Disseminated psoriasis: stages and how to treat it

Psoriasis is a chronic disease that affects the skin, joints and sometimes internal organs. Common psoriasis is a generalized form of the disease that is more severe and lasts longer.

So, when speaking about widespread psoriasis, they mean skin lesions that cover more than 10% of the body surface.

Epidemiology

There are no exact statistics on the incidence of widespread psoriasis. However, it is estimated that the overall prevalence of the disease on the planet is about 3% (of which 1% are Americans).

40% of the world's population has a genetic predisposition to developing psoriasis.

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Causes of widespread psoriasis

Why does widespread psoriasis occur? The reasons for its occurrence are no different from the general causes of psoriasis. The disease is considered multifactorial - that is, one whose development can depend on many factors.

The etiology of widespread psoriasis is not fully understood: a large role is attributed to the influence of heredity, as well as some external factors.

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Risk factors

The most common risk factors are:

• various infections (especially streptococcal and viral);
• frequent or chronic stressful situations;
• treatment with certain groups of drugs (beta-blockers, lithium- or arsenic-based medications, antimalarial drugs, combination oral contraceptives);
• excessive and chronic alcohol consumption;
• excessive and regular smoking;
• autoimmune processes;
• external skin damage.

Hereditary predisposition is expressed in a disorder of intracellular metabolism, which, in turn, provokes increased proliferation of epidermal cells, a failure of differentiation and an increasing disruption of immunity in the skin layers.

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Pathogenesis

Under the influence of any risk factor, a violation of the balance occurs along the entire chain of intracellular and humoral immune protection. Such a violation entails an incorrect reaction of immune complexes, which provoke tissue damage with a simultaneous increase in the synthesis of biologically active components: this is how autoimmune disorders are formed.

In addition to immune disorders, other, non-immune mechanisms are also assumed to be involved. However, it should not be forgotten that all pathogenetic theories of the development of widespread psoriasis are hypothetical: none of them provide an explanation for all cases of the disease.

A peculiar, latent form of psoriasis can be transmitted by inheritance. That is, a person is genetically predisposed to the disorder of intracellular metabolic processes - including the disruption of the exchange processes of nucleic acids in the epidermal layer of the skin. In the presence of favorable factors (risk factors), the disease begins to manifest itself: cell division accelerates with insufficient maturity.

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Symptoms of widespread psoriasis

Generalized psoriasis most often begins with limited, or localized, psoriasis. The first signs appear first: a flattened, inflamed papule, which is characterized by the following symptoms:

• pinkish color (from pale to reddish);
• a flattened surface on which small, light-silver scales can be found;
• There is a bright, scale-free border around the perimeter of fresh papules.

The first papules are found in the elbow and knee area, near the sacral spine, or on the scalp (the so-called "crown"). Gradually, the rash becomes continuous and widespread, with large areas of skin involved in the process.

A papule in psoriasis looks like an inflamed nodule, slightly convex relative to the healthy surface of the skin. Its borders are clearly defined, the surface is pinkish (from pale pink to bright red). On top, the inflamed element is covered with loose light silver scales, which, when slightly scraped off, reveal three main typical signs:

• with light superficial scraping, peeling intensifies;
• with more intensive scraping, a glossy, varnished surface is revealed;
• When scraping deeply, a pinpoint drop of blood is found.

All of the listed symptoms are called characteristic phenomena: they essentially reflect all stages of development of widespread psoriasis.

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Stages

The course of widespread psoriasis is determined by the stages of the disease. This is the stage of progress, regression, and also the intermediate - stationary - stage. Depending on the periodicity of the pathology, the doctor selects the appropriate treatment tactics.

• The progressive stage is characterized by an increase in the number and size of psoriatic rashes. During this stage, peeling becomes stronger, scales spread over the entire surface of the affected area. Only the so-called "growth crown" remains open and free of scales - a narrow crown, distinguished by a sharp red tint.
• The stationary stage is accompanied by further development of widespread psoriasis: the nodules increase in size, merge into large spots. At the same time, the crown collapses, becomes flat, and peeling gradually disappears. Further spread of the rash stops.
• The regression stage is the reverse development of widespread psoriasis, when the spots become paler and gradually disappear almost without a trace. Sometimes pigment spots (for example, brownish or light, different from the usual color of healthy skin) form in place of such spots.

