Pustular psoriasis

One of the rare forms of endocrine diseases is pustular psoriasis. Let's consider its features, symptoms, diagnostic methods, treatment and prevention.

Exudative or pustular psoriasis, according to many scientists, is a 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 lesions (L40-L45)

• Psoriasis L40

• L40.0 Psoriasis vulgaris
• L40.1 Generalized pustular psoriasis
• L40.2 Acrodermatitis, persistent
• L40.3 Palmar and plantar pustulosis
• L40.4 Guttate psoriasis
• L40.5 Psoriasis arthropathica
• L40.8 Other psoriasis
• L40.9 Psoriasis, unspecified

In most cases, the defect develops spontaneously or against the background of the use of strong medications. The pathology is classified as chronic and incurable, manifested by round rashes of red or pink color with peeling. 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. It is related to systemic disorders, as it affects not only the skin, but also the mucous membranes, nails, musculoskeletal system, hair. The disease is not contagious and is not transmitted by contact, but can be associated with hereditary factors.

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Epidemiology

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

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

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Causes pustular psoriasis

The disease is one of 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 causes. Let's consider the main ones:

• Diseases of the endocrine system
• Diseases of the digestive tract
• Nervous strain
• 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 will undergo a range of different diagnostic tests. The type of treatment and its duration depend on their results.

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Risk factors

Exudative psoriasis is a multifactorial disease. Hereditary predisposition, weakened immune system and metabolic disorders play a huge role in its development. Exogenous and endogenous risk factors are distinguished, let's consider them:

• Hormonal imbalance
• Infectious diseases
• Pregnancy
• Use of potent topical preparations
• Nervous tension and stressful situations
• Contact with chemicals
• Long-term exposure to ultraviolet radiation
• Irrational use of drugs

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

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Pathogenesis

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

• Hereditary
• Viral
• Neurogenic
• Hypothesis of congenital lysosomal instability, epidermal capillary defects, keratinization disorders and lipid metabolism processes.

Due to hyperproliferation, skin inflammation is exacerbated. In the lesions, cells produce interleukin-1, which is similar to the epidermal T-lymphocyte activation factor produced by keratinocytes. Interleukins and interferons can act as inflammation mediators, contributing to the chronicity of the pathological process.

Pathogenesis is directly related to the cause and factors that provoked the disorder. The treatment tactics depend on it. The course of the disease is significantly aggravated by emotional stress, medication, epidermal trauma, streptococcal infections, alcohol abuse and poor nutrition.

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Symptoms pustular psoriasis

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

• At first, hyperemia and inflammation appear. After this, symmetrical pustule rashes gradually appear on the skin. The patient complains of itching and burning. Unpleasant symptoms intensify at night and when using household chemicals (soap, shampoo).
• Pustules contain sterile fluid, some of which merge, forming large lesions. When the blisters burst, the open wound becomes infected. Because of this, the disease becomes purulent.
• Against this background, erythroderma may begin. Some patients develop ring-shaped, serpiginous and other types of erythematous-pustular rashes on the skin and mucous membranes. Dystrophic changes can affect the nails, face, scalp, joints and even kidneys.

The disease develops over several months with constant exacerbations of symptoms. During this period, the patient suffers from 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 appear as focal inflammation, itching and burning. Gradually, papules with liquid form on the surface of the epidermis, which burst, forming large wound areas. When trying to remove them, a bleeding surface appears, which turns into scales during healing.

In its classic manifestation, the disease is characterized by a triad of the following symptoms:

• "Stearin spot" - when the skin is lightly scraped, peeling increases, which makes the papules look like a drop of stearin.
• "Thermal film" - is formed after the scales are removed, leaving a moist, thin surface.
• "Bloody dew" - appears when the thermal film is damaged. Spots of blood appear on the skin, caused by trauma to the full-blooded papillae of the dermis.

The pathological condition is characterized by an increase in rashes with mechanical or chemical irritation. The rash appears within two weeks. On the elbows, knees, and scalp, it remains for a long period of time, without spreading to other areas.

