Psoriasis spots: red, white, pigmented

Spots in psoriasis - papulosquamous skin disease - can vary in their morphology, distribution and severity. But with any kind of this chronic dermatosis, its first signs appear as eruptions in the form of spots.

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Causes of the spots with psoriasis

While the key reasons for the formation of spots in psoriasis have not been finally established, in modern dermatology, they adhere to the most convincing version - the autoimmune nature of hyperproliferation and abnormal differentiation of keratin skin cells. This is confirmed not only by the presence of psoriasis in family history, but also by the revealed links of disorders in this pathology with the aberrations of the genetic loci PSORS on 12 chromosomes.

Thus, the strongest correlation was established for the PSORS-1 locus on the short arm of chromosome 6 in the 6p21.3 region where the genes encoding proteins that control the response of immune system cells to foreign genes and provide the functions of human leukocyte antigen (HLA) are concentrated.

The most important function of the human skin is immune, therefore, as a result of genetic factors, a hypertrophied reaction of local immunity develops, which manifests itself in the form of spots in psoriasis. Local protective reaction begins with the synthesis of T- and B-lymphocytes, macrophages, mast cells, neutrophils, histiocytes, basophils of the complex of cytokines-mediators of inflammation: prostaglandins (E1, E2, T2a); interleukins IL-5, IL-6, IL-8; leukotrienes; tumor necrosis factor alpha (TNFα), which stimulates the formation of an inflammatory focus; transforming growth factor alpha (TGFα), etc.

In addition, the keratinocytes themselves, when activated in the cytokine-activated intracellular autoimmune process, begin to synthesize interleukin-initiating enhanced cell growth (IL-1α and IL-1β); increasing the rate of protein synthesis epidermal growth factor (EGF); promoting cell proliferation of nerve growth factor (NGF).

As a result, all this multiplies the expression of basal keratinocytes and the rate of their migration into the upper layers of the epidermis, which violates the physiological process of keratinization (keratinization) in certain areas of the skin. This is the pathogenesis of the appearance of spots in psoriasis - localized thickening of the stratum corneum. Its lamellar delamination (desquamation) on the surface of the rash is due to the accelerated keratinocyte keratinocytes. And as a result of activation of the endings of sensitive nerve C-fibers of the skin, the production of neuropeptides, substance P and vasodilating calcitonin polypeptide CGRP, which cause persistent hyperemia of the rash - red spots in psoriasis, is increased.

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Symptoms

The spots in psoriasis have several modifications and their corresponding symptoms. With the most common vulgar psoriasis, the spots look like plaques that first appear as flat, clearly delimited erythematous maculae - round-oval, diameter less than 1 cm - or dense red papules that just rise above the healthy skin. Usually they appear on elbows, knees, lower back and on the head (on the scalp), and then on any other parts of the body, but almost always symmetrically.

Increasing in size at the advanced stage of the disease, these red spots in psoriasis can merge with the formation of plaques up to several centimeters in diameter. Some red spots are fringed by the "halo" of pale skin (Voronov's ring). The etiology of this symptom is seen by dermatologists in the release into the blood of substances that inhibit the increase in the level of prostaglandins that extend the capillaries of the skin. However, when the disease progresses, the surrounding papules of the ring have a pink color and are the boundary of the zone of the inflammatory process.

Pretty soon the spots become denser and more embossed, and their top is covered with silver-white scales (keratinized skin cells, similar in appearance to those of stearin). And such a plaque - stearin stain with psoriasis - a characteristic sign of the disease. In other ways, as well as the next symptom, which is to intensify desquamation after trying to scrape the scales with a fingernail. Moreover, under the scraped, horny skin cells, the patient sees a damp, bright, borderline (terminal) film of intensely pink color - a modified epidermal structure. And here is another symptom of spots in psoriasis - a symptom of Auspitz in the form of protruding small drops of blood.