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Forms

Taking into account the stage of the inflammatory reaction, the degree of prevalence of the disease, and the severity of the pathology, several types of psoriasis are distinguished.

• Widespread exudative psoriasis is manifested by inflammation of the skin, with the formation of scales and crusts, often in several layers. When trying to remove the crusts, a wet surface is exposed.
• Articular widespread psoriasis, in addition to skin reactions, is characterized by joint damage. The disease is accompanied by pain and swelling of the joints, decreased mobility.
• Common vulgar psoriasis develops as a result of the slow progression of the usual psoriatic process, when the rashes merge with the involvement of large areas of the skin. This type of psoriasis is accompanied by redness and swelling of the skin, peeling, severe itching, general weakness, enlarged lymph nodes, etc.
• Widespread plaque psoriasis is accompanied by fever, leukocytosis, increased ESR, general weakness. Small superficial plaques suddenly appear in places of skin redness. At the same time, the patient begins to feel burning and pain. The plaques merge with the detachment of the affected epidermis. This type of psoriasis occurs with pronounced periods of exacerbation, in the form of attacks.
• The papulo-plaque form is considered one of the most severe forms of the disease, which can occur both limitedly and in the form of widespread psoriasis. Exacerbation begins suddenly, with a sharp increase in temperature and deterioration of the patient's general condition. The provoking factor is usually stress, infectious pathologies, as well as improper use of drugs for general or local treatment. Papules and plaques are extremely painful, can occur not only in previously affected areas, but also on clean and healthy skin.

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Complications and consequences

In most cases, complications are understood to mean the development of more severe forms of widespread psoriasis. Since widespread psoriasis itself is a complication of a common limited lesion, in the absence of adequate treatment it can develop into more severe forms:

• psoriasis of the joints;
• mutilating arthritis;
• damage to internal organs.

Psoriasis of the joints may be accompanied by inflammatory phenomena in the joints of the extremities, spine, ankle, wrists, fingers. The lesion is usually asymmetrical, which is a distinctive feature in differentiation from rheumatoid arthritis.

Mutilating arthritis is a complication of joint psoriasis. This pathology occurs with the destruction (melting) of bone tissue, as a result of which the joints become curved and immobile.

Damage to internal organs often accompanies the widespread form of psoriasis. In particular, the cardiovascular system, endocrine system, and nervous system are involved in the process. Patients have an increased risk of developing myocardial ischemia, cerebrovascular accident, hypertension, diabetes, etc.

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Diagnostics of widespread psoriasis

Common psoriasis has a fairly typical clinical picture, so there are usually no difficulties in making the correct diagnosis.

Tests for diagnostics of widespread psoriasis are rarely prescribed, since the vivid clinical picture almost always unmistakably indicates psoriasis. In some cases, a general and biochemical blood test is prescribed. Serodiagnostics and other additional tests are not used.

Instrumental diagnostics can be represented by a skin biopsy, which makes it possible to detect:

• coarsening of the stratum corneum, a large number of immature keratocytes;
• increased proliferation of keratocytes;
• massive filling of the affected layers of the skin with T-lymphocytes and macrophages;
• rapid formation of new capillaries in the affected skin.

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Differential diagnosis

Differential diagnostics are carried out:

• with syphilitic papular rashes;
• with widespread neurodermatitis;
• with systemic lupus erythematosus;
• with eczema and other common dermatoses.

Treatment of widespread psoriasis

Widespread psoriasis requires combined systemic therapy, which will involve detoxifying, antihistamine, anti-inflammatory medications, both external and internal.

During the progression of the disease, intravenous administration of hemodez, calcium gluconate, sodium thiosulfate is prescribed, simultaneously with the external application of special creams.