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Stages

Pustular psoriasis has several stages of development, which differ in their symptoms. Let's consider them:

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

Depending on the stage of the disease, the nature of the rash and its location, a treatment plan is drawn up.

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Forms

Many dermatological diseases have several stages, forms and types. Types of pustular psoriasis depend on the localization of the rash and its nature. The disease is divided into two large types: generalized and localized, let's consider them:

1. Generalized – occurs in both healthy people and those who already suffer from other forms of the disorder. Characterized by the sudden formation of erythema with severe itching and burning.

• Tsubmusha - most often occurs in absolutely healthy people. Erythema appears on the body - inflamed areas that are hot to the touch. Gradually, they turn into pustules that merge with each other, affecting large areas of the body. This type is recurrent.
• Acrodermatitis Hallopeau is a dermatosis with pustules of unclear genesis. 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 open up, forming erosive areas with purulent crusts. The disease is chronic, progressive with scleroderma-like changes and epidermal atrophy.
• Herpetiform impetigo - in most cases occurs in pregnant women, less often in children and men. It develops suddenly, the rash is painful pustules, localized in the groin area, on the inner thigh, in the armpits.

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

• Localized form of Acrodermatitis Hallopeau - occurs in the pubic area, can occur with vulgar psoriasis.
• Barber's psoriasis is a chronic, recurring form. It affects the hands and feet. The pustules gradually dry out, forming dense brown crusts.

The limited type is much easier to treat, and local remedies are sufficient to eliminate it. While with the generalized form, the patient will have to undergo long-term complex therapy with various forms of medication, 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 occur both locally and in combination with rashes on other parts of the body, including joint damage. The peculiarity of this form is that due to the lack of diagnostics, it is very often mistaken and treated as a fungal disease.

The disease affects people of different ages, but most often occurs in patients aged 30-50. It is based on hereditary predisposition. 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.

Palmar psoriasis has two types:

• Plaque-fan-shaped - a red rash, located fan-shaped, clearly standing out among healthy tissues. Gradually, silvery scales appear on the papules, which merge into plaques, creating the appearance of cracks.
• Calloused - characterized by excessive growth of the stratum corneum of the skin, i.e. layering of the epidermis on the palms. The areas of layering are most often located on the lateral surfaces of the palms and can merge with each other.
• Circular - appears as large areas of peeling in the form of rings and circles.

Nails may be involved in the pathological process. Patients complain of severe itching and burning, which cause insomnia and neuroses. Treatment is long and difficult. Difficulties begin in the diagnostic process, since the disease must be differentiated from pathologies with similar symptoms.

During therapy, ointments with corticosteroids are used, but the body quickly gets used to such drugs, making the treatment ineffective. Therefore, patients are prescribed combined action drugs, which include several active components. After the acute period has been stopped, patients are prescribed drugs to accelerate tissue regeneration, that is, skin restoration.

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Pustular psoriasis of the soles

A dermatological disease characterized by the formation of pustular pustules on the feet is pustular psoriasis of the soles. The disease is cyclical, periods of exacerbation are often replaced by complete remission. Most often, people aged 25 to 50 years suffer from it. The pathology develops due to inflammatory processes in the body, various allergic reactions and intoxication. Smokers and people with chronic alcoholism are at risk.

Peculiarities:

• The rash affects the arches of the feet, gradually spreading over their entire surface. Small yellow blisters with an inflamed rim, filled with exudate, appear on the skin.
• Pustules peel off spontaneously, causing suppuration due to the addition of a microbial infection. Unopened rash dries up, forming brown crusts that peel and form cracks.
• The skin on the affected surfaces turns pink, then red-blue. The patient complains of severe itching and pain due to the pustules being constantly injured.
• If the defect affects the toes, the nail plate peels off, but the interdigital folds and the skin on the bends of the toes remain healthy.

Excessive growth of rough skin on the feet leads to callus, which is located chaotically. Calluses can merge with each other, forming large wound surfaces. But the lesion has certain boundaries that separate it from clean skin. Treatment is long-term, and begins with the removal of foci of infection, taking corticosteroids and broad-spectrum antibiotics.

