Common psoriasis: stages and how to treat

Psoriasis is a chronic disease in which the skin is affected, joints and - sometimes - internal organs. Common psoriasis is the generalized form of the disease, which is more severe and prolonged.

So, speaking of common psoriasis, they mean a skin lesion that captures more than 10% of the body surface.

[1], [2], [3]

Epidemiology

There are no accurate statistics of the incidence of advanced psoriasis. However, it is estimated that the total spread of the disease on the planet is about 3% (of which 1% are Americans).

40% of the world population has a genetic predisposition to the development of psoriasis.

[4], [5], [6], [7], [8], [9], [10], [11], [12]

Causes of the common psoriasis

Why there is a common psoriasis? The causes of its appearance are no different from the general causes of psoriasis. The disease is considered multifactorial - that is, the development of which can depend on many factors.

The etiology of common psoriasis has not been fully elucidated: a large role is assigned to the influence of heredity, as well as some external factors.

[13], [14], [15], [16], [17], [18]

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 (β-blockers, lithium or arsenic-based medicines, antimalarials, oral contraceptives of combined action);
• excessive and chronic use of alcohol;
• excessive and regular smoking;
• autoimmune processes;
• external damage to the skin.

Hereditary predisposition is expressed in the disorder of intracellular metabolism, which, in turn, provokes increased proliferation of epidermocytes, differentiation failure and growing immunity disorders in the skin layers.

[19], [20], [21], [22], [23], [24]

Pathogenesis

Under the influence of any risk factor there is a disruption of the balance throughout the chain of intracellular and humoral immune defense. Such a violation entails an incorrect reaction of immune complexes, which provoke damage to tissues with a simultaneous increase in the synthesis of biologically active components: thus, autoimmune disorders are formed.

In addition to immune disorders, involve other non-immune mechanisms. However, it should not be forgotten that all pathogenetic theories of the development of common psoriasis are conjectural: none of them provides explanations for all cases of the onset of the disease.

A hereditary pathway can transmit a peculiar, latent form of psoriasis. That is, a person is genetically predisposed to a disorder of intracellular metabolic processes, including the disruption of nucleic acid exchange processes in the epidermal layer of the skin. In the presence of favorable factors (risk factors), the disease begins to manifest itself: cell division is accelerated when their maturity is insufficient.

[25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39]

Symptoms of the common psoriasis

Common psoriasis usually begins with a limited, or localized, psoriasis. Initially, the first signs appear: it is a flattened inflamed papule, which is distinguished by the following symptoms:

• pinkish color (from pale to reddish);
• flattened surface on which it is possible to detect light silvery small scales;
• On the perimeter of fresh papules there is a bright, scaly-free border.

The first papules are found in the elbow and knee zone, near the sacral spine, or on the scalp (the so-called "crown"). Gradually, the rashes become continuous and ubiquitous, involving extensive skin patches in the process.

Papula with psoriasis looks like an inflamed nodule, slightly convex with respect to the healthy surface of the skin. Its borders are clearly delineated, the surface is pink (from pale pink to bright red). Above, the inflamed element is covered with loose light silver scales, which, with a slight scraping, reveal three main typical features:

• with slight surface scraping, the scaling is enhanced;
• with a more intense scraping, a glossy, as if varnished, surface is opened;
• with a deep scraping, a spot bloody droplet is found.

All these symptoms are called characteristic phenomena: they, in fact, reflect all stages of development of common psoriasis.

[40], [41], [42]

Stages

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

• The progressing stage is characterized by an increase in the number and size of psoriatic eruptions. During this stage, the peeling becomes stronger, the scales spread throughout the surface of the affected area. Open and free from scales is only the so-called "whisk of growth" narrow corolla, which is marked by a sharp red tint.
• The stationary stage is accompanied by the further development of a common psoriasis: nodules enlarge, merge into large spots. In this case, the corolla subsides, becomes flat, and the peeling gradually descends to "no." Further spread of rashes stops.
• The stage of regression is the reverse development of a common psoriasis, when the spots become paler and gradually disappear almost without traces. Sometimes spot spots are formed pigmented spots (for example, brownish or light, different from the normal color of healthy skin).

[43], [44], [45], [46], [47], [48]

Forms

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

• Common exudative psoriasis is manifested by inflammation of the skin, with the formation of scales and crusts, often in the form of several layers. When trying to remove the crusts exposed wetting - wet surface.
• Joint psoriasis, in addition to skin reactions, is characterized by joint damage. The disease is accompanied by pain and swelling of the joints, a decrease in their mobility.
• The common vulgar psoriasis develops as a result of the slow progression of the ordinary psoriatic process, when the rash merges with the involvement of large areas of skin. This type of psoriasis is accompanied by redness and swelling of the skin, peeling, severe itching, general weakness, swollen lymph nodes, etc.
• The common plaque psoriasis is accompanied by a febrile condition, leukocytosis, increased ESR, general weakness. In places of skin reddening, small surface plaques appear abruptly. Simultaneously, the patient begins to feel burning, pain. Plaques merge with a detachment of the affected epidermis. This kind of psoriasis proceeds with pronounced periods of exacerbation, in the form of attacks.
• Papular-plaque form is considered one of the most serious forms of the disease, which can occur, both limitedly and in the form of widespread psoriasis. The exacerbation begins suddenly, with a sharp rise in temperature and a worsening of the general condition of the patient. The provoking factor is usually stress, infectious pathology, as well as improper use of drugs for general or local treatment. Papules and plaques are sharply painful, they can occur not only in previously affected areas, but also on clean and healthy skin.

