Plantar psoriasis: causes and how to treat it

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

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Causes plantar psoriasis

The following factors contribute to the development of psoriasis manifestations on the plantar area:

• Heredity.
• Malfunctioning immune system
• Infectious diseases.
• Physical trauma to the skin.
• Long-term treatment with antibiotics.

Nowadays, doctors tend to believe that the appearance of psoriasis is associated with poor nutrition. Pathology can be a consequence of disrupted protein and lipid metabolism occurring in the intestines. During remission, the amount of toxic substances decreases.

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Risk factors

Risk factors that contribute to the development of plantar psoriasis include:

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

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Pathogenesis

At the moment, the etiology of psoriasis is unknown. Experts distinguish 2 main hypotheses regarding the origin and nature of the pathology.

The first connects the appearance of plantar psoriasis with disturbances in the processes of maturation and differentiation of 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 has an autoimmune nature, in which there is a strong growth and proliferation of skin cells, especially keratinocytes.

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Symptoms plantar psoriasis

The symptom complex is as follows:

• the skin in the palms and feet area becomes thicker;
• skin affected by psoriasis is dry, covered with cracks, where inflammatory processes occur, accompanied by pain;
• Pustules with a clear liquid appear on the skin of the palms and feet, which over time become white and turn into dark crusts.

The first signs of the disease are dry skin and redness on the arches of the feet, hyperkeratosis of the upper part of the epidermis and cracks on it, accompanied by constant pain. The rough skin is affected by callus-like growths, which are bordered by even thicker skin. Often - plaques of a round shape, covered with scales. They are located chaotically on the surface of the skin or merge with each other. Within the plaque, you can see deep-seated pustules in the skin. These formations are non-infectious in nature.

Stages

In order to more easily assess the course of the disease, determine its sensitivity to a certain method of treatment and correctly choose further tactics of therapeutic measures, a clear identification of stages is extremely necessary. The following stages of skin lesions are distinguished:

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

The progression stage is characterized by the onset of exacerbation of plantar psoriasis. During this period, new papules appear, which merge with each other, peeling in the form of scales occurs on the surface of the newly appeared elements, the edges of the plaques resemble a small hyperemic rim, the Koebner phenomenon occurs (any skin damage becomes typical psoriatic plaques, and not cicatricial formations).

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

The regressive stage signals that the exacerbation of the disease is on the decline and the task of preventing its exacerbation appears. During this period, small folds and radial lines around the plaques (Voronov's rim) appear, peeling decreases, and light or dark pigmentation appears instead of plaques.

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

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Forms

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

The pustular type includes vulgar psoriasis or ordinary psoriasis, which affects the skin of the feet in isolation. This type of disease can also affect the skin of the palms, then we are talking about pustular palmoplantar psoriasis. Patients with this pathology have a tendency to thickening of 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 that bleed easily when injured.

Barber's pustular palmoplantar psoriasis. The sign of the disease is the appearance of the primary element - a blister filled with liquid contents. The skin around it becomes inflamed and thickened, partial peeling is possible. This type of psoriasis is difficult to treat. In addition to the characteristic rash, peeling and unbearable itching appear, the nail plates are affected.

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Complications and consequences

The consequences and complications of plantar psoriasis are as follows:

Psychological distress. Patients are overly concerned with their appearance. Self-esteem decreases.

Psoriatic arthritis. Joint damage occurs due to infiltration of periarticular tissues.

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

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Diagnostics plantar psoriasis

Diagnostic measures to identify plantar psoriasis begin with a visit to the doctor. The dermatologist will collect anamnesis and carefully examine the affected areas. In medicine, the term psoriatic triad is used (stearin spot, terminal film, bloody dew).

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

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Tests

Diagnosis of plantar psoriasis in most cases does not cause problems. In some cases, doctors may prescribe the following tests to determine the condition of the body:

• complete blood count
• biochemical blood test
• blood test for allergic reactions
• histological examination of the skin
• stool analysis for dysbacteriosis
• Skin scraping for fungal infection

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Instrumental diagnostics

To make a more accurate diagnosis, dermatologists can use the following types of instrumental studies:

• Dermatoscopy.
• X-ray examination.
• Keep photographic records of psoriasis spots to ensure that the correct treatment is chosen.

According to indications, the following are prescribed: ECG, ultrasound.

Differential diagnosis

Difficulties in diagnosing plantar psoriasis may arise when differentiating it from plantar pustulosis, as well as eczema (eczema has a more pronounced itching sensation) and mycosis (analysis to identify the fungal pathogen is recommended).

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Treatment plantar psoriasis

To select a therapy for plantar psoriasis, it is necessary to take into account various causes, including:

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

Therapy is divided into general systemic and local.

