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Punctate psoriasis: Guttate Psoriasis: Causes, Symptoms and Treatments: National Psoriasis Foundation

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Psoriasis: Practice Essentials, Background, Pathophysiology

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  • Skin and Wound Care | Psoriasis Causes, and Treatments

    By the WoundSource Editors

    Psoriasis is a chronic, noncontagious skin disease resulting from an atypical autoimmune response which leads to accelerated skin growth and the formation of skin lesions. Psoriasis causes skin cells that typically take a month to grow to form in a matter of days. This in turn leads to the buildup of cells on the surface of the skin which then form silvery scales over red, dry, itchy patches called plaques. The most common form of psoriasis (and the focus of this article) is the abovementioned plaque psoriasis, also referred to as psoriasis vulgaris, accounting for 80-90% of psoriatic patients.

    Background:

    While psoriasis is considered to be a skin disease, it is actually caused by an underlying autoimmune disorder. In this case, T-cells which typically protect the body from infection are activated, causing inflammation and an increase in the rate of cell production. Typically, skin grows in such a way to replace itself around every 30 days. However, with psoriasis the skin replaces itself faster than it can slough off, resulting in silvery plaques over the affected skin.

    Symptoms:

    With plaque psoriasis, the affected area will turn red with inflammation and be covered with silvery dry scales. Typically these lesions form on the elbows, knees, scalp and trunk, though psoriasis can affect any area on the body, including the soft tissue inside of the mouth. When removed, the skin underneath these plaques will often display telltale punctate bleeding points, referred to as the Auspitz sign. Typically, plaques will occur symmetrically on both sides of the body, and can be both itchy and painful. Psoriasis can also affect the joints, with inflammation causing discomfort or even distortion, and is referred to as psoriatic arthritis. Most patients will experience symptoms of psoriasis in cycles, with the affected area flaring up for a time before subsiding or going into full remission.

    Causes:

    While the exact cause of psoriasis is unknown, in most cases the condition is hereditary (although multiple genes are involved, so it is often unclear from whom it has been inherited). In some cases, the first outbreak can be triggered by stress, skin injury, or streptococcal infection, such as strep throat. While it is currently accepted that the immune system plays an important role in the overproduction of skin cells leading to psoriasis, the extent of involvement and exact role it plays is still unclear.

    Treatment:

    Currently, there is no cure for psoriasis, but sufficient management of the condition and symptoms is attainable for most patients. Treatment of psoriasis varies greatly from patient to patient based on the severity of the condition.

    The three levels of treatment for psoriasis, ordered by increasing severity of symptoms are:

    • Topical application of corticosteroids
    • Phototherapy treatments
    • Systemic therapy (medications take orally, by injection or by infusion)

    Due to the chronic nature of psoriasis, treatments are often combined in various ways and rotated every 6 to 24 months in order to reduce adverse reactions or resistance. Most cases of psoriasis are relatively mild, and simply applying cream or lotion to keep the skin moist can significantly improve the condition.

    Risks:

    The following precautions can help minimize the occurrence of flare-ups and maximize the effectiveness of treatment in patients with psoriasis:

    • Maintain good health in order to help the immune system fight off infections that can in turn aggravate the skin.
    • Be aware of the triggers for psoriasis, most notably stress, dry winter weather, skin injury, smoking and heavy drinking.
    • Keep a record of flare-ups, including any relevant information about the preceding circumstances.
    • Take good care of the skin, applying lotions, creams and/or emollients daily and avoid scratching the affected area.
    • After bathing, pat skin dry. Rubbing can irritate the skin and lead to lesions.
    • Avoid bathing in hot water or using harsh soaps, as these can aggravate the affected skin.

    For more information:

    Psoriasis and Psoriatic Arthritis at the American Academy of Dermatology
    Psoriasis Overview at the American Osteopathic College of Dermatology
    Psoriasis Overview at the Mayo Clinic
    Psoriasis Overview at the New Zealand Dermatological Society
    Psoriasis Overview at WebMD
    The National Psoriasis Foundation

    Products for Psoriasis – Dermatology

    Psoriasis | Nature Reviews Disease Primers

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  • Plaque Psoriasis

    A 40-year-old man presented with itchy erythematous lesions on his arms and upper back of 10-month duration. There was no history of joint pain. Family history was negative for similar skin problems. Physical examination revealed erythematous plaques with scales on his arms and upper back. Scraping of the scales resulted in fine punctate bleeding. He also had pitting of the nails. Plaque psoriasis or psoriasis vulgaris is characterized by sharply demarcated, erythematous, round or oval, plaques with loosely adherent silvery-white micaceous scales. Removal of the scales results in fine punctate bleeding (Auspitz sign). The lesions are usually symmetrically distributed and pruritic.

    Typical sites include the knees, elbows, arms, torso, and scalp. Involvement of the scalp, face, and the intertriginous and diaper areas is more common in infants and young children. Skin lesions tend to persists for months to years and intermittent flares are common. New lesions may form at the site of trauma (Koebner phenomenon). Mucosal involvement is unusual. Seronegative inflammatory arthritis develops in about 30% of patients. Psoriatic arthritis can precede, coincide with, or follow the development of the skin lesions. Most patients eventually develop nail involvement which includes pitting, discoloration, onycholysis, or onychodystrophy. Nail involvement precedes the skin lesions in approximately 4% of patients. Complications of psoriasis include an increased risk of non-melanoma skin cancer and emotional distress in more severely affected individuals. Occasionally, patients with psoriasis may also develop uveitis and inflammatory bowel disease. Estimates of prevalence range from 1 to 2%. Approximately 25% of patients develop the disease before 20 years of age. Both sexes are affected equally. The condition is more common in Caucasian individuals than in black or Asian individuals. The prevalence is greatest in northern, colder climates, and the disease is more severe in the colder months. A family history of psoriasis in a first-degree relative is present in about 30% of patients with childhood-onset psoriasis.

     

    American Osteopathic College of Dermatology (AOCD)

    Calcipotriene (calcipotriol) is a synthetic drug derived from calcitriol otherwise known as vitamin D. It works by regulating the production and growth of skin cells. In the United States, this drug was first marketed under the trade name Dovonex and is used mainly for the treatment of psoriasis. This drug has many off-label applications that are alternative therapies for many dermatologic diseases.

    Mechanism: During a study on the effects of vitamin D on osteoporosis, the effect of calcipotriol on psoriasis was discovered. Some patients involved in this study included those with the presence of psoriatic lesions. During treatment with vitamin D analogs, the psoriatic lesions demonstrated significant reduction in number as compared to the number of lesions present before treatment was initiated.

    The exact mechanism of action is still unknown, however, calcipotriol has shown to inhibit cell growth and development without any evidence of harmful effects to the cell itself. This inhibition of cell growth reverses the number of abnormal cells which are found in patients with psoriasis. Calcipotriol demonstrates a regulatory role on the skin’s immune system, therefore reducing the expression of certain immune markers responsible for the development of psoriasis. In one study, patients applied calcipotriol ointment twice daily for 8 weeks. This study demonstrated marked improvement in 70% of patients and complete resolution of psoriasis in 11% of patients treated. The use of calcipotriol cream twice daily for 8 weeks had a slightly lower percentage of improvement and resolution but still considered significant at 50% and 4%, respectfully. Using twice daily application of calcipotriol has not been shown to be superior to once daily dosing in patients with psoriasis.

    Uses: Calcipotriol ointment and cream is approved for treatment of mild to moderate plaque psoriasis in adults older than 18 years old. Calcipotriol topical solution is approved to treat chronic, moderately severe scalp psoriasis. There are also many potential off-label uses of this medication including:

    Side effects: Studies have shown that calcipotriol has an excellent safety profile. It is associated with very few serious adverse effects and well tolerated among patients undergoing treatment. Mild side effects that have been reported with the use of prescribed doses of calcipotriol cream and ointment include, but are not limited to the following: skin atrophy, folliculitis, burning, irritation, itching, skin dryness, rash, hyperpigmentation, redness, and increased calcium levels in the blood and urine. Side effects that warrant immediate medical attention include worsening of psoriasis, development of a new skin rash, and dermatitis (redness and skin swelling associated with itching).

    Women planning to become pregnant or currently are pregnant should inform their physician before beginning a treatment regimen. Harmful effects on the fetus during pregnancy in animal studies have been observed, but there are currently no adequate studies in pregnant women using calcipotriol.

    Ultraviolet light exposure while using calcipotriol ointment or cream has been shown to increase the risk of skin tumor development. Those using calcipotriol should avoid excessive natural and artificial sunlight exposure while being treated with this medication. Hypercalcemia can also occur in patients using calcipotriol and should have calcium levels regularly monitored by a physician during the course of treatment.

