Plantar psoriasis: causes and how to treat

Plantar psoriasis accounts for 25% of all skin diseases, it affects the soles of the feet, which seriously complicates the treatment. This is a long-lasting (several years) non-infectious process. It is accompanied by pain and severe itching, which causes not only physical suffering, but also psychological discomfort. The root cause of plantar psoriasis can be a common skin injury.

[1], [2]

Causes of the plantar psoriasis

The following factors contribute to the occurrence of psoriasis manifestations in the plantar area:

• Heredity.
• Malfunction of the immune system
• Infectious diseases.
• Physical trauma of the skin.
• Prolonged treatment with antibiotic drugs.

In our time, doctors tend to believe that the appearance of psoriasis has a relationship with malnutrition. Pathology can be a consequence of disturbed protein and lipid exchanges occurring in the intestine. During the remission the amount of toxic substances decreases.

[3], [4], [5], [6]

Risk factors

The risk factors that contribute to the emergence of plantar psoriasis include:

• streptococcal infection,
• use of drugs (beta-blockers, antimalarial drugs, systemic steroids),
• excessive use of alcohol,
• skin trauma,
• dry skin,
• endocrine factors.

[7], [8], [9],

Pathogenesis

At this time, the etiology of psoriasis is unknown. Specialists identify 2 main hypotheses regarding the origin and nature of pathology.

The first one connects the appearance of plantar psoriasis with disorders in the maturation and differentiation of the cellular epithelium. The problem arises when the functioning of the upper layer of the skin and its cells is disrupted.

Supporters of another hypothesis believe that the appearance of psoriasis is of an autoimmune nature, in which strong growth and proliferation of skin cells, especially keratinocytes.

[10], [11], [12]

Symptoms of the plantar psoriasis

Symptom complex of manifestations is as follows:

• the skin in the area of the palms and feet becomes thicker;
• skin affected by psoriasis dry, covered with cracks, where inflammatory processes occur, accompanied by pain;
• on the skin of the palms and feet appear pustules with a transparent liquid, which eventually becomes white and turns into dark crusts.

The first signs of the manifestation of the disease is dryness of the skin and redness on the arches serves, hyperkeratosis of the upper part of the epidermis and cracks on it, accompanied by constant soreness. The coarse skin is affected by corolla-like growths that are fringed by an even thicker skin. Often - plaques of rounded shape, covered with scales. They are placed chaotically on the surface of the skin or merge with each other. Within the plaque, you can see pustules that are deep in the skin. These formations are of a non-infectious nature.

Stages

To make it easier to assess the course of the disease, to determine its sensitivity to a particular method of treatment, and to choose the right tactics for therapeutic measures, a clear identification of the staging is essential. The following stages of skin damage are distinguished:

1. progressive;
2. stationary;
3. regressive.

The stage of progression is characterized by the onset of exacerbation of plantar psoriasis. In this period, new papules appear that merge, on the surface of the newly appeared elements, scaling occurs in the form of scales, the edges of the plaques are similar to a small hyperemic rim, the phenomenon of Kebner appears (any skin lesions become typical psoriatic plaques, and not cicatricial forms).

The stationary stage is manifested by a decrease in inflammatory skin changes: new red papules stop appearing, the growth of existing plaques decreases; flakes completely cover the plaque, the rim around the flaking elements disappears, the Kebner phenomenon is absent.

The regressive stage signals that the exacerbation of the disease is on a decline and there is a problem of preventing its aggravation. In this period, small creases and radial lines around the plaques (Voronov's rim), a decrease in peeling, the appearance of light or dark pigmentation instead of plaques arise.

The basis of staged is the intensity of the inflammatory process.

[13], [14],

Forms

There are two types of plantar psoriasis - these are pustular and non-pustular (plaque) variants.

To the pustular type is vulgar psoriasis or an ordinary, isolated skin that damages the skin. This kind of disease can affect the skin of the palms, then it is a question of pustular palmar-plantar psoriasis. Patients with this pathology tend to thicken the stratum corneum of the epidermis (hypercaratosis). The initial stage of the disease is manifested by psoriatic plaques with a scaly surface, inside which there are small vessels, with trauma easily bleeding.

