What are the most effective treatments for pustular psoriasis. How can patients manage symptoms and prevent flare-ups. What role do lifestyle changes play in controlling pustular psoriasis. What new therapies are emerging for this challenging skin condition.

Understanding Pustular Psoriasis: A Distinct Form of Psoriasis

Pustular psoriasis is a rare and severe form of psoriasis characterized by the formation of small, pus-filled blisters (pustules) on reddened, inflamed skin. Unlike typical plaque psoriasis, pustular psoriasis can be more challenging to treat and may require a different approach to management.

This condition can occur in localized areas of the body or become generalized, affecting large portions of the skin. The pustules are not infectious but can be painful, itchy, and prone to bursting, leading to further complications.

Types of Pustular Psoriasis

• Palmoplantar pustulosis (PPP): Affects the palms and soles
• Acrodermatitis continua of Hallopeau (ACH): Involves the fingertips and toes
• Generalized pustular psoriasis (GPP): Can cover large areas of the body

Understanding the specific type of pustular psoriasis is crucial for determining the most appropriate treatment strategy. Each subtype may respond differently to various therapies, necessitating a personalized approach to care.

Topical Treatments: The First Line of Defense

Topical treatments are often the initial approach for managing pustular psoriasis, especially in milder cases or when the condition is localized to specific areas of the body. These medications are applied directly to the affected skin and can help reduce inflammation, scaling, and pustule formation.

Corticosteroids: Powerful Anti-Inflammatory Agents

Topical corticosteroids are a mainstay in the treatment of pustular psoriasis. They work by suppressing the immune response in the skin, thereby reducing inflammation and alleviating symptoms. Corticosteroids come in various strengths, from mild to super-potent, and are prescribed based on the severity of the condition and the area of the body affected.

How long can topical corticosteroids be used safely? While effective, prolonged use of high-potency corticosteroids can lead to skin thinning and other side effects. Therefore, they are typically used for short periods or in rotation with other treatments to minimize risks.

Vitamin D Analogues: Regulating Skin Cell Growth

Vitamin D analogues, such as calcipotriene and tacalcitol, are synthetic forms of vitamin D that help normalize skin cell production and reduce inflammation. These medications can be particularly effective when used in combination with topical corticosteroids, offering a synergistic effect in managing pustular psoriasis symptoms.

Retinoids: Promoting Skin Cell Turnover

Topical retinoids, derived from vitamin A, can help regulate skin cell growth and reduce inflammation. Tazarotene is a commonly prescribed topical retinoid for pustular psoriasis. It works by normalizing cell differentiation and has anti-inflammatory properties, making it an effective option for some patients.

Systemic Medications: When Topical Treatments Aren’t Enough

In cases of severe or widespread pustular psoriasis, systemic medications that work throughout the body may be necessary. These treatments can be more potent but also carry a higher risk of side effects, requiring careful monitoring by a healthcare provider.

Oral Retinoids: Powerful Regulators of Skin Cell Growth

Oral retinoids, such as acitretin, are often considered a first-line systemic treatment for pustular psoriasis. These medications work by regulating skin cell production and reducing inflammation. They can be particularly effective in managing generalized pustular psoriasis and palmoplantar pustulosis.

What precautions should be taken when using oral retinoids? Due to their potential for side effects and teratogenicity (risk of birth defects), oral retinoids require careful monitoring and are contraindicated in pregnant women or those planning to become pregnant.

Methotrexate: An Immunosuppressive Approach

Methotrexate is an immunosuppressive medication that can be effective in treating pustular psoriasis by slowing down the rapid growth of skin cells and reducing inflammation. It’s often used when other treatments have failed or in combination with other therapies for enhanced efficacy.

Cyclosporine: Rapid Relief for Severe Cases

Cyclosporine is a potent immunosuppressant that can provide rapid improvement in severe cases of pustular psoriasis. It works by inhibiting T-cell function, thereby reducing inflammation and skin cell proliferation. However, due to its potential for serious side effects, cyclosporine is typically used for short-term management or as a bridge to other long-term treatments.

Biologics: Targeted Therapies for Pustular Psoriasis

Biologic medications represent a significant advancement in the treatment of pustular psoriasis. These drugs target specific components of the immune system involved in the inflammatory process, offering a more targeted approach with potentially fewer systemic side effects compared to traditional immunosuppressants.

TNF-α Inhibitors: Blocking a Key Inflammatory Mediator

Tumor Necrosis Factor-alpha (TNF-α) inhibitors, such as adalimumab, etanercept, and infliximab, have shown efficacy in treating pustular psoriasis. These biologics work by blocking TNF-α, a protein that plays a crucial role in inflammation.