     

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    The medical information provided in this site is for educational purposes only and is the property of the American Osteopathic College of Dermatology. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician – patient relationship. If you have a specific question or concern about a skin lesion or disease, please consult a dermatologist. Any use, re-creation, dissemination, forwarding or copying of this information is strictly prohibited unless expressed written permission is given by the American Osteopathic College of Dermatology.

    Cutaneous Myiasis Caused by Chrysomya megacephala in an Infant with Psoriasis Vulgaris – FullText – Case Reports in Dermatology 2020, Vol. 12, No. 3

    Abstract

    Cutaneous myiasis is an infestation of the skin by fly larvae, which usually occurs in adults. We present a case of cutaneous myiasis caused by Chrysomya megacephalain a 3-month-old infant with psoriasis vulgaris. In this case report, we highlight the clinical, histopathologic, taxonomic identification, and treatment of cutaneous myiasis occurring in psoriatic skin.

    © 2020 The Author(s). Published by S. Karger AG, Basel


    Introduction

    Myiasis is an infestation of living tissue by fly larvae of the order Diptera[1]. Cutaneous myiasis can be subdivided into two main clinical subtypes, furuncular and wound myiasis [2]. Most of the cases are reported in adults and rarely in children [3]. A similar case was reported in which the larva penetrated the brain of a 5-month-old infant resulting in the demise of the patient [4]. We report a case of cutaneous myiasis caused by Chrysomya megacephala in an Asian infant with psoriasis vulgaris.

    Case Report

    A 3-month-old Thai girl presented with a 3-week history of generalized skin rash and developed a lump on the scalp after presenting with the primary rash for 2 weeks. Her grandmother had a history of psoriasis vulgaris, but she had no history of atopy in her family. Physical examination showed yellowish-brown crust and scale on an erythematous patch on the scalp, eyebrows, and ears and generalized, erythematous scaly plaques on the trunk (Fig. 1a) and extremities. The scalp showed a punctate wound at the vertex (Fig. 1b), containing many maggots (Fig. 1c, d). The scalp wound was debrided, and skin biopsy studies were performed. Dermatopathology showed typical psoriasis vulgaris at the epidermis and maggots in the subcutis (Fig. 2a–c). We sent the maggots for taxonomic identification by the Faculty of Medical Technology, Prince of Songkla University (Dr. Pengsakul). Worm size was 9 mm (Fig. 3a). The posterior spiracle (Fig. 3b), hook (Fig. 3c), and adult flies (Fig. 3d) developing from the maggots were identified as C. megacephala.

    Fig. 1.

    Clinical photographs. a Skin rash on the trunk and extremities. b Skin lesions and ulcer on the scalp. c Maggot removed from the wound. d Larvae.

    Fig. 2.

    Dermatopathology. a Low magnification showing psoriasiform at the epidermis and maggots in the subcutis. b High magnification of the epidermis showing psoriasiform hyperplasia, infiltration of neutrophils within the epidermis, and spongiform pustule of Kogoi. c High magnification of the subcutis presenting with maggots.

    Fig. 3.

    Taxonomic identification with Chrysomya megacephala.a Size of the worm. b Posterior spiracle. c Hook. d Adult fly.

    The diagnosis was furuncular myiasis caused by C. megacephala with underlying psoriasis vulgaris. Treatment involved manual removal of the larvae and 2 doses of oral ivermectin 200 μg/kg/dose. The latter treatment was started because the lesions contained a large number of worms which were difficult to manually remove. Her lesion improved without any adverse events from oral ivermectin.

    Discussion

    Furuncular myiasis is the most common form of primary cutaneous myiasis, and Cordylobia anthropophaga is the most common agent [1]. We report the first case of furuncular myiasis caused by C. megacephala, commonly known as the oriental latrine fly, in an infant with psoriasis. This fly also causes substantial economic problems in the Asia Pacific and Africa, where sun-drying is the primary method for preserving fish [5]. The first report of human myiasis caused by C. megacephala was in Thailand; however, this case was detected postmortem [6].

    Risk factors for cutaneous myiasis are poor hygiene with low socioeconomic status [7]. The complication of cutaneous myiasis is a secondary bacterial infection. It can penetrate the brain via incompletely ossified bone of the skull, particularly in an infant [4]. In this case report, the possible association between psoriasis and cutaneous myiasis explained by an infant developed psoriatic rash and occurring secondary cutaneous myiasis. The patient had a strong familial history of psoriasis and set generalized skin rash on the whole body before maggot infestations of the scalp. However, psoriasis often occurs provoked by infections and it is usually relatively resistant to a secondary infection. Previous reports proposed secondary infection of maggot on the children scalp resulting in traumatic psoriatic plaque [8, 9].

    Treatment of cutaneous myiasis include occlusion, manual removal of the larvae and larvicides [2, 3, 10]. In the pediatric population, there is no specific standard guideline treatment [11]. Occlusion and surgical intervention are recommended options. Ivermectin is not recommended in young children (<5 years of age or <15 kg) because of insufficient evidence [12]. However, a recent review showed ivermectin was well tolerated in the children without any evidence of severe or long-term side effects [13]. In this case, we manually removed the larvae and added oral ivermectin to the treatment. We treated with ivermectin because of inadequate treatment from surgical intervention. Adverse effects associated with ivermectin use include cutaneous and systemic effects such as rash, pruritus, myalgia, abdominal pain, hypotension, and dizziness [10, 12]. In this case, there were no adverse reactions noted secondary to ivermectin.

    In conclusion, we report this case to enhance recognition for the prevention of cutaneous myiasis and to provide adequate taxonomic identification for proper diagnosis and treatment when there is a high level of suspicion.

    Statement of Ethics

    Written informed consent to publish this case (including images) was obtained from the patient’s parents. The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki and was approved by the Research Ethics Committee, Faculty of Medicine, Prince of Songkla University (REC. 62-320-14-1).

    Conflict of Interest Statement

    There are no conflicts of interest.

    Funding Sources

    None.

    Author Contributions

    S.S. drafted the manuscript and K.A. revised it critically for important intellectual content. S.S., K.A., P.K. and T.P. were involved in the conception of this case report and gave final approval of the version published.

    References


    1. Bernhardt V, Finkelmeier F, Verhoff MA, Amendt J. Myiasis in humans-a global case report evaluation and literature analysis. Parasitol Res. 2019 Feb;118(2):389–97.


    2. Burkhart CN, Burkhart CG, Morrell DS. Infestations. In: Bolognia JL, Schaffer JV, Cerroni L, editors. Dermatology. 4th ed. China: Elsevier; 2018. pp. 1503–15.


    3. Calvopina M1 Ortiz-Prado E. Castañeda B, Cueva I, Rodriguez-Hidalgo R, Cooper PJ. Human myiasis in Ecuador. PLoS Negl Trop Dis. 2020;14:e0007858.


    4. Rossi MA, Zucoloto S. Fatal cerebral myiasis caused by the tropical warble fly, Dermatobia hominis. Am J Trop Med Hyg. 1973 Mar;22(2):267–9.


    5. Wall R, Howard JJ, Bindu J. The seasonal abundance of blowflies infesting drying fish in south-west India. J Appl Ecol. 2001;38(2):339–48.


    6. Sukontason KL, Narongchai P, Sripakdee D, Boonchu N, Chaiwong T, Ngern-Klun R, et al. First report of human myiasis caused by Chrysomya megacephala and Chrysomya rufifacies (Diptera: Calliphoridae) in Thailand, and its implication in forensic entomology. J Med Entomol. 2005 Jul;42(4):702–4.


    7. Fernandes LF, Pimenta FC, Fernandes FF. First report of human myiasis in GoiáS state, Brazil: frequency of different types of myiasis, their various etiological agents, and associated factors. J Parasitol. 2009 Feb;95(1):32–8.


    8. Mariwalla K, Langhan M, Welch KA, Kaplan DH. Cutaneous myiasis associated with scalp psoriasis. J Am Acad Dermatol. 2007 Aug;57(2 Suppl):S51–2.


    9. Pereyra-Rodríguez JJ, Bernabeu-Wittel J, Conejo-Mir MD, Ruiz-Pérez de Pipaón M, Conejo-Mir J. Treatment of cutaneous myiasis associated with scalp psoriasis in a 13-year-old girl with oral ivermectin. J Am Acad Dermatol. 2010 Nov;63(5):908–9.