In systemic therapy, drugs are prescribed according to the schemes. Glucocorticosteroid drugs are used to treat plantar psoriasis.

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

Antibiotics are used extremely rarely (in case of secondary infection of psoriatic rashes), as well as in case of infections that cause exacerbation of psoriasis (tonsillitis, pharyngitis, pyoderma). In these cases, drugs of the macrolide group are used - Erythromycin, Azithromycin, Clarithromycin and others.

To reduce itching, antiallergic drugs are used: Loratadine, Cetirizine, Zodak and others.

Local external therapy of plantar psoriasis involves the use of ointments with glucocorticosteroids. Combined ointments are widely used in treatment. For example, Elokom or Elokom-S ointment (contains salicylic acid). Elokom-S is highly effective and safe. In the case of horny and vulgar forms of plantar psoriasis, therapy should begin with ointments or creams that promote the healing of cracks. Such medications should be used for three days, after which it is necessary to move on to foot baths. During the same period, you can use Elokom-S. Salicylic acid will cleanse the skin of horny deposits and allow the ointment to be well absorbed. This treatment is carried out for 14 days.

Vitamins

A person experiences a constant deficiency of nutrients, so vitamin preparations for plantar psoriasis play a significant role in the effectiveness of treatment.

The complex therapy includes vitamins of various groups. Vitamins of groups B, E, D. Vitamin A maintains normal levels of keratin in skin cells. Both oil solution and tablets are used, overdose is fraught with dysfunction of the liver, pancreas and gall bladder. Vitamin E saturates cells with oxygen. Complex preparations can be used. The dose is calculated based on daily consumption with food. The regimens are individual and prescribed by the attending physician.

Physiotherapy treatment

For various types of psoriasis, the following physiotherapeutic measures are used:

• photochemotherapy,
• PUVA therapy,
• ultraviolet radiation,
• phototherapy,
• X-ray therapy,
• ultrasound therapy,
• general cryotherapy,
• magnetic therapy,
• diadynamic therapy,
• laser therapy,
• baths,
• spa therapy.

Folk remedies

Folk remedies are successfully used to treat plantar psoriasis at the initial stage and give a greater effect than medical drugs. The recipes of folk 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, unlike medications. Creams, ointments, lotions, baths, and oral use of herbal teas are used for therapy.

It is important to remember that foot baths must be taken regularly and the water temperature should be less than 40 degrees.

Our ancestors have long appreciated birch tar during the treatment of psoriasis. It relieves inflammation well, reduces pain and itching. The product is added to water and the foot bath is ready.

A soda bath will help improve the patient's condition by relieving inflammation and severe itching. Prepare a strong salt solution and soak your feet in it.

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

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Herbal treatment

Herbal decoctions and infusions are good for relieving symptoms of plantar psoriasis.

A decoction of succession. This plant has long been used to treat itchy dermatoses. Succession leaves must be brewed. The resulting decoction is added to water until it becomes light brown. It is used both in the form of baths and compresses. The duration of the procedures is a quarter of an hour.

A decoction of assorted celandine, liquorice root. Pour boiling water over a mixture of equal proportions of ingredients and leave for one hour. Use the resulting product for a bath lasting no more than 15 minutes.

Freshly squeezed celandine juice is effective for plantar psoriasis. The juice diluted in water should be used to wipe psoriatic lesions.

A good remedy is a poultice of clover flowers. Place the flowers of the plant in gauze and put them in boiling water for 1 minute. Then cool them and apply to the foot for no more than two hours.

Homeopathy

Homeopathic remedies for therapy are created taking into account the characteristics 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 agents that have a positive effect on certain systems. Dermatotropic agents include: Acidum nitricum, Calcium carbonicum, Arsenicum iodatum, Kali arsenicosum, Silicea, Sulphur, Sepia, Thuja.

Complex homeopathic preparations Psorihel and Psoriaten ointment are sold without a prescription in pharmacy supermarkets.

In order not to make a mistake in choosing a drug, to select the most effective combinations, it is necessary to consult a homeopathic doctor.

Surgical treatment

Surgeries for plantar psoriasis are very rare. They are performed if conservative treatment has not yielded an effect. Surgical intervention is necessary to remove the affected joint tissues to restore their functionality and fix them in the correct position.

Prevention

Preventive measures consist of following well-known rules:

• daily routine,
• rational nutrition,
• getting rid of bad habits,
• general hardening of the body,
• walks in the fresh air,
• swimming in the sea,
• sunbathing.

There are also special methods that help reduce the manifestations of plantar psoriasis.

During the treatment of pustular plantar psoriasis, it is necessary to use a hydrocolloid coating, which is necessary for healing 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, bath, sauna are excluded. Socks should be made of materials that do not absorb sweat, so as not to cause irritation.

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Forecast

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