[49], [50], [51]

Complications and consequences

In most cases, under the guise of complications, the development of more severe forms of common psoriasis is understood. Since the common psoriasis itself is a complication of the usual limited lesion, in the absence of adequate treatment, it can go into more severe forms:

• psoriasis of the joints;
• mutilating arthritis;
• defeat of internal organs.

Psoriasis of the joints can be accompanied by inflammatory phenomena in the joints of the limbs, vertebral column, ankle, wrists, fingers. The lesion is usually asymmetric, which is a distinctive feature when differentiating with rheumatoid arthritis.

Mutilating arthritis is a complication of psoriasis of the joints. Such pathology proceeds with the destruction (melting) of bone tissue, as a result of which the joints become bent and become immovable.

The defeat of the internal organs often accompanies the common form of psoriasis. In particular, the cardiovascular system, the endocrine system, the nervous system are involved in the process. Patients are at increased risk of developing myocardial ischemia, cerebral circulation, hypertension, diabetes mellitus, etc.

[52], [53], [54], [55]

Diagnostics of the common psoriasis

The prevalent psoriasis has a fairly typical clinical picture, so there is usually no difficulty with the correct diagnosis.

Analyzes for the diagnosis of common psoriasis are rarely prescribed, as a vivid clinical picture almost always accurately indicates exactly the psoriasis. In some cases, a general and biochemical blood test is prescribed. Serodiagnosis and other additional tests are not used.

Instrumental diagnosis can be represented by a biopsy of the skin, in which it is possible to detect:

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

[56], [57], [58], [59], [60]

Differential diagnosis

Differential diagnosis is carried out:

• with syphilitic papular eruptions;
• with a common neurodermitis;
• with systemic lupus erythematosus;
• with eczema and other common dermatoses.

Treatment of the common psoriasis

A common psoriasis requires combined systemic therapy, which will involve detoxification, antihistamines, anti-inflammatory drugs, both external and internal.

During the progress of the disease, a drip of haemodesis, calcium gluconate, sodium thiosulphate is prescribed, along with external application of special creams.

In addition, with the prevalent psoriasis, the following medicines may be relevant:

• Acitretin (Neotigazone) is a synthetic analogue of retinoic acid, which stabilizes the reactions of proliferation and recovery of epidermal cells with a minimal set of side effects. Accurate pharmacological data on the drug is still unknown, but its clinical effectiveness is proven. Acitretin has a pronounced teratogenic effect, therefore it is contraindicated not only by pregnant women, but also by those who plan pregnancy in the next 2-3 years. The daily amount of the drug is 25-50 mg per day. The course of treatment is approximately 4-8 weeks.
• Methotrexate is an antitumor drug that exerts a pronounced therapeutic effect in severe forms of advanced psoriasis. The drug is taken in an amount of 10-25 mg per week, with a gradual increase in dosage. Methotrexate is categorically contraindicated during pregnancy and its planning. Of the most common side effects: anemia, emaciation, nausea, headaches, apathy, blurred vision, low blood pressure, cystitis, osteoporosis, allergies.
• Ciclosporin-A is an immunosuppressive agent that inhibits cellular rejection and hypersensitivity reactions. Cyclosporin-A is taken orally, whole. Dosage of the drug is individual (on average - 3 mg per kg per day in two divided doses). Side effects during treatment are dose-dependent and transitory (pass after dose reduction and drug withdrawal).
• Diclofenac is a non-steroidal anti-inflammatory agent for eliminating pain and other signs of an 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. Prolonged use of the drug can cause abdominal pain, stomach ulcers, bleeding of the stomach mucosa, aphthous stomatitis, sleep disorders, swelling, dry skin.

Vitamins

When common psoriasis is often prescribed complex vitamin preparations. The purpose of their application is to support the shaken immunity, facilitate the processes of skin renewal, prevent infection.

Patients with advanced psoriasis are advised to pay attention to the following complex preparations:

• Undevit is an inexpensive but effective remedy containing a group of B vitamins, vitamin A, ascorbic acid, tocopherol, nicotinic acid. Thanks to the reception of Undevit, metabolic processes are stabilized, the detoxification function of the liver is facilitated, many unpleasant symptoms of the disease are eliminated.
• Revit is a well-known drug, which includes vitamins most demanded by the body: retinol, vitamins B¹ and B², ascorbic acid. Revit strengthens immunity, normalizes metabolism, facilitates signs of exacerbation of advanced psoriasis.
• Decamevit is a multivitamin preparation, represented by group B vitamins, ascorbic acid, nicotinic acid and folic acid, retinol, rutozide, methionine. The drug reduces the intensity of recurrence of psoriasis, promotes the healing of the affected skin.

The appointment of vitamins with common psoriasis is always advisable: they are taken in courses, with periodic replacement of drugs.

Physiotherapeutic treatment

The leading physiotherapy procedures for advanced psoriasis are the following:

• PUVA-therapy, or chemophototherapy - is a complex procedure using long UV-waves in combination with photosensitizing agents. This procedure allows to block the proliferation of cells, inhibits the disturbed keratinization, stabilizes the exchange of prostaglandins and the function of cell walls. The procedures are performed every other day, for 1.5 months;
• selective phototherapy is UFO medium waves, without the use of photosensitizing drugs.

PUVA-therapy is prescribed in the most severe cases of psoriasis, with the largest spread of rashes. Selective physiotherapy is applicable for less significant pathological manifestations.

Alternative treatment

Since common psoriasis is quite a complicated disease that requires regular and long-term treatment, patients often turn to auxiliary medical methods - for example, to the prescriptions of alternative medicine. It is worth noting that some recipes can indeed be effective, but against the background of alternative treatment should not abandon the traditional drug therapy.

• Fresh celandine is divided into parts, and the separated juice is treated with the affected skin. However, since this method can only be used in the summer, it is recommended to prepare the drug from celandine for future use. For its preparation take 0.5 liters of vodka, 1 tbsp. L. Dry celandine, insist 7 days in the dark. The resulting product can lubricate the affected skin, which at the end of the procedure is smeared with fish oil.
• A good effect in the spread of psoriasis is honey, which is taken by mouth (1-2 tbsp in the morning) and added to the nutrient ointments that are applied to the affected psoriasis.
• To accelerate the regeneration of the skin after a relapse, juice of three-year-old aloe is used. Such juice lubricate the damaged skin several times a day, until visible cleansing of the skin.

Alternative agents, like any other, can cause an allergic reaction. Therefore, the first time you apply this or that remedy, you need to closely monitor the reaction of the skin. At the slightest manifestation of allergy, the drug is stopped.

[61], [62], [63], [64]

Herbal Treatment

1. Prepare a mixture of the following dry herbs (1 tsp): oregano, sage, horsetail, cowberry, rhizome of ayr, juniper fruit, birch buds. The mixture is poured into 0.4 liters of boiling water, insisted for about an hour, filtered. Take the drug every morning and night, 100 ml.
2. The recipe recommended above can also be prepared from another set of herbs: 1 tsp. St. John's wort, violets, turns, nettles, calendula flowers.
3. Prepare an equal mixture of the herb of St. John's wort and onions of the orchis, as well as marigolds, wild rose berries, sage herbs and string. Separate 75 g of the mixture, pour 0.5 liters of boiling water, insist about 5 hours. After that, the medicine is filtered and drunk to 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 ivan color. This amount of the mixture should be enough for a full treatment course. Pour 1 tsp. Mixture of a glass of boiling water, insist 5-7 minutes and drink instead of tea. For a day you should drink one and a half liters of this drink.

Homeopathy

From the huge list of homeopathic medicines that are used in dermatology, with the common psoriasis, you can apply the following:

• Arsenicum iodate is prescribed for large-scaly form of psoriasis, accompanied by increased dryness of the skin, itching. Usually use 3, 6, 12 and 30 dilution;
• Arsenicum albumus is often used to treat common psoriasis in children. Other indications for prescribing the drug are: sensation of itching and burning, cold hypersensitivity, fine-scaly peeling, mental imbalance;
• Sepia is prescribed in the dilutions 3, 6, 12, 30. This drug is relevant for the formation of cracks on plaques, with coarsening of the skin, with hyperpigmentation;
• Silicea is used to treat patients with excessively sensitive and vulnerable skin, as well as with increased sweating;
• Sulfur in dilution 3, 6, 12, 30 is used for sensitive, flabby skin, with weak immunity and increased reaction to thermal stimuli.

If you strictly adhere to the recommended dosage, then there will be no side effects from homeopathic treatment.

Operative treatment

The operation with common psoriasis can be prescribed only in the event of joint damage, and even then not always. The decision about surgery is taken by the doctor only when there is a danger of complete loss of movement in this or that joint.

Prevention

To prevent the spread of psoriasis throughout the body, it is necessary to comply with all the physician's prescriptions, regularly treat relapses and listen to preventive recommendations:

• when choosing clothes, it is better to stop on products of a free cut, from natural "breathing" fabrics;
• avoid contact with various chemicals, including household chemicals;
• when choosing cosmetics for the face and body, it is necessary to give preference to special means for irritated and sensitive skin;
• It is important to avoid stress situations in every possible way;
• it is necessary to lead, if possible, an active lifestyle, breathe fresh air, ride a bicycle, etc .;
• you need to eat right, and maintain a healthy bowel condition;
• sunbathing with psoriasis should be carefully and dosed;
• All infectious diseases in the body should be treated qualitatively and in a timely manner.

[65], [66], [67], [68], [69], [70]

Forecast

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

The main condition for a maximally positive prognosis is a timely request for medical care and compliance with all the recommendations of the doctor. Only concerted and competent actions will stop the spread of psoriasis and even contribute to its regression.

[71], [72]