Generalized pustular psoriasis

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

• A large amount of 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, muscle and joint pain, weakness and malaise occur. A blood test reveals leukocytosis and an increase in ESR values.
• Gradually, vesicles and pustules with pus and exudate appear on the inflamed areas. They form very quickly, layering and forming wet surfaces and solid brown crusts. Such areas are easily injured, turning into erosions with gradual epithelialization.

The acute phase lasts from 2 weeks to 2 months. During this period, some crusts dry up, others heal, but the process of formation of new pustules still continues. A vivid picture occurs on the skin: wet erosions and brownish crusts. During the remission period, the epidermis gradually recovers, the former areas of rashes have a bluish-red color.

Pustular psoriasis of Zumbusch

Generalized or pustular psoriasis of Zumbusch is a severe and dangerous disease. It is characterized by a rapid onset: large inflamed areas appear on the skin, on which pustules with purulent contents gradually appear. The patient's temperature rises, weakness appears, pain in the joints and muscles. During the healing process, brown crusts form on the skin, if they are injured, they turn into erosions and ulcers that do not heal for a long time.

Most of the rashes are in the genital area and skin folds, as well as on the flexor surface of the joints. In some cases, the pathological process affects the mucous membranes, scalp and nails. The treatment is long and quite complicated. The patient will undergo 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 will not recur.

Barber's pustular psoriasis

A localized form of rashes affecting the palms and soles is Barber's pustular psoriasis. Women most often suffer from this type of disorder. In the acute period, red spots with peeling and clear boundaries appear on the skin. Gradually, pustules form on the rash, which are located in the thickness of the epidermis with sterile contents.

The blisters are localized on the lateral surface of the feet and hands, under the fingers, and can also affect the nail plate. The disease is long-term, has a wave-like course and is difficult to treat. Very often, during the diagnostic process, it is confused with eczema or a fungal infection. To eliminate the acute symptoms of the bacterid, a special diet is indicated, various topical agents with a softening effect, temporary steroid hormones and a number of other drugs.

Complications and consequences

Pustular psoriasis is severe, causing discomfort and pain. Its consequences and complications arise when doctor's recommendations are not followed and during exacerbations. Most often, patients face problems such as:

• Malabsorption is a disorder of the digestion and absorption of nutrients in the small intestine. It is accompanied by the following symptoms: diarrhea, sudden weight loss, anemia, hypovitaminosis, and electrolyte imbalance.
• Hypocalcemia is a decrease in the level of ionized calcium in the blood serum. It manifests itself as a disorder of electrophysiological processes on cell membranes, and occurs 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 separation of the nail plate from the tissues of the finger.
• Alopecia is a complete or partial loss of hair on the head and body, and a disruption in the growth of new hair.
• Necrosis of the renal tubules in case of oligemia is a violation of the division of cytoplasmic proteins, causing the destruction of cells. It appears due to the action of pathogenic microorganisms and when the blood supply is disrupted.

If the pathological condition occurs with fever and intoxication, then without appropriate therapy it quickly becomes acute, which can be fatal.

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Diagnostics 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, factors that provoked the pathology, establishing its form and type. The examination begins with a visit to a dermatologist, a visual examination and anamnesis collection.

When making a diagnosis, the following aspects are taken into account:

• Clinical picture of the disorder.
• The presence of the psoriatic triad (the phenomenon of stearin spot, terminal film, pinpoint bleeding).
• Koebner phenomenon in the progressive 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, a hereditary predisposition.

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Tests

In most cases, psoriatic lesions are identified after a visual examination. Tests are prescribed when it is impossible to make a diagnosis based on external signs.

Laboratory diagnostics consists of:

• General blood test – is performed to exclude allergic reactions. The onset of the disease may 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 – necessary to identify possible causes of rashes and develop a treatment plan.
• Urine analysis – assessment of water-salt balance
• Stool analysis – detection of helminth eggs and infectious intestinal lesions.
• Antibodies to HIV – human immunodeficiency virus can trigger psoriasis.
• Rheumatoid factor test – 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 liver enzymes – GTT, AST, ALP, ALT.

After this set of tests, additional studies may be prescribed, and based on their results, the doctor will draw up a treatment plan.