IL-17 Inhibitors: Targeting a Specific Inflammatory Pathway

Interleukin-17 (IL-17) inhibitors, including secukinumab and ixekizumab, have demonstrated promising results in treating pustular psoriasis. These biologics target the IL-17 pathway, which is heavily involved in the pathogenesis of psoriasis and related conditions.

IL-23 Inhibitors: A Newer Class of Biologics

Interleukin-23 (IL-23) inhibitors, such as guselkumab and risankizumab, represent a newer class of biologics that have shown efficacy in treating pustular psoriasis. By targeting the IL-23 pathway, these medications can help reduce inflammation and improve symptoms.

How do biologics compare to traditional systemic medications in terms of safety and efficacy? While biologics offer targeted therapy with potentially fewer systemic side effects, they can be more expensive and may require regular injections. The choice between biologics and traditional systemics often depends on individual patient factors, disease severity, and response to previous treatments.

Phototherapy: Harnessing the Power of Light

Phototherapy, or light therapy, can be an effective treatment option for pustular psoriasis, particularly when used in combination with other therapies. This approach involves exposing the skin to controlled amounts of ultraviolet (UV) light to reduce inflammation and slow skin cell growth.

Types of Phototherapy

• Narrowband UVB: The most common form of phototherapy for psoriasis
• PUVA (Psoralen + UVA): Combines UVA light with a light-sensitizing medication
• Excimer laser: Delivers high-intensity UVB light to specific areas

Phototherapy can be particularly beneficial for patients with widespread pustular psoriasis or those who have not responded well to topical treatments alone. However, it requires regular treatments and may not be suitable for all patients, particularly those with a history of skin cancer or photosensitivity.

Emerging Therapies: The Future of Pustular Psoriasis Treatment

As our understanding of the underlying mechanisms of pustular psoriasis grows, new targeted therapies are being developed and tested. These emerging treatments offer hope for patients who have not responded well to existing options or who seek more effective long-term management strategies.

JAK Inhibitors: A Promising New Class of Medications

Janus kinase (JAK) inhibitors are a class of oral medications that have shown promise in treating various inflammatory skin conditions, including pustular psoriasis. These drugs work by inhibiting specific enzymes involved in the inflammatory cascade, potentially offering rapid and significant improvement in symptoms.

Which JAK inhibitors are being studied for pustular psoriasis? Several JAK inhibitors, including tofacitinib, baricitinib, and upadacitinib, are being investigated for their efficacy in treating pustular psoriasis. Early results have been encouraging, with some patients experiencing rapid clearance of pustules and associated symptoms.

IL-36 Inhibitors: Targeting a Key Inflammatory Pathway

Recent research has identified the interleukin-36 (IL-36) pathway as a significant contributor to the pathogenesis of pustular psoriasis. As a result, medications targeting this pathway are in development and showing promising results in clinical trials.

Spesolimab, an IL-36 receptor antagonist, has demonstrated efficacy in treating generalized pustular psoriasis in clinical trials. This targeted approach could offer a new treatment option for patients with this challenging form of psoriasis.

Lifestyle Modifications and Supportive Care

While medical treatments are crucial in managing pustular psoriasis, lifestyle modifications and supportive care play an essential role in overall disease management and quality of life improvement for patients.

Stress Management: A Key Factor in Pustular Psoriasis Control

Stress is a well-known trigger for psoriasis flares, including pustular psoriasis. Implementing stress-reduction techniques can help manage symptoms and reduce the frequency of flare-ups.

• Mindfulness meditation
• Regular exercise
• Adequate sleep
• Cognitive-behavioral therapy

Dietary Considerations: Nutrition’s Role in Skin Health

While no specific diet has been proven to cure pustular psoriasis, certain dietary modifications may help reduce inflammation and support overall skin health.

Can dietary changes impact pustular psoriasis symptoms? Some patients report improvement with anti-inflammatory diets, such as the Mediterranean diet, or by identifying and eliminating potential food triggers. However, more research is needed to establish definitive dietary recommendations for pustular psoriasis.

Skincare Routine: Gentle Care for Delicate Skin

Proper skincare is essential for managing pustular psoriasis and preventing complications. A gentle, consistent skincare routine can help soothe irritated skin and maintain skin barrier function.

1. Use mild, fragrance-free cleansers
2. Apply moisturizers regularly to keep skin hydrated
3. Avoid hot showers and harsh scrubbing
4. Protect skin from irritants and excessive sun exposure

The Importance of Individualized Treatment Plans

Pustular psoriasis is a complex condition that can vary significantly from person to person. As such, treatment approaches must be tailored to each individual’s specific needs, taking into account factors such as disease severity, affected areas, comorbidities, and personal preferences.

Collaborative Care: The Role of a Multidisciplinary Team

Managing pustular psoriasis often requires a multidisciplinary approach, involving dermatologists, rheumatologists, and other specialists as needed. This collaborative care model ensures comprehensive management of both skin symptoms and potential systemic complications.