    10. Francesconi F, Lupi O. Myiasis. Clin Microbiol Rev. 2012 Jan;25(1):79–105.


    11. Solomon M, Lachish T, Schwartz E. Cutaneous Myiasis. Curr Infect Dis Rep. 2016 Sep;18(9):28.


    12. Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY. Ectoparasites: scabies. J Am Acad Dermatol. 2020 Mar;82(3):533–48.


    13. Wilkins AL, Steer AC, Cranswick N, Gwee A. Question 1: is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg? Arch Dis Child. 2018 May;103(5):514–9.

    Author Contacts

    Kumpol Aiempanakit

    Division of Dermatology, Department of Internal Medicine, Faculty of Medicine

    Prince of Songkla University

    Hat Yai, Songkhla 90110 (Thailand)

    [email protected]


    Article / Publication Details


    Received: May 27, 2020
    Accepted: October 29, 2020
    Published online: November 23, 2020

    Issue release date: September – December


    Number of Print Pages: 6

    Number of Figures: 3

    Number of Tables: 0



    eISSN: 1662-6567 (Online)


    For additional information: https://www.karger.com/CDE


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    Psoriasis – Kieran’s Medical Notes

    Definition

    • Chronic inflammatory skin disease
    • Characterised by erythematous, circumscribed scaly papules, and plaques on elbows, knees, extensor limbs, scalp, and, less commonly, nails, ears, and umbilical region
    • Typically lifelong, with a fluctuating course of exacerbations and remission.
    • Causes itching, irritation, burning, and stinging in half the cases

    Risk Factors

    • Genetic
      • Linked to the class I and II major histocompatibility complex on human chromosome 6.
      • Genetic foci found to be associated with psoriasis include PSOR1 and PSOR2.[9] [10]
    • Immune response
      • Associated with increased activity of T cells in underlying skin.
      • Biological agents used to treat severe psoriasis directly modify the function of T cells
      • HIV-positive patients develop more severe psoriasis. [10][11] [12]
    • Infection
      • Guttate psoriasis is observed to follow an upper respiratory infection, such as streptococcal pharyngitis, and is believed to be an infection-induced disease. 
      • Viral infection and immunisation have also been linked to the flare of psoriasis. [10] [13]
    • Stress
      • Stress aggravates the occurrence of psoriasis and makes psoriasis worse. 
      • Stress reduction techniques may be useful in controlling psoriasis. [15] [16]
    • Trauma
      • Trauma, such as surgical scars and injection sites, may result in the appearance of new psoriatic lesions at the sites of injury. [17]
    • Smoking
      • Smokers have a higher risk of psoriasis. 
      • This has been documented in several population studies. 
      • In one study the risk of having psoriasis was 1.7 to 1.9 times more likely in former or current smokers. 
      • The risk of having pustular psoriasis was even higher at 5.3 times. [16]

    Differential diagnosis 

    Epidemiology

    • The incidence of psoriasis is around 60 per 100,000 people[2] 
    • In general, about 1.5% to 3.5% of the white population has psoriasis. [3] 
    • The mean age of onset is 28 years, with equal distribution between men and women. [4] 
    • Asian populations appear to have a very low prevalence of psoriasis (0.3%). [5]
    • The incidence of psoriatic arthritis is 1.4 per 100,000 and a prevalence of 24 per 100,000
      • this is a conservative figure including only those with significant arthritis [6] 
      • Another estimate suggests an incidence of 6.6 per 100,000 and a prevalence of 100 per 100,000. [7] 
    • Around 7% to 11% of psoriatic patients have arthritis. [2] [7] [8]

    Aetiology 

    • The aetiology is unknown. Several factors have been suggested:
      • Immunology
        • Psoriasis appeared after cessation of systemic corticosteroids (rebound)
        • It is aggravated by the use of anti-malarials, lithium, and beta-blocker drugs
        • Lesions of psoriasis are associated with increased activity of T cells in underlying skin
        • Biological agents used to treat severe psoriasis directly modify the function of T cells
        • HIV patients have more severe and frequent psoriasis. [10] [11] [12]
      • Infection
        • Guttate psoriasis is observed to follow an upper respiratory infection, such as streptococcal pharyngitis
        • Viral infection and immunisation have also been linked to the flare of psoriasis. [10] [13]

    Clinical features

    • Skin lesions
      • Typically erythematous, circumscribed scaly papules and plaques
        • On elbows, knees, extensor surfaces of limbs, scalp, and, less commonly, nails, ears, and umbilical region
        • Typically blanching
      • In plaque psoriasis, there are raised inflamed plaque lesions with a superficial silvery-white scaly eruption
        • The scale may be scraped away to reveal inflamed and sometimes friable skin beneath
      • In guttate psoriasis, there are widespread, erythematous, fine, scaly papules (water drop appearance) on trunk, arms, and legs.
        • The lesions often erupt after an upper respiratory infection. [1]
      • In pustular psoriasis, (von Zumbusch) there are sterile pustules on the hands and feet
        • Diffuse or circular erythematous lesions with pustules and scaling on the trunk. [1]
      • In erythroderma (erythrodermic psoriasis), there is generalised erythema with fine scaling.
        • It is often associated with pain, irritation, and sometimes severe itching. [1]
    • Auspitz’s sign is the appearance of punctate bleeding spots when psoriasis scales are scraped off, named after Heinrich Auspitz
    • FHx
    • Light skin
      • Psoriasis is around twice as common in white populations as in black people
    • Skin discomfort
      • Skin is highly sensitive and itching can be severe. 
      • Bleeding may occur if the lesions are scratched. 
      • The skin can be painful, particularly if joints are involved
    • Smoking
      • Smokers are at higher risk of psoriasis.

    Pathophysiology

    • Psoriasis is a hyperproliferative disorder, involving a complex cascade of inflammatory mediators
    • Mitotic activity of basal and suprabasal cells is significantly increased, with cells migrating from the basal layer to the stratum corneum in just a few days
      • The silver scale on the surface of psoriasiform lesions is simply a layer of dead cells. [10] [14]
    • Cytokines, particularly proinflammatory cytokines, T cells, macrophages, and vascular endothelial growth factor are heavily involved in pathogenesis
      • Tumour necrosis factor-alpha (TNF-alpha), in particular, has been a target of biological therapy. 
      • TNF-alpha is high in serum, synovium and psoriatic plaques. 
    • Human monoclonal antibodies that block TNF-alpha receptors, or inhibit binding or activation of TNF-alpha receptors, have been shown to significantly control psoriasis

    Investigations

    • Skin biopsy
      • Intraepidermal spongiform pustules and Munro neutrophilic microabscess within the stratum corneum
      • In addition to these classical features, others include focal parakeratosis and epidermal acanthosis with dilated capillaries within dermal papillae.
    • Skin biopsy should be ordered only when diagnosis is in doubt, but biopsy does not always show classic pathological features.

