Forms of psoriasis

Psoriasis (psoriasis) or scaly lichen is a non-infectious dermatosis. The true causes of the disease are not clear. Currently, the provoking factor is considered to be a violation of autoimmune processes. Dry, raised reddish spots form on the surface of the skin. In some cases, patients diagnosed with psoriasis do not have visible manifestations. The appearance of psoriatic elements is due to excessive proliferation of lymphocytes or chronic inflammation. The disease has a sudden onset. The disease proceeds in waves - acute stages alternate with periods of remission. The forms of psoriasis are varied. Treatment is persistent and long-term, because the disease often recurs.

Initial form

Psoriasis has a cyclical course. This tendency is due to the change of periods of its development. The disease consists of four stages:

• initial,
• progressive,
• stationary,
• regressive.

The initial stage of psoriasis is characterized by the formation of small hemispherical papules (the size of a pinhead) of a pinkish color with a smooth surface on the skin. After some time, silvery-white, easily removable scales appear. During this period, new small psoriatic rashes appear or existing elements grow.

Mild form of psoriasis

To assess the severity of psoriasis, the degree is determined:

• changes in the epidermis; swelling and redness; presence of severe irritation;
• bleeding,
• peeling,
• infection of psoriatic elements.

Mild psoriasis is characterized by:

• local nature of the rash;
• small area of distribution;
• Connective tissue, nails and eyes are not involved in the process.

Mild forms of psoriasis are the stationary state and the period of remission. Hormonal agents are not used to treat the disease in these cases. They are used:

• ointment-like preparations containing zinc;
• phototherapy;
• balanced diet;
• proper organization of work and rest;
• reducing stress loads.

Common forms of psoriasis

Scaly lichen is a common dermatosis that has a variety of forms and manifestations.

Scaly. It is diagnosed in more than 80% of cases. The disease is characterized by:

• The appearance of reddish or pinkish scales on the surface of the skin, which differ in appearance from healthy skin in color and dense structure.
• The scales are easily removed, the skin underneath them is injured and bleeds.
• Patients experience irritation, tightness, burning and itching in the affected areas of the epidermis.

Guttate. This form of psoriasis has:

• Specific color from pink to purple.
• The intensity of the shade depends on the stage of the disease.
• Psoriatic elements are small in diameter and outwardly resemble drops or tears, located singly or merging with each other.

Flexural surfaces. This form of psoriasis is characterized by development in the folds of the skin and in the places of bends:

• armpits,
• in the genital area,
• popliteal fossa,
• elbow bends,
• in case of excess body weight in the folds under the stomach or chest.

Unlike other forms of psoriasis, the plaques do not flake or itch, the surface is smooth and even, and is easily damaged by clothing.

Nail plates. The disease affects fingernails and/or toenails. The appearance of the nails changes. The characteristic manifestations are as follows:

• color change;
• the appearance of thickenings;
• the appearance of stripes and spots;
• delamination of the nail plate.

Refusal of treatment leads to complete loss of nails. Before starting treatment, a thorough examination of the patient is necessary, because the appearance is similar to fungal diseases.

Pustular (psoriasis pustulosa). Severe form of psoriasis:

• The top layer of the skin is affected by small blisters with transparent contents.
• Pustules (the primary inflammatory elements of the rash) rise above the epidermal layer of healthy skin and are easily injured.
• Damage can lead to re-infection.
• Pustular psoriasis affects individual areas or the entire body.

Rheumatoid. Affects both the epidermal layer of the skin and connective tissue. Standard location - joints of the knees, pelvis, shoulders. The patient feels pain in the joints affected by the disease. Pain of varying intensity. Externally, the fingers and toes are deformed and swollen, tactile sensitivity of the hands and feet decreases. The disease is severe and leads to dysfunction of the joints, resulting in immobility.

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Limited forms of psoriasis

A linear pathological process that occupies over 9% of the entire skin surface. The limited form of psoriasis is characterized by spreading to certain areas of the body. For example, the limited form of pustular psoriasis affects the soles of the feet and palms. The limited form of psoriasis is characterized by a milder course than the widespread form, but it recurs more often and requires long-term therapy.

Exudative form

The exudative form of psoriasis (psoriasis exsudativa) is characterized by yellow-gray rashes with loose scales. The patient feels itching and burning in the affected areas. This type of disease occurs in:

• patients with endocrine pathologies;
• patients with impaired immunological processes;
• people who are overweight;
• children and the elderly.

Plaques are bright red. They are spread over large areas of the body. Instead of plaque, crusts of a yellowish-brown hue are formed. Exudate appears if the patient has metabolic disorders. Drug therapy is used to treat the exudative form of psoriasis. It consists of the use of:

• anti-inflammatory medications;
• diuretic medications to remove excess fluid;
• medicines with antihistamine effect;
• vitamin preparations to improve metabolism.

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Vulgar form

The vulgar form of psoriasis (psoriasis vulgaris) is characterized by mild rashes that exist for a long time in certain places. Most often, the skin in the area of large joints and the scalp is affected. Psoriatic elements are small pinkish papules with clearly defined nodules. Flaking is easy to detect by scraping off a little of the papule. Over time, the number of elements increases, they are located in groups. The vulgar form of psoriasis is provoked by:

• scratches; microcracks; metabolic disorders;
• stress; severe infections;
• allergic reactions to drugs.