Regular Monitoring and Treatment Adjustments

Given the chronic nature of pustular psoriasis and the potential for changes in disease activity over time, regular monitoring and treatment adjustments are crucial. This may involve periodic assessments of disease severity, evaluation of treatment efficacy, and screening for potential side effects or complications.

How often should patients with pustular psoriasis follow up with their healthcare provider? The frequency of follow-up visits depends on the individual’s disease severity and treatment regimen. Generally, more frequent visits are recommended during active flares or when initiating new treatments, with less frequent follow-ups for stable patients.

Patient Education and Self-Management

Empowering patients with knowledge about their condition and teaching self-management skills are essential components of effective pustular psoriasis care. This includes education about:

• Recognizing early signs of flares
• Proper use of prescribed medications
• Identifying and avoiding triggers
• When to seek medical attention

By actively involving patients in their care, healthcare providers can improve treatment adherence and outcomes, ultimately enhancing the quality of life for those living with pustular psoriasis.

Pustular psoriasis: Treatment options

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Pustular Psoriasis on Face: Symptoms, Diagnosis, Treatment

Pustular psoriasis is an uncommon type of psoriasis that causes small, pus-filled blisters. Very rarely, these pustules may appear on your face.

Psoriasis is a noncontagious autoimmune disease that affects about 2% to 3% of the global population. Pustular psoriasis, on the other hand, is far less common: Only about 1% of people with a psoriasis diagnosis have pustular psoriasis. But many people have both pustular psoriasis and another type of psoriasis.

Pustular psoriasis is marked by small, whiteish, pus-filled blisters, or pustules. You’ll most often notice these pustules on the soles of your feet and the palms of your hands. They may also show up elsewhere on your body or on your face, but this doesn’t happen often.

Here’s what to know about identifying pustular psoriasis on your face and getting treatment.

Pustular psoriasis happens in periods of flares, or outbreaks, and remissions.

At the beginning of a flare, you’ll usually notice your skin feels tender and changes color. For instance, it may appear reddish, violet, or dark purple, depending on your skin tone.

In just a few hours, you may start to notice pustules beginning to pop up. These pustules, which can feel very painful, contain white or yellowish pus and may burst open. They’ll eventually darken in color and then crust over. The pustules then peel off, leaving your skin underneath scaly or shiny.

Generally speaking, pustular psoriasis tends to show up on your hands and feet. You may notice pustules on other parts of your body, but they only rarely show up on your face. If you do develop pustules on your face, you’ll most likely have them on other parts of your body too.

The pustules may, in some cases, resemble an acne breakout. It’s also possible to confuse the pustules with symptoms of another skin condition or infection, such as eczema or herpes.

Von Zumbusch pustular psoriasis

This rare type of pustular psoriasis, also called generalized pustular psoriasis, can cause pustules over large areas of your body, not just your face. It’s very serious — sometimes fatal — and requires immediate medical care.

Without treatment, you may experience hair and nail loss, bacterial infections, liver damage, or cardiorespiratory failure.

Other signs and symptoms of this condition include:

• intense itching
• fever and chills
• muscle weakness
• rapid pulse
• anemia
• dehydration

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Experts have yet to fully determine the cause of pustular psoriasis.

Psoriasis is an autoimmune disease, which means your immune system plays a role. When you have an autoimmune disease such as psoriasis, your body attacks healthy tissue by mistake, which causes your flares.

Factors that may trigger a pustular psoriasis flare include:

• smoking
• pregnancy
• facial skin injuries or infections
• excess sunlight or ultraviolet (UV) light exposure on your face
• weather changes, particularly cold, dry, or windy weather
• certain foods, chemicals, or medications, such as biologics or systemic steroids
• having another autoimmune disease

Your genes may also increase your chances of developing psoriasis, since the condition seems to run in families.

Pustular psoriasis is more common in adults, though it may sometimes affect children.

Impetigo herpetiformis

This type of pustular psoriasis begins during the last trimester of pregnancy and involves pustules that develop on your inner thighs, groin, under your nails, and inside your mouth.

These pustules will cluster together, join, and spread across your body.

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Pustular psoriasis tends to have a pretty distinct appearance when compared with more common rashes and skin conditions. That said, it’s still fairly rare, especially when it affects your face. So, getting the right diagnosis may sometimes prove challenging.

If you have a discolored rash or blisters that don’t seem to improve over time, or come and go in cycles, a good next step involves connecting with a dermatologist. These doctors specialize in diagnosing and treating conditions that affect your skin, hair, or nails. Some dermatologists may recognize pustular psoriasis on sight.

