Limited psoriasis

Psoriatic rashes can have a strict localization and always appear in the same places on the body. The clinical course of this form of the disease is usually milder. However, it is characterized by frequent and persistent exacerbations. With limited psoriasis, no more than 10% of the total body surface is usually affected, some authors also name a more significant percentage of damage - up to 40. The main thing is that the localization of the rash is strictly constant.

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Epidemiology

The population frequency of psoriatic disease in most studies is estimated at 1 to 5% with significant variations depending on the climatic conditions of the region. For example, in the developed countries of the Scandinavian Peninsula and among the indigenous population of the Russian Far North, the incidence rate is estimated at approximately 4%. In Kuwait, this figure is 0.11% and is recognized as the lowest in the world. The prevalence of the disease is influenced not only by climatic conditions, the likelihood of developing psoriasis is determined by heredity and is due to subpopulation characteristics. For example, according to observations of American dermatologists, African Americans suffer from psoriasis much less often than white Americans, it is practically not found in American Indians. Although in general, in the United States, more than 7% of the population suffered from psoriasis.

According to some evidence, the indigenous population of Africa is not susceptible to this disease, although in Uganda the share of psoriasis is 2.8% of skin pathologies, which corresponds to the European prevalence rate.

The majority of patients with this disease (3/4) suffer from genetically determined psoriasis type I. This type of disease manifests itself at a young age, its course is more severe. Type II disease is not determined by hereditary predisposition, it affects mature people and is characterized by a milder clinical course.

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Causes limited psoriasis

The etiology of psoriasis, including limited psoriasis, is still unclear. There are many assumptions about the origin of the disease, a significant place in them is given to genetic predisposition, genes have been identified that increase the likelihood of the disease in their carriers. The share of heredity in the formation of pathology is up to 70%, the role of external factors is estimated at 30%. Psoriasis, determined by genetic predisposition, is detected in most patients, and its first manifestation is observed at the age of up to 25 years. The absence of genetic predisposition does not guarantee safety, simply under the influence of a number of external factors the disease can develop at a more mature age.

Risk factors for the development of the disease are very diverse. It is believed that the first manifestation is provoked not by one factor, but by their combination, which at some evil hour weakens the human immune system. Sometimes the patient himself cannot name the reasons visible to him, and they remain unknown.

So, in addition to heredity, the onset of the disease can be triggered by changes in hormonal levels (puberty, pregnancy, menopausal disorders, treatment with hormonal drugs). One of the leading roles belongs to stressful situations associated with severe physical and/or mental overstrain. Skin surface injuries, foci of chronic infections (pharyngitis, sinusitis), vaccination, drug therapy with certain types of drugs (antipsychotics, cytostatics, immunostimulants, etc.) can trigger the first manifestation of psoriasis. At risk are alcoholics and smokers, allergy sufferers and diabetics, people suffering from excess weight and chronic diseases, who have changed their climatic conditions of residence.

It is believed that bacterial or viral infections suffered by the patient may cause gene mutations, and there is also a link between race and disease incidence.

The causes of the disease are still hypothetical, however, the consequences and impact on the skin, as well as other body systems, have been studied quite well.

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Pathogenesis

The pathogenesis of the disease is associated with disorders in the immune system. But whether they are primary or an immune response to the inflammatory process in the dermis is not known for certain.

Healthy human skin is renewed every four weeks – during this period new cells mature, and old ones die, having fulfilled their functions, and peel off. In areas with psoriatic rashes, this process occurs at an accelerated pace – the skin is renewed every three to four days. Newly formed immature cells rush to the surface, almost immediately dying and forming a massive thickened layer. In places of rashes, many active T-lymphocytes, macrophages and other immune cells are found, hyperproliferation of skin cells that do not have time to properly form. Active pro-inflammatory mediators that are found in damaged areas of the skin are histamine, hydrolase enzymes, prostaglandins and other products of arachidonic acid metabolism. Their overproduction is hypothetically provided by cytokines synthesized by macrophages or keratinocytes. In these areas, the barrier function of the skin does not work, and they become defenseless against adverse effects.

