory that explains psoriasis as a defect in DNA.
- Endocrine theory , according to which psoriasis occurs due to disturbances in the functioning of the endocrine system, in particular the pituitary gland and the thyroid gland.
- Exchange theory . Scientists have found that patients with psoriasis have problems with lipid and nitrogen metabolism, as well as an increased content of toxins in the body.
All these theories have a right to exist, but so far none of them has been fully proven. Therefore, the modern treatment of psoriasis is aimed at reducing the severity of symptoms, reducing the recurrence of the disease and general improvement of the body.
By the way
Symptoms similar to those of psoriasis were described in detail in ancient Roman medical treatises. However, in those days, psoriasis was often confused with other skin diseases of a completely different origin. For the first time, psoriasis was recognized as an independent disease only in 1799, and a non-infectious pathology only at the end of the 19th century.
Who is affected by the disease?
Psoriasis does not distinguish between genders – both women and men suffer from it equally often.Usually psoriasis manifests itself at a young age – the peak falls on 15-25 years . However, if you did not have psoriasis in your youth, this does not mean that the danger has passed – sometimes the first manifestation of psoriasis appears at the age of about 50-60 years. The good news is that people who experience psoriasis later in life are less likely to develop this disease.
According to the WHO, if one of the parents suffers from psoriasis, the risk of developing the disease in a child is approximately 14%, and if both – 41% .However, children of parents who have never encountered this problem also suffer from psoriasis.
According to statistics, psoriasis most often affects people with thin, fair, dry skin.
First symptoms of the disease
Psoriasis begins imperceptibly: at the first stage of development, the disease affects small areas of the skin, as a rule – on the bends of the limbs, scalp and along the hairline. Sometimes the first manifestations of psoriasis occur at the place of constant mechanical irritation of the skin, in other words, where the clothes press and rub.At first, a person feels itching and a feeling of tightness of the skin, then small towering islands of reddened, flaky skin appear. On these spots, gray dead skin flakes appear, similar to wax shavings, which are easily peeled off. Sometimes such plaques become wet, lamellar scales-yellowish crusts are formed on their surface. When the latter are removed, a weeping, bleeding surface is exposed. Gradually, the plaques grow and merge with each other, affecting more and more areas of the skin.
Signs of different types of psoriasis
There are several types of psoriasis:
Seborrheic psoriasis . Most often occurs on the scalp. It manifests itself as itching and flaking, spreads to the area behind the ears and the skin along the hairline.
Psoriasis exudative . With this type of psoriasis, the affected areas of the skin not only peel off, but also get wet, and yellowish crusts appear on the surface of the papules (nodules from the rash).
Intertriginous psoriasis . More typical for children. In this type of psoriasis, the plaques are bright red, with little or no scaling. Sometimes the plaques are moist. Parents often confuse this type of psoriasis with diaper rash.
Plantar psoriasis . Occurs on the soles and palms. It is manifested by thickening of the skin, dryness, cracks.
Old psoriasis is manifested by large plaques that do not go away for a very long time, sometimes neoplasms appear on them – warts and papillomas.
Rupioid psoriasis – one of the forms of chronic psoriasis. Crusts appear on the plaques, and gradually the plaque becomes taller, taking the shape of a cone.
Psoriasis teardrop is characterized by a profuse rash with many small papules.
Psoriasis of the nail plates (psoriatic onychia) causes deformation of the nails, the appearance of yellow-brown spots under them. A common type of psoriasis that occurs in 25% of patients with this disease.
Psoriasis of the mucous membranes affects the oral cavity and causes papules on the mucous membranes.
Frequency of psoriatic manifestations
The course of psoriasis is cyclical. At a progressive stage, itchy plaques or small rashes appear, which gradually merge into one spot. After 1–4 weeks, the process of plaque spreading stops, they become covered with silvery scales. This is the so-called stationary stage. It is followed by a regressive stage, when the plaques gradually disappear.However, do not be deceived – this does not mean that recovery has come. If psoriasis is not treated, everything will be repeated from the beginning, and after a while the stages will begin to replace each other constantly, and exacerbations will become almost monthly.
