Pustular psoriasis

One of the rare forms of endocrine diseases is pustular psoriasis. Consider its features, symptoms, methods of diagnosis, treatment and prevention.

Exudative or pustular psoriasis, according to many scientists, is contact dermatitis of allergic etiology. According to the international classification of diseases of the 10th revision, it belongs to this category:

XII Diseases of the skin and subcutaneous tissue (L00-L99)

Papulosquamous disorders (L40-L45)

• Psoriasis L40

• L40.0 Psoriasis vulgaris
• L40.1 Generalized pustular psoriasis
• L40.2 Acerodermatitis resistant
• L40.3 Pustulosis of the palmar and plantar
• L40.4 Psoriasis teardiform
• L40.5 Arthropathy psoriasis
• L40.8 Other psoriasis
• L40.9 Other specified disorders of psoriasis

In most cases, the defect develops spontaneously or against the background of the use of strong medications. Pathology is included in the category of chronic and incurable, manifested by round eruptions of red or pink with flaking. It can occur on any part of the body, but most often affects the scalp, elbows, knees, palms and soles.

The disease affects people aged 10 to 50 years. Refers to systemic disorders, as it affects not only the skin, but also mucous membranes, nails, musculoskeletal system, hair. The disease is not contagious and is not transmitted by contact, but can be associated with hereditary factors.

[1]

Epidemiology

Psoriasis is a polyethological disease, a huge role in its development is played by genetic predisposition and disorders of the immune system. Epidemiology indicates its widespread prevalence. According to medical statistics, about 3% of people around the world suffer from this defect.

Most often, the disease is diagnosed at a young age, that is, up to 30 years: in women before 16, and in men after 22. Very often it develops in people with diabetes, obesity, hypothyroidism of the thyroid gland. The number of patients is higher among the population with a high atherogenic food profile. That is why psoriasis is rare in countries where a large number of omega-3 polyunsaturated fatty acids (fish, seafood) are consumed, which have an anti-atherogenic effect.

[2], [3], [4], [5]

Causes of the pustular psoriasis

The disease belongs to the most severe pathologies of the epidermis, but the exact causes of pustular psoriasis are unknown. There are many theories about its etiology and pathogenesis. It is associated with genetic factors and a number of other reasons. Consider the main ones:

• Diseases of the endocrine system
• Diseases of the digestive tract
• Nervous overvoltage
• Low blood calcium levels
• Jaundice
• Psychoneurological disorders
• Allergic reactions of various etiologies
• Dysfunction of endocrine glands
• Immune system disorders

To establish the exact cause of the defect and the factors that provoke it, the patient is waiting for a set of various diagnostic studies. The type of treatment and its duration depend on their results.

[6], [7], [8]

Risk factors

Exudative psoriasis is a multifactorial disease. A huge role in its development is played by hereditary predisposition, weakened immune system and metabolic disorders. Exogenous and endogenous risk factors distinguish, we will consider them:

• Hormonal disbalance
• Infectious diseases
• Pregnancy
• The use of strong external drugs
• Nervous Overstresses and Stressful Situations
• Contact with chemicals
• Long-term exposure to ultraviolet radiation
• Unreasonable use of medicines

According to medical statistics, about 40% of cases occur suddenly. But most often the disorder develops due to aggressive therapy of a vulgar form of pathology and other chronic pathological processes in the body.

[9], [10], [11]

Pathogenesis

The mechanism of the disease development is based on the violation of proliferation and differentiation of keratinocytes. Pathogenesis indicates a shortening of the cell cycle and an increased production of keratinocytes. Because of this, the layer of the epidermis thickens and a lot of scales are formed. There are several theories of the origin of pustular psoriasis:

• Hereditary
• Viral
• Neurogenic
• Hypothesis of congenital instability of lysosomes, defects in capillaries of the epidermis, violations of keratinization and lipid metabolism.

Because of hyperproliferation, skin inflammation worsens. In lesions, the cells produce interleukin-1, which is similar to the activation factor of the epidermal T-lymphocytes produced by keratinocytes. Mediators of inflammation can be interleukins and interferons that contribute to the chronicization of the pathological process.

Pathogenesis is directly related to the cause and factors that triggered the disorder. The tactics of treatment depend on it. The course of the disease is significantly aggravated with emotional overstrain, medication, epidermal trauma, streptococcal infections, alcohol abuse and malnutrition.

[12], [13], [14], [15]

Symptoms of the pustular psoriasis

Pustular lesion of the epidermis is observed in 1% of patients with psoriasis and is most often localized in the area of the palms and soles. Symptoms of pustular psoriasis are cyclical and depend on the form of the disease, its type and stage.

• At first, there is hyperemia and inflammation. After this, symmetrical rashes-pustules gradually appear on the skin. The patient complains of itching and burning. Unpleasant symptoms are worse at night and when using household chemicals (soap, shampoo).
• Pustules contain a sterile liquid, some of them merge, forming extensive foci. When the blisters burst, infection of the open wound occurs. Because of this, the disease becomes pimpled.
• Against this background, erythroderma can begin. Some patients have ring-shaped, serpiginating and other types of erythematous-pustular eruptions on the skin and mucous membranes. Dystrophic changes can capture nails, face, scalp, joints and even kidneys.