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Instrumental diagnostics

Examination of psoriasis using various mechanical devices and instruments is instrumental diagnostics. During the examination, the following procedures can be carried out:

• Skin biopsy is one of the most accurate methods. The doctor takes a sample of damaged tissue (no more than 6 mm) and examines it at a microscopic level.
• X-ray is a procedure necessary to detect psoriatic arthritis. The doctor examines the joints, determining the degree of damage to bone tissue, as it can occur with any form of psoriasis.

In addition to the two main instrumental methods, the doctor may prescribe tissue histology to determine the following changes: increased vascularization, absence of the granular layer, thinning of the germinal layer of the epidermis over the elongated ones, Munro microabscesses.

Differential diagnosis

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

• Andrews pustular bacterid develops against the background of chronic bacterial infections: tonsillitis, dental diseases and gallbladder lesions.
• Lichen planus - papules have a polygonal shape, an umbilicated depression in the center, a waxy sheen and a mesh pattern.
• Syphilis - papular syphilides have a hemispherical shape, copper-red color and arise due to pale treponema.
• Seborrheic dermatitis does not have clear infiltration; Kartamyshev’s method is indicated for differentiation.
• Atopic dermatitis is a dull erythema with flaking, severe itching, excoriations on the face, neck, elbows and popliteal fossa, and upper chest.

If the patient has a localized form, i.e. Barber's pustular psoriasis affecting the palms and soles, then this condition is differentiated from dermatophytosis of the feet, hands, 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 acute course can be caused by the human immunodeficiency virus.

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Treatment pustular psoriasis

Complete recovery from psoriasis, especially in its pustular form, is almost impossible. The treatment plan is made by a doctor, individually for each patient. The results of diagnostics, the stage of the disease, the form and other features of the pathology are taken into account.

Treatment of pustular psoriasis is a complex of the following procedures:

• Drug therapy – the patient is prescribed medications of various forms of release and action. Treatment begins with topical preparations, since their main goal is to clear the skin of pustules, soften it and prevent peeling. Systemic agents are also used: corticosteroids, retinoids, cyclosporines, antibiotics.
• Physiotherapy – the affected areas are irradiated with ultraviolet light, in combination with the use of tablets, ointments, medicinal baths and other procedures.
• Sanatorium and resort treatment is carried out in a state of remission, that is, when the rashes practically disappear. Patients are prescribed the following procedures: aerotherapy, balneotherapy, heliotherapy.
• Dietary nutrition is a very important part of treatment. The patient's diet should include plant-based products, low-fat dairy products and cereals. During the diet, it is necessary to give up sweets, smoked products, pickles, fatty and fried foods. The diet is indicated both in the state of exacerbation and remission.

Regardless of the treatment method, the entire process is quite long and complicated. Successful recovery depends on strict adherence to medical instructions.

Medicines

Pustular psoriasis is severe, accompanied by extensive skin lesions and deterioration 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 to undergo long-term and difficult complex therapy.

Medicines for internal use:

1. Antihistamines are used in acute cases of pathology, reduce the intensity of itching and swelling. They help with deterioration of general well-being (sleep disorders, headaches, irritability), as they have a sedative effect.

• Diazolin

H1-histamine receptor blocker. Has antiallergic, antipruritic, antiexudative and sedative properties. Used for severe skin itching, various allergic reactions, eczema, urticaria, hay fever. Prescribed for adults and children over 10 years old. The daily dosage should not exceed 300 mg, the duration of use is determined by the doctor.

The tablets are contraindicated in case of intolerance to the active components, during pregnancy and lactation, gastric ulcer, inflammation in the gastrointestinal tract, prostatic hypertrophy and heart rhythm disturbances. With prolonged use, side effects and overdose symptoms 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 consult a doctor.

• Suprastin

A drug that affects the peripheral nervous system. It is used for various allergic diseases and reactions. Effectively relieves itching, burning and other unpleasant symptoms. The 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 administration of the drug is indicated.

Main contraindications: glaucoma, pregnancy and lactation, prostatic hypertrophy. Side effects: drowsiness, general weakness. In case of overdose, nausea, epigastric pain, dizziness appear.