Plaque form

The main reason for the appearance of plaque psoriasis is a violation of metabolic reactions in the body. Initially, a small number of papules covered with easily peeling scales appear on the skin. Over time, they grow and merge to form plaques. Plaque psoriasis, which causes itching, is located on large areas of the skin. Plaques are often subject to injury, and fungal and bacterial flora develops on them. Therapy is carried out using medical products for external use. If gentle treatment does not bring the desired result, then the following are used:

Hormonal agents; cytostatic drugs; vitamin complex.

Winter uniform

The winter form of psoriasis is characterized by a decrease in symptoms in warm seasons and an exacerbation with the onset of cold weather. The provoking factor is excessively dry air and sudden changes in temperature. It occurs in mild or severe forms. If the treatment is adequate, recovery occurs.

Summer form of psoriasis

Patients with psoriasis in the progressive stage may experience an increase in body temperature and the appearance of red rashes, which occur under the influence of:

• mechanical irritations,
• hot baths,
• incorrect treatment,
• autointoxication, sun rays.

The rash appears on areas of the skin free of psoriatic elements and over time forms a continuous erythroderma. Plaques and papules become indistinguishable. The areas of affected skin peel off in thin scales, hair loss and thickening of the nail plates are observed. After some time, erythroderma disappears and the standard picture of psoriasis appears. The appearance of erythroderma is characterized by seasonality. In the spring and summer, redness is provoked by sunlight and profuse sweating.

Pustular form

One of the severe forms of psoriasis is pustular. Psoriatic rashes - pustules look like blisters filled with exudate. Skin in the areas of pustule formation:

• red;
• edematous;
• inflamed;
• thickened.

Secondary infection occurs when the skin is injured. According to the type of course, there are primary and secondary benign forms. In the first variant, the disease has a malignant severe course. Symptoms of the primary form:

• multiple pustular elements located in the infiltrative lesion;
• purulent pustules peel intensively;
• itching;
• erythema;
• swelling of the skin;
• burning.

The second variant of pustular psoriasis is characterized by the appearance of pustules in areas of vulgar psoriasis or at the site of existing nodules. The disease is persistent in nature, leading to the patient's disability. This is a very rare form of psoriasis.

Pustular psoriasis is divided into two broad groups - generalized and local. The generalized form of psoriasis includes:

• Zumbusch psoriasis;
• Crocker's dermatitis;
• Herpetiform impetigo of Hebra-Kaposi.

Localized forms of pustular psoriasis:

• localized form of acrodermatitis Hallopeau;
• Barber's psoriasis;
• vulgar psoriasis with pustules.

Patients with pustular psoriasis are subject to hospitalization. Inpatient treatment is carried out according to the following scheme:

• detoxification of the body;
• hormone therapy to reduce swelling and suppress inflammation;
• retinoids are used to relieve inflammation;
• Immunomodulators are used to stop proliferation;
• At the stabilization stage, PUVA therapy is used.

Papulo-plaque form

Papulo-plaque type of psoriasis is a severe form of the disease, occurring both locally and widely. The exacerbation of the disease is sudden, sharp with a rise in body temperature and a general deterioration in the patient's condition. The causes that provoke the papulo-plaque form of psoriasis are the following:

• stressful situations, conflicts;
• infectious diseases;
• illiterate use of medications for external use or general therapy.

Psoriatic rashes (papules and plaques) are accompanied by pain. Elements appear on areas of healthy skin, and not on areas previously affected by psoriasis.

This type of psoriasis requires complex treatment, which uses: detoxifying, antiphlogistic and antihistamine drugs for local and internal use.

Palmar-plantar form

Palmoplantar psoriasis is divided into: pustular and non-pustular types. Non-pustular form includes vulgar psoriasis with local lesions of the soles and palms. A characteristic feature is a tendency to hyperkeratosis. As a result, a scaly surface develops on the plaques and with many vessels, when injured, they begin to bleed.

The pustular form of palmoplantar psoriasis is distinguished by the fact that the disease begins with the appearance of pustules. The skin near the pustule becomes inflamed, thickens and tends to peel. If a bacterial infection joins in, the pustules become purulent. In addition, the patient is bothered by itching, desquamation and nail damage. This form of psoriasis is difficult to treat. For therapy, the following are used locally:

• hydrogels;
• ointments containing salicylates;
• creams with glucocorticosteroid hormones.

Arthropathic form

This form of psoriasis can be called psoriatic arthropathy or arthritis (psoriasis arthropathica), the most complex and severe manifestation of the disease. Psoriatic arthropathy is characterized by joint deformation, changes in the appearance of the surface of the feet, fingers. Over time, psoriatic arthropathy moves to larger joints and the spine. It manifests itself as painful sensations in the upper and lower extremities, their modification, limited mobility. Before changes occur in the joints, rashes appear on the epidermis, but damage to the joint tissue is possible without affecting the skin. Drug treatment of arthropathic psoriasis is carried out using:

• corticosteroid injections;
• the use of analgesics;
• immunomodulatory drugs;
• retinoids;

During an exacerbation of the disease, therapeutic measures are aimed at reducing:

Swelling, inflammation, pain.