The appearance of the spots varies depending on the stage of psoriasis, and during the regression of the disease, the plaques decrease, turn pale, become flat and cease to peel. At this stage, either discolored, almost white spots appear after the psoriasis (due to the lack of melanin pigment in the damaged epidermal autoimmune process), or darker pigment spots after psoriasis. In the latter case, the cause may be associated with a more active state of melanocytes (skin cells that produce pigment) in individual patients, as well as with higher levels of pituitary melanocortin (MSH) and adrenocorticotropic hormone (ACTH).

Diagnostics of the spots with psoriasis

In addition to typical spots in psoriasis, rashes may have other morphological subtypes:

• very small, hyperemic papules, characteristic of psoriasis;
• rash in the form of small (2-10 mm) nodules with a drop-shaped form of the disease (most characteristic of children);
• spots in the form of rings with intact skin inside them (ring-shaped psoriasis, in most cases occurs in pediatric practice);
• red-orange spots, not covered with scales, but dense yellow-colored multilayered crusts, under which the wet skin is exposed, occur in so-called exudative psoriasis;
• cone-shaped patches-plaques of 2-5 cm on the hands and feet (in the area of the edema of the skin near the joints) with strongly pronounced hyperkeratosis, resembling oyster shells, can be called rupioid psoriasis;
• if small red pustules appear on the red psoriatic spot localized on the palms of the hands or soles of the soles, which dry up to purulent crusts; the skin is painful, and the inflamed place causes a burning sensation, then experts diagnose the pustular form of psoriasis. And with the expansion of the affected area and fever, it may be a generalized pustular psoriasis.

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Differential diagnosis

How is the diagnosis of psoriasis, and what is the need for differential diagnosis - for more details see the publication of vulgar psoriasis

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Treatment of the spots with psoriasis

Since systemic therapy of psoriasis is currently limited to the long-term administration of only a few drugs with serious side effects (discussed below), the treatment of psoriasis spots by external means, that is, the symptomatic treatment of psoriasis is the most commonly used tactic for managing patients with this diagnosis.

We offer a detailed publication - Psoriasis, in which you will find a description of therapeutic techniques, including physiotherapeutic treatment of psoriasis.

What you need and can be used externally to reduce spots in psoriasis, detailed in articles - Creams for psoriasis and non-hormonal ointments for psoriasis

And if the local treatment does not improve the skin condition, then in the arsenal of dermatologists there are such medicines as Methotrexate, Cyclosporine and Acitretinum.

Methotrexate is an anti-metabolite that suppresses the immune system, which can be prescribed (orally or by injection once a week) to adults with severe forms of psoriasis or psoriatic arthritis. This drug helps to reduce the symptoms of psoriasis in five to six weeks from the start of use, but some have to take Methotrexate for half a year. Among the side effects of this remedy are nausea, fatigue, headaches, increased sensitivity to sunlight. In addition, there is a significant risk of liver damage in patients taking Methotrexate, and approximately one in two hundred patients develop cirrhosis.

Ciclosporin belongs to the drugs-immunosuppressants and inhibits the activity of immune cells, slowing the proliferation of keratinocytes. Typically, the drug provides some relief for several weeks and reaches a stable level of control of the rashes within three to four months. However, the use of Cyclosporine may increase the risk of developing renal dysfunction, skin cancer and other severe pathologies.

A drug Acitretinum (another trade name is Neotigazone) is a retinoid, a vitamin A derivative, which is ingested one capsule daily for two to four months. Possible side effects are expressed in the form of hypervitaminosis A (increased brittleness of the nails, hair loss, skin peeling on the whole body, muscle and joint pain, increased calcium content in the blood, etc.).

As an alternative, other retinoid drugs are recommended - Isotretinoin (Accutane, Roaccutane) or Etretinat (Tigazon). The standard daily dose is 0.1 mg per each kg of body weight; the maximum duration of admission is 4 months (with a two-month break before the next course of treatment). Retinoids, like other systemic drugs used in the treatment of psoriasis, are absolutely contraindicated in pregnancy and lactation.

If you are interested in alternative treatment of spots in psoriasis, read the material - Treatment of psoriasis in the home

And also learn about what can be the prevention of psoriasis