The disease develops within several months with constant exacerbation of symptoms. During this period, the patient suffers from a general malaise, weakness, chills and fever.

First signs

In its symptoms, the exudative form differs from the clinical picture of a simple type of rash. The first signs are manifested as focal inflammation, itching and burning. Gradually, the papules with a liquid form on the surface of the epidermis, which burst, forming large wound areas. When you try to remove them, a bleeding surface appears, which, when healing, turns into scales.

In the classical manifestation, the disease is characterized by a triad of such signs:

• "Stearin stain" - with a slight scraping of the skin, the peeling increases, which gives the papules the similarity with a drop of stearin.
• "Thermal film" - is formed after removal of the scales, leaving a wet, thin surface.
• "Bloody dew" - appears when the thermal film is damaged. On the skin there are pinpoint drops of blood, caused by traumatism of the full-blooded papillae of the dermis.

The pathological condition is characterized by increased rashes during mechanical or chemical stimulation. The rash appears within two weeks. On the elbows, knees, scalp, it remains for a long period of time, not extending to other areas.

[16], [17], [18], [19], [20]

Stages

Pustular psoriasis has several stages of development, which differ in their symptoms. Consider these:

• Initial - on the body appears a rash, which quickly proliferates. Plaques oval or round and pink in color, covered with whitish scales on top.
• Stationary - comes in 7-21 days after the onset of the pathological process. Plaques of light color, ring-shaped, their surface is covered with silvery scales.
• Decaying - plaques acquire a shade of skin, itching is less intense, around the rash formed a ring of keratinized skin. This period lasts from several months to a year or more.

Depending on the stage of the disease, the nature of the rashes and their localization, a treatment plan is drawn up.

[21], [22], [23], [24]

Forms

Many dermatological diseases have several stages, forms and species. Types of pustular psoriasis depend on the location of rashes and their nature. The disease is divided into two large types: generalized and localized, consider them:

1. Generalized - occurs both in healthy people, and in those who are already ill with other forms of frustration. It is characterized by a sharp formation of erythem with severe itching and burning.

• Tsubmusha - most often occurs in absolutely healthy people. On the body appear erythema - inflamed patches, hot to the touch. Gradually they turn into pustules, which combine with each other, hitting large areas of the body. This species has a recurring character.
• Acerodermatitis Allopo - dermatosis with pustules of unknown origin. The rash is localized in the acral areas, that is, on the soles of the feet and hands. The disease occurs in the form of small rashes with clear boundaries. As the pustules grow, they erupt, forming erosive areas with purulent crusts. The disease is chronic, progressing with scleroderm-like changes and atrophy of the epidermis.
• Herpetiform impetigo - in most cases occurs in pregnant women, less often in children and men. It develops abruptly, rashes - painful pustules, localized in the groin, on the inside of the thigh, in the armpits.

2. Localized (limited) - affects up to 10% of the total surface of the body. Strictly localized on certain parts of the body, for example, on the soles of the feet or palms. It flows more easily than the generalized form.

• Localized form Acrodermatitis Allopo - occurs on the pubic area, can occur with vulgar psoriasis.
• Psoriasis of Barbera is a chronic, recurrent form. It affects the hands and feet. Pustules gradually dry out, forming dense crusts of brown color.

The limited form is treated much easier, for its elimination there are enough local aids. While in the generalized form, the patient will receive a long-term complex therapy with various forms of medicines, diet therapy, and physiotherapy.

Pustular psoriasis of the palms

Exudative rashes on the palms indicate a serious dermatological disease. Pustular psoriasis of the palms is quite common. It can proceed, both locally and in combination with the rashes of other parts of the body, including with joint damage. The peculiarity of this form is that, because of the lack of diagnosis, it is often taken and treated as a fungal disease.

The disease affects people of different ages, but most often occurs in patients 30-50 years of age. It is based on a hereditary predisposition. The provoking factors are regular mechanical or chemical irritation of the hands, prolonged contact with water, various infectious diseases (scarlet fever, sinusitis, tonsillitis), intoxication, endocrine system damage and a number of other factors.

The palmar form of psoriasis has two types:

• Plaque-fan-shaped - a rash of red color, located fan-shaped, distinctly prominent among healthy tissues. Gradually on the papules appear silvery scales that merge into plaques, creating a kind of cracks.
• Horny - characterized by excessive growth of the stratum corneum, that is, the layering of the epidermis on the palms. Plots of stratification are most often located on the lateral surfaces of the palms, can merge with each other.
• Circular - manifested as large foci of peeling in the form of rings and circles.

In the pathological process, nails can be involved. Patients complain of severe itching and burning, which cause insomnia and neuroses. Treatment is long and difficult. Difficulties begin in the process of diagnosis, as the disease must be differentiated with similar pathologies similar in symptomatology.