• Claritin

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

Main side effects: nausea, vomiting, dry mouth, increased fatigue, headaches and dizziness, drowsiness. In case of overdose, the above reactions have a more pronounced effect. To eliminate them, gastrointestinal lavage is indicated.

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

2. Hepatoprotectors and enzymes have immunomodulatory properties and are used in cases of severe inflammation and gastrointestinal tract dysfunction.

• Festal

A medicine that promotes the breakdown and absorption of foods high in fat, carbohydrates and proteins. It is used for inflammatory processes in the gastrointestinal tract, secretory insufficiency, flatulence, and indigestion. The recommended dosage is 1-3 pills 2-3 times a day after meals. Contraindicated for use in hepatitis and abstructive jaundice.

• Lycopid

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

Contraindicated for use in case of intolerance to active components, malabsorption syndrome, during pregnancy and lactation. Not prescribed for patients with hyperthermia and exacerbation of autoimmune thyroiditis. Side effects are manifested in the form of hyperemia and mild allergic reactions. No need to discontinue the drug.

3. Antibiotics are necessary in the acute course of the disease, when the pustules are filled with purulent contents, as well as in case of extensive weeping wounds. Antibiotics are prescribed when inflammation is detected (tonsillitis, pyelonephritis, sinusitis), which supports the course of the disorder. The choice of drugs depends on the localization of pathological rashes, penicillins, macrolides, cephalosporins are most often prescribed.
4. Nonsteroidal anti-inflammatory drugs (NSAIDs) – relieve inflammation and reduce pain.

• Ketorol

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

Side effects are manifested by many organ systems, but most often patients experience the following reactions: nausea, vomiting, dizziness, muscle pain and weakness, drowsiness, nervousness, tremor. Contraindications: pregnancy and lactation, patients under 16 years of age, intolerance to the components of the drug, bronchospasms, erosive and ulcerative pathologies of the digestive system, dehydration, peptic ulcers, hematopoiesis disorders.

• Nurofen

An effective anti-inflammatory, analgesic and antipyretic agent. It is used for severe pain syndrome, rheumatoid diseases, infectious and inflammatory lesions. It is available in the form of tablets and cream. Tablets are taken 200-800 mg 3-4 times a day, the ointment is applied to the affected area 2-3 times a day. Side effects are rare, and are manifested by the following symptoms: gastrointestinal disorders, swelling, increased blood pressure, bronchospastic and skin allergic reactions. Contraindicated for use in heart failure, ulcerative colitis, ulcerative lesions of the stomach and extensive wound surfaces on the skin.

5. Enterosorbents are indicated for long-term defects. They have a detoxifying effect, absorbing harmful microflora and its waste products. Such drugs reduce the risk of allergic reactions in the body and have a positive effect on the immune system. Most often, patients are prescribed: Hemodez, Polysorb, Enterodez.
6. Immunosuppressants – the development of the disease is associated with damage to T-lymphocytes, i.e. cells of the immune system. Immunosuppressants (Cyclosporin-A, Sandimmune) are used to restore them. These drugs have increased toxicity, so their use is possible only in a hospital setting.

Externally acting medicines:

1. Corticosteroids are hormonal drugs for external use, considered the most effective for psoriasis. They quickly relieve inflammation, eliminate itching and burning, and improve overall well-being. Products from this pharmacological group must be used for a short period of time. This is due to the fact that with prolonged application, skin atrophy begins, and stretch marks appear. The drug should be discontinued gradually, since the opposite effect is possible, when the signs of the disease return and are much stronger.

• Elokom

Synthetic topical glucocorticosteroid with the active substance mometasone furoate. It has anti-inflammatory, vasoconstrictive, antipruritic, antiallergic and antiexudative effects. It is used for the symptomatic treatment of inflammation, itching and burning in dermatological and allergic diseases, psoriasis, seborrheic dermatitis, lichen planus. The ointment is applied in a thin layer to the affected areas of the skin once a day. The duration of treatment depends on the severity of the disease.

