Exudative form of psoriasis

Of all the forms of psoriasis classified in clinical dermatology, exudative psoriasis causes the most problems in the definition of symptoms. However, all agree that this type of disease in the stage of progression demonstrates a higher degree of local inflammation, which is manifested by the intense formation of exudate in the epidermal tissue.

[1], [2], [3], [4], [5], [6]

Causes of the exudative psoriasis

Since the etiology of psoriasis has not been finally determined, the exact causes of exudative psoriasis are also unknown. But, in the process of studying the disease, a lot of convincing evidence of involvement in its development of a certain inadequacy of the reaction of cellular immunity, gene aberrations, metabolic disorders and disruptions in the endocrine system has been obtained.

[7], [8], [9], [10], [11]

Risk factors

Such risk factors for the emergence of exudative psoriasis, such as the presence of a history of type 2 diabetes mellitus (and associated low sensitivity of tissues to insulin) are noted; disorders of protein metabolism in hypothyroidism and autoimmune thyroiditis; increased lipid levels in the blood for obesity; severe arterial hypertension; varicose veins and insufficient venous circulation in the lower limbs; all forms of allergy. It should be noted that in many sources these systemic metabolic and disease disorders are considered as concomitant and other forms of psoriasis.

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

[12], [13]

Pathogenesis

The pathogenesis of any form of psoriasis is associated with hypertrophic division of basal keratinocytes of the epidermis, their accelerated differentiation and keratinization (dying off), as well as a violation of keratin production. This leads to the accumulation of dead keratinocytes in the upper layer of the epidermis (horn) and their enhanced detachment (desquamation). These processes represent, in fact, an abnormal reaction of immunocompetent cells (T-lymphocytes, T-helpers, NK cells, neutrophils, macrophages, mast cells) and active production of mediators of inflammation with dendritic and keratinocytes of the skin.

Exudative psoriasis, in contrast to the usual plaque, is characterized by a higher permeability of the walls of the vessels of the skin due to inflammation, which leads to accumulation in the intercellular matrix of the damaged tissues of the inflammatory infiltrate.

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

Symptoms of the 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 (papules, as with vulgar psoriasis, no). Swelling of the skin is slight or absent.

In the course of the development of the disease, other symptoms of exudative psoriasis appear: monomorphic rashes increase and take the form of squamous-inflammatory plaque-like foci with diffuse contours. Characteristic for vulgar psoriasis, the stearin stain is also absent, as the surfaces of the inflammatory foci are covered with serous crusts - yellowish, gray-yellow and yellowish-brown.

These crusts are nothing but keratin scales, impregnated and fastened with exudate. At first, they are soft, and then thicken and continue to thicken, overlapping each other as it dries (indicating increased proliferation of keratinocytes). When removing crusts, an intensely pink, wetting surface opens.

The release of histamine from damaged mast cells causes severe itching (leading to combs, sleep disturbances and neuroses), and the cracking of the crusts covering them can be accompanied by bleeding and soreness. Individual foci can merge with the formation of large surfaces, the area of which is very significant.

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

[19], [20], [21], [22]

Complications and consequences

The consequences and complications in the long-term progressive stage of exudative psoriasis can have the appearance of thickening of the skin - lichenization. And the result of damage to the skin or its irritation at the site of the rash can be the attachment of infection and the development of an extensive inflammatory process with suppuration and necrosis of the epidermis and subcutaneous tissue.

[23], [24], [25], [26]

Diagnostics of the exudative psoriasis

Diagnosis of this form of psoriasis is carried out on the basis of examining the skin, assessing the intensity of the manifestation of symptoms, determining the stage of the disease and the area of the lesion.

Instrumental diagnosis is carried out using a dermatoscope, which allows you to visually increase the rash.

[27], [28], [29], [30], [31]

Differential diagnosis

Taking samples from the surface of the focus of inflammation and its histological examination may require differential diagnosis - to distinguish the exudative form of psoriasis from such skin diseases as pink or red flat lichen, atopic dermatitis, keratosis, dermatomycosis, etc.

Treatment of the exudative psoriasis

To treat exudative psoriasis gave the desired effect, that is, removed the symptoms and prolonged remission, the methods of therapeutic treatment and drugs are selected by dermatologists for each patient, taking into account the characteristics of his body, severity and stage of the disease.

Extensive lesions of the skin in exudative psoriasis can be treated with immunosuppressive drugs (Infliximab, Remicade), Imunofan or antimetabolites (Methotrexate). Infliximab is administered by intravenous infusion, Imunofan - subcutaneously or into muscle (once every two days, only 10 injections).

Methotrexate (in tablets of 2.5 mg) is taken one tablet two or three times a day or once a week is administered intramuscularly; the course of treatment is prescribed and prescribed by the doctor only. Among the possible side effects of methotrexate are nausea, diarrhea, ulceration of the mucosa in the mouth, a decrease in hemoglobin and platelets in the blood.

A positive effect for psoriasis is the elimination of harmful substances (detoxification) with the help of Hemodesis (two or three times a week, a dropper is placed).

With an itch that worries patients with exudative psoriasis, one can not do without antihistamines (Suprastin or Tavegil). Read more how skin pruritus is removed in psoriasis

In psoriasis, dermatologists recommend taking vitamins such as A, C, E, PP, group B, lecithin, and also trace elements - zinc and selenium.

The main medicines for external use are ointments and creams: with salicylic acid, sulfur or tar; zinc ointment; ointments with corticosteroids - Oxicort, Diprosalic, Celestoderm-B (Acriderm), Clobetasol, Lorinden, Flucinar, Elokom, etc .; with vitamin D - Psorokutan (Daivonex); with bitumen - Dithranol (Antralin, Zignoderm). How these remedies work, what contraindications and side effects have, and how they should be used - in detail in articles - Creams for psoriasis and non-hormonal ointments for psoriasis

To reduce the inflammation and itching of the skin, homeopathy offers such a tool for external use, like Psoriaten, which contains an extract of the crust of the mahogany holly.

Physiotherapeutic treatment of exudative psoriasis includes photo- and PUVA-therapy, balneology and peloid therapy. More information about these treatment methods read - Treatment of psoriasis

It can bring relief and alternative treatment, more information is contained in the publication - Treatment of psoriasis in the home

And how to treat herbs, for more details see the article - Medicinal Herbs from Psoriasis

Prevention

To date, it is not possible to prevent the development of any of the varieties of psoriasis. But that exudative psoriasis is not exacerbated, experts recommend protecting the skin from injuries, not smoking and not drinking alcohol, avoiding synthetic clothing, not using ultraviolet, not overworking and not giving in to stress.

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

[32], [33], [34]

Forecast

In the case of psoriasis, the prognosis is disappointing, since it is not possible to cure this disease. But you can improve the condition and prolong the period of remission. It is important to control exudative psoriasis, so that the quality of life does not decrease.

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