In the process of therapy, ointments with corticosteroids are used, but the body quickly becomes accustomed to such drugs, making the treatment ineffective. Therefore, patients are assigned a combination of drugs, which include several active components. After the acute period is stopped, patients prescribe drugs to accelerate the regeneration of tissues, that is, the restoration of the skin.

[25]

Pustular psoriasis of soles

Dermatological disease, which is characterized by the formation of pustular pustules on the feet - this is pustular psoriasis soles. The disease is cyclic, the periods of exacerbation often give way to complete remission. Most often it affects people aged 25 to 50 years. Pathology develops due to inflammatory processes in the body, various allergic reactions and intoxication. At risk are smokers and people with chronic alcoholism.

Features:

• The rash affects the vaults of the feet, gradually spreading across their entire surface. On the skin there are small bubbles of yellow color with an inflamed rim, filled with exudate.
• Pustules exfoliate involuntarily, provoking suppuration due to the attachment of microbial infection. Unopened rash dries up, forming brown crusts that peel and form cracks.
• The skin on the affected surfaces is painted in pink, and then in a red-blue color. The patient complains of severe itching and painful sensations due to the fact that the pustules are constantly injured.
• If the defect captures the toes, then the nail plate exfoliates, but the interdigital folds and the skin on the folds of the fingers remain healthy.

Excessive growth of coarse skin on the feet leads to omozolelicity, which is located chaotically. Corns can merge with each other, forming large wound surfaces. But defeat has certain boundaries that separate it from pure skin. Treatment is long, and begins with the removal of foci of infection, the use of corticosteroids and broad-spectrum antibiotics.

Generalized pustular psoriasis

One of the most severe forms of skin pathologies is generalized pustular psoriasis. Rashes affect almost the entire body, including nails, accompanied by itching, burning and pain. The disorder begins abruptly, at the beginning, erythema, that is, psoriatic foci, is formed. Inflamed sites are quite large, rise above healthy tissues and cause burning.

• A large amount of the rash is localized in the perineum, genitals and joints. Against the background of dermatological changes, the general condition of the patient worsens. The temperature rises, there are muscular and joint pains, weakness and malaise. In the blood test, leukocytosis and an increase in ESR values are detected.
• Gradually, inflamed areas appear with vesicles and pustules with pus and exudate. They are formed very quickly, layering and forming wet surfaces and solid brown peels. Such areas are easily traumatized, turning into erosion with a gradual epithelization.

The acute phase lasts from 2 weeks to 2 months. During this period, some crusts dry out, others heal, but the process of formation of new pustules is still ongoing. On the skin there is a bright picture: wet erosion and brownish crusts. During the period of remission, the epidermis is gradually restored, the former areas of the rashes have a bluish-red color.

Pustular psuliasis of Tsumbush

Generalized or pustular zumbusha psoriasis is a serious and dangerous disease. Characterized by a rapid onset: on the skin there are inflamed areas of large sizes, on which pustules with purulent contents gradually appear. The patient has fever, weakness, joint and muscle pain. During the healing on the skin brown crusts are formed, if they are injured, they turn into erosion and ulcers, which do not heal for a long time.

Most rashes in the genital area and skin folds, as well as on the flexural surface of the joints. In some cases, the pathological process captures the mucous membranes, the scalp and the nails. Treatment is long and rather complicated. The patient is waiting for a course of drug therapy, diet therapy and a course of physiotherapy. But even such a comprehensive approach to the problem does not guarantee that it does not recur.

Pustular psoriasis of Barbera

The localized form of eruptions, affecting the palms and soles - this is pustular psoriasis of Barber. Most often, this type of disorder affects women. In the acute period on the skin there are red spots with peeling and clear boundaries. Gradually, pustules form on the rash, which are located in the thickness of the epidermis with sterile contents.

Bubbles are localized on the lateral surface of the feet and hands, under the fingers, and can also hit the nail plate. The disease is long-lasting, flowing undulating and poorly treatable. Very often in the process of diagnosis, he is confused with eczema or fungal infection. To eliminate the acute symptoms of the bacterium is shown a special diet, various topical agents with a softening effect, steroid hormones of temporary action and a number of other drugs.

Complications and consequences

Pustular psoriasis is severe, causing discomfort and pain. Its consequences and complications arise when the medical recommendations are not observed and during the period of exacerbation. Most often, patients face such problems as:

• Malabsorption - a violation of the processes of digestion, absorption of nutrients in the small intestine. It is accompanied by such symptoms: diarrhea, severe weight loss, anemia, hypovitaminosis, electrolyte metabolism disturbance.
• Hypocalcemia is a decrease in the level of ionized calcium in the blood serum. It is manifested by the disorder of electrophysiological processes on cell membranes, proceeds in acute and chronic forms.
• Pyoderma is a purulent lesion of the epidermis due to infection with pyogenic cocci.
• Onycholysis is a pathological disease of the nails, which is characterized by the detachment of the nail plate from the finger tissues.
• Alopecia - full or partial hair loss on the head and body, a violation of the growth of new hair.
• Necrosis of the renal tubules in case of oligemia is a violation of separation of cytoplasmic proteins, which causes destruction of cells. Appears due to the action of pathogens and blood flow disorders.