It is possible and necessary to treat psoriasis. If you do not take action in time, psoriasis will quickly turn into a chronic stage, and it will be extremely difficult to get rid of it. For the treatment of psoriasis, medicinal methods, physiotherapy, as well as local remedies for external use – ointments and creams for psoriasis, are used today, the effectiveness of which is quite high.
However, it should be noted that before using any remedies for psoriasis, you should consult your doctor. At least because a layman cannot make a diagnosis on his own.
90,000 causes, symptoms, treatment methods. Medical center “Medyunion”
Seeing dry red spots on your skin? It can be psoriasis – a chronic skin pathology. These patches are called psoriatic plaques.Most often they appear on the head, lower back, elbows.
Causes of psoriasis
Both the skin and the entire human body are involved in the process of plaque formation. Causes can be viral, infectious, hereditary, psychosomatic, or mixed.
- constant nervous stress, breakdowns, depression;
- genetic predisposition;
- hormonal failure;
- allergic reactions;
- diseases of the gastrointestinal tract;
- liver disease;
- metabolic disorders;
- viral, bacterial, fungal infections;
- Frequent mechanical injury and irritation.
Psoriasis can appear spontaneously and also disappear spontaneously. Since the disease is chronic, there are periods of exacerbation and remission.
Human skin can act as a mirror that reflects the physiological and emotional state of a person. The skin is sensitive to changes in the body. This is called the psychosomatic cause of psoriasis. Therefore, when treating a disease, it is worth paying attention to the patient’s psychological state.
- Convex spots with white scales;
- dryness and flaking;
- deformed nail plate;
- bleeding from cracked plaques;
- joint pain.
90,045 itching at the site of the rash;
90,045 cracks or blisters;
Types of psoriasis
- Simple. It is diagnosed in 85% of cases. There is redness in areas of the skin with white scales.Such psoriasis on the head is common. The skin under the scales is easily injured, and wounds can bleed and cause pain.
- Reverse. It appears at the folds: under the breast in women, in the folds of the skin, armpits, inner thighs, external genitalia.
- Pustular. This type of psoriasis produces transparent blisters. Red inflamed skin around the pustule.
- Rs. In addition to the presence of plaques, this species is characterized by acute inflammation of the epidermis.The skin under the patches is pink and wet.
- Drop-shaped. It features a large number of small bubbles of red or purple color. They resemble dots or drops in shape. Such psoriasis appears on the arms, head, neck, shoulders, back, hips.
Is psoriasis transmitted?
This is a common question that worries patients and their families. The disease is not contagious, since the cause of its occurrence is not associated with pathogens. It is assumed that psoriasis can only be transmitted genetically, that is, when there is a genetic predisposition.Often in healthy people, psoriasis on the nails is a concern. After all, the patient touches any surfaces. However, don’t worry.
Diagnosis of psoriasis
If you find symptoms of psoriasis in yourself or your child, you need to seek an examination by a dermatovenerologist. Since psoriasis lesions on the body are of a special nature, additional laboratory research may not be needed to make a diagnosis. If psoriatic arthritis is diagnosed, a rheumatologist’s consultation is required.
How is psoriasis treated?
To get rid of the disease and improve the patient’s quality of life, an integrated approach is used to treat psoriasis, which consists of the following:
- Local treatment. Ointments and creams do an excellent job with flaking and itching in small areas of localization of the disease. It is especially effective in treating psoriasis on the face and hands. Hormonal ointments, salicylic acid, retinoids, moisturizers.
- Drug therapy. An additional method of effective treatment for psoriasis when ointments do not help.Medicines reduce inflammation, swelling and itching, and block the increased activity of skin cells. However, the pills have many side effects, such as increased fatigue, decreased appetite, and increased blood pressure. Therefore, follow all the doctor’s recommendations for the dosage of the drug.
- Therapeutic shampoos. When psoriasis is localized on the head and neck, medicated shampoos are used: antifungal, tar, containing corticosteroids. Shampoo eliminates pathogens of pathological inflammation, eliminates scales, relieves burning and itching.