Pustular palmar-plantar psoriasis of Barber. Sign of the disease is the appearance of the primary element - a bubble filled with liquid contents. The skin near it inflames and thickens, a partial detachment is possible. This kind of psoriasis is difficult to treat. In addition to the characteristic eruptions, there is peeling and unbearable itching, nail plates are affected.

[15], [16]

Complications and consequences

The sequelae and complications of plantar psoriasis are as follows:

Psychological distress. Patients are overly concerned about appearance. Decreased self-esteem

Psoriatic arthritis. As a result of infiltration of the periarticular tissues, joint damage occurs.

Psoriatic erythroderma. Under the pressure of irritating factors, red rashes develop (erythema). First they affect the areas free of psoriatic rash, gradually merging into solid erythroderma.

[17], [18], [19], [20]

Diagnostics of the plantar psoriasis

Diagnostic measures for the identification of plantar psoriasis begin with a visit to the doctor. The doctor-dermatologist will make an anamnesis and carefully examine the lesion sites. In medicine, the term psoriatic triad (stearin stain, terminal film, blood dew) is used.

Then, both general clinical tests and specific examinations will be scheduled.

[21], [22],

Analyzes

The diagnosis of plantar psoriasis in most cases does not cause problems. Doctors in some cases, to determine the state of the body can appoint the following studies:

• general blood analysis
• blood chemistry
• blood test for allergic manifestations
• histological examination of the skin
• feces analysis for dysbiosis
• scraping of the skin for the presence of fungal infection

[23], [24], [25]

Instrumental diagnostics

Doctors-dermatologists of the formulation of a more accurate diagnosis can use the following types of research:

• Dermatoscopy.
• X-ray examination.
• Conduct photodocumenting of psoriasis spots to make sure the correct treatment is chosen.

According to the indications prescribe: ECG, ultrasound.

Differential diagnosis

Difficulties in the diagnosis of plantar psoriasis can arise when differentiating from plantar pustules, as well as eczema (with a more pronounced itching sensation when eczema) and mycosis (an analysis is recommended to identify a fungus pathogen).

[26], [27]

Treatment of the plantar psoriasis

For the selection of therapy for plantar psoriasis, it is necessary to take into account various causes, among which:

• area of damage,
• form and type of psoriasis,
• stage of the disease,
• severity of the course of the disease,
• general health of the patient, his age,
• occupation of the patient and much more.

Therapy is divided into system-wide and local.

With systemic therapy prescribe drugs according to the schemes. For the therapy of plantar psoriasis, glucocorticosteroid preparations are used.

Systemic treatment includes PUVA therapy (exposure to skin by ultraviolet rays and a photoactive substance).

Antibiotics are used extremely rarely (with secondary infection of psoriatic eruptions), as well as in infections that exacerbate the course of psoriasis (sore throats, pharyngitis, pyoderma). In these cases, drugs of the macrolide group are used - Erythromycin, Azithromycin, Clarithromycin and others.

To reduce the itching use antiallergic drugs - Loratadin, Cetirizin, Zodak and others.

Local external therapy of plantar psoriasis involves the use of ointments with glucocorticosteroids. A wide distribution in the treatment of combined ointments. For example, ointment Elokom or Elokom-S (in the composition there is salicylic acid). Elokom-C is highly effective and safe. With horny and vulgar forms of plantar psoriasis, therapy should begin with ointments or creams that promote healing of cracks. These medications must be used within three days, after which you need to go to the foot baths. In the same period, you can use Elokom-C. Salicylic acid will purify the skin of the horny deposits and allow the ointment to absorb well. This treatment is carried out for 14 days.

Vitamins

A person experiences a permanent lack of useful substances, so vitamin preparations with plantar psoriasis play a significant role in the effectiveness of treatment.

The complex of therapy includes vitamins of various groups. Vitamins B, E, D. Vitamin A maintains a normal level of keratin in skin cells. Applied as an oily solution and a tablet, an overdose is fraught with a violation of the liver, pancreas and gallbladder. Vitamin E saturates the cells with oxygen. Complex preparations can be used. The dose is calculated based on daily intake of food. The reception schedules are individual and are assigned by the attending physician.