The disease is individual and requires a personalized approach to treatment. Cases of effective treatment of psoriasis as a primary dermatosis confirm one theory of pathogenesis, however, it does not always bring success. Treatment of psoriasis as an autoimmune process can also be successful, and often a complex of anti-inflammatory measures is effective.

Contact with sick people is not dangerous; even a blood transfusion from a person with psoriasis to a healthy person will not cause the disease in the latter.

All hypotheses still have a right to exist, but there is no absolute confirmation of any of them, and each theory also has enough refutations.

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Symptoms limited psoriasis

The localization of the rash corresponds to areas of the body that are characterized by drier skin (for example, the extensor surfaces of the limbs (elbows), head, lumbar region of the back). The first signs are a red papular rash, the diameter of the elements of which is approximately the size of a pinhead. Papules have clearly defined boundaries. They are prone to growth with the formation of plaques covered with silvery-gray scaly plates. The size of psoriatic plaques is very variable - from a few millimeters to 10 cm. The affected areas of the body, as a rule, do not itch too much. Psoriatic plaques peel, the plates easily peel off from the surface, and denser scales remain below (scaly lichen).

Excessive proliferation of keratinocytes in psoriatic plaques is accompanied by the formation of skin infiltrates and contributes to the thickening of the skin layer raised above the healthy skin. A triad of symptoms that indicate the psoriatic origin of the rash:

• the surface of the plaque is silvery-gray and resembles a stearin stain in appearance;
• if you remove the scaly plates from it, underneath them you will find a terminal film, which looks smooth and moist;
• blood dew - drop-shaped portions of blood that appear on the film.

The skin covered with psoriatic plaques is usually dry, sometimes it cracks and suppurates; the areas where the rash is localized are characterized by a feeling of tightness of the skin.

The course of psoriatic disease is wave-like, which is typical for any form of the disease. Limited psoriasis, as a rule, is characterized by frequent and persistent relapses.

Stages

The stages of manifestation are conventionally divided into:

• progressive - it is characterized by the constant appearance of new bright red rashes that develop into itchy erythema with clear boundaries;
• stationary - new rashes do not appear, the growth of old lesions stops, the limiting rim (up to ≈ 5 mm) dries up and the plaques become covered with scaly plates;
• regressive - the rash goes away, disappearance begins from the center of the lesions to their periphery.

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Forms

Scaly lichen has several clinical varieties, the most common form of which is limited vulgar psoriasis. The above description corresponds to this type. Favorite places for localization of psoriatic plaques are the outer folds of the limbs (elbows, knees), the scalp, less often - the body, for example, in the lumbar region. The rash almost never affects the face, although occasionally the rash goes to the upper part of the forehead. Small damaged areas of smooth skin almost do not itch, however, seborrheic rashes itch a lot. On the scalp, there may be separate small plaques, sometimes they merge into one continuous erythema, cracked and with exudate. Rashes on the scalp and behind the ears, in the area of the nose, lips, on the chest and between the shoulder blades are called seborrheic psiasis. Plaques of this localization are characterized by blurred outlines, their color is not silver-gray, but yellowish. On the scalp there is excess dandruff, masking the plaques, they can go down to the forehead and neck (psoriatic crown).

The clinical form of limited pustular disease is Barber's palmoplantar psoriasis. It usually has a benign course, affects mostly people engaged in manual work associated with caustic chemicals. Psoriatic plaques are covered with pustules - painful blisters filled with sterile inflammatory exudate, surrounded by edematous, inflamed, peeling skin.

Any form of psoriasis can be localized, although almost always psoriatic plaques of a different type and in other places can be found on the patient’s body.

Reverse (intertriginous) - painful spots are localized in areas where large natural folds are located (interdigital, anogenital, in the armpits and under the breast) and look atypical. They practically do not peel, their surface is glossy, shiny, often moist-red. Diagnosis of this form of the disease causes some difficulties.

Papillomatous is usually localized around the ankles, wrists, on the instep and the lower third of the shin. The rash is in the form of round papules, convex above the skin surface, long-term relapses and mechanical friction lead to the fact that hypertrophic changes in the skin are often observed in these areas. There is a risk of malignancy.