- Healing injections. Antihistamines block severe itching, and biological drugs have a beneficial effect on the immune system.
For the diagnosis and treatment of psoriasis in adults and children, sign up for the Medyunion clinic in Krasnoyarsk by phone +7 (391) 201-03-03.
Causes, symptoms and treatment in Moscow
Psoriasis – Chronic non-infectious disease, dermatosis, mainly affecting the skin.
The autoimmune nature of this disease is currently assumed. Psoriasis usually causes overly dry, red, raised patches of the skin. However, some psoriasis sufferers do not have any visible skin lesions. The spots caused by psoriasis are called psoriatic plaques . These spots are by nature sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin, as well as excessive angiogenesis (formation of new small capillaries) in the underlying skin layer.
Prevalence of Psoriasis
Psoriasis is a common disease and occurs with approximately the same frequency as diabetes mellitus. In Northern Europe, it occurs in 1.5-3% of the population, in the United States – 1%, Germany – 1.3%, Denmark – 2.3%, China – 0.3%, no cases were noted among the Indians of South America. In dermatological clinics, patients with psoriasis average 6-8%.
Sex and age of onset of illness
The onset of psoriasis was noted at birth and at the age of 108.Most often, psoriasis begins in men at 29, in women at 27 years old. Men and women suffer from psoriasis with the same frequency. Psoriasis is a chronic inflammatory skin disease, in the pathogenesis of which heredity and various provoking factors play a distinct role. Psoriasis is characterized by disturbances in the reproduction and maturation of the main skin cells – keratinocytes, as well as various biochemical, immunological and vascular changes in the skin and a certain connection with the functional state of the nervous system.Recently, great importance in the pathogenesis of psoriasis is given to disorders of the immune system.
Psoriasis is an abnormal reaction of the body to external stimuli, in which, in some areas of the body, the top layer of the skin dies off much faster than normal. If usually the cycle of division and maturation of skin cells occurs in 3-4 weeks, then with psoriasis this process takes only 4-5 days. Currently, psoriasis is considered a hereditary multifactorial disease: the basis of the disease is not one, but a whole complex of reasons – immunological changes, metabolic disorders, concomitant endocrine and neurological disorders.At the same time, we can say for sure: psoriasis is not an infectious, and therefore not a contagious disease. The problem of the origin of psoriasis has not yet been finally resolved.
There are various theories on this score.
According to one theory, there are two types of psoriasis :
- Type I psoriasis is caused by inherited damage to the immune system. This form of psoriasis affects about 65% of people, and the disease manifests itself at a young age, from 18 to 25 years.
- Type II psoriasis occurs in people over 40 years of age, and is not associated with heredity or the immune system. Moreover, unlike type I psoriasis, which prefers the skin, type II psoriasis more often affects the nails and joints
According to another theory, the cause of psoriasis is exclusively immunity disorders caused by various factors: it can be stress, or infectious diseases, or a cold climate, or unhealthy diet. For example, it was noted that alcohol can provoke an exacerbation of psoriasis – this is especially true for beer, champagne, and spirits.The use of products containing vinegar, pepper, chocolate also aggravates the course of the disease and can cause an exacerbation. According to this theory, psoriasis is a systemic disease. This means that in case of serious disturbances in the functioning of the immune system, the process can spread to other organs and tissues, for example, to the joints. As a result, psoriatic arthritis can develop, which is characterized by damage to the small joints of the hands and feet.
When diagnosed with psoriasis , symptoms of can appear on various parts of the body – on the scalp under the hair, palms, soles of the feet, armpits, on the back and on the nails.However, the most common symptoms of psoriasis (psoriatic plaques) appear on the elbows, knees, and buttocks. Psoriasis has the following main symptoms: a rash on the skin in the form of plaques covered with scales, or small blisters that are difficult to treat – the main symptom of psoriasis , which is also accompanied by itching, inflammation of the joints.
It should be noted that when psoriasis is diagnosed, symptoms can be varied. Depending on the nature of the symptoms, various types of psoriasis are distinguished (psoriasis of the head, nails, teardrop, postular, etc.)