Physiotherapeutic treatment

The following physiotherapeutic measures are used for various types of psoriasis:

• photochemotherapy,
• PUVA therapy,
• ultraviolet irradiation,
• phototherapy,
• X-ray therapy,
• ultrasound therapy,
• general cryotherapy,
• magnetotherapy,
• diadynamic therapy,
• laser therapy,
• baths,
• balneotherapy.

Alternative treatment

Alternative agents are successfully used to treat plantar psoriasis in the initial stage and give a greater effect than medications. The recipes of alternative healers are based on the centuries-old experience of our ancestors. The main advantage of treatment with natural preparations is that they do not harm the human body, in contrast to medicines. For therapy, creams, ointments, lotions, baths, and oral herbal teas are used.

It must be remembered that taking foot baths is necessary regularly and the water temperature should be less than 40 degrees.

Our ancestors from ancient times appreciated birch tar during the treatment of psoriasis. It well cures inflammation, reduces pain and itching. The agent is added to the water and the foot tray is ready.

Soda bath will help improve the patient's condition by removing inflammation and severe itching. Prepare a strong solution of salt and hold the foot in it.

Preparation of ointment based on butter and propolis. Take natural butter (60 g) and heat. Then add the crushed or finely chopped propolis (8 g) and a couple drops of vitamin A. Apply a thick layer of ointment to the affected areas under the bandage and leave it overnight.

[28], [29]

Herbal Treatment

The symptoms of plantar psoriasis are well removed by decoctions and infusions of herbs.

Decoction of succession. This plant has long been used in the treatment of itching dermatoses. Leaves must be brewed. The resulting broth is added to the water until a light brown color is obtained. Applied in the form of baths and compresses. The procedure lasts a quarter of an hour.

Broth-assorted from a string, celandine, licorice root. Mixture of equal proportions of ingredients pour boiling water and insist one hour. The resulting remedy should be used for a bath with a duration of no more than 15 minutes.

Juice fresh squeezed celandine (podtynika) is effective for plantar psoriasis. Juice diluted in water must be wiped with psoriatic lesions.

Good means of lotion from the flowers of clover. Plant flowers in gauze and dip into boiling water for 1 minute. Then they are cooled and put on the foot for no more than two hours.

Homeopathy

Homeopathic remedies for therapy are created taking into account the peculiarities of psoriasis and its various manifestations. During the use of these drugs the body is reconfigured. This means that the internal forces of the human body will be used to restore the imbalance.

Treatment is carried out by combining traditional drugs with organotropic drugs, which have a positive effect on certain systems. To dermatotropic drugs include: Acidum nitricum, Calcium carbonicum, Arsenicum iodatum, Kali arsenicosum, Silicea, Sulfur, Sepia, Thuja.

In pharmacy supermarkets without prescriptions complex homeopathic preparations Psorinochel and Psoriaten ointment are released.

In order not to make a mistake in the choice of a drug, to choose the most effective combinations it is necessary to get a consultation of a homeopath physician.

Operative treatment

Operations with plantar psoriasis are very rare. Conducted if the conservative treatment had no effect. Surgical intervention is necessary to remove the affected joint tissues in order to restore their operability and fixation in the correct position.

Prevention

Preventive measures are the implementation of well-known rules:

• daily regime,
• balanced diet,
• getting rid of bad habits,
• total hardening of the body,
• walks in the open air,
• bathing in the sea,
• sunbathing.

Also, there are special methods that help to reduce the appearance of plantar psoriasis.

During the treatment of pustular plantar psoriasis, it is necessary to use the hydrocolloid coating necessary for the healing of wounds and cracks. Due to its effect, the feet are covered with a film and the skin is not injured, itching and inflammation are reduced.

Wash your feet with warm water. Pedicure, sauna, sauna are excluded. Socks should be made of materials that do not absorb sweat so that irritation does not appear.

[30]

Forecast

Any form of psoriasis is an incurable chronic disease, but the prognosis is favorable. Therapy of psoriasis is aimed at increasing the period of remission and improving the quality of life of patients.