Dermatologists can use other tests to confirm a suspected diagnosis and rule out other skin conditions. They may recommend:

• A physical exam and medical history: A dermatologist will want to confirm you don’t have pustules on other parts of your body. A personal and family medical history can help them help pinpoint any factors or triggers that might raise your risk of psoriasis.
• A complete blood count (CBC): This blood test can reveal signs of inflammation, along with irregularities in your white blood cell levels. A low count of lymphocytes — a type of white blood cell — is one sign of pustular psoriasis.
• Electrolyte and liver panels: These tests can help a dermatologist determine whether you have low blood levels of calcium (hypocalcemia) and excess liver enzymes.
• A punch biopsy or culture of the pustules: Taking a sample of one of your pustules can help a dermatologist rule out infections and other skin conditions.
• A pregnancy test: If pregnancy is a possibility for you, a dermatologist will recommend a pregnancy test. This can help them find a safe and effective treatment.

A dermatologist can also offer more guidance with identifying triggers to help minimize future flares.

If you have pustular psoriasis on your face, medical treatments may include:

• Topical medications: A care team will likely prescribe a topical cream or ointment as the first mode of treatment. These medications don’t just help relieve inflammation and irritation. They may also help lower your risk of flares.
• UV light therapy: Therapy with either artificial or natural UV light may also help relieve your psoriasis symptoms. A dermatologist may also suggest psoralen and UVA (PUVA) therapy, a treatment that combines psoralens with UV light. You’ll take an oral or topical psoralen drug before the UV treatment to increase your skin’s sensitivity to light.
• Oral medications or injections: A doctor may prescribe other medications such as the retinoid acitretin (Soriatane), the immunosuppressants cyclosporine or methotrexate, or biologics.

Learn more about treatment options for psoriasis.

At-home remedies may include:

• Coal tar soap: Coal tar soap has antiseptic properties that may help treat your psoriasis.
• Aloe vera gel: Aloe vera gel helps reduce your pain and inflammation.
• Epsom salt baths: Epsom salt baths soothe itchiness, pain, and swelling.
• Capsaicin cream: Capsaicin cream helps relieve pain by temporarily numbing your nerve endings associated with pain and swelling.
• Acupuncture: Acupuncture helps ease symptoms for some people. Experts continue to study the benefits of acupuncture for psoriasis.

Certain lifestyle changes may also help reduce your risk of flares. It may help to:

• get regular exercise, if you’re able
• avoid smoking
• limit alcohol use
• eat a balanced diet and limit trigger foods, such as red meat, processed foods, and nightshade vegetables
• keep your skin hydrated
• avoid soaps and shower products that contain fragrances or harsh chemicals
• keep a diary to help understand and track triggers
• take steps to minimize stress in your life, on your own or with support from a therapist

Find more home remedies for psoriasis.

Pustular psoriasis can potentially cause pustules on your face, but this is very rare. More often, you’ll notice pustules on other areas of your body, such as your hands and feet.

It’s always a good idea to check in with a doctor, or other healthcare professional, or a dermatologist if you have any persistent sores or rashes on your face. They can give you a thorough diagnosis and recommend the right treatment.

If you live with psoriasis, you can minimize your chances of a flare by avoiding your triggers and keeping your skin hydrated.

Treatment of psoriasis in the EMC Clinic of Dermatovenereology and Allergology-Immunology in Moscow

Psoriasis is a chronic inflammatory skin disease with a hereditary predisposition, which is characterized by complex changes in the upper layers of the skin, primarily an increased division of skin cells, which leads to the formation of psoriatic rashes. Numerous biochemical and immunological changes take place in psoriasis.

Psoriasis is registered everywhere. The most common psoriasis in European countries (up to 2. 9% of the population), the lowest rates are registered in Asia and West Africa (0.4%). The share of psoriasis among the total number of skin diseases reaches 15%. On average, 4% of the general population has psoriasis. Recently, there has been an increase in severe forms of the disease that are resistant to treatment, and the percentage of patients with comorbidities is also growing. Some patients with psoriasis develop a progressive joint change called psoriatic arthritis, which can lead to disability.

The presence of psoriasis is in itself a stress factor for the patient, which significantly reduces the quality of life. In addition, the mechanism of development of psoriasis is in many respects similar to the mechanism of development of some diseases of the internal organs, primarily type 2 diabetes mellitus, obesity, arterial hypertension and elevated blood cholesterol levels, which lead to the formation of atherosclerotic plaques in blood vessels. Such changes, in turn, increase the risk of cardiovascular disease, stroke and other complications. Therefore, psoriasis is not only a skin disease: it can indirectly have a negative impact on other organs and systems of the human body.

The etiology of psoriasis is not fully understood, but there is a definite relationship between the occurrence of psoriasis and the presence of stress, foci of chronic infection, climatic changes, malnutrition, smoking, alcohol consumption, and a genetic predisposition to psoriasis has been proven.