Contraindicated for use in case of intolerance to the components and with special caution for face treatment. Side effects are manifested in the form of temporary loss of sensitivity, itching and burning. Attacks of nausea, dizziness, dry skin, striae are also possible. Long-term use causes an overdose - skin atrophy, suppression of the pituitary-adrenal system. Correction of water-electrolyte balance is indicated for treatment.

• Advantan

Local anti-inflammatory agent. It is used for dermatitis, eczema and psoriasis of various etiologies. The product is applied to the skin once a day, the course of treatment is up to 12 weeks for adults and no more than 4 weeks for children. Contraindicated for use in case of 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 site of application.

• Locoid

A medicinal product with hydrocortisone. It is used for superficial pathological processes in the epidermis without infection. It helps with psoriasis, eczema and dermatitis. The ointment is applied in a thin layer to the site of the rash, 1-3 times a day. The product can be used for exudative and weeping wounds. Effectively dries, cools, moisturizes and disinfects.

Side effects are rare and depend on the duration of use. Patients may experience skin irritation, atrophic changes, slow wound healing and pigmentation changes. Contraindicated in case of intolerance to the components of the product, fungal, viral and parasitic diseases.

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

2. Non-hormonal anti-inflammatory agents are used to treat all forms and stages of rashes. Most often, patients are prescribed the following ointments: sulfur, sulfur-tar, dermatol, ichthyol, zinc. They have disinfectant, resolving, anti-inflammatory and regeneration-accelerating properties.

• Tar - the use of ointments with tar allows you to completely clear the skin of pustules within a month. Local application can be combined with tar baths. Tar is a natural remedy for dermatological diseases. It has no contraindications and does not cause side effects. Its only drawback is a strong odor 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 ointments contain not only solidol, but also various vegetable oils, plant extracts, bee honey and wax. This allows you to normalize metabolic processes in cells, improve blood microcirculation.

Also, non-hormonal drugs can be prescribed: Tsitopsor, Psorium, Ivanov's ointment, Magnipsor. To eliminate itching and burning, soften the skin, reduce the number of plaques and pustules, urea-based products are prescribed (it has moisturizing properties): Lokopeiz, Mustela, Topic 10. Advanced stages are treated with herbal preparations that have restorative and softening properties: Plantozan B, Psorilom, Lomo psoriasis.

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

The most popular and affordable keratolytic is salicylic acid. Medicines with lactic acid, aromatic retinoids (Isotretinoin, Differin) and glycolic acid can also be used. For the treatment of psoriasis, the following drugs are most often prescribed: Baziron AC, Solcoderm, Belosalik, Vipsogal, Lorinden A. They accelerate the healing of damaged skin by softening flaky plaques. Treatment should not last longer than 20 days, since the active components have a cumulative effect and can penetrate the systemic bloodstream, causing side effects.

4. Shampoos are another type of psoriasis medication. They are used for rashes on the scalp. Most often, tar-based products (Psorilom, Friderm), antifungal and antimicrobial (Nizoral, Skin-Cap) are used. Shampoos stop scalp flaking, relieve irritation and itching, and speed up the healing process.

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

Vitamins

Psoriasis is a chronic disease that significantly 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 its treatment. Vitamins are taken both internally and externally.

• Vitamin-containing ointments and creams

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

• Vitamins for oral administration

Useful microelements must be obtained from food. For example, vitamin E is an antioxidant that improves the condition of the skin, vitamin A is involved in the synthesis of proteins and lipids, maintaining the normal condition of the skin and mucous membranes.

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

Physiotherapy treatment

Complex therapy of psoriasis allows achieving good results in a short time. Physiotherapeutic treatment is aimed at restoring the skin and alleviating painful symptoms. Physiotherapy is carried out at the inpatient stage and during remission, that is, it is not used in acute cases and when rashes appear.

Let's look at the most popular and effective methods:

• Ultraviolet irradiation – the affected areas are treated with ultraviolet waves. This method is well tolerated and allows for stable remission from several months to several years.
• PUVA therapy – the skin is treated with UV rays and photosensitizers (oral medications). Improves skin condition and promotes remission. Contraindicated in diabetes, pregnancy, intolerance to solar radiation, renal or