Psoriatic onychodystrophy (nail psoriasis) is the destruction of the nail structure and the periungual bed; if the process is prolonged, hyperfragility of the nails or onycholysis (disappearance of the nail) is possible. Psoriatic arthropathy often manifests itself in this way.

Usually, at the first manifestation of the disease, the lesions are always limited and affect small areas of the body. Over time, the affected area increases, and progressive development of the disease is observed. A mild stage of dermatosis is considered when damage affects up to 3% of the body surface, from 3 to 10% - moderate, more than 10% - severe.

Failure to consult a doctor in a timely manner with the problem of psoriatic rashes, even on a very limited area, can have very serious consequences and complications. In the initial and usually mild stage of the disease, exacerbation is relieved with the help of external treatments; in the case of a widespread process, more serious therapeutic agents are used.

In addition, inflamed skin can become infected. This will cause suppuration, swelling, erythema, and, accordingly, complicate the diagnosis and treatment process.

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Diagnostics limited psoriasis

Diagnostic measures begin with a visual examination. If there are signs of the psoriatic triad, the patient is questioned to establish the events that preceded the disease. The patient is prescribed the necessary laboratory tests. Usually, with limited psoriasis at the onset of the disease, the test results do not go beyond the normal range.

In case of complications and a significant, albeit limited, area of damage, blood tests show intense inflammation, the presence of endocrine system disorders or rheumatism.

Sometimes, to clarify the diagnosis, a piece of skin is taken for biopsy. The study should reveal histologically underdeveloped keratinocytes, their hyperproliferation (Rete bodies), excess immunocytes in the affected area and accelerated formation of new capillaries there.

The main instrumental diagnostics of psoriatic disease is dermatoscopy. Auxiliary diagnostics are performed, if necessary, as prescribed by the attending physician, to form an opinion on the functioning of other body systems and the presence of diseases of other internal organs - radiography, ultrasound of the abdominal organs and thyroid gland, electrocardiography.

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Differential diagnosis

Differential diagnostics allows distinguishing psoriasis from diseases with similar symptoms. It is performed on the basis of a complete anamnesis, collected on the basis of visual signs, examination results and laboratory tests. Psoriatic disease is differentiated from cutaneous T-cell lymphoma (in addition to visualized differences, spinal fluid puncture is sometimes used); lichen planus, the localization of which is similar to papillomatous psoriasis ("bracelets" on the wrists and ankles, occasionally affecting the nails); chronic lichen (simple and pink); nummular eczema; candidiasis; seborrheic dermatitis; dermatophytosis and secondary syphilis.

Treatment limited psoriasis

Mild local psoriatic lesions usually respond well to local therapy. However, it should be remembered that achieving long-term remission is only possible with a healthy lifestyle and adherence to certain dietary rules. Canned food, fatty, smoked, salted foods, products that cause allergic reactions are excluded, alcohol and smoking are prohibited. Since the reaction to the same product is individual in different people, dietary recommendations for patients may not coincide. However, the general point of view on the organization of nutrition in psoriatic disease suggests the predominance of alkali-forming products in the diet (70-80%), and half of them should preferably be eaten raw.

Treatment begins with the prescription of simpler, non-hormonal, external ointments or lotions.

For example, Salicylic ointment, which is included in many psoriasis medications. This product has powerful anti-inflammatory and disinfectant properties, and also perfectly exfoliates dead skin flakes. For psoriasis, a two-percent Salicylic ointment is used. Its disadvantage is a strong drying effect, so it is sometimes mixed with petroleum jelly. This ointment should not be combined with other external drugs of local action.

Also, zinc-based preparations or a combination of zinc and salicylic acid give a good effect. For example, Zinokap aerosol. This is the most convenient form of release, irrigation of the affected areas is carried out remotely, for seborrheic forms of psoriasis there is a special nozzle. The drug has pronounced anti-proliferative and antiseptic properties, practically does not cause side effects and overdose phenomena. Can be used from the age of one year. Sprayed on the affected areas twice or three times during the day. Duration of treatment is from a month to one and a half.