    Management

    a) conservative
    b) medical

    • Emolients
      • Ointments (such as Aquaphore) or thick creams (such as Cerave, Nivea, or Eucerin) that are used to reduce scale and irritation. [22] 
      • They are available as over-the-counter preparations and should be applied at least once a day, preferably twice a day, but can be applied more often if required
      • Although both preparations are effective, most patients prefer creams to ointments, and compliance tends to be better with cream preparations.
    • Topical corticosteroids
      • Generally, the lowest potency of topical corticosteroid should be used. 
      • This often means a mid-potency agent for adults and most body areas. 
      • Low-potency treatments are appropriate for lesions on the face or intertriginous areas or for infants. 
      • High-potency topical corticosteroids are usually reserved for adults requiring short-term treatment of thick plaques that are resistant to lower-potency agents. [19]
    • Topical vitamin D analogues
      • Agents such as calcipotriol bind with vitamin D-selective receptors
      • Have been shown to inhibit the hyperproliferation and abnormal differentiation of keratinocytes characteristic of psoriatic lesions. [19]
      • These agents do not smell or stain clothes and may be more acceptable than tar or dithranol products.
      • Calcipotriol has a relatively slow onset of action and its maximal effect is after 6 to 8 weeks
      • For patients with scalp psoriasis, combination preparations consisting of a topical vitamin D analogue and corticosteroid (calcipotriene plus betamethasone dipropionate) are a welcome addition to the available topical therapies. [35]
    • Oral retinoids
      • These drugs (e.g., acitretin) are moderately effective in many cases and are often combined with other treatments.[C Evidence]
      • Treatment is not recommended for >6 months.
      • Liver function and blood lipid concentration should be monitored.
      • Women of childbearing ages are not suitable for this regimen as retinoid agents are teratogenic.
    • Methotrexate
      • Folic acid antagonist and works as an antiproliferative and anti-inflammatory agent.[C Evidence]
      • Although effective in most patients, it has the potential for hepatotoxicity. [24]
      • Methotrexate is contraindicated in the following groups: 
        • pregnant patients; people with renal impairment, hepatitis, or cirrhosis; 
        • people who abuse alcohol;
        • unreliable patients; 
        • patients with leukaemia or thrombocytopenia
      • Folic acid may be used in addition to methotrexate to minimise adverse effects (such as GI symptoms).
    • Dithranol cream
    • Ciclosporin
      • An effective treatment for psoriasis but has significant adverse effects.[C Evidence]
      • Long-term use (i.e., >12 months) is not recommended. 
      • A break (i.e., drug vacation) is recommended after 1 year, switching to other drugs such as methotrexate. 
        • Ciclosporin can then be restarted
    • Biological agents
      • Newer biological therapies are recommended as possible treatment
        • if the psoriasis is very severe and the disease has not improved with other treatments such as ciclosporin, methotrexate, or PUVA,
        • or the patients have had adverse effects with these in the past, or such therapy is contraindicated. [24] 
      • Alefacept
        • Has a dual mechanism of action that involves induction of T-lymphocyte apoptosis and interruption of T-lymphocyte activation.[A Evidence]
      • Etanercept
        • Inhibits tumour necrosis facto-alpha (TNF-alpha), an important cytokine involved in the pathogenesis of psoriasis
        • Has been shown to significantly reduce the severity of plaque psoriasis.[A Evidence]
        • Furthermore, etanercept has been demonstrated effective in treating psoriasis in adults, children, and adolescents.[25]
      • Infliximab
        • Also inhibits the activity of TNF-alpha and has been shown to have efficacy in the treatment of chronic plaque psoriasis
        • It has also been demonstrated to improve health-related quality of life in patients with psoriasis. [28] 
        • Meta-analysis has demonstrated that infliximab is more effective than adalimumab and etanercept. [29]
      • Adalimumab
        • Inhibits the activity of TNF-alpha and has been shown to have efficacy in in the treatment of chronic plaque psoriasis. [30] [31]
        • It is more effective than methotrexate and placebo. [32] 
        • Studies have demonstrated improvement in health-related quality of life. [33]
      • Ustekinumab
        • Humanized monoclonal antibody
        • Inhibits Interleukins 12 and 23.
        • It has been shown to be effective in clinical trial for psoriasis. [34]
    • Retinoid-PUVA (re-PUVA)
      • The re-PUVA regimen consists of methoxsalen and ultraviolet A (PUVA) with an oral retinoid
      • May prevent antigen presentation process by Langerhans cells in the skin
      • Acitretin is given the day before PUVA therapy, which enhances the efficacy.
      • Adverse features include inconvenient scheduling (treatment is delivered 3 to 5 times per week), phototoxicity (during and after treatment), and burning if the dose is not adequately controlled

    c) surgical
    Prognosis

    90,000 Stages of psoriasis. How does psoriasis start and what can be done at the initial stage?

    Psoriasis cannot be cured once and for all, therefore the main goal of therapy is to achieve a stable and maximum long-term remission.

    How to achieve stable remission?

    Treatment of psoriasis is most effective at the earliest stage. At the first signs of the disease, it is recommended to start therapy with safe non-hormonal agents and be sure to consult a doctor.

    How to relieve exacerbation of psoriasis?

    “Tsinocap” is an example of a modern combination drug capable of relieving symptoms at all stages of psoriasis in children and adults.

    More …

    Accurate implementation of all the doctor’s recommendations, the exercise of patience and perseverance will help to overcome psoriasis.

    More …

    If untreated, chronic psoriasis can worsen symptoms and increase the incidence of exacerbations.

    Remedy for psoriasis …

    Children’s psoriasis belongs to the group of chronic dermatoses, in most cases it occurs and worsens in the cold season.

    More …

    For the treatment of psoriasis, hormonal drugs are often prescribed, but with prolonged use they can cause unwanted side effects.

    Learn more …

    Psoriasis is one of the most common chronic dermatoses: the disease causes a rash in the form of pink plaques with silvery scales, often accompanied by itching. To one degree or another, about 3% of the entire population of our planet encounters this pathology, that is, we are talking about millions of people.Psoriasis can appear at any age, although most often the first signs of the disease are found either from 15 to 25 years old or after 50. However, if you have never had psoriasis, this does not mean that it will never appear. Everyone needs to know how psoriasis proceeds and how it should be treated, since in the early stages, psoriasis treatment is most effective.

    Mechanism of development of the disease

    The reasons for the development of psoriasis are a real medical secret.Scientists have been seriously investigating this disease for over 150 years, but we still don’t know as much about it as we would like.

    The fact that psoriasis is not an infectious disease and is not transmitted from person to person was known as early as the 19th century. But what causes psoriasis? Today there are several theories on this score. Perhaps the whole point is in the violation of metabolic processes, perhaps in a genetic error. However, we already know for sure what can provoke the development of the disease.

    Changes in the immune system are to blame for everything.They can be genetically determined or occur due to the influence of some external factors. The onset of the disease can be triggered by neuropsychic factors (such as stress), skin trauma, taking certain medications (especially antibiotics), alcoholism, and infectious diseases.

    Be that as it may, changes in the work of the body’s defense system lead to the fact that the life cycle of skin cells becomes very short, they begin to divide at a tremendous rate and do not have time to die off naturally.This is how a characteristic psoriatic plaque is formed – a painful speck that rises above the level of the skin and is covered with dry scales. This process is accompanied by inflammation: there is a release of inflammatory mediators that support both the inflammation itself and provoke the excessive formation of skin cells. The result is a vicious circle, and anyone trying to cure psoriasis knows how difficult it is to break this sequence. To alleviate the condition in psoriasis and achieve a stable remission, it is necessary to suppress the inflammatory processes, as well as to ensure intensive restoration of the skin and its barrier function.

    Stages of psoriasis according to the degree of exacerbation

    Three stages can be clearly traced during the course of the disease:

    Progressive stage

    This is the very beginning of the disease, and it can be very violent. Suddenly, small, no more than a pinhead, nodular rashes appear on the skin. A small gray scale of skin is visible at the apex of each nodule. The rash grows and forms plaques, and severe itching appears. Sometimes the plaques get wet, and due to a violation of the barrier function of the skin, an infection can also join the psoriasis at this stage.

    Stationary stage

    After a while, the process seems to freeze – papules (inflamed nodules) do not pass, but new ones no longer appear. The plaques are covered with dry skin scales or crust. During this period, the inflammation subsides.

    Regressive stage

    At the last stage of psoriasis, plaques gradually decrease and dissolve (usually starting from the central part, therefore, by the end of the regressive stage, rings and bizarre patterns appear on the skin), peeling and itching disappear.Very soon, only areas of slightly depigmented skin remain from psoriatic plaques.

    This is the completion of the psoriasis cycle, but not recovery. The whole process can be repeated at any time. If left untreated, psoriasis will recur over and over again almost monthly.

    It is important to know
    Alcohol in psoriasis is extremely harmful. According to some estimates, people who abuse alcohol are about 5 times more likely to get psoriasis than those who are indifferent to drinking.

    Stages of the disease according to the degree of damage

    Psoriasis is also classified according to the severity of the lesions, dividing it into mild, moderate and severe forms . The difference between them is in the area of ​​the affected skin. It is not difficult to calculate this figure even without the participation of a specialist: an open palm of an adult is approximately 1% of the entire surface of the skin.

    • Mild psoriasis refers to cases where less than 3% of the skin surface is affected.
    • Medium – 3 to 10% of the skin surface.
    • Severe degree – 10% of the entire skin and more.

    If psoriasis affects the joints, it is severe – no matter what area of ​​the skin is affected.

    In medical practice, there are several scales for assessing the severity of psoriasis. They assess various factors – from the area of ​​skin lesions to the level of disease activity. Most often, the so-called PASI index is used to determine the severity of psoriasis.

    How to recognize psoriasis at an early stage

    Treatment of psoriasis is most effective at the earliest stage.Therefore, it is so important to make a diagnosis on time. Only a dermatologist can tell you whether you have psoriasis or some other skin disease. However, you yourself can recognize this disease in yourself by several characteristic signs:

    • Most often, psoriasis first manifests itself on the bends of the arms and legs, at the hairline or where clothes are tightly in contact with the body or rub – under the belt of trousers, various elastic bands or shoulder straps.
    • At the onset of the disease, a very itchy rash appears, covered with gray or silvery skin scales, which are very easily removed.
    • If you remove the scale, you will see thin, shiny and slightly damp skin underneath.
    • If you scrape the plaque with something like a spatula, removing the scales, then the blood will appear on the spot in the form of tiny droplets. However, it is better not to use the latter method for self-determination of psoriasis – it is so very easy to infect an infection.

