Forms of psoriasis

Psoriasis (psoriasis) or scaly lichen is a non-infectious dermatosis. The true causes of the disease are not clear. Currently, a provoking factor is a violation of autoimmune processes. On the surface of the skin is formed dry, raised reddish spots. In some cases, patients with a diagnosis of psoriasis have no apparent manifestations. The appearance of psoriatic elements is due to excessive lymphocyte proliferation or chronic inflammation. The disease has a sudden onset. The disease proceeds wavy - acute stages alternate with periods of remission. The forms of psoriasis are diverse. Treatment is stubborn and long-lasting, because the disease often recurs.

Initial form

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

• initial,
• progressing,
• stationary,
• regressing.

For the initial stage of psoriasis is characterized by the formation on the skin of the skin of small hemispherical papules (with a pinhead) of a pinkish color with a smooth surface. After a while, appear silvery-white, easily scraping scales. In this period there are new small psoriatic eruptions or the growth of existing elements.

Mild form of psoriasis

To assess the severity of the form of psoriasis determine the degree:

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

The mild form of psoriasis is characterized by:

• local character of rashes;
• small area of distribution;
• connective tissue, nails and eyes are not involved in the process.

The mild forms of psoriasis are the steady state and the period of remission. To treat the disease in these cases, hormonal drugs do not use. Apply:

• Maze-like preparations containing zinc;
• phototherapy;
• balanced diet;
• correct organization of work and rest;
• reduction of stress loads.

Common forms of psoriasis

Scaly lichen is a common dermatosis, manifested in a multiplicity of forms and manifestations.

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

• Appearance on the surface of the skin of reddish or pinkish scales, different in appearance from healthy skin color and dense structure.
• Scales easily removed, the skin under them is injured, bleeds.
• Patients experience irritation, constriction, burning and itching on the affected parts of the epidermis.

Teardrop-shaped. 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 of small diameter and outwardly resemble drops or tears, located singly or merging with each other.

Bending surfaces. For this form of psoriasis is characterized by development in the folds of the skin and in the folds:

• axillary hollows,
• in the genital area,
• popliteal cavities,
• elbows folds,
• with excessive body weight in the folds under the belly or chest.

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

Nail plates. The disease affects the nails of the hands and / or feet. The appearance of the nails changes. Characteristic manifestations are as follows:

• color change;
• the appearance of thickening;
• occurrence of streaks and spots;
• stratification of the nail plate.

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

Pustular (psoriasis pustulosa). Severe form of psoriasis:

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

Rheumatoid. It affects both the epidermal layer of the skin and the connective tissue. The standard location is the joints of the knees, pelvis, and shoulders. The patient feels pain in affected joints. Pain sensations of different intensity. Externally, the fingers on the arms and legs are deformed and swollen, and the tactile sensitivity of the arms and legs decreases. The disease is difficult and leads to joint dysfunction, resulting in immobility.

[1], [2]

Limited forms of psoriasis

Linear pathological process, occupying more than 9% of the entire surface of the skin. For a limited form of psoriasis is characteristic of the spread in certain parts of the body. For example, a limited form of pustular psoriasis covers the soles of the feet and palms. The limited form of psoriasis is characterized by a lighter flow than the common one, but it often recurs and requires prolonged therapy.

Exudative form

Exudative form of psoriasis (psoriasis exsudativa) is characterized by rashes of yellow-gray color with loose scales. In places of injury, the patient feels itching and burning. This type of disease occurs in:

• patients with endocrine pathologies;
• patients with impaired immunological processes;
• people with excessive body weight;
• children and the elderly.

Plaques are bright red. They are common in large areas of the body. Instead of a raft, crusts of a yellowish-brown hue form. There is exudate, if a patient has metabolic reactions. To treat the exudative form of psoriasis, drug therapy is used. It consists in the application of:

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

[3], [4]

The vulgar form

For the vulgar form of psoriasis (psoriasis vulgaris) are characterized by mild rashes, long-term existing in certain places. Most often the skin is affected in the area of large joints and the scalp. Psoriatic elements are small pinkish papules with well-defined nodules. Peeling is easy to detect by scraping a little of the papule. Over time, the number of elements increases, they are arranged in groups. Provoke a vulgar form of psoriasis:

• combing; microcracks; metabolic disease;
• stress; severe infections;
• allergic reactions to medicines.