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Articular form

The articular form of psoriasis affects the epidermis and articular tissue of the fingers, as well as the intervertebral space. The disease may have the following names:

• internal psoriasis;
• psoriatic polyarthritis;
• bone psoriasis.

Severe form of psoriasis. Internal psoriasis occurs some time after the appearance of vulgar psoriasis. The disease is periodic - exacerbation phases are replaced by remissions. The condition during the lull of the disease is not stable. The aggravation of the consequences of the disease occurs in the winter season.

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Seborrheic form

This form of psoriasis appears in patients suffering from seborrheic dermatitis with specific clinical features:

• The scales stick together under the influence of sebum, as a result of which they attach to the surface of the skin, becoming yellow.
• Psoriatic lesions are weakly infiltrated and resemble spots.
• If you scrape off the scales from the plaque, their number increases.
• When the scales are removed from the plaque, a reddish, shiny surface will be exposed.
• Capillaries grow into the top layer of the skin.
• On the scalp it manifests itself as dandruff.
• The auricles resemble a patch of eczema.
• It differs in seasonality.

Infiltrative form

In various forms of psoriasis, infiltration of the skin by macrophages and lymphocytes is observed. In this case, the skin thickens in the affected areas and is slightly raised above the healthy skin. Pale gray or silvery spots similar to hardened paraffin are formed. Infiltrative types of psoriasis include:

• exudative;
• warty;
• palmar-plantar;
• intertriginous;
• teardrop-shaped, etc.

Atypical forms

In addition to the typical types, there are also atypical forms of psoriasis:

• intertrigenous;
• nails;
• psoriatic erythroderma.

Intertrigenous (psoriasis intertriginoides) is manifested by the appearance of psoriatic elements in the folds of the skin. Pathological foci resemble erosions and are accompanied by peeling off of the upper layer of skin along the edge of the formation. It appears in the following diseases:

• adipositas (obesity);
• diabetes mellitus (diabetes mellitus);
• neurocirculatory dystonia (neurocirculatory dystonia).

Psoriasis of the horny (nail) plate can have a point and widespread form. The first is manifested by small, the size of a piercing, pits on the horny plate. In appearance, the nail begins to resemble a thimble. In addition to the pits, the following appear:

• clouding of the nail plate;
• subungual hemorrhages (pinpoint, linear).

Another form of psoriasis of the horny plate of the hypertrophic type is characterized by:

Thickening, deformation and discoloration of the nail (it becomes dirty white). Over time, the nail plates take on the shape of animal claws and are completely destroyed.

Psoriatic erythroderma appears under the influence of provoking factors:

• sun rays;
• transferred tonsillitis;
• overvoltage;
• taking antimicrobial drugs.

The plaques form different shapes, flake and resemble a dense shell of a brownish hue.

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Severe forms of psoriasis

In medical practice, the PASI index is used to determine the severity of psoriasis. It was first introduced in 1979. Knowing the PASI index, it is possible to determine the tactics, strategy and effectiveness of the patient's therapy. The index is calculated when diagnosing, during therapeutic measures and after treatment. This makes it possible to evaluate the dynamics of the adequacy of therapy.

To calculate the PASI index, quantitative indicators of the degree of manifestation of general clinical symptoms are used:

• infiltration;
• itching;
• thickening of the skin;
• peeling;
• hyperemia.

For accurate calculations, an assessment of the affected area will also be required.

To determine the PASI index, the patient's body is conditionally divided into 4 areas:

• head - 10%,
• upper limbs - 20%,
• torso (chest, back, abdomen) - 30%,
• lower limbs - 40%.

Each of the specified areas of the body is individually assigned a value on a 6-point scale (0-6) taking into account the intensity of the lesion by psoriatic elements. Then the degree of psoriatic manifestations (erythema, flaking, infiltration) is assessed. The assessment is carried out on a 4-point scale (0 indicates the absence of characteristic signs, and 4 - a strong level of manifestation). Then, according to the criteria, their own indicator is determined for each of the areas of the body, using a special calculation formula and numerical coefficients. Then the degree of lesion is calculated for each of the 4 areas. The values are summed up and PASI is determined.

Disease severity levels according to PASI scores:

• 0-10 points – mild form of the disease;
• 10-30 points – average severity of the process;
• 30-72 – severe course of the disease.

Severe forms of psoriasis are considered to be:

• coverage with psoriatic elements more than 5%;
• eyes and joints are affected;
• complication of the disease by a secondary infection that occurs against the background of weakening of the immune factors of the skin.

Severe forms of psoriasis include:

• erythroderma,
• pustular form;
• exudative type;
• arthropathic variant.

For the treatment of severe forms of psoriasis until stable remission, a comprehensive approach to treatment is used. They combine local remedies and drugs taken orally, injections and physiotherapy, which, when used correctly, always give positive results.