If the doctor identified psoriasis at an early stage, then it is quite possible that you will be prescribed mainly prophylactic rather than therapeutic agents.
For significant manifestations of psoriasis, apply:
- cryotherapy – cold exposure method;
- plasmapheresis – blood purification,
- ultraviolet therapy – treatment consists of short-term procedures similar to visiting a solarium.For greater effectiveness of treatment, this method is often combined with taking special medications (PUVA therapy).
In no case do not try to engage in ultraviolet treatment yourself without the advice of a doctor. In psoriasis, small doses of ultraviolet radiation are curative, while higher doses, on the contrary, can spur the development of the disease. The same goes for sunbathing.
Unfortunately, psoriasis cannot be completely cured, since the body “retains the memory” of the disease in the form of biochemical, immunological and functional changes.Recurrence of psoriasis can occur at any time, therefore, patients with such a diagnosis need to be constantly monitored by a dermatologist.
90,000 Treatment of acute guttate psoriasis in addition to drugs directed against streptococcal infection
The purpose of this review is to find out how well different non-antistreptococcal drugs (i.e. drugs that are not directed to treating streptococcal infection) work for acute guttate psoriasis or guttate exacerbation of chronic psoriasis in adults and children, and how safe they are compared to placebo ( identical, but inactive) or other treatment.This topic is important because there is a lack of information and evidence regarding the best treatment for guttate psoriasis. We collected and analyzed all relevant studies to answer this question and found one study.
Psoriasis is a chronic skin disorder characterized by red patches covered with scales (known as plaques). About 2% of people suffer from psoriasis. Guttate psoriasis is characterized by smaller lesions and is more common in children and young adults.Treatment for guttate psoriasis aims to clear the skin of lesions for as long as possible, and includes topical (applied to the skin) or oral (taken by mouth) drugs, phototherapy (i.e. ultraviolet light therapy) and biologics (through which living the body forms the active substance). It is not known which of these options is better at eliminating lesions in guttate psoriasis, and whether they are safe.
Characteristics of research
We found one relevant study comparing the effects of intravenous injections of two different lipid (fat) emulsions twice daily for 10 days: one emulsion (two or more liquids that often do not mix) was derived from fish oil and the other from soybean oil.The observation period for the participants was 40 days. The study was conducted in Germany among 21 adults (18 men and 3 women) between the ages of 21 and 65. The average skin lesion area was 25%. Participants were admitted to hospital for acute guttate psoriasis. The study was funded by an oil emulsion company.
Treatment options for which we found no evidence include phototherapy and topical, oral and biologics.The only study found did not assess two main outcomes: the percentage of people receiving treatment whose skin was clear (or nearly cleared) of lesions, and the side effects, or harm, of the treatment.
Also, most secondary outcomes were not assessed, including worsening guttate psoriasis or relapse within six months of completion of treatment, and the percentage of participants who achieved a Psoriasis Area and Severity Index of 75 or a Physician’s Overall Score of 1 or 2. The included study did not report assessing the harm from treatment; however, the study authors reported rare skin irritation at the injection site, but did not report the number of participants who experienced it.
Participants assessed some of the outcomes themselves, including skin lesions, impact on daily life, itching, burning and pain. After 10 days of treatment, study participants who received a fish oil lipid emulsion (75% of people in this group) experienced a greater improvement than those who received a soybean oil lipid emulsion (18% of people in this group). However, these results are controversial as they are based on very low quality evidence.
Evidence is current to June 2018.
Quality of evidence
We rated the available evidence as very low quality.
We considered that the study may be at risk of bias due to design limitations and the participation of only a small number of people. In addition, only adults were included in the study, although guttate psoriasis is more common in children.
How does psoriasis, one of the most common skin diseases, arise and is treated? Dermatovenereologist Says
– Treatment of psoriasis is divided into several types.Local – various external agents that are applied to the skin. They are used by all patients and are the main treatment for people with mild psoriasis.
Moderate psoriasis is treated with phototherapy – the so-called PUVA therapy or narrow-band medium-wave ultraviolet therapy, which is considered more modern and safer.