    For complete confidence, you need to consult a doctor, as patients themselves often confuse psoriasis with various types of lichen or allergic dermatitis and use unsuitable remedies for treatment.

    What to do if you find symptoms of the initial stage of psoriasis?

    Psoriasis cannot be cured once and for all, therefore the main goal of therapy is to achieve a stable and longest possible remission. You should know that without proper treatment, psoriasis quickly becomes chronic: exacerbations can occur up to 9 times a year, with a duration of up to 15 days. What if you suspect you have psoriasis? Often people, having discovered signs of this disease, make a big mistake, resorting to “heavy artillery” – hormonal ointments (the so-called topical glucocorticosteroids, or THCS), without consulting a doctor.Usually, patients explain such a step by the fact that they allegedly heard from friends that such funds help quickly. This is a big mistake!

    What is the danger of such self-medication? Hormonal ointments for psoriasis have a lot of side effects and contraindications. It is extremely undesirable to use them without the strict recommendation of a doctor on the duration of use, frequency, area of ​​application on the body, and also without taking into account the individual characteristics of your body. THCS belong to the category of highly effective agents, the use of which (from the point of view of the ratio of benefits and harms) is justified only in extremely severe cases.At the initial stage of the development of psoriasis, prolonged and uncontrolled use of TCGS can aggravate the course of the disease: cause addiction, withdrawal syndrome, skin atrophy, so that ultimately psoriasis returns, but in a more severe, often recurrent form.

    For effective treatment of psoriasis in the early stages, non-hormonal agents, for example, based on zinc pyrithione, should be used. Zinc pyrithione, or active zinc, is a very effective remedy for the treatment of psoriasis, which has a complex effect:

    • suppresses excessive proliferation of skin cells and inflammation, reducing scaling and the formation of psoriatic plaques;
    • relieves itching;
    • protects damaged skin from bacterial and fungal infections;
    • restores the lipid layer and the protective functions of the skin.

    Zinc pyrithione does not cause withdrawal symptoms, and the list of contraindications and side effects is minimal. The effectiveness of zinc pyrithione in the treatment of psoriasis, including in comparison with hormonal agents, has been confirmed by a number of Russian and foreign studies. One of the drugs based on zinc pyrithione, which have proven their effectiveness and safety, is the domestic drug “Tsinocap”, produced in the form of a cream and an aerosol. In addition to active zinc, “Zinocap” is also enriched with D-panthenol, which has an additional anti-inflammatory effect, prevents the loss of moisture in the skin, provides softening and helps to restore the intercellular structures of the skin.

    Treatment of psoriasis – causes, symptoms and treatment methods

    22 July 2021

    When the disease manifests itself on the skin, it becomes noticeable to others, it causes particular discomfort. After all, it is impossible to explain to everyone that the disease is completely non-infectious.

    When the disease manifests itself on the skin, it becomes noticeable to others, it gives special discomfort. After all, it is impossible to explain to everyone that the disease is completely non-infectious. Unfortunately, many uninformed people believe that psoriasis is caused by an infection and avoid any contact with a person who has manifestations of it.In this article, we will try to put an end to this attitude.

    What is psoriasis

    Psoriasis is scaly lichen caused, as shown by modern research, by a serious malfunction of the immune system. By its nature, it is dermatosis, that is, skin lesions, therefore, a dermatologist is involved in the treatment of psoriasis. The disease develops at any age, regardless of gender and type of human activity. According to the WHO, more than 4% of the world’s population has psoriasis.

    Symptoms

    In psoriasis, red, dry patches form on the skin, they are slightly raised above the skin, so they seem to create covered like plaques or scales. These papules indicate foci of chronic inflammation, where there is an increased formation of epidermal cells and new small capillaries.

    • The size of plaques is from 1 mm to 2-3 cm in diameter.
    • Due to the abundance of capillaries, they have a pink-red color.
    • Silver-white scales with a loose surface.
    • Mainly located on the arms and legs in the elbows and knees, scalp, trunk.
    • Often appear in the place of fresh wounds, scratches.
    • When the scales are removed, peeling increases, as if you were scratching a candle, and a shiny, damp surface forms in its place, droplets of blood are visible.
    • Thickening, punctate depressions, red spots under the nail plate appear on the nails,

    The skin areas affected by psoriasis look rather unpleasant in appearance, which gave rise to a prejudice against this disease.

    It is customary to distinguish between several forms of psoriasis, depending on its manifestation.

    • In the usual (vulgar) variety, the plaques are flat, pink-red in color, 50 mm in diameter or more, covered with silvery scales.
    • Exudative psoriasis is characterized by the appearance of moist, crust-like scales on the plaques, which are grayish-yellow in color. Sometimes they get wet.
    • The hollow form is characterized by the presence of small abscesses.
    • Psoriatic erythroderma affects the entire skin, the patient suffers from bouts of nausea, headache, severe weakness.
    • Arthropathic psoriasis also affects the small joints of the foot and hand.

    The last three forms of the disease are considered the most severe. They can arise both from the very onset of the disease and develop as a result of improper treatment or in the presence of adverse factors, for example, bad habits.

    How does the disease proceed?

    Psoriasis has an undulating character: the disease either recedes or worsens. Periods of exacerbation occur mainly in autumn and spring, as well as stressful situations, climate change, diet.

    There are four stages of psoriasis:

    • initial – small rashes no more than 1-3 mm in diameter, within 3-4 days. After the appearance of the rash, it becomes covered with a light gray bloom. It is generally accepted that if a person sought medical help within 21 days after the first rash, then the development of psoriasis can be stopped;
    • progressive – large areas of the skin are affected, on which pronounced silvery-white scales are formed. The rash itches a lot, there is a burning sensation.The stage lasts from 2 to 8 weeks. During this period, severe forms of psoriasis can develop, so it is extremely important to immediately consult a doctor;
    • stationary – this stage is also called the period of subsiding, it lasts indefinitely, here everything is individual. The rashes are covered with a dense gray crust, the skin is very rough, peeling;
    • regressive – at this stage the rashes become not so noticeable, one might even say that they dissolve. Itching disappears completely. No new lesions are formed.After this stage, remission occurs.

    With vulgar and exudatic forms of psoriasis, the prognosis is generally favorable. If the form is severe – pustular, psoriatic erythroderma or arthropathic psoriasis, then the question of obtaining disability is raised.

    Pregnancy can give the course of the disease an unpredictable direction, so expectant mothers are not recommended to use ointments containing hormones, tar, and also to undergo systemic therapy.

    Causes of psoriasis

    The causes of psoriasis are not fully understood, but it has been proven that the disease is non-infectious, that is, it is not transmitted from one person to another.With psoriasis, the process of division and maturation of skin cells is disrupted. The top layers of the skin die off faster than normal.

    • If psoriasis occurs at a young age, affecting the skin, most likely, this is due to a hereditary predisposition to the disease.
    • The second type of psoriasis affects joints and nails, occurs most often in people of mature and older age, which is not associated with a genetic factor.
    • Also, a number of studies have shown that the cause of the disease is psychosomatics, that is, it is caused by severe stress.

    In addition, it has been proven that the development of psoriasis can be triggered by an unsuitable climate, excessive consumption of alcohol, chocolate, vinegar-based pickles, pepper.

    Studies confirm the fact that psoriasis is a systemic disease that can affect internal organs and the skeleton.

    Methods of treatment

    Unfortunately, psoriasis cannot be completely cured at the moment. Modern methods of therapy make it possible to alleviate the course of the disease, achieve a certain cosmetic effect and reduce the likelihood of complications.The dermatologist builds treatment tactics depending on the stage of psoriasis, the size of the skin lesion, the age and sex of the patient, the individual characteristics of the organism, and concomitant diseases.

    Drug treatment

    In milder forms of psoriasis, the doctor selects drugs for local action: hormonal ointments, salicylic ointment, tar preparations, naftalan, emollient creams, lotions, shampoos. For more severe lesions, systemic treatment is prescribed, in particular, tablets: acitretin, methotrexate, cyclospori-A and others.These are very serious drugs, the dosage is selected individually, taking into account the results of blood tests.