Plaque shape

The main cause of the appearance of plaque form of psoriasis is the violation of metabolic reactions in the body. Initially, a small number of papules covered with easily peeled scales appear on the skin. After a while they expand and merge to form plaques. Plaque form of psoriasis, which causes itching, is located on large areas of skin. Plaques are often injured, and fungal and bacterial flora develops on them. Therapy is performed using medications for external use. If sparing treatment does not bring the desired result, then apply:

Hormonal means; cytostatic drugs; complex of vitamins.

Winter form

For the winter form of psoriasis is characteristic of the stagnation of symptoms in warm seasons and exacerbation with the onset of cold weather. The provoking factor is excessively dry air and sudden temperature changes. Flows in light or heavy form. If the treatment is adequate, then recovery comes.

Summer form of psoriasis

Patients with psoriasis in the progressing stage may experience an increase in body temperature and the appearance of rashes of red that arise under the influence of:

• mechanical irritations,
• hot tubs,
• improper treatment,
• auto-toxicity, sunlight.

Eruptions appear on free from psoriatic elements of the skin and eventually form a solid erythroderma. Plaques and papules become indistinguishable. The areas of the affected skin are scaly with thin scales, hair loss and thickening of the nail plates are observed. After a while, the erythroderma disappears and a standard pattern of scaly lichen appears. The appearance of erythroderma is seasonal. In the spring-summer season, redness provokes sun rays and profuse sweating.

Pustular form

One of the severe forms of psoriasis is pustular. Psoriatic rashes - pustules look like blisters filled with exudate. Skin covers in places where pustules are formed:

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

There is a secondary infection when the skin is injured. According to the type of flow, the primary form and the secondary benign are distinguished. 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 intensively flaky;
• itching;
• erythema;
• swelling of the skin;
• burning.

The second variant of pustular psoriasis is characterized by the appearance of pustules in foci with vulgar psoriasis or on the site of existing nodules. Disease with a persistent nature, leading to disability of the patient. This is a very rare form of psoriasis.

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

• tsumbusha psoriasis;
• persistent Crocker dermatitis;
• herpetipetic impetigo of Kebosh-Gebra.

Localized forms of pustular psoriasis:

• the local form of acrodermatitis Allopo;
• psoriasis of Barber;
• vulgar psoriasis with pustules.

Patients with pustular psoriasis are hospitalized. In stationary conditions, the treatment is carried out according to the following scheme:

• detoxification of the body;
• hormone therapy to reduce edema and suppress the inflammatory process;
• for the removal of inflammation use retinoids;
• To stop the proliferation apply immunomolulants;
• In the stage of stabilization, PUVA therapy is used.

Papulo-plaque form

The papulo-plaque form of psoriasis is a severe form of the manifestation of the disease, occurring both locally and extensively. The exacerbation of the disease is sudden, abrupt with a rise in body temperature and a general deterioration in the patient's condition. The causes of the provoking papulo-plaque form of psorizaza are as follows:

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

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

This type of psoriasis requires a comprehensive treatment, which uses: detoxification, antiflgistic and antihistamines for local and internal use.

Palmar-plantar form

Palmar-plantar psoriasis is divided into: pustular and non-pustular species. To non-vestose form include vulgar psoriasis with local lesion of soles and palms. A characteristic feature is a tendency to hyperkeratosis. As a result, a scaly surface develops on the plaques and with a multitude of vessels, with the injury they begin to bleed.

The pustular form of the palmar-plantar psoriasis differs in that the disease begins with the appearance of pustules. The skin near the pustule inflames, thickens and is prone to peeling. If a bacterial infection joins, then the pustules get nagged. In addition, the patient is troubled by itching, desquamation and defeat of the nails. This form of psoriasis is difficult to treat. For therapy use topically:

• 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. For psoriatic arthropathy, the joints are deformed, the appearance of the surface of the feet, the toes of the limbs changes. Through time, psoriatic arthropathy passes to larger joints and a vertebral column. It is manifested by painful sensations of the upper and lower extremities, their modification, limited mobility. Before there are changes in the joints, there are rashes on the epidermis, but it is possible to damage the joint tissue without affecting the skin. Medicamental treatment of arthropathic psoriasis is carried out using:

• corticosteroid injections;
• using analgesics;
• immunomodulatory drugs;
• retinoids;

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

Edema, inflammation, pain.