If a pathological condition occurs with fever and intoxication, then without adequate therapy it quickly passes into an acute form, which threatens a fatal outcome.

[26], [27], [28], [29], [30]

Diagnostics of the pustular psoriasis

Such a dermatological disease as psoriasis has an acute onset and a number of painful symptoms. Diagnosis of pustular psoriasis consists of many different procedures aimed at identifying the cause, the factors that provoked pathology, the establishment of its form and species. The examination begins with a visit to a dermatologist, a visual examination and an anamnesis.

During the diagnosis, the following aspects are taken into account:

• Clinical picture of the disorder.
• Presence of psoriatic triad (phenomenon of stearin stain, terminal film, spot bleeding).
• The phenomenon of Kebner in the progressing stage.

If the picture of the pathological condition is ambiguous, then it is necessary to establish whether there are relatives who suffered from this defect, that is, hereditary predisposition.

[31], [32], [33]

Analyzes

In most cases, psoriatic rashes are identified after visual inspection. Analyzes are prescribed in the case when it is impossible to diagnose by external signs.

Laboratory diagnostics consists of:

• A general blood test is performed to exclude allergic reactions. The appearance of the disease can be associated with leukocytosis and anemia. With extensive lesions, the disorder affects the salt balance of the blood, causing dehydration. During the study, the emphasis is on leukocytes and the rate of erythrocyte sedimentation.
• Biochemical blood test - is necessary to identify possible causes of rashes and plan treatment.
• Urinalysis - assessment of water-salt balance
• Stool analysis - detection of helminth eggs and infectious lesions of the intestine.
• Antibodies to HIV - the human immunodeficiency virus can provoke psoriasis.
• Investigation of rheumatoid factor - the analysis is aimed at identifying the protein that accompanies inflammatory processes. In psoriasis, it should be negative, positive values indicate rheumatoid arthritis.
• Analysis of hepatic enzymes - GTT, AST, APF, ALT.

After the given complex of analyzes, additional researches can be appointed, by their results the doctor makes the plan of treatment.

[34], [35], [36], [37]

Instrumental diagnostics

Examination of psoriasis with the use of various mechanical devices and instruments is an instrumental diagnosis. During the study, the following procedures can be performed:

• Skin biopsy is one of the most accurate methods. The doctor removes damaged tissue (no more than 6 mm) and examines at a microscopic level.
• Radiography is a procedure necessary for the detection of psoriatic arthritis. The doctor examines the joints, determining the degree of damage to bone tissue, since it can occur in any form of psoriasis.

In addition to the two main instrumental methods, the physician can prescribe the histology of the tissues to determine such changes: increased vascularization, absence of a granular layer, thinning of the epidermal growth layer over the elongated layer, and Munro microabscess.

Differential diagnosis

Since psoriasis is similar in its symptoms to many other skin diseases, differential diagnostics is used to detect it. The disease is most often compared with such pathologies:

• Pustular bacterium Andrews - develops against a background of chronic bacterial infections: tonsillitis, dental diseases and gallbladder lesions.
• Red flat lichen - papules have a polygonal shape, an umbilical indentation in the center, a waxy shine and a mesh pattern.
• Syphilis - papular syphilis have a hemispherical shape, copper-red color and arise due to pale treponema.
• Seborrheic dermatitis - does not have a clear infiltration, for differentiation shows the reception of Kartamyshev.
• Atopic dermatitis is a mild erythema with flaking, severe itching, excoriation on the face, neck, elbow and popliteal fossa, upper chest.

If the patient has a localized form, that is, pustular psoriasis of Barber, affecting the palms and soles, this condition is differentiated with dermatophytia of the feet, brushes, and dyshidrotic eczema. The generalized form is compared with bacteremia and sepsis through blood culture. An HIV test is mandatory, since a sudden onset and an acute course can be caused by the human immunodeficiency virus.

[38], [39]

Treatment of the pustular psoriasis

Complete recovery from psoriasis, and especially with its pustular form, is almost impossible. The therapy plan is made by a doctor, individually for each patient. The records take the results of diagnosis, stage of the disease, form and other features of the pathology.

Treatment of pustular psoriasis is a complex of such procedures:

• Drug therapy - the patient is assigned different in form of release and action of medicines. Treatment begins with topical preparations, since their main goal is to clean the skin of pustules, soften it and prevent peeling. Also use means of systemic action: corticosteroids, retinoids, cyclosporins, antibiotics.
• Physiotherapy - the affected areas are irradiated with ultraviolet, combined with the use of tablets, ointments, therapeutic baths and other procedures.
• Sanatorium-and-spa treatment is performed in a state of remission, that is, when the rashes practically disappear. Patients are prescribed such procedures: aerotherapy, balneotherapy, heliotherapy.
• Dietary nutrition is a very important part of the treatment. In the diet of the patient should be products of vegetable origin, fat-free sour-milk products and cereals. During the diet, you must give up sweets, smoked foods, pickles, fatty and roasted. The diet is indicated in both a state of exacerbation and remission.