    With a progressive stage of psoriasis therapy, strict medical supervision is required. To stop the inflammatory process, intravenous infusions of hemodesis, solutions of sodium thiosulfate, calcium gluconate, as well as the intake of intraintestinal sorbents are prescribed.

    To achieve a stable positive result, drug treatment of psoriasis in the stage of subsiding and remission is supplemented by physiotherapy procedures, a special diet.

    Physiotherapy procedures

    In modern dermatology, phototherapy with a UV lamp is widely used for the effective treatment of psoriasis. The essence of the method is that ultraviolet rays:

    • enhance local immunity;
    • trigger the production of vitamin D;
    • normalize metabolic processes in the cells of the epidermis.

    In addition, the UV lamp does not cause burns and scars on the skin and does not require the mandatory use of photosensitizers.

    Important! Phototherapy has a number of contraindications. In particular, the procedures cannot be carried out in the presence of:

    • tumor processes;
    • acute inflammations;
    • tuberculosis in open form.

    Phototherapy with a UV lamp is performed during the period of psoriasis subsiding and during remission. The procedures can be performed at home as well.

    Traditional methods of treatment

    At the initial stage, to relieve discomfort, traditional medicine recommends applying juniper or lavender oil to the rash, mixed with baby cream.Also fights inflammation well with 3% hydrogen peroxide.

    With a progressive stage, celandine tincture helps relieve itching and remove the burning sensation: 3 tablespoons of ground dry herb are mixed with salt water, infused for 2-3 hours, stored in the refrigerator. The resulting agent is pointwise lubricated with rashes. Natural birch tar has also proven itself well (only suitable for spot application).

    During the stationary stage, you can use all of the above means by adding to them beekeeping products – propolis, wax, honey.Papules are smeared with propolis mixed with boiled vegetable oil and melted wax, and honey is taken orally in a tablespoon twice a day.

    The key to successful psoriasis treatment is regular consultations of a competent dermatologist. Remember that all drugs, treatment methods, recipes of traditional medicine must be coordinated with your doctor. Self-medication can lead to a sharp deterioration in the condition and the transition of the disease to a more severe form.

    90,000 What you need to know about psoriasis

    Psoriasis (psoriasis vulgaris , squamous lichen) – is one of the most common chronic skin diseases.It is characterized by a monomorphic rash consisting of flat papules of various sizes, which tend to merge into large pink-red plaques, quickly becoming covered with loose silvery-white scales. In addition to the skin, psoriasis affects the nails and joints. In developed countries, 1.5-2% of the population suffers from psoriasis, equally often men and women.

    Figure 1. The most typical localization of psoriasis.

    Classification:

    • Non-pustular forms:
      • Common psoriasis:
        • with early onset (type I) – in women, the disease begins on average at 16 years old, in men at 22 years old;
        • with late onset (type II) – begins in old age, with an average of 56 years.
      • Psoriatic erythroderma.
    • Pustular forms:
      • Palmar-plantar pustular psoriasis (Barbera’s pustular psoriasis).
      • Pustular psoriasis, flowing like a centrifugal annular erythema.
      • Generalized pustular psoriasis (Tsumbusha pustular psoriasis).

    Heredity: Disease with polygenic inheritance.If one of the parents is sick, the child’s risk of psoriasis is 8%; if both father and mother suffer from psoriasis – 41%.

    Provoking factors:

    • Mechanical trauma to the skin (including rubbing and scratching) is the leading cause of the appearance of new rashes (Kebner’s phenomenon).
    • Infection: Acute streptococcal infection contributes to guttate psoriasis.
    • Stress: 40% of adult patients associate
      exacerbation of psoriasis with emotional overload, this happens even more often in children.
    • Medicines for systemic use – corticosteroids, lithium salts, antimalarial agents, interferons.

    Three stages are distinguished during psoriasis:

    • Progressive – characterized by the appearance of fresh miliary rashes, the continued growth of already existing papules, a bright color of the rash. Peeling of papules is especially pronounced in the central part, and along the periphery there is a hyperemic border – a corolla of growth (Pilnov’s rim), Often new elements appear at the sites of minor injuries, scratches – a positive isomorphic reaction (Kebner’s phenomenon).Usually in these cases, the papules are located linearly, indicating by their localization the site of irritation. The isomorphic reaction is explained by the presence of pronounced hyperergia, readiness for an inflammatory reaction. The slightest irritation of the skin is accompanied by the formation of a new rash, itching worries.
    • Stationary – the appearance of new and the growth of old papules stops, their color acquires a pronounced cyanotic hue, peeling decreases.
    • Regressive – is characterized by the appearance on the periphery of many papules of Voronov’s “pseudoatrophic rim” (after the papule growth stops, a whitish zone a few millimeters wide usually appears around it with a gentle folding of the stratum corneum), gradual disappearance of clinical symptoms, resorption of papules starting from the center of the elements along towards their periphery: peeling disappears, the color fades, and then all papules dissolve, often leaving behind temporary hypopigmentation (psoriatic pseudo-leucoderm) .

    The nature of skin lesions. Elements of the rash. Papules and plaques with clear boundaries, covered with silvery-white scales (see Fig. 2 and 3). The positive symptom of Auspitsa (the phenomenon of blood dew): when scraping the papules, point drops of blood are obtained that do not merge with each other. Pustules, erythroderma.

    Figure 2 – Common psoriasis: elbow lesion.A bright pink plaque with clear boundaries covered with thick but easily detachable scales. The scales are silvery white, resembling mica. The plaque arose when several small papules merged.

    Figure 3 – Common psoriasis: plaque duty.
    Dense asbestos-like silvery-white scales almost completely cover the plaque

    Color Pink, “salmon”.

    Form. Round, oval, polycyclic, annular, linear.

    Location. Individual elements, arranged randomly or in the form of arcuate, serpentine figures. Coverage of one or more adjacent dermatomes, as in shingles. The fusion of elements among themselves up to erythroderma.

    Localization. Bilateral lesion (see Fig. 4), which is occasionally symmetrical. Favorite localization – elbows, knees, scalp, skin folds. On open areas of the body, rashes are far from always. Facial involvement is rare and indicates a persistent course of psoriasis.

    Figure 4 – Common psoriasis: trunk involvement.

    In guttate psoriasis – scattered small papules that do not have a favorite localization (see Fig. 5).

    Figure 5 – Guttate psoriasis. Red, scaly, in places merging papules and plaques dotted the entire body. The disease arose soon after a sore throat.

    Features. With psoriasis, do not rub and scratch the plaques, as this leads to the appearance of new rashes.

    Psoriasis of the scalp – plaques covered with thick, difficult to separate scales (Fig.6). Lichenization (the result of constant scratching and rubbing of the skin). Moisture and cracks, especially behind the ears. Location. Scattered, scattered plaques or diffuse lesions of the entire scalp. With psoriasis of the scalp, there is almost never alopecia.

    Figure 6 – Psoriasis of the scalp. Thick scales cover the entire scalp like a helmet. Red plaques spread to the skin of the forehead.

    Psoriasis of nails.Damage to nails of varying severity occurs in 25% of patients with psoriasis. Psoriasis of the nails often goes away on its own or as the rash on the skin resolves. Nails are affected in 25% of patients with psoriasis. Both fingernails and toenails are affected. Characterized by pinpoint depressions (thimble symptom), subungual hyperkeratosis, onycholysis (Fig. 7 and 8). A pathognomonic sign is yellowish-brown spots under the nail (a symptom of an oil spot).

    Figure 7 – Psoriasis of nails.The symptom of a thimble – a lot of punctate depressions on the
    nail plate – is very characteristic, but not pathognomonic for psoriasis. The differential diagnosis is carried out with the defeat of the nails with alopecia areata. This patient also showed marginal onycholysis and mild subungual hyperkeratosis

    Figure 8 – Psoriasis of nails. The symptom of an oil stain – yellowish-brown spots on the nail bed – is a pathognomonic sign of psoriasis. Marginal onycholysis is also visible

    Palms and soles (fig.9) may be the only affected area. Rashes are difficult to treat.

    Figure 9 – Common psoriasis: lesion of the soles. Clearly demarcated red plaques
    covered with thick yellowish scales. Mainly the support areas of the foot are affected. Similar eruptions were found on palms

    Treatment of psoriasis should be comprehensive.It includes general and local therapy, physical therapy, adherence and diet. When prescribing treatment, it is necessary to take into account the stage of the process, the clinical form and the type of psoriasis.

    DO NOT TREAT YOURSELF IF A ROSE ON THE SKIN, CONSULT A DOCTOR. THE BEFORE THE TREATMENT IS STARTED, THE BETTER THE RESULT AND THE FASTER EFFECT.