In addition, for widespread psoriasis, the following medications may be relevant:

• Acitretin (Neotigazon) is a synthetic analogue of retinoic acid, which stabilizes the reactions of proliferation and restoration of epidermal cells with a minimum set of side effects. The exact pharmacological data on the drug are still unknown, but its clinical effectiveness has been proven. Acitretin has a pronounced teratogenic effect, so it is contraindicated not only for pregnant women, but also for those planning pregnancy in the next 2-3 years. The daily dose of the drug is 25-50 mg per day. The course of treatment is approximately 4-8 weeks.
• Methotrexate is an antitumor drug that has a pronounced therapeutic effect in severe forms of widespread psoriasis. The drug is taken in an amount of 10-25 mg per week, with a gradual increase in dosage. Methotrexate is strictly contraindicated during pregnancy and its planning. The most common side effects are: anemia, weight loss, nausea, headaches, apathy, deterioration of vision, low blood pressure, cystitis, osteoporosis, allergies.
• Cyclosporine-A is an immunosuppressant that inhibits cellular rejection and hypersensitivity reactions. Cyclosporine-A is taken orally, whole. The dosage of the drug is individual (on average - 3 mg per kg per day in two doses). Side effects during treatment are dose-dependent and transient (they disappear after reducing the dose and discontinuing the drug).
• Diclofenac is a non-steroidal anti-inflammatory drug for pain relief and other signs of inflammatory reaction. The average dosage of the drug is 25-50 mg up to 3 times a day. Diclofenac is not used during pregnancy and lactation. Long-term use of the drug can cause abdominal pain, stomach ulcers, bleeding of the gastric mucosa, aphthous stomatitis, sleep disturbance, swelling, dry skin.

Vitamins

In case of widespread psoriasis, complex vitamin preparations are often prescribed. The purpose of their use is to support the weakened immune system, facilitate skin renewal processes, and prevent infection.

Patients with widespread psoriasis are advised to pay attention to the following combination drugs:

• Undevit is an inexpensive but effective remedy containing a group of B vitamins, vitamin A, ascorbic acid, tocopherol, nicotinic acid. Thanks to the intake of Undevit, metabolic processes are stabilized, the detoxification function of the liver is facilitated, and many unpleasant symptoms of the disease are eliminated.
• Revit is a well-known drug that contains the most needed vitamins in the body: retinol, vitamins B¹ and B², ascorbic acid. Revit strengthens the immune system, normalizes metabolism, and alleviates signs of exacerbation of widespread psoriasis.
• Decamevit is a multivitamin preparation, represented by B vitamins, ascorbic acid, nicotinic and folic acid, retinol, rutoside, methionine. The preparation reduces the intensity of psoriasis relapse, promotes healing of the affected skin.

Prescribing vitamins for widespread psoriasis is always advisable: they are taken in courses, with periodic replacement of drugs.

Physiotherapy treatment

The leading physiotherapeutic procedures for widespread psoriasis are the following:

• PUVA therapy, or chemophototherapy, is a complex procedure using long UV waves in combination with photosensitizing agents. This procedure allows blocking cell proliferation, inhibits impaired keratinization, stabilizes prostaglandin metabolism and cell wall function. The procedures are performed every other day for 1.5 months;
• Selective phototherapy is UV irradiation with medium waves, without the use of photosensitizing drugs.

PUVA therapy is prescribed in the most severe cases of psoriasis, with the largest area of rash distribution. Selective physiotherapy is applicable for less significant pathological manifestations.

Folk remedies

Since widespread psoriasis is a rather complex disease that requires regular and long-term treatment, patients often turn to auxiliary treatment methods - for example, to traditional medicine recipes. It is worth noting that some recipes can really be effective, but against the background of traditional treatment, one should not refuse traditional drug therapy.