Regardless of the method of treatment, the whole process is quite lengthy and complex. The success of recovery depends on the unswerving performance of medical evidence.

Medications

Pustular psoriasis is severe, accompanied by extensive skin lesions and worsening of the general condition. Medicines are used at all stages of the disease, to reduce its unpleasant symptoms. In the generalized form, hospitalization is possible. In any case, the patient will have a long and difficult complex therapy.

Medicines for internal use:

1. Antihistamines - used in the acute course of pathology, reduce the intensity of itching and swelling. Helps with a deterioration in overall health (sleep disorders, headaches, irritability), as they have a sedative effect.

• Diazoline

H1-histamine receptor blocker. Has antiallergic, antipruritic, antiexudative and sedative properties. It is used with severe itching, various allergic reactions, eczema, hives, hay fever. It is prescribed for adults and children over 10 years. The daily dosage should not exceed 300 mg, the duration of application is determined by the doctor.

Tablets are contraindicated in case of intolerance of active components, during lactation pregnancy, with gastric ulcer, inflammations in the digestive tract, prostatic hypertrophy and heart rhythm disturbances. With prolonged use, adverse reactions and symptoms of overdose are possible: dry mouth, irritation of the gastric mucosa, dizziness, paresthesia, drowsiness, dysuria, tremor. To eliminate them, you need to stop taking the medicine and see a doctor.

• Suprastin

Drug affecting the peripheral nervous system. It is used for various allergic diseases and reactions. Effectively removes itching, burning and other unpleasant symptoms. Dosage depends on the severity of pathological reactions. As a rule, patients are prescribed 250 mg 2-3 times a day, in especially severe cases, intramuscular injection is indicated.

The main contraindications: glaucoma, pregnancy and lactation, prostatic hypertrophy. Side effects: drowsiness, general weakness. In case of an overdose, nausea, epigastric pain, dizziness occur.

• Claritin

The selective blocker of H1 receptors with the active component is loratadine. It is used for seasonal allergic diseases of various locations (rhinitis, urticaria, dermatitis, eczema). To reduce the painful symptoms, it is recommended to take 0.5-1.5 tablets per day. The main contraindications: intolerance of active substances, breastfeeding and the age of patients younger than 2 years. Use during pregnancy is possible only with acute need.

The main side effects: nausea, vomiting, dry mouth, fatigue, headaches and dizziness, drowsiness. In case of an overdose, the above reactions have a more pronounced effect. To eliminate them, the gastrointestinal tract is shown.

If the disorder is accompanied by severe inflammatory processes, the doctor prescribes desensitizing action preparations for intravenous administration (blocking of H1-histamine receptors and suppression of mediators of allergic reactions). Most often it is calcium chloride or sodium thiosulfate.

2. Hepatoprotectors and enzymes - have immunomodulatory properties, are used in cases of severe inflammation and disruption of the gastrointestinal tract.

• Festal

A drug that facilitates the breakdown and assimilation of foods high in fat, carbohydrates and proteins. It is used for inflammatory processes in the digestive tract, secretory insufficiency, flatulence, insufficiency of digestion. The recommended dosage is 1-3 tablets 2-3 times a day after meals. Contraindicated to use in hepatitis and abrupture of jaundice.

• Lycopid

The immunomodulator with the active substance is glucosaminylmuramyl dipeptide. Stimulates the activity of neutrophils and macrophages, increases cytotoxic and bactericidal activity. It is used for complex treatment of immunodeficient conditions, acute and chronic forms of purulent-inflammatory lesions of the skin and soft tissues, infectious diseases of various locations, chronic viral hepatitis B, C. The drug is intended for oral and sublingual administration. Dosage regimen and duration of therapy is determined depending on the symptoms of the disease, therefore it is individual for each patient.

Contraindicated use when intolerance of active components, malabsorption syndrome, during pregnancy and lactation. It is not prescribed for patients with hyperthermia and with exacerbation of autoimmune thyroiditis. Side effects are manifested in the form of hyperemia and light allergic reactions. Cancellation of the drug is not required.

3. Antibiotics - are necessary in the acute course of the disease, when the pustules are filled with purulent contents, as well as with extensive wetting wounds. Antibiotic drugs are prescribed for the detection of inflammation (tonsillitis, pyelonephritis, sinusitis), supporting the course of the disorder. The choice of drugs depends on the location of pathological eruptions, most often prescribed penicillins, macrolides, cephalosporins.
4. Nonsteroidal anti-inflammatory drugs (NSAIDs) - stop inflammation and reduce pain.