There are several forms of psoriasis

• Vulgar. Areas of rashes in the form of nodules or plaques of red color, slightly raised above the surface of healthy skin, covered with silvery-white scales, are characteristic. Rashes are localized most often on the extensor surfaces of the limbs, on the elbows, on the knees, on the scalp, in the lumbosacral region, on the buttocks, and can also be on the genitals.
• Teardrop. It is characterized by the presence of a large number of small dry red or purple, similar in size to drops, elements of psoriatic lesions. Rashes are localized mainly on the skin of the trunk, less pronounced on the skin of the arms and legs. Very often, the first manifestation of guttate psoriasis is preceded by an outbreak of streptococcal infection of the nasopharynx.
• Erythroderma . Psoriatic rash spreads to the entire surface of the body, including the face, hands, feet, scalp.
• Pustular psoriasis . This is a rare form of psoriasis, when small superficial pustules appear on the surface of psoriatic plaques. These pustules do not contain germs. Pustular psoriasis may affect only the palms and soles, or it may affect the entire surface of the body.

Regardless of the clinical form, it is possible to damage the nail plates of the hands and feet in the form of pinpoint impressions of the nails, a slight detachment of the nail plate from the bed, white or cream-colored spots under the nail, and some other changes. Such lesions require attention from a dermatologist, as they indicate the potential for joint damage in a few years.

Rashes in psoriasis can often be localized on the skin of the scalp and not affect other parts of the skin. In this case, patients are concerned about dryness of the scalp, itching, a feeling of tightness and abundant fine-lamellar peeling, sometimes hair loss.

Treatment of psoriasis

Treatment of psoriasis includes systemic therapy, topical (local) therapy and physiotherapy methods. At the moment, EMC contains all modern knowledge, technologies and drugs for the treatment of psoriasis.

EMC psoriasis treatment includes:

Systemic therapy, topical (local) therapy and physiotherapy methods. At the moment, EMC has the opportunity to treat psoriasis with modern methods. Dermatologists of our clinic in the treatment of psoriasis use only those methods that have proven their effectiveness throughout the world.

EMC psoriasis treatment includes:

• Special diet , limiting the intake of salty and fatty foods, easily digestible carbohydrates.

• General and local drug therapy , which is prescribed depending on the stage of the disease, the prevalence of the skin process, the clinical form of the disease. General therapy may include a vitamin A derivative (Acitretin), it is possible to prescribe drugs such as Methotrexate, Cyclosporine. Topical therapy includes products containing tar, corticosteroid ointments, creams and lotions, vitamin D ointments, zinc pyrithione.

• Biological therapy (the most modern method of treatment). These are drugs based on monoclonal antibodies that block individual parts of the immune system that are involved in the development of psoriasis (for example, Enbrel, Stelara, Efleira, Cozentix, Skyrisi, etc.).

• Physiotherapeutic treatment . PUVA therapy, narrow wave phototherapy.

At the European Medical Center (Moscow), dermatologists individually approach each clinical case and choose the most optimal complex therapy for treatment. Treatment of psoriasis in the Clinic of Dermatovenereology and Allergology-Immunology is carried out as part of a multidisciplinary team, when the decision on the tactics of managing patients is taken jointly by doctors of various related specialties. This approach allows you to achieve the maximum therapeutic effect.

what it is, what it looks like, symptoms and treatment

what is psoriasis

Psoriasis is a chronic autoimmune disease in which red, scaly patches appear on the surface of the skin. They are often called plaques.

Psoriasis cannot be contracted – it is an autoimmune disease, not an infectious disease.

Psoriasis is manifested by inflammation of the skin, as well as abnormally rapid growth and exfoliation of cells (keratinocytes) that make up the stratum corneum – the epidermis. Normally, it is completely renewed in a month, and in people with psoriasis, this process is many times accelerated and takes an average of 3-4 days.

The photo may seem shocking.
Click to view.

Psoriatic plaque

In addition to skin lesions, the disease causes inflammation of the joints (approximately 30% of cases). A little less often – in 10% of cases – psoriasis leads to inflammation of the choroid (uveitis).

Prevalence of psoriasis

Psoriasis most often affects people 15-35 years old, but in general the disease can manifest itself at any age. The first peak of the onset of pathology occurs at 15–20 years, the second at 55–60.

On average, psoriasis affects approximately 1-2% of people worldwide. In Russia, according to the clinical recommendations of the Russian Ministry of Health, in 2021 the prevalence of the disease was 243.7 cases per 100,000 population.

Types of psoriasis

Like many chronic diseases, psoriasis is distinguished by stages, severity, and also by the form of manifestation.

By stage

There are three stages in psoriasis: progressive, stationary and regression (remission).

In the progressive stage red spots appear on the skin. Merging, they form large scaly plaques with a pronounced red contour around the edges – it is called erythematous Erythema Redness on the skin caused by capillary dilation and blood flow. corolla, or corolla of growth.
New plaques are very itchy and can hurt.