Ointments based on birch tar are also used, for example, Wilkinson's ointment - a combination drug containing tar, purified sulfur, naphthalene oil, green soap. The action of the ointment components is reduced to the resorption of infiltrates and softening of the skin, as well as mild analgesia. It has disinfectant and antiparasitic properties, which makes it possible to use it for associated fungal infections. The presence of sulfur in its composition ensures the formation of keratoplastic compounds with organic substances, restoring the damaged skin surface. The product is applied twice a day for two weeks, then a break is taken for a month. The ointment is not used for seborrheic psoriasis.

The modern drug Daivonex, released in the form of cream and solution. The active component of these products is calcipotriol (analog of vitamin D). It inactivates T-lymphocytes and inhibits hyperproliferation of keratinocytes. The therapeutic effect of this drug is promised to be quite fast - within two weeks. It can be used both independently and in combination with glucocorticosteroids, cyclosporine, and is not used simultaneously with salicylic drugs.

Hormonal ointments provide fast action. Dermovate with the active ingredient clobetasol propionate is considered the most effective. Release form - ointment or cream, which are used to treat rashes once or twice a day. Duration of use - no more than 28 days, the weekly rate should not exceed 50g. A side effect may be the development of pustular psoriasis.

Topical dosage forms containing glucocorticosteroids are positioned as relatively safe. However, they should only be used as prescribed by a dermatologist. Their effect is noticeable almost immediately, but it is short-lived. These ointments and solutions are addictive, cause withdrawal symptoms, and it is worth thinking before starting hormone therapy.

Any medication, even those based on natural ingredients, can cause allergic reactions and instead of the expected improvement, lead to an exacerbation of the process. Before starting treatment, you can do a skin test on a tender healthy area of skin, for example, the inside of the forearm. Apply a thin layer of ointment at night and wait until the morning. If, upon waking up, you do not find redness or rash, you can start using it.

Vitamins are used in complex therapy of psoriatic disease. It is difficult to underestimate the importance of vitamin A in the restoration of the skin. Vitamin D prevents skin diseases, eliminates scaly skin, the antioxidant properties of vitamins C and E are used in the treatment of psoriasis. If necessary and according to indications, vitamins of other groups can be prescribed.

For limited rashes, physiotherapy treatment is successfully used - PUVA therapy, laser therapy, in particular, laser blood irradiation, magnetic therapy; medicinal electrophoresis and phonophoresis.

Surgical treatment for limited psoriasis is usually not used. Surgical reconstructive methods are used in advanced cases of psoriatic arthropathy.

Alternative treatment

Limited psoriasis is a serious enough disease, people have been trying to treat it for a long time, so there are a lot of folk recipes that alleviate the patient's condition. Before using folk treatment, it is advisable to consult with your dermatologist, and also take into account that folk remedies can also cause allergic reactions.

In the treatment of local psoriatic rashes, birch tar has a good effect. It is made from birch bark, modern cleaning methods allow its safe use.

Birch tar has a rather complex composition, which ensures its ability to soften the outer layer of the epidermis, exfoliating dead cells and helping to restore the smooth surface of the skin. At the same time, it has an antimicrobial and insecticidal effect, and together with the affected stratum corneum, it removes the microbes that have settled there. All this helps to reduce inflammation and normalize the process of skin cell proliferation. Tar can cause an allergic reaction, so before starting treatment, you need to do a test: it is recommended to apply a little tar to the skin inside the elbow with a cotton swab and wait half an hour, if there is no reaction, you can use it without fear. Tar treatment should be done in compliance with simple rules:

1. Before the procedure, especially in case of old rashes, it is advisable to take a bath with medicinal herbs and oils;
2. After using tar, the skin's photosensitivity increases, it is necessary to protect yourself from the sun and cover the treated areas with light, breathable fabric;
3. It is recommended to do the procedures every day before going to bed, since the smell of tar remains even after thorough rinsing, and it goes away overnight;
4. During treatment, it is necessary to monitor the functioning of the urinary system (periodically take a urine test).