    Doctor – surgeon K.V. Melnikova

    Psoriasis – causes, symptoms and treatment: at what age does it appear and can it be cured

    Table of Contents

    Psoriasis is a common chronic skin disorder characterized by red, raised patches with silvery white scales on the head, lower back, nails, vulva, and elsewhere.The disease can develop at almost any age (including young patients). Today, about 3% of the world’s inhabitants suffer from pathology. Often, the disease not only causes physical discomfort, but also becomes the cause of depression, low self-esteem, in some cases even leads to complete isolation of a person who begins to feel ashamed of his body.

    Causes of psoriasis

    At the moment, the exact causes of psoriasis are unknown, but the pathology is being treated, since it is known that the pathology can be provoked by:

    • Metabolic disorders
    • Immunological failures
    • Neurological disorders

    There is a hypothesis according to which a genetic factor plays an important role in the development of pathology.Psoriasis in children, for example, is often hereditary. If pathology occurs in an adult, experts isolate its viral and bacterial nature.

    Also, the development of the disease can be provoked:

    • Skin features (dryness and thinness)
    • Bad habits
    • Frequent stress
    • The effect of fungi
    • Taking antidepressants and a number of other medical devices
    • Excessive hygiene (frequent hand washing, for example)
    • Exposure to salts, acids and other aggressive external factors

    Treatment of psoriasis should be carried out depending on the cause.It is very important to see a doctor at the first signs of pathology. The specialist will carry out an accurate comprehensive diagnosis and prescribe an adequate individual therapy.

    Is psoriasis contagious?

    Some people think psoriasis is contagious and shy away from people with the condition. What provokes the patient’s desire to hide from those around him at home, becomes the cause of complexes and serious psychological problems. In fact, it has already been proven (through numerous studies) that psoriasis is not contagious.If the whole family is sick, this only speaks of the importance of the genetic factor in the development of pathology.

    Stages of development

    At the moment, specialists distinguish 3 stages in the development of pathology:

    • Progressive . It is characterized by the constant formation of new rashes, provoking severe itching 90 104
    • Stationary . This stage is characterized by the termination of the emergence of new formations. In the stationary stage, an existing rash begins to heal 90 104
    • Regressive .This stage is characterized by the appearance of rims around the formations. Only increased skin pigmentation reminds of the disease. Skin affected by rashes has a darker color

    Also, there are several degrees of severity of pathology:

    • Light . With this psoriasis, no more than 3% of the skin surface is affected 90 104
    • Medium . Characterized by 3-10% damage
    • Heavy . This pathology is characterized by the involvement of more than 10% of the body surface 90 104

    First signs

    Psoriasis, symptoms, causes, the treatment of which is determined by the doctor, is characterized by such signs as:

    • Convex red spots with silvery or white scales
    • Deformation of nails and their delamination
    • Exfoliation of dead skin cells
    • Cracks in the skin causing discomfort
    • Blistering feet and palms

    If any symptoms of psoriasis appear, treatment should be started immediately!

    Symptoms of psoriasis

    It should be understood that plaques on the body are only external symptoms of psoriasis.In fact, numerous body systems suffer from pathology, as well as tendons, joints and even the spine. The thyroid gland, kidneys and liver are often affected.

    For this reason, patients complain about:

    • Chronic fatigue
    • Constant feeling of weakness
    • Depressive state

    In some cases, psoriasis is complicated by a fungal infection, complete loss of nail plates, limited joint mobility.A form of psoriasis such as psoriatic erythroderma, for example, can lead to skin detachment. This, in turn, disrupts the body’s ability to regulate temperature, the barrier function of the dermis, and can be fatal!

    Course of the disease

    Psoriasis is characterized by an undulating course. Most patients have periods of remission, improvement and exacerbation. The latter, as a rule, are provoked by aggressive external influences. Exacerbations usually begin after drinking alcohol, stress and infection.Psoriasis is dangerous because for a long time it can manifest itself only by the formation of plaques. Often they are located in one place and do not bother the patient in any way. Because of this, he does not go to the doctor. Suddenly, plaque can begin to grow and cover the entire body. In the absence of treatment, the pathology progresses, involves internal organs and systems. Symptoms of the disease are aggravated, and the patient’s condition worsens.

    In some patients, there is a continuous course of pathology.There are no periods of remission. With this course, the condition worsens gradually, the disease begins with a rash on certain parts of the body. Then the individual formations merge with each other. The patient notices a deterioration in the condition of the nails, general weakness and other symptoms.

    Psoriasis Treatment

    Treatment of psoriasis symptoms in adults depends largely on the stage of the disease.

    Almost always, therapy is carried out in a comprehensive manner and includes:

    • The use of external agents.Patients are prescribed emollients and other medications in the form of creams, lotions, and ointments. They contain zinc, tar, naphthalan and other substances that improve the overall condition of the skin
    • Medicines for oral administration. Hormones, antineoplastic and other agents are prescribed
    • Physiotherapy procedures. Techniques such as plasmapheresis, cryotherapy, photochemotherapy are beneficial
    • Compliance with general regime
    • Prescribing a special diet

    When developing a psoriasis treatment program, a number of factors are taken into account, including:

    • Gender and age of the patient
    • Presence of concomitant diseases
    • General health
    • Impact of occupational and other external factors

    In some cases, it is enough for the patient to change his job or his lifestyle in general, in others – to undergo several long courses of treatment.

    Treatment of psoriasis in adults and children is also carried out using modern laser technologies. Therapy allows you to weaken the symptoms of pathology, provide a long and stable remission, save the patient from ugly rashes and complexes associated with them. A special excimer laser acts only on the affected areas of the skin, without affecting the healthy ones around. Thanks to this, there is no need for a long recovery after the procedure and there are no side effects after the session.Laser therapy requires no preparation, is safe and painless. Psoriasis, which is regularly treated using this method, becomes a diagnosis with which the patient lives without any restrictions.

    Diet for psoriasis

    Even not every experienced specialist can accurately answer the question of which diet will be effective for psoriasis. This is due to the individual characteristics of the patient’s body. Some psoriasis sufferers respond positively to a certain category of food, others to the opposite.For this reason, the diet is always individually selected and constantly adjusted. In any case, it is very important that the patient receives all the nutrients in full.

    With psoriasis, experts recommend excluding:

    • Nuts and citrus zest
    • Spices and smoked products
    • Spicy and salty foods
    • Blue cheese
    • Alcohol
    • Fatty meat and sausages
    • Sweets

    It is very important to saturate the diet with fatty acids, which are abundant in fish.Fatty acids are helpful in relieving itching, flaking, and irritation of the skin. In addition, they increase the body’s defenses.

    Benefits of treatment at MEDSI

    • The use of modern methods of treating psoriasis in adults and children. MEDSI conducts phototherapy sessions using laser radiation
    • Use of modern equipment. In our center on Krasnaya Presnya, the Excilite µ system has been installed, which allows removing ugly plaques from the patient’s body without pain or side effects
    • Possibilities for prolonging periods of remission and improving the general condition of patients suffering from psoriasis for many years
    • Involvement of not only dermatologists, but also trichologists, cosmetologists and physiotherapists in the treatment of psoriasis
    • Employees of high-level specialists who have been successfully treating psoriasis, eliminating the causes and symptoms of the disease for many years
    • Comfortable atmosphere in all clinics and attentive attitude to patients of any age

    To use professional help in the treatment of psoriasis, it is enough to make an appointment with a specialist by phone +7 (495) 7-800-500.

    90,000 Psoriasis – signs, causes, symptoms, treatment and prevention

    Causes

    To date, the exact causes of psoriasis are unknown. There are only theories of the possible development of the disease.

    The hereditary theory is one of the most widespread. Scientists have identified a pattern in the frequency and development of psoriasis in people whose parents and closest relatives suffer from the same disease. There are also viral, neuroendocrine, infectious-allergic theories.The development of psoriasis in people with metabolic disorders is observed, which may also be one of the theories of the origin of the disease.

    Symptoms

    Psoriasis rashes will occur on almost all areas of the skin, but most often develop on the extensor surfaces of the upper or lower extremities (in the elbow and knee joints), on the scalp, as well as in the lumbosacral region. There is also an atypical location of the rash on the body, for example, in the area of ​​large folds.

    The disease begins acutely with the appearance of small flat elevations of the skin (papules) of pink or red color, which are covered with white-silvery peeling scales of the epidermis. These plaques (papules) gradually increase in size, which can merge with each other to form extensive infiltrative foci with uneven outlines.