• Ketorol

The drug with analgesic properties with the active component is ketorolac. After ingestion, it has an anti-inflammatory, pronounced analgesic and antipyretic effect. It is used to reduce the pain syndrome of severe or moderate severity caused by any cause. Produced in the form of injections (10-30 mg once) and tablets (4 pieces per day). The course of treatment should not exceed 5 days.

Adverse reactions appear on the part of many organs of the system, but most often the patients encounter such reactions: nausea, vomiting, dizziness, muscle pains and weakness, drowsiness, nervousness, tremor. Contraindications: pregnancy and lactation, age of patients under 16, intolerance of the components of the agent, bronchospasm, erosive and ulcerative pathologies of the digestive system, dehydration, peptic ulcers, hematopoiesis.

• Nurofen

Effective anti-inflammatory, analgesic and antipyretic. It is used for severe pain syndrome, rheumatoid diseases, infectious and inflammatory lesions. Produced in the form of tablets and cream. Tablets take 200-800 mg 3-4 times a day, ointment is applied to the lesion site 2-3 times a day. Side effects occur rarely, manifested by such symptoms: violations of the gastrointestinal tract, swelling, increased blood pressure, bronchospastic and skin allergic reactions. Contraindicated to use in heart failure, ulcerative colitis, ulcerative lesions of the stomach and extensive wound surfaces on the skin.

5. Enterosorbents - are shown for a long duration of the defect. They have a detoxifying effect, absorbing the harmful microflora and the products of its vital activity. Such drugs reduce the risk of allergic reactions in the body, positively affect the immune system. Most often the patient is prescribed: Hemodez, Polysorb, Enterodez.
6. Immunosuppressors - the development of the disease is associated with the defeat of T-lymphocytes, that is, cells of the immune system. To restore them, immunosuppressors are used (Cyclosporin-A, Sandimmun). These drugs have an increased toxicity, so their use is possible only in a hospital.

Medicines of external influence:

1. Corticosteroids - hormonal preparations of external use, are considered the most effective in psoriasis. Quickly remove inflammation, eliminate itching and burning, facilitate overall well-being. Means from this pharmacological group should be used for a short period of time. This is due to the fact that with prolonged application begins atrophy of the skin, appear strias. The drug should be withdrawn gradually, since the opposite effect is possible, when the symptoms of the disease return and manifest much more.

• Elokom

Synthetic topical glucocorticosteroid with the active substance - mometasone furoate. Has anti-inflammatory, vasoconstrictive, antipruritic, antiallergic and antiexudative action. It is used for symptomatic treatment of inflammation, itching and burning with dermatological and allergic diseases, with psoriasis, seborrheic dermatitis, red flat lichen. Ointment is applied a thin layer on the affected skin areas 1 time per day. The duration of treatment depends on the severity of the disease.

It is contraindicated to use with intolerance to the components and with extreme caution for facial treatment. Side effects are manifested in the form of a temporary loss of sensitivity, itching and burning. Also, possible attacks of nausea, dizziness, dry skin, striae. Long-term use causes overdose - skin atrophy, oppression of the pituitary-adrenal system. For treatment, the correction of the water-electrolyte balance is shown.

• Advantan

A local anti-inflammatory drug. It is used for dermatitis, eczema and psoriasis of various etiologies. The agent is applied to the skin 1 time per day, treatment course up to 12 weeks for adults and not more than 4 weeks for children. Contraindicated use when hypersensitivity to active components, viral infections, tuberculosis or syphilis of the skin. Side effects are manifested in the form of hyperemia of the skin, itching and burning at the place of application.

• Lokoid

Medicinal product with hydrocortisone. Used for surface pathological processes in the epidermis without infection. Helps with psoriasis, eczema and dermatitis. The ointment is applied a thin layer to the site of the rash, 1-3 times a day. The remedy can be used for exudative and wet wounds. Effectively dries, cools, moisturizes and disinfects.

Adverse reactions occur rarely and depend on the duration of application. Patients may experience skin irritation, atrophic changes, slow healing of wounds, and changes in pigmentation. It is contraindicated to use with intolerance components of the drug, with fungal, viral and parasitic diseases.

Combined preparations can be used to improve the results of therapy. They include hormones with salicylic acid: Ecolum C, Belosarik or an analogue of vitamin D3 (calcipotriol). Also popular are the ointments Lorinden S and Diprosalik.

2. Non-hormonal anti-inflammatory drugs are used to treat all forms and stages of rashes. Most often, patients are prescribed such ointments: sulfuric, sulfur-tar, dermatol, ichthyol, zinc. They have disinfecting, absorbable, anti-inflammatory and regenerating properties accelerating.

• Tar - the application of ointments with tar allows for a month to completely clean the skin of pustules. In this case, the local application can be combined with tar baths. Tar is a natural remedy for dermatological diseases. It has no contraindications and does not cause adverse reactions. Its only drawback is a sharp smell and increased photosensitivity of the skin with prolonged use.
• Solidol - ointments based on this substance have analgesic, exfoliating, wound-healing, antipruritic, antibacterial, anti-inflammatory properties. The composition of ointments includes not only solidol, but also various vegetable oils, plant extracts, bees honey and wax. This allows us to normalize metabolic processes in cells, improve blood microcirculation.

Also from non-hormonal drugs can be appointed: Tsitopsor, Psorium, ointment Ivanova, Magnipse. To eliminate itching and burning, softening the skin, reducing the number of plaques and pustules, prescribe funds based on urea (has moisturizing properties): Lokopeiz, Mustela, Topek 10. Launched stages are treated with phytopreparations that have restorative and softening properties: Plantozan B, Psorilom, Lomo psoriasis.

3. Keratolitics are a group of substances that accelerate the process of exfoliating dead cells. Their activity is associated with the destruction of the connection between the epidermis and the keratinized cells. Preparations with keratolitics are effective in dermatitis, neurodermatitis, echthyosis, various mycoses and other dermatological diseases.

The most popular and affordable keratolytic is salicylic acid. Also drugs with lactic acid, aromatic retinoids (Isotretinoin, Differin) and glycolic acid can be used. For the treatment of psoriasis, most commonly prescribed drugs are: Baziron AS, Solkoderm, Belosalik, Vipsogal, Lorinden A. They accelerate the healing of damaged skin by softening the flaking plaques. Treatment should not be longer than 20 days, as active components have a cumulative effect and can enter the systemic bloodstream, provoking side effects.

4. Shampoos - this is another type of medicine for psoriasis. They are used for rashes on the scalp. The most commonly used agents with tar (Psoril, Friederm), antifungal and antimicrobial (Nizoral, Skin-Cap). Shampoos stop peeling of the scalp, relieve irritation and itching, accelerate the healing process.

All the above medicines for pustular psoriasis should be used only after consultation and appointment of a dermatologist. Self-medication can aggravate the course of the disease, provoking its aggravation and a number of painful symptoms.

Vitamins

Psoriasis is a chronic disease that substantially exhausts and weakens the protective properties of the immune system. Vitamins are aimed at restoring the normal functioning of the body, alleviating the symptoms of the disease and treating it. Vitamins are taken either inside or outside.

• Vitamin-containing ointments and creams

Such preparations include synthetic analogues of vitamin A, D3, E and others. They have moderately low activity, therefore, in order to achieve a therapeutic effect, long-term use is required from 2-3 months to a year. Most often, patients are prescribed such medicines: Daivonex, Cremegen, Tazorak, Zorak. Their action is aimed at suppressing the active division of epidermal cells, moisturizing the skin, stopping itching and burning.

• Vitamins for oral administration

Useful micronutrients must be obtained with food. For example, vitamin E is an antioxidant that improves skin condition, vitamin A - takes part in the synthesis of proteins and lipids, maintaining normal skin and mucous membranes.

It is also possible to use special vitamin complexes: Aevit (improves lipid metabolism and blood supply of the epidermis), Omega-3 (regulates the exchange of calcium and phosphorus in the body, has anti-inflammatory effect), Hexavit (stimulates regeneration), Undevit (activates metabolic processes in tissues, accelerates healing), Complex (complex of vitamins and minerals for skin and nails), ascorbic acid and others.

Physiotherapeutic treatment

Complex therapy of psoriasis allows to achieve good results in a short time. Physiotherapeutic treatment is aimed at restoring the skin and alleviating the painful symptoms. Physiotherapy is carried out at a stationary stage and during remission, that is, with acute course and the appearance of rashes it is not used.

Consider the most popular and effective methods:

• Ultraviolet irradiation - the affected areas are treated with ultraviolet radiation. This method is well tolerated and allows achieving a stable remission from several months to several years.
• PUVA-therapy - the skin is treated with UV rays and photosensitizers (preparations for oral administration). Improves skin condition and promotes remission. Contraindicated in diabetes mellitus, during pregnancy, intolerance to sunlight, with renal or liver failure. May cause side effects: allergic reactions, headaches, nausea.
• X-ray therapy - the wound areas are treated with X-rays. It has antipruritic, anti-inflammatory properties, accelerates the process of pustules resolution.
• Cryotherapy - reduces the intensity of itching and pain, improves metabolic processes. The skin is treated with a drug mixture, the temperature of which is -160 ° C. To achieve a positive result, 20-25 procedures are needed at a frequency of 1-2 times a day, the duration of one procedure is 2-3 minutes.
• Hirudotherapy - leeches are used for treatment. They improve local blood circulation and normalize immune responses.
• Fish-doctor - this technique is aimed at cleansing the skin from psoriatic rashes. For this, the patient is placed in water with fish, which during the procedure eat up a layer of plaques, eliminating psoriasis.

The application of the above methods depends on the location of the rash, the form of the disease and the general health of the patient.

Alternative treatment

Very often in psoriasis, not only the methods of traditional medicine, but also alternative treatment are used. Consider several effective recipes for minimizing painful symptoms:

• Mix in equal proportions birch tar and any vegetable oil. The resulting mixture must be applied to the wound surfaces 1-3 times a day.
• 50 g of celandine grass, rinse and grind to a cough-like state. The plant is mixed with goose fat and cooked in a water bath for 40-60 minutes. Once the ointment has cooled, it can be treated with rashes, including on the scalp.
• Take 50 g of propolis and 500 g of butter. Propolis chop, melt the butter in a water bath and mix both ingredients. The resulting mixture must be boiled over low heat until obtaining a viscous mass of a uniform consistency. Ointment accelerates the healing of ulcers and erosions.
• 300 grams of milk and 30 grams of flax seeds, crushed leaves of grapes and burdock root mix thoroughly. The mixture must be boiled over low heat for 7-10 minutes. As soon as the broth cools down, it is filtered and used for lotions. Gauze bandages and cotton swabs are applied to the wound, the procedure is carried out 1-2 times a day.

The above-described alternative recipes are effective in many forms of psoriasis, and especially when pustular. But before using them, consult a dermatologist.

[40], [41], [42]

Herbal Treatment

Plant components are part of many effective drugs to eliminate pustules and other rashes. Herbal medicine refers to non-traditional medicine, so it must be agreed with the attending physician.

• Mix 100 g of the turn with the root of valerian, St. John's wort and leaves of celandine for 30 grams each. All components must be poured in 500 ml of boiling water and let it brew for 15 minutes. After cooling, take the medicine for ½ cup 2 times a day.
• 100 g of herb celandine, pour 4 liters of water and cook in a saucepan with the lid closed for 40-60 minutes. The resulting broth filter and add during water procedures. The temperature of the water during bathing should be 38 ° C, the procedure is recommended to be carried out every day for 15-20 minutes.
• Take in equal proportions the root of licorice, celandine and leaves of oregano. Ingredients need to pour 200 ml of boiling water and boil in a water bath for 10-15 minutes. Decoction strain, cool and take no more than 100 ml 2-3 times a day.
• Take in equal proportions celandine, sage, turn, valerian and St. John's wort. 50 grams of herbal collection pour 200 ml of boiling water and let it brew for 15-20 minutes. Once the infusion has cooled, it is worth it to filter and add to the bath while bathing.

The above recipes help to minimize the painful symptoms of the disease, accelerate the healing process and can be used during the remission period.

Homeopathy

For the treatment of psoriasis using a variety of efficacy and the principle of action of the technique. Homeopathy is an alternative medicine. It has a cumulative effect and helps to strengthen the immune system. Consider the popular homeopathic remedies:

• Arsenicum iodateum - is used for large pustules and scales. It removes itching, burning and painful sensations.
• Sepia - the agent is indicated for psoriasis with diaper rash, the formation of areas with altered pigmentation, cracks and skin erosions.
• Arsenicum album - suitable for the treatment of children and elderly patients. Effectively copes with rashes on the scalp, eliminates itching, burning, dry skin. Beneficial effect on the general well-being and the state of the nervous system.
• Sulfur - pustules with purulent contents, itching, burning, frequent relapses of the disease.
• Silicea - is prescribed for patients with sensitive skin type, purulent eruptions, pronounced roughness.

All of the above drugs are used in 3,6,12 and 30-th dilution. The use of homeopathy is possible only after consultation with a homeopath. The doctor selects the most effective means, prescribes its dosage and duration of use.

Prevention

Measures to prevent psoriasis are aimed at reducing the frequency of exacerbations and lengthening remission. Prevention is represented by such recommendations:

• During water procedures, the skin can be cleaned only with soft sponges, and wipe with a soft towel. Be sure to use moisturizers, this will protect the hydrolipid skin of the epidermis.
• Protect the skin from mechanical and chemical damage. To prevent allergic reactions, give preference to clothing and bed linen from natural fabrics.
• In a residential building it is necessary to provide increased humidity. The use of the conditioner is contraindicated, since it causes dry skin.
• Carry out seasonal prevention of colds and infectious diseases. Avoid nerve strains, stress and hypothermia.
• Adhere to dietary nutrition, which implies the rejection of fatty, sweet, salty, smoked, flour. Avoid drinking alcohol and other bad habits.

These preventive recommendations have a beneficial effect not only on the condition of the skin, but also on overall well-being.

[43], [44], [45]

Forecast

Psoriasis is an incurable disease that occurs throughout life. The prognosis depends on its form, stage and features of the patient's body. According to medical statistics, about 17% of patients complain of complications of varying severity, and 2% of cases are fatal.

Pustular psoriasis poses no danger to others, that is, the disease is not transmitted by contact or by airborne droplets. But for a patient, a pathological condition is associated with a high risk of diseases of the cardiovascular system and various inflammatory processes. The disorder has a bad effect on the psychoemotional state, increasing the risk of exacerbation of chronic disorders, the emergence of diabetes, hypertension and even oncology.

[46]