These methods give a good result, but the patient is “tied” to this photo booth and has to go to procedures every day, which is far from being convenient for everyone (in case of an exacerbation, as a rule, 15–20 procedures are required, four are usually carried out a week – approx … “Papers” ). A person can live in an area where there is simply no such cabin – then you have to go somewhere and go to a hospital or rent a hotel to receive a course of photo therapy.
The third line of treatment is the prescription of immunosuppressants. Drugs in this group inhibit certain components of the immune system and thus are able to normalize the uncontrolled growth of the epidermis, characteristic of psoriasis.
The last, new group of drugs – genetically engineered biological agents.They act very selectively, targeting one specific factor of immunity, which is key in the chain of development of the immune-inflammatory process in the human body with psoriasis. If we manage to “turn off” this factor, then the entire chain of development of the disease is cut off, and the stimulation of skin structures to the unrestrained growth and development of the inflammatory process stops.
These drugs are quite effective: they allow you to achieve complete or almost complete cleansing of the skin from psoriatic rash for a long time.On the other hand, they have acceptable safety in contrast to the “classic” immunosuppressants.
With the help of the drugs that were previously, we, on the one hand, achieved a positive result in the treatment of psoriasis, and on the other hand, caused immunosuppression, that is, depression of the immune system in the patient’s body. Genetically engineered biological drugs, as a rule, do not give such total depression [immunity].
Drugs are taken from once a week to once every three months – depending on the specific drug and the stage of treatment.At the induction stage, that is, the initial phase of treatment (usually lasts 1–2 months – approx. “Paper” ), the drug is administered a little more often than at the stage of maintenance therapy, when the result has already been achieved and the patient simply maintains good condition of his skin …
We cannot completely cure psoriasis today. However, genetically engineered biological drugs, with long-term use, are able to induce and maintain remission of psoriasis and prevent the progression of psoriatic arthritis.
– As a rule, drugs are metabolized in the liver – and antipsoriatic drugs too. If the patient abuses alcohol, then the antitoxic function of the liver is compromised – this adversely affects, on the one hand, the metabolism of drugs, and on the other, on the course of the disease itself.
There is no special diet for psoriasis – it is not an allergic disease. But the consumption of large amounts of fatty foods, simple carbohydrates, leads to the appearance of excess body weight, which adversely affects the course of not only the psoriasis itself, but also the conditions that accompany it.
In addition, if a person has psoriatic arthritis, overweight and a sedentary lifestyle are additional factors that will contribute to joint inflammation. This can lead to exacerbation of arthritis and its severe course.
– If psoriatic arthritis occurs and it progresses, then at a young age it can cause deformation and destruction of the joint. This will lead to disability and limitation of physical function.
Another situation is a universal lesion, when the entire skin is one large psoriatic plaque and there is no healthy skin at all.As a rule, this condition is accompanied by a rise in temperature and intoxication. Such forms are not treated on an outpatient basis – hospitalization and therapy under the supervision of a specialist are necessary.
Another option is generalized pustular psoriasis, when, in addition to nodules, there also appear what is medically called papulopustules (nodules with pustules). If this happens, expensive, sometimes very stubborn, inpatient treatment is required. It is better to prevent the development of such a severe form of the disease than to deal with adverse consequences later.
Unfortunately, in recent years, the number of people with generalized pustular psoriasis in our country has increased: in most cases this is due to the independent treatment of psoriasis with hormonal drugs, about which people receive information on the Internet, but do not understand the full severity of the consequences that this leads to. self-medication.
In many cases, the earlier treatment is started, the better the result will be. Therefore, when it comes to common processes, you need to go to the doctor and discuss possible methods and means of therapy.