Injured areas of the skin are especially prone to the appearance of new spots: a psoriatic plaque can quickly develop in the place of friction (for example, on clothes), as well as in the area of ​​a scratch or scratch. Doctors call this phenomenon the Koebner phenomenon.

This phenomenon, also known as the “isomorphic reaction”, was discovered by the German dermatologist Heinrich Koebner in 1872. The doctor noticed that in some patients with psoriasis in places of trauma, for example, after scratches, injections or bruises, new plaques appear on the skin.

Stationary Stabilization phase. The plaques stop growing, but continue to bother and peel off. A new rash and spots usually do not appear.

Regression stage occurs when the manifestations of psoriasis begin to disappear. Peeling passes, plaques brighten and flatten. Symptoms in this phase decrease.

By severity

To assess the severity of psoriasis, doctors use the PASI (Psoriasis Area and Severity Index) system – an index for assessing the severity and prevalence of psoriasis. It requires a professional analysis of such parameters as the severity of erythema, infiltration, scaling, and the calculation of the area affected by skin rashes.

Depending on the results of the examination, doctors distinguish between mild, moderate and severe degrees of the disease.

Form

According to the clinical picture of manifestations, several main forms of psoriasis are distinguished: psoriasis vulgaris, inverse, seborrheic, exudative, guttate, pustular, psoriasis of the palms and soles, and psoriatic erythroderma.

Vulgar (common) psoriasis is one of the most common forms, accounting for about 90% of all cases of the disease. First, red spots appear on the skin, which in a few days transform into convex scaly plaques. As the plaques develop, they merge into large itchy and scaly lesions. Then the state passes into the stage of stabilization and regression: the manifestations of the disease temporarily recede and the person’s well-being improves.

The most common places where psoriasis vulgaris appears are the extensor (outer) part of the skin of the elbows and knees. Also, foci appear on the trunk and scalp.

Psoriasis vulgaris on the outer part of the elbow

Inverse (“reverse”) psoriasis proceeds in the same way as ordinary psoriasis. The difference lies only in the location of the foci: they appear not on the extensor (outer) part of the knees and elbows, but on the flexion (inner) – that is, under the knee, under the armpits and in the area of ​​the elbow, as well as in the neck, eyelids, navel, inguinal folds. The skin in these places is more tender, moist and often rubs against clothes. Because of this, it may itch more than with the usual form of the disease, but peeling in these places is less pronounced.

Seborrheic psoriasis proceeds in the same way as usual, but its foci are located in places with a large number of glands that secrete sebum. These are the scalp, behind the ear folds, cheeks and nasolabial region of the face, forehead, chest and back (mainly the upper part).

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Seborrheic psoriasis on the scalp

Exudative psoriasis is a type of disease in which, in addition to peeling, exudate also appears in the lesion. It is a liquid containing protein, some blood cells, and other substances. Exudate can be released from capillaries during inflammation.

The crust on the surface of the plaques in the exudative form of the disease is usually dense, grayish-yellow, sometimes slightly moist. This type of psoriasis most often occurs in people with endocrine disorders: thyroid pathologies, type 2 diabetes, or obesity.

Guttate psoriasis is manifested not by plaques on the skin, but by numerous papules – swollen dots of bright red color with peeling in the center. Papules can vary in size from about 1 to 10 mm. They cover mainly the trunk, arms and legs.

Guttate psoriasis usually occurs in children after streptococcal infections (eg, sore throats). It is treated somewhat better than other types of psoriasis, but in some cases it can turn into an ordinary (vulgar) form.

Pustular psoriasis is characterized by the appearance of multiple pustules on a red erythematous background. Pustules are formations that look very similar to pimples. Such psoriasis can be the result of infectious diseases, stress, hormonal failure, improper medication or inadequate use of ointments.
Initially, numerous pustules appear on the red spots. Then they merge into one large purulent spot (or “purulent lake”).

The generalized form of pustular psoriasis is difficult to tolerate: with episodes of fever, weakness, as well as severe pain and burning of the skin. In parallel, there may be a change in the nails, pain in the joints.

Psoriasis of the palms and soles – typical psoriatic rashes appear on the palms and soles, less often in the form of localized pustular psoriasis. It can also affect and deform the nails – they thicken, become cloudy and uneven.

Psoriasis on the palm

Erythrodermic psoriasis is quite rare and is considered an extremely severe form of the disease. There is reddening of about 90% of the body, severe itching and pain appear, the skin swells, flakes. The temperature often rises and the lymph nodes become inflamed.

Typically, this type of psoriasis is the result of an exacerbation of another form of the disease due to improper treatment or adverse environmental factors (for example, sunburn in advanced psoriasis vulgaris, inadequate use of irritating external agents, or intravenous administration of glucocorticosteroids).