• Recipe #1. It is preferable to choose tar from a pharmacy, packaged in a glass bottle (not plastic). Apply tar to the affected areas at the beginning of treatment for 10 minutes (for several days), then wash off with tar soap only. Gradually extend the application time by 1-2 minutes to half an hour or 40 minutes maximum. Continue treatment until complete remission is achieved. The effect is noticeable already in the first days. The skin in the areas of application may acquire a darkish shade due to the tar, which will then disappear.
• Recipe #2. It uses tar with 2% boric acid added. It is recommended to apply this mixture with a hard brush and wash it off after half an hour, then lubricate the affected areas with a lanolin-based softening cream.
• Recipe #3. Mix 50 ml of castor oil and the same amount of tar with 100 g of honey and whipped whites from two home-made chicken eggs. Put in the refrigerator for three days. Apply a thin layer to the affected areas every night before going to bed for a month. Repeat the course if necessary.

Phytotherapy is also not left aside. Herbal treatment of psoriasis is performed both externally and internally.

You can make an ointment from dry celandine grass. Grind the grass into powder and mix with turkey fat. Simmer this mixture in a water bath for at least an hour, let it cool. Apply to the affected areas of the skin.

Herbal infusions:

• make a mix of chopped dry herbs in the following proportions: three parts of succession herb, and one part each of valerian root, celandine and St. John's wort, pour 200 ml of boiling water over a tablespoon of the mix and simmer in a water bath for a quarter of an hour, cool, strain and drink half a glass twice a day after meals;
• Pour 400 ml of boiling water into a thermos, add 40 g of wild pansy and the same amount of celandine, leave for two to three hours, cool and take two tablespoons three times a day before meals (store the infusion in the refrigerator for no more than two days, after this period, pour it out and make a fresh one).

In the summer, when you are at your dacha or in another ecologically clean place, you can lubricate each spot with fresh celandine juice; by the end of the summer, you can achieve remission in this way.

Homeopathy can significantly alleviate the condition of a patient with psoriasis. This is a very effective treatment that can improve the quality of life and almost lead to complete recovery. Treatment with small doses involves long-term treatment, however, it minimizes side effects and adverse reactions. The most effective treatment is prescribed by a homeopathic doctor, taking into account all the features of the patient's health and family history. Prescriptions are absolutely individual, therefore - therapeutic improvement occurs for a long time, and if you are patient and follow the recommendations, then relapses can be avoided. In the treatment of limited psoriasis, such drugs as Aquifolium (seborrheic psoriasis), Crotalus horridus (palmar), Manganum and Phosphorus (extensor surfaces) are used, however, when prescribing, not only the localization of the rash is taken into account.

You can use homeopathic drugs from the pharmacy, but they lack the main thing - individuality. Although they can also be useful, both in monotherapy and in combination with other medicinal and folk remedies.

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Prevention

The main preventive measure for limited psoriasis is a healthy lifestyle and healthy diet, and this also applies to latent periods.

It is necessary to carry out regular cleansing of toxins from your body to remove the overload from the skin. Monitor the normal functioning of the intestines, trying to avoid constipation, diarrhea or their alternation.

Patients with seasonal forms of psoriasis should take this feature of their body into account, for example, by visiting solariums in winter, undergoing physical therapy, or avoiding solar radiation by covering the body with clothing, umbrellas, and hats with brims.

Avoid overeating and be careful with medications when treating other diseases.

Cook with sea salt, take baths with sea salt, or spray sea water on the affected areas daily.

Regularly consume flaxseed oil, brewer's yeast and nettle (in any form: fresh - in salads and borscht; dried - in tea and infusion), exclude gluten and dairy products from the diet for some time, if the condition improves, then it is worth excluding them forever.

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Forecast

Officially, the disease is considered incurable, however, the prognosis, especially for limited psoriasis, is relatively favorable. Currently, it is possible to achieve long latent periods, although this requires effort, but it is worth it. Strict adherence to medical recommendations, adherence to a diet and a healthy lifestyle gives significant results. Alternative medicine on forums promises a complete cure, but the patient's predisposition to psoriatic rashes remains with him forever.

Many are interested in the question of military service for young people who have had manifestations of psoriasis. Limited psoriasis and the army are incompatible concepts, and most likely, the young man will be recognized as partially fit for service, that is, in peacetime such people are not called up. However, this issue remains within the competence of the military medical examination.