The exudative form of psoriasis

Of all the forms of psoriasis classified in clinical dermatology, exudative psoriasis raises the most questions in determining the symptoms. However, everyone agrees that this type of disease in the progression stage demonstrates a higher degree of expression of the local inflammatory process, which is manifested by the intensive formation of exudate in the epidermal tissue.

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Causes exudative psoriasis

Since the etiology of psoriasis has not been fully established, the exact causes of exudative psoriasis are also unknown. However, as the disease is studied, a lot of convincing evidence has been obtained of the involvement of a certain inadequacy of the cellular immune response, gene aberrations, metabolic disorders and endocrine system failures in its development.

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Risk factors

The following risk factors for the development of exudative psoriasis have been noted: a history of type 2 diabetes mellitus (and the associated low tissue sensitivity to insulin); protein metabolism disorders in hypothyroidism and autoimmune thyroiditis; elevated blood lipid levels in obesity; severe arterial hypertension; varicose veins and venous insufficiency in the lower extremities; any forms of allergy. It should be noted that in many sources, these systemic metabolic disorders and diseases are considered concomitant with other forms of psoriasis.

The pathological process can be triggered by severe stress, traumatic damage to the skin or irritating effects of chemicals, as well as prolonged exposure to cold.

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Pathogenesis

The pathogenesis of any form of psoriasis is associated with hypertrophic division of basal keratinocytes of the epidermis, their accelerated differentiation and keratinization (death), as well as disruption of keratin production. This leads to the accumulation of dead keratinocytes in the upper layer of the epidermis (horny) and their increased exfoliation (desquamation). These processes are, in essence, an abnormal reaction of immunocompetent cells (T-lymphocytes, T-helpers, NK cells, neutrophils, macrophages, mast cells) and active production of inflammation mediators by dendrocytes and keratinocytes of the skin.

Exudative psoriasis, unlike conventional plaque psoriasis, is characterized by higher permeability of the walls of skin vessels caused by inflammation, which leads to the accumulation of inflammatory infiltrate in the intercellular matrix of damaged tissues.

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Symptoms exudative psoriasis

The first signs of the initial stage of this form of psoriasis are expressed in the appearance of bright red spots, usually of irregular shape (there are no papules, as in vulgar psoriasis). Swelling of the skin is slight or absent.

As the disease progresses, other symptoms of exudative psoriasis appear: monomorphic rashes increase in size and take the form of squamous-inflammatory plaque-like lesions with blurred contours. The characteristic sign of a stearin spot for vulgar psoriasis is also absent, since the surfaces of the inflammatory lesions are covered with serous crusts - yellowish, gray-yellow and yellowish-brown.

These crusts are nothing more than keratin scales soaked and held together by exudate. At first they are soft, then they become denser and continue to thicken, layering on top of each other as they dry (which indicates increased proliferation of keratinocytes). When the crusts are removed, an intensely pink, oozing surface is revealed.

The release of histamine from damaged mast cells in the skin causes intense itching (resulting in scratching, sleep disturbances and neuroses), and cracking of the crusts covering them can be accompanied by bleeding and pain. Individual lesions can merge to form large surfaces, the area of which can be quite significant.

The localization of rashes in the exudative form of psoriasis varies, including in the area of skin folds, in the folds of the limbs; the skin on the legs is very often affected.

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Complications and consequences

The consequences and complications of a long-term progressive stage of exudative psoriasis may take the form of thickening of the skin - lichenification. And the result of damage to the skin or its irritation at the site of the rash may be the addition of an infection and the development of an extensive inflammatory process with suppuration and necrosis of areas of the epidermis and subcutaneous tissue.

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Diagnostics exudative psoriasis

Diagnosis of this form of psoriasis is based on examination of the skin, assessment of the intensity of symptoms, determination of the stage of the disease and the area of the lesion.

Instrumental diagnostics is carried out using a dermatoscope, which allows visual enlargement of the rash.

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Differential diagnosis

Taking a sample from the surface of the inflammation site and its histological examination may be required for differential diagnostics – to distinguish the exudative form of psoriasis from skin diseases such as pink or red lichen planus, atopic dermatitis, keratosis, dermatomycosis, etc.

Treatment exudative psoriasis

In order for the treatment of exudative psoriasis to give the necessary effect, that is, to remove symptoms and prolong remission, dermatologists select therapeutic methods and drugs for each patient, taking into account the characteristics of his body, the severity and stage of the disease.

Extensive skin lesions in exudative psoriasis can be treated with immunosuppressive drugs (Infliximab, Remicade), Immunofan or antimetabolites (Methotrexate). Infliximab is administered by intravenous infusion, Immunofan - subcutaneously or intramuscularly (once every two days, a total of 10 injections).

Methotrexate (2.5 mg tablets) is taken one tablet two or three times a day or intramuscularly once a week; the course of treatment and the regimen of use are prescribed only by a doctor. Possible side effects of Methotrexate include nausea, diarrhea, ulceration of the mucous membrane in the mouth, decreased levels of hemoglobin and platelets in the blood.

A positive effect in psoriasis is achieved by removing harmful substances (detoxification) with the help of Hemodez (an IV drip is administered two to three times a week).

For itching, which plagues patients with exudative psoriasis, you cannot do without antihistamines (Suprastin or Tavegil). Read more about how to relieve skin itching in psoriasis

For psoriasis, dermatologists recommend taking vitamins such as A, C, E, PP, group B, lecithin, as well as microelements - zinc and selenium.

The main medications for external use are ointments and creams: with salicylic acid, sulfur or tar; zinc ointment; ointments with corticosteroids - Oxycort, Diprosalik, Celestoderm-B (Akriderm), Clobetasol, Lorinden, Flucinar, Elokom, etc.; with vitamin D - Psorkutan (Daivonex); with bitumen - Dithranol (Anthralin, Tsignoderm). How these products work, what contraindications and side effects they have, and how to use them - in detail in the articles - Creams for psoriasis and Non-hormonal ointments for psoriasis

To reduce inflammation and itching of the skin, homeopathy offers a remedy for external use called Psoriaten, which contains an extract of the bark of Mahonia acutifolia.

Physiotherapeutic treatment of exudative psoriasis includes photo- and PUVA-therapy, balneology and pelotherapy. Read more about these treatment methods - Treatment of psoriasis

Folk remedies can also bring relief, more useful information is contained in the publication - Treatment of psoriasis at home

And how to carry out treatment with herbs, read more in the article - Medicinal herbs for psoriasis

Prevention

Today, it is not possible to prevent the development of any type of psoriasis. But to prevent exudative psoriasis from worsening, experts recommend protecting the skin from injury, not smoking or drinking alcohol, avoiding synthetic underwear, not overusing ultraviolet radiation, not overworking, and not succumbing to stress.

It is useful to eliminate possible food triggers of the disease, for which the Diet for Psoriasis has been developed

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Forecast

In case of psoriasis, the prognosis is disappointing, since this disease cannot be cured yet. But it is possible to improve the condition and extend the period of remission. It is important to control exudative psoriasis so that the quality of life does not decrease.

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