Symptoms of psoriasis

Manifestations of psoriasis vary depending on the type of disease and its severity.

Common symptoms and signs of psoriasis:

• red raised scaly patches on skin;
• itching in the area of ​​foci of inflammation and peeling;
• change in nails: pinpoint impressions, thickening and crumbling of the plate, its discharge;
• joint pain (sometimes).

For an accurate diagnosis, you need to contact a specialized specialist – a dermatologist.

Mechanism of development of psoriasis

Psoriasis is an autoimmune disease.

All autoimmune pathologies are associated with an error in the functioning of the immune system. Normally, it “scans” the body around the clock and searches for pathogen cells by foreign protein molecules that distinguish them from “normal” cells characteristic of the body.

As soon as foreign protein molecules are detected, the immune system activates special immune cells – T-lymphocytes, which should destroy the enemy.

But for some people, the recognition system “friend or foe” can break down. As a result, the immune system begins to attack healthy cells of individual organs or tissues, provokes inflammation in their locations and in every possible way harms your body, which, in fact, should protect.

This is what happens with psoriasis: the immune system attacks the skin. It activates T-lymphocytes and “sets” them on skin cells. Once they reach their target, T-lymphocytes release substances that cause inflammation, called cytokines. They provoke the first symptoms: redness, swelling, itching and pain.

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In psoriasis, skin cells divide several times faster, resulting in scaling and peeling

Under the influence of cytokines, an inflammatory process develops, and skin cells begin to actively divide – this is how active peeling occurs and a convex plaque is formed.

Since the process of cell renewal is accelerated by almost ten times, the main cells of the epidermis (keratinocytes) do not have time to form properly. And therefore, they cannot perform their barrier function.

As a result, the stratum corneum becomes permeable and ceases to protect the deeper layers of the skin from the environment and moisture loss. All this leads to more inflammation.

Until the immune system calms down, the disease will progress and the symptoms will increase.

Causes of psoriasis

The exact reasons why psoriasis develops are not yet fully understood. However, many studies agree that the development of psoriasis is associated with genetics, as well as lifestyle, comorbidities, and adverse environmental factors.

Genetics

The disease is often inherited from parents to children. Psoriasis is mainly associated with the gene of the HLA-C system. It codes for a protein that allows the immune system to recognize its own (harmless) cells.

In patients with psoriasis in the HLA-C gene, doctors more often than in other people find a special genetic marker – HLA-Cw6. However, its presence speaks only of a predisposition to illness. Not all people with the HLA-Cw6 marker necessarily have psoriasis, and not all patients diagnosed with the disease have a similar genetic change.

Lifestyle

It is believed that permanent damage to the skin, frequent friction, sunburn and hypothermia can be triggers for the development of the disease. Especially if there is a hereditary predisposition in the form of the HLA-Cw6 genetic marker or close relatives suffering from psoriasis.

Another risk factor includes constant stress, alcohol abuse and smoking – all this adversely affects the metabolism, the functioning of internal organs and the immune system.

Comorbidities

Some types of psoriasis, such as guttate psoriasis, may develop after a streptococcal infection.

Also, the risk of developing pathology is increased in people with autoimmune diseases. These include, for example, type 1 diabetes, Crohn’s disease, systemic lupus erythematosus, and rheumatoid arthritis.

In such diseases, the general mechanism of the immune system is disturbed: it perceives some of its own cells as something foreign, reacts with inflammation and destroys them. Accordingly, the risk that she will mistakenly add other cells to the “black list” increases.

Complications of psoriasis

Psoriasis is based on a malfunction of the immune system and chronic systemic inflammation. It develops due to the constant aggression of immune cells towards healthy tissues.

Autoimmune processes differ in that they can spread: the immune system is able to include other healthy cells in the list of “enemies” at any time.

For example, against the background of psoriasis, Crohn’s disease or ulcerative colitis can develop – in case the immune system mistakenly attacks the tissues of the gastrointestinal tract as well.

In addition to autoimmune diseases, people with psoriasis are prone to various endocrine pathologies (metabolic syndrome, obesity, type 2 diabetes mellitus), cardiovascular diseases (hypertension, heart attack) and other dysfunctions of internal organs. All this is associated with a chronic inflammatory process that affects the hormonal background and interferes with normal metabolism.

A separate complication is psoriatic arthritis. It occurs in about 30% of people with psoriasis.

In psoriatic arthritis, the immune system attacks the connective tissue, most often the joints of the lower extremities are affected. Inflammation of the articular structures develops, the skin in the affected area may turn red, edema appears, as well as pain and / or stiffness when trying to bend or straighten the joint.

In 10% of people with psoriasis, the pathology spreads to the eyes and develops uveitis. The choroid of the eye becomes inflamed, which leads to decreased vision and discomfort.