    Rashes on the oral mucosa are practically not observed. But occasionally, you can still find a round or irregular rash that rises above the level and has a whitish color.There is no soreness or itching sensation.

    In the psoriatic process, the nail plates are often affected (their surface begins to resemble a thimble), thickening and destruction of the nails occurs. Transverse grooves may also appear.

    Psoriasis rashes can be localized, common and universal.

    Depending on the prevalence of the clinical form, psoriasis may be accompanied by a sharp rise in body temperature and a severe general condition (psoriatic erythroderma).

    If exudation on the surface of plaques predominates, then gray-yellow scales are formed, this process is observed in exudative psoriasis. With increased exudation and the development of the process, vegetations appear in the skin folds, which are very itchy and accompanied by burning.

    Pustular psoriasis looks like intraepidermal abscesses, which are located on a reddened base with the presence of typical psoriatic plaques.

    The most severe form of psoriasis is arthropathic, which is accompanied by damage to the joints (arthritis).With this form, there will be sharp soreness, swelling of the joints and limitation of their mobility. Subsequently, the joints begin to deform, which entails disability for the patient with psoriasis.

    In children, the most common form of psoriasis is exudative.

    There are several stages of the psoriatic process:

    The progressive stage is characterized by the appearance of new point elements of bright red color, which increase along the periphery and appear at the site of skin irritation by various factors.

    In the stationary stage, new eruptions no longer appear, but large pink plaques the size of a coin or more remain.

    The regressive stage is accompanied by flattening of plaques and their resorption. If the regression of the rash begins from the center of the plaque, then they acquire a ring-shaped shape. And with regression from the edge of the plaque, a strip of depigmented skin is formed along the periphery.

    After the disappearance of plaques and any kind of manifestation of psoriasis, hyperpigmentation or depigmentation remains on the skin.

    90,000 Skin diseases. Psoriasis. | SEVKAVKURORTSERVIS

    Skin diseases. Psoriasis.

    Human skin is considered an independent organ that performs vital functions. Healthy skin is a prerequisite for well-being. But she is also susceptible to pathological processes. The undoubted advantage is that at a very early stage you can see the disease and start treatment.But there are also negative aspects: skin diseases cause aesthetic and psychological discomfort to a person. Therefore, first of all, it is necessary to diagnose the disease, and secondly, to start treatment.

    One of the skin diseases is psoriasis, a chronic non-infectious disease that affects the skin and nails. People, regardless of age, are prone to psoriasis: both children and adults. However, the cause of the disease has not yet been identified. Psoriasis manifests itself as red scaly spots and has several varieties:

    • plaque psoriasis
    • pustular psoriasis
    • punctate psoriasis
    • psoriasis of flexion surfaces

    Treatment of psoriasis can be carried out not only in a polyclinic, but also in a sanatorium.In the health resorts of the Caucasian Mineral Waters, namely in Pyatigorsk, considerable experience has been accumulated in the treatment of psoriasis. The spa approach is based on an integrated approach: diet therapy, mud therapy, physiotherapy procedures and balneotherapy.

    In the sanatoriums of Pyatigorsk, mud from Lake Tambukan is used for the treatment of psoriasis. Silt sulphide mud, along with the Dead Sea mud, is rich in chlorine, magnesium and calcium, has a regenerating effect and has an antiseptic effect.

    Ultraviolet irradiation (UFO), electrosleep, phyto and light therapy, intravenous laser blood purification (ILBI), magnetic field treatment (Multimag apparatus), etc. can be prescribed from the physiotherapy block.

    Mineral showers and baths with the use of hydrogen sulphide water gushing from the bowels of the Goryachaya mountain, which have an immunostimulating effect, are effective procedures in the treatment of psoriasis in the health resorts of Pyatigorsk.

    Experts recommend a spa treatment lasting at least 14 days.Even for such a short period of time, a vacationer is able not only to see, but also to feel a positive result from the procedures passed, and for the next 9-11 months to forget about this misfortune.

    Medical center “NARUS”, Khimki


    Psoriasis (squamous lichen) is a chronic non-contagious disease that affects the skin, nails and joints. It is characterized by the appearance of a monomorphic rash on the skin: bright pink nodules covered with silvery scales.The elements of the rash can merge in various configurations, resembling a geographical map. It is accompanied by moderate itching of the skin. Psoriasis worsens the appearance of the skin and brings psychological discomfort to the patient. With joint damage, psoriatic arthritis develops. Generalized pustular psoriasis of pregnant women is dangerous, leading to fetal damage and miscarriage.

    Causes and pathogenesis of psoriasis

    The etiology and pathogenesis of psoriasis are not fully understood, but research results suggest that a hereditary, infectious or neurogenic nature is most likely.

    The hereditary nature of psoriasis is confirmed by the facts that the incidence is higher in those families in which psoriasis has already been diagnosed, in addition, in monozygotic twins, the incidence rate is also higher than in other groups. The infectious etiology of psoriasis is reduced to the presence of altered complexes and inclusions, as in a viral infection, but, however, the virus has not yet been identified.

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

    Clinical manifestations of psoriasis

    The primary element of psoriasis is a single papule of pink or red color, which is covered with a large number of loose silvery-white scales.An important diagnostic feature is the triad of psoriasis: the phenomenon of a stearin spot, a terminal film, and precise bleeding when the scales are scraped off.

    At the stage of development of psoriasis, there are few rashes, gradually over the course of months and even years, their number increases. Psoriasis very rarely debuts with intense and generalized rashes, such an onset can be observed after acute infectious diseases, severe neuropsychic overload and after massive drug therapy.If psoriasis has such an onset, then the rash is edematous, has a bright red color and quickly spreads throughout the body, psoriatic plaques are hyperemic, edematous and often itchy. Papules are localized on the flexion surfaces, especially in the knee and elbow joints, on the trunk and scalp.

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

    In the third stage of psoriasis, the intensity of the peripheral growth of plaques decreases, and their boundaries become clearer, the color of the affected skin acquires a bluish tint, intense peeling is observed on the entire surface of the elements. After the final cessation of the growth of psoriasis plaques, a pseudoatrophic rim is formed along their periphery – the Voronov rim.In the absence of treatment for psoriasis, plaques thicken, sometimes papillomatous and warty growths can be observed.

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

    Exudative psoriasis differs from usual by the presence of crusted scales on plaques, which are formed due to soaking with exudate, there may be oozing in the folds of the body. Patients with diabetes mellitus, people with hypothyroidism (hypothyroidism) and overweight are at risk for the incidence of exudative psoriasis. Patients with this form of psoriasis report itching and burning in the affected areas.

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

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

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

    The arthropathic form of psoriasis is one of the most severe, there is pain without deformation of the joint, but in some cases the joint is deformed, which leads to ankylosis.In psoriatic arthritis, the symptoms of psoriasis on the part of the skin can occur much later than arthralgic phenomena. First of all, the small interphalangeal joints are affected, and only later the large joints and the spine are involved in the process. Due to the gradually developing osteoporosis and destruction of the joints, the artopathic form of psoriasis often ends with the disability of patients.

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

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

    Diagnosis of psoriasis

    The diagnosis is made by dermatologists on the basis of external skin manifestations and patient complaints.Psoriasis is characterized by the psoriatic triad, which includes the phenomenon of stearin spot, the phenomenon of psoriatic film and the phenomenon of blood dew. When scraping even smooth papules, peeling increases, and the surface takes on a similarity to a stearin spot. With further scraping after the complete removal of the scales, the thinnest delicate translucent film is detached, which covers the entire element. If the exposure is continued, the terminal film is rejected and a moist surface is exposed, on which spot bleeding occurs (a drop of blood resembling a drop of dew).

    In atypical forms of psoriasis, it is necessary to carry out differential diagnosis with seborrheic eczema, papular syphilis and lichen rosacea.

    Histological studies reveal hyperkeratosis and almost complete absence of the granular layer of the dermis, the prickly layer of the dermis is edematous with foci of accumulations of neutrophilic granulocytes, as the volume of such a focus increases, it migrates under the stratum corneum of the dermis and forms microabscesses.

    Psoriasis treatment

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

    Physiotherapeutic procedures such as paraffin baths, UV irradiation are indicated for various forms of psoriasis. Effectively laser treatment of psoriasis and phototherapy.

    During the rehabilitation period, spa treatment with sulfide and radon sources helps to achieve stable and long-term remission.

    Prevention of psoriasis

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

    Doctors of the medical clinic “Narus”, using timely therapy and the latest methods of physiotherapy, will help to achieve long-term remission of psoriasis.

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