Psoriasis – the basics of phototherapy | Medical center “Health Code” in Mariupol
Psoriasis is a skin disorder in which red, flaky, crusty spots covered with white scales appear on the surface of the skin. These spots usually appear in the elbows, knees, scalp, and lower back, but can appear anywhere else on your body. Most people only suffer from small skin lesions associated with psoriasis.In some cases, psoriatic plaques may itch or hurt. The plaques can be quite large, but can be in the form of a rash
Clinical types of psoriasis by localization:
- psoriasis on hands and feet
- psoriasis on the body
- psoriasis on the scalp
- psoriasis on the face
Forms of psoriasis:
- Psoriasis teardrop
- Coin psoriasis
- Plaque psoriasis
- Arthropathic (joint damage)
Stages of development of psoriasis:
- Progressing stage
- Stationary stage
- Stage of regression
- Winter (most favorable).
- Summer (psoriasis worsens against the background of increased insolation).
- Mixed (exacerbations are not associated with the season).
Provoking factors-GIT pathology (Hepar, Pancreas, etc., the presence of Helicobacter, etc.) viruses, stress, mechanical trauma to the skin (including rubbing and scratching), acute infectious diseases, bad habits ( alcohol, smoking, drugs).
General principles of psoriasis treatment-Psoriasis cannot be cured completely, but it is possible to reduce the external manifestations of the disease for a long time.Psoriasis can come and go on its own, often with long periods of remission. Psoriasis cannot be cured quickly. When all the doctor’s prescriptions are fulfilled, a good result takes from 1 to 2.5 months. For a particular patient, an individual approach is required, since drugs do not work equally effectively for all patients. Severe forms of psoriasis require complex systemic inpatient treatment. With psoriasis, constant supervision of a dermatologist and systematic treatment are necessary, adherence to the treatment regimen, constant skin care, a hypoallergenic diet.Physiotherapy, spa treatment.
Psoriasis Skin Care:
Proper skin care for psoriasis is one of the most important components of the treatment of this disease. In psoriasis, it is better to give preference to a shower, as baths dry the skin. Although in rare cases you can afford a warm (36-38 degrees) bath, provided that it will not be long (up to 15 minutes). To avoid dry skin, use a neutral, fragrance-free soap. Do not rub or stretch the skin while washing.The towel should be used very carefully, only lightly pressing it against the wet body. After washing, you must thoroughly dry all hidden areas and folds, in particular the ear canals, the area behind the ears, folds under the mammary glands, armpits, umbilical and groin areas, as well as the skin between the toes.
In psoriasis, it is important to keep the skin moist at all times. Otherwise, the skin becomes rough and cracked. The use of moisturizers should be regular so that the skin does not lose its barrier properties.Today, there are many different moisturizers and keratolytic agents, and it can be difficult to choose a truly effective and safe product. It is better to use products labeled “O / W” (oil in water) on the packaging, which make the skin less oily as when using products labeled “W / O” (water in oil).
Phototherapy for psoriasis – (phototherapy, phtotherapy, UVB-therapy 311 nm) – this UVB spectrum is not only the most effective in terms of treatment, but also the most painless and safe method of treatment for humans.
UVB311nm photo therapy lamp has an immunoregulatory effect, normalizing the balance of inflammatory and anti-inflammatory factors in the affected skin. At the same time, as in the case of PUVA treatment, excessive cell division is inhibited. When treating psoriasis, the elements gradually fade, become less dense, peeling disappears. This is due to a decrease in the number of cellular elements in the foci of psoriasis. There is also a pronounced antipruritic effect and an effect on the metabolism of vitamin D.
Phototherapy with narrow spectrum 311nm UVB rays is performed 3-5 times a week. The course of phototherapy usually consists of 20–35 procedures. It depends on the prevalence and severity of the disease. To increase the period of remission, gradual withdrawal and supportive treatment is recommended. Narrow spectrum 311nm lamp therapy uses lower doses of ultraviolet radiation, due to which the risk of developing skin neoplasms is reduced to a minimum;
Phototherapy is very easy to tolerate.And the effect is achieved quickly!
You can consult a doctor and undergo a full course of treatment at the Psoriasis Phototherapy Center of the Health Code MC at the address: st. Bakhmutskaya, 20- “A”, tel. 096-301-03-18
Pictures 1 and 3 – before starting phototherapy treatment.
Photos 2 and 4 – phototherapy treatment for 15-20 procedures.
We are waiting for you at the Medical Center “Health Code”