• Fresh celandine is divided into parts, and the separated juice is used to treat the affected skin. However, since this method can only be used in the summer, it is recommended to prepare a celandine preparation for future use. To prepare it, take 0.5 liters of vodka, 1 tbsp. of dry celandine, and leave for 7 days in the dark. The resulting product can be used to lubricate the affected skin, which is then lubricated with fish oil.
• Honey, taken orally (1-2 tablespoons in the morning) and added to nourishing ointments that are applied to areas affected by psoriasis, has a good effect on widespread psoriasis.
• To speed up skin regeneration after relapses, use the juice of three-year-old aloe. This juice is applied to the damaged skin several times a day until the skin is visibly cleared.

Folk remedies, like any other, can cause an allergic reaction. Therefore, when using a particular remedy for the first time, you need to carefully monitor the skin reaction. At the slightest manifestation of allergy, stop using the drug.

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Herbal treatment

1. Prepare a mixture of the following dry herbs (1 teaspoon each): oregano, sage, horsetail, lingonberry, calamus rhizome, juniper berries, birch buds. Pour 0.4 liters of boiling water over the mixture, leave for about an hour, filter. Take the medicine daily in the morning and at night, 100 ml.
2. The recipe recommended above can also be prepared from a different set of herbs: 1 teaspoon each of St. John's wort, violet, succession, nettle, and calendula flowers.
3. Prepare an equal mixture of St. John's wort and orchis bulbs, as well as calendula, rose hips, sage and celandine. Separate 75 g of the mixture, pour 0.5 l of boiling water, and leave for about 5 hours. After this, filter the medicine and drink 100 ml after breakfast and dinner.
4. Prepare a mixture of 10 g of oak bark, 20 g of yarrow and walnut partitions, 30 g of celandine, 30 g of calendula, 30 g of willow bark, 50 g of nettle, 40 g of Ivanov flowers. This amount of mixture should be enough for a full course of treatment. Pour 1 teaspoon of the mixture into a glass of boiling water, leave for 5-7 minutes and drink instead of tea. You should drink one and a half liters of this drink per day.

Homeopathy

From the huge list of homeopathic preparations used in dermatology, the following can be used for widespread psoriasis:

• Arsenicum iodatum is prescribed for large-scale psoriasis, accompanied by increased dryness of the skin and itching. Usually, 3, 6, 12 and 30 dilutions are used;
• Arsenicum album is often used to treat widespread psoriasis in children. Other indications for the drug include: itching and burning sensation, cold hypersensitivity, fine scaly peeling, mental instability;
• Sepia is prescribed in dilutions of 3, 6, 12, 30. This drug is relevant for the formation of cracks on plaques, rough skin, and hyperpigmentation;
• Silicea is used to treat patients with overly sensitive and vulnerable skin, as well as with excessive sweating;
• Sulfur in dilutions of 3, 6, 12, 30 is used for sensitive, flabby skin, weak immunity and increased reaction to thermal irritants.

If you strictly adhere to the dosages recommended by your doctor, there will be no side effects from homeopathic treatment.

Surgical treatment

Surgery for widespread psoriasis can only be prescribed in case of joint damage, and even then not always. The decision on surgical intervention is made by the doctor only when there is a risk of complete loss of movement in one or another joint.

Prevention

To prevent the spread of psoriasis throughout the body, it is necessary to follow all doctor's orders, regularly treat relapses and listen to preventive recommendations:

• when choosing clothes, it is better to opt for loose-fitting items made from natural, “breathable” fabrics;
• skin contact with various chemicals, including household chemicals, should be avoided;
• when choosing cosmetics for the face and body, it is necessary to give preference to special products for irritated and sensitive skin;
• It is important to avoid stressful situations in every possible way;
• It is necessary to lead an active lifestyle as much as possible, breathe fresh air, ride a bicycle, etc.;
• you need to eat right and maintain a healthy gut;
• sunbathing with psoriasis should be done carefully and in moderation;
• All infectious diseases in the body should be treated efficiently and in a timely manner.

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Forecast

Psoriasis is considered an incurable chronic disease, but proper treatment helps to transfer the pathology into a stable state of relief (remission) and keep it under control for the maximum possible period of time.

The main condition for the most positive prognosis is timely medical attention and compliance with all doctor's recommendations. Only coordinated and competent actions will stop widespread psoriasis and even promote its regression.

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