In addition to physiological complications, psoriasis can affect a person’s mental health. A change in appearance, poor skin condition and unbearable itching can cause self-doubt and lead to a depressive disorder.

Psoriasis diagnostics

A dermatologist deals with the diagnosis of skin diseases, including psoriasis.

At the appointment, the doctor will ask about the symptoms and how long ago they appeared. Then he will ask his closest relatives about skin diseases: parents, brothers and sisters. A family history allows the specialist to immediately assume diseases that can be inherited – psoriasis is one of them.

The doctor will also ask about situations that provoke the appearance of new rashes and exacerbation of symptoms. For example, new psoriatic lesions may occur after taking a hot bath or prolonged exposure to the sun. In some patients, plaques appear at injection sites, scratches, after rubbing the skin against clothing – this is how the Koebner phenomenon characteristic of psoriasis manifests itself.

An important point in establishing the diagnosis is the examination of the rashes. In case of insufficient completeness of the picture of the disease, a specialist can observe rashes in dynamics, prescribe a histological examination of the skin (biopsy).

If the doctor is not sure that plaques on the skin are psoriasis, a biopsy and a histological examination of the skin are ordered.

Histological examination of skin and subcutaneous neoplasms

The examination allows to detect malignant changes in the tissues of skin neoplasms (moles, papillomas, warts, age spots). For analysis, material obtained by biopsy or during surgery is used.

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In some cases, a specialist may test for the psoriatic triad, the main diagnostic features of psoriasis.

First, the dermatologist will take a slide or scalpel and gently scrape the surface of the plaque. A slight exfoliation of whitish scales from its surface, or the phenomenon of a stearin stain, is the first sign of a triad.

After all scabs have been exfoliated, the surface of the plaque is smooth, shiny and slightly moist. This is the second sign of the triad – the terminal film.

If the doctor continues to scrape the spot, pinpoint bleeding will appear on its surface, which is called Auspitz syndrome, or bloody dew, the third sign of the psoriatic triad.

After the examination and history taking, the doctor will prescribe laboratory tests. It is generally recommended to take a clinical blood test – it reflects the general state of health. The patient is also referred for blood biochemistry. It allows you to evaluate the work of internal organs and metabolism – with a long course, psoriasis can provoke pathologies of the cardiovascular and endocrine systems.

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A urinalysis is also often ordered. Urinary disorders may prevent certain medications from being prescribed.

Urinalysis

General analysis of urine includes physical and chemical examination of urine (color, density, composition) and microscopic examination of its sediment. A general urine test is prescribed to check the state of the body, to identify pathologies of the urinary system, gastrointestinal tract, endocrine, infectious and inflammatory diseases.

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For the same reason, according to clinical guidelines, tests for HIV and hepatitis are prescribed. Against the background of these infections, the disease can be more severe.

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Also, in preparation for treatment, women should do a pregnancy test – for example, take a blood test for beta-hCG. The fact is that many systemic drugs that are most often prescribed for the treatment of psoriasis and give a good effect are contraindicated during pregnancy.

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If there is a complaint of joint pain, the doctor will also refer the patient for an MRI, CT or X-ray to confirm or rule out psoriatic arthritis. If joint inflammation is confirmed, the dermatologist will recommend an examination by a rheumatologist.

Treatment of psoriasis

If the area of ​​skin involvement is small, patients are given topical corticosteroid creams or ointments. They suppress inflammation and reduce the manifestations of the disease.

In addition, the doctor may prescribe topical analogues of vitamin A or vitamin D. These drugs relieve inflammation, accelerate the exfoliation of the stratum corneum of the skin and slow the growth of psoriatic plaques. It is also recommended to use moisturizers for the skin from the lines of pharmacy dermatocosmetics.

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Mild psoriasis is often treated with topical ointments and creams

In moderate to severe psoriasis, systemic treatment may be required – in the form of classical immunosuppressive and genetically engineered biological drugs in the form of tablets or subcutaneous injections. They have a pronounced effect, but require a thorough examination before prescribing.

Systemic glucocorticosteroids for psoriasis are contraindicated and can only be prescribed by a doctor in certain (extremely severe) situations and in a hospital setting. Otherwise, such treatment can lead to a pronounced deterioration in the condition.

Also, psoriasis is treated with the help of phototherapy: ultraviolet light of a certain spectrum is directed to the plaques. For such treatment, many physiotherapy rooms have special lamps.

The most modern and effective way to treat psoriasis is monoclonal antibodies (genetically engineered biological therapy). These drugs can block some steps in the inflammatory response, such as certain cytokines CytokinesProteins that are produced primarily by immune system defense cells that cause inflammation and plaque growth in psoriasis.

Prevention of psoriasis

There is no specific prophylaxis that could prevent the development of psoriasis.