[5]

Articular form

The joint form of psoriasis affects the epidermis and articular tissue of the fingers of the limbs, as well as the intervertebral space. The disease can bear such names:

• internal psoriasis;
• psoriatic polyarthritis;
• psoriasis of bones.

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

[6], [7]

Seborrheic form

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

• Scales stick together under the influence of sebum, so they attach to the surface of the skin, becoming yellow.
• Psoriatic rashes are poorly infiltrated, resemble spots.
• If you scrape off a plate of scales, then their number increases.
• When removing scales from the plaque, a reddish shiny surface is exposed.
• Capillaries germinate on the upper layer of the skin.
• In the scalp manifests dandruff.
• The ears resemble a hotbed of eczema.
• It is seasonal.

Infiltrative form

With various forms of psoriasis, infiltration of the skin by macrophages and lymphocytes is observed. In this case, the skin thickens at the lesions and rises slightly above the healthy skin. Formed pale gray or silvery spots similar to frozen paraffin. The infiltrative forms of psoriasis include:

• exudative;
• verrucous;
• palmar-plantar;
• intertriginous;
• drop-shaped and others.

Atypical forms

In addition to the characteristic species there are also atypical forms of psoriasis:

• intertriogenous;
• nails;
• psoriatic erythroderma.

Intertrigogenous (psoriasis intertriginoides) is manifested by the appearance of psoriatic elements in the folds of the skin. Pathological foci are similar to erosion and along the edge of education are accompanied by a detachment of the upper layer of the skin. Appears with the following diseases:

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

Psoriasis of the horny (nail) plate can have a dotted and common form. The first is shown small, in size with the carp, pits on the horny plate. In appearance, the nail becomes like a thimble. In addition to the pits appear:

• turbidity of the nail plate;
• subungual hemorrhages (point, linear).

For another form of psoriasis of the horny plate on the hypertrophic type is characteristic:

Thickening, deformation and discoloration of the nail (color becomes dirty-white). Over time, the nail plates acquire the shape of the animal's claws and are completely destroyed.

Psoriatic erythroderma appears under the influence of provoking factors:

• sunlight;
• suffered angina;
• overvoltage;
• reception of antimicrobial agents.

Plaques form different shapes, are shelled and resemble a dense shell of brownish hue.

[8], [9]

Severe forms of psoriasis

In medical practice, the PASI score is used to determine the severity of psoriasis. First introduced in 1979. Knowing the indicator of PASI can determine the tactics, strategy and effectiveness of patient therapy. The index is calculated when the diagnosis is made, during therapy 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 estimate of the area of the lesion is required.

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

• head - 10%,
• upper extremities - 20%,
• trunk (chest, back, stomach) - 30%,
• lower limbs - 40%.

Each of these areas of the body is individually assigned a value on a 6-point scale (0-6), taking into account the intensity of lesions of psoriatic elements. Further, the degree of psoriatic manifestations (erythema, peeling, infiltration) is assessed. The evaluation is carried out on a 4-point scale (0 indicates a lack of characteristic features, and 4 indicates a strong level of manifestation). Then, according to the criteria, determine their indicator for each of the regions of the body, using a special calculation formula and numerical coefficients. Then calculate the degree of damage for each of the 4 sites. The values are summed and determined by PASI.

The levels of disease defeat, according to PASI indicators:

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

Severe forms of psoriasis are:

• covering with psoriatic elements more than 5%;
• affected eyes, joints;
• complication of the disease secondary infection, which occurs against the background of weakening immune factors of the skin.

The severe forms of psoriasis include:

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

For the treatment of severe forms of psoriasis to a stable remission, an integrated approach to treatment is used. Combine local drugs and drugs taken internally, injections and physiotherapy, which, when correctly applied, always yield positive results.