The first signs of relapse are the appearance on the different parts of the body with a drier skin (for example, the limbs, the head, in the lower back) papules of a reddish color of 1.5-2 mm. They are clearly limited, covered with loose large-scale scales, prone to growth with the formation of scaly pale gray psoriatic plaques. Their size varies from small (up to 1 cm) to significant surfaces - with the palm and more.
Dermatosis usually accompanies itching. The rashes begin to peel off, the scales on the surface easily peel off and under them remain denser, placed deeper (this explains the other name of the disease - scaly lichen).
Overproduction of keratinocytes and the formation of skin infiltrates in psoriatic plaques cause in these places a thicker raised layer of skin. When scraping scales, the plaques may bleed slightly. On damaged skin can appear cracks and suppuration, constantly felt its tightness.
Scraping the papule, you can observe a triad of specific signs:
- much flaky silvery-gray stain, like a mulched drop of stearin;
- after removing the scales on it, a terminal film is shown, moist and shiny;
- droplets of blood, excreted on the exposed spine-like layer (bloody dew).
The disease is characterized by a wavy current - the latent period alternates with the manifest one, it can be divided into three stages:
- progressing when new bright red papules are stably born, growing into a clear itchy erythema surrounding the primary education;
- stationary, when new primary papules cease to form, the growth of old foci stops, around them appears a dry rim up to five millimeters in width and the papules become covered with scales;
- regressive, when the symptoms begin to disappear in the direction from the center of the foci to their periphery.
Psoriasis has a variety of clinical varieties and flow variants. The most common form is common or vulgar psoriasis, which in turn is divided into subspecies, the main ones are plaque (described above) and drop-shaped.
The usual location of plaques - on the elbows, knees, scalp, less often on the body. The person, usually, remains clean, although sometimes the lesion comes to the forehead. Slight damage to the smooth skin is not itchy, but the scalp is characterized by severe itching. On the head, the foci can be isolated or merge into one continuous surface with cracks and exudation.
In children and adolescents, as a complication of streptococcal angina, teardrop-shaped psoriasis may develop. One to two weeks after the beginning of the angina, small spots appear on the entire body, especially the trunk and limbs. The size of the spots, as a rule, is less than a centimeter in diameter, itches not much. This subspecies of vulgar psoriasis is less common than plaque, it is easily treated with local medications, sometimes in combination with physical procedures by ultraviolet, sometimes it can go by itself, but there is also a transition to a chronic form.
In addition to the usual, they also classify such species as atypical psoriasis (seborrheic, oyster-like, warty, intertriginous, palms and soles, mucous and nails) and complicated (exudative, erythrodermic, arthropathic, pustular).
Seborrheic - localized on the corresponding parts of the body (the scalp part of the head and behind the ears, in the zone of the nose, lips, chest and between the shoulder blades). The outlines of the spots are not distinct, the scales are not stearic, but yellowish. Under the hair on his head, there is a lot of dandruff, which disguises psoriatic spots with a transition to the forehead in the form of a psoriatic crown.
Oyster-like (rupioid) - rounded plaques with many layered large scaly crusts, which makes them look like an oyster.
Warty - the usual places of localization: ankles, wrists, lower third of the shin and lifting of the foot. Papules are rounded, with prolonged exacerbation and mechanical action, the skin in these places is hypertrophied. Probably malignancy.
Intertriginous - located in the area of large body folds (anogenital, axillary, under the breast, between the fingers), psoriatic plaques also have an atypical appearance (there is almost no peeling, the surface of the focus is smooth, bright red, often damp). It is accompanied by soreness. Diagnosis and treatment cause certain difficulties.
Psoriasis of the nails (psoriatic onychodystrophy) - destructive colors - on yellowish, whitish, gray, the surface becomes spotted, striated, coarsening under the fingernail and around it. The process can be delayed to the state of hyper-brittle nails and their absolute absence (onycholysis). Most often the nails are affected with psoriatic arthropathy.
Pustulous or exudative psoriasis is a complicated form of the disease. Psoriatic plaques covered with painful bladder, filled with sterile inflammatory exudate - pustules. The surrounding skin is edematous, inflamed, exfoliating.
Clinical manifestations of this species are palmar-plantar localized psoriasis of Barber and generalized psumbiasis of Zumbush with dissemination of pustules on the skin of all parts of the body and orientation toward unification into more significant elements.
This is a very severe form of psoriasis, a real threat to life. The onset of exacerbation is sudden and rapid - bright red erythema spans almost the whole body, small pustules begin to appear on it, their number increases, they unite the so-called "purulent lakes". This process has a wavy character - while the pustules dry out earlier, the following are formed. The process is accompanied by fever, increasing weakness and leukocytosis. This condition requires immediate hospitalization.
Erythrodermic - characterized by the spread of dermatosis on large surfaces of the body, sometimes generalized, severe itching, swelling of the skin and subcutaneous tissue, painful sensations. This species is often a relapse of ordinary psoriasis with unstable course, usually developing with the interruption of systemic therapy or treatment with topical preparations containing glucocorticosteroids.
Erythrodermal psoriasis can lead to death of the patient, because the thermoregulatory and protective function of the skin is diluted, which contributes to complications - septicemia or disseminated pyoderma.
Localized pustular and erythrodermic psoriasis can be the debut of the disease and change over time into a normal plaque.
For psoriatic arthropathy (arthropathic psoriasis), inflammation of the small joints of the extremities is typical. However, there are arthropathies of any localization (hip, knee, spine). This type of disease is a combination of dermatosis with arthritis, the consequences of which can become a patient's disability or death.
As a rule, during the debut of the disease, small parts of the skin are affected, they eventually increase, and the progression of scaly lichen can begin. An easy degree of disease is the spread of lesions, occupying up to 3% of the body area, the average - from 3 to 10%, heavy - more than 10%.
Often the question arises: can the temperature rise when exacerbation of psoriasis? For vulgar psoriasis, an increase in temperature is not typical, however, with severe forms of the disease - psoriatic erythroderma, generalized pustular psoriasis and psoriatic arthritis, exacerbation is accompanied by a high temperature (≈39 °).
Exacerbation of psoriasis in pregnancy
According to observations, in pregnant women suffering from psoriasis, in about two-thirds of cases the condition improves (although after the birth the disease is manifested as before), but the probability of relapse during this period can not be ruled out. Changing the hormonal background of a woman can start the process of developing the disease. Exacerbation of psoriasis in the first trimester allows to predict the further situation and the outcome of pregnancy.
The symptomatology of recurrences of the disease in pregnant women depends on the type and severity of the disease.
The most severe relapses are infrequent, however, they should be known. For example, psoriatic arthropathy for a future mother can result in increased joint pain, which is explained by increased load on the joints due to the rapid addition of body weight.
A severe form of exacerbation can sometimes be expressed in the form of generalized pustular psoriasis, caused by hormonal and metabolic changes in the woman's body. Plaques, which usually appear on the abdomen and in the groin, are covered with pustules. The process is accompanied by severe itching, dyspeptic disorders, fever and even mental disorders. The main cause of exacerbation of psoriasis in pregnant women is an increased production of the hormone cortisol by the adrenal glands. It is urgent to seek medical help. In the event of termination of pregnancy, symptoms usually disappear immediately.
In pregnant women, exacerbation can be expressed by herpetiform psoriatic impetigo (impetigo of pregnant women), which in the vast majority of cases develops precisely in this state. Eruptions look like small pustules, usually located in large folds. They are placed in groups or in the form of a ring, the skin is inflamed, edematous, itching is not observed, the pustules are not infected, subsequently the rash spots are covered with brownish crusts. The process can take a chronic form or worsen by going to the mucous membranes.
Provoke the appearance of impetigo of pregnant women allegedly neuroendocrine disorders. According to most experts - this is a form of generalized pustular psoriasis. With the birth of a child, the mother's condition stabilizes, but, usually, the following pregnancies proceed exactly this way.
The consequences and complications of such exacerbations can eventually lead to fetal death and spontaneous abortion, premature birth, birth of a small child and even maternal death.
Scaly lichen during pregnancy is often accompanied by depression, the occurrence of which modern medicine does not explain.
Exacerbation of the disease in a future mother causes difficulties in the selection of medications, since most drugs for treating psoriasis are teratogenic. In this period it is not recommended to use retinol preparations, cytostatics, antibiotics, hormonal drugs.
Women who are expecting a child are recommended to reduce the manifestations of relapse of a means of natural origin, ultraviolet irradiation, cosmetic products on fat basis. For the prevention of depression, you can use herbal teas, SPA-procedures (after a medical consultation), yoga for pregnant women, psychotherapeutic trainings, walks.
If an exacerbation of psoriasis threatens the life of a woman, the issue of abortion is raised, during the feeding of the child - it is transferred to feeding with adapted mixtures, and mothers are prescribed specific drugs.
Psoriasis is not a contraindication to motherhood. A conscious, competent attitude to the upcoming pregnancy, including preparatory measures for conception (vitamin therapy, sanatorium treatment, massages, restorative procedures, yoga, getting rid of foci of infection in the body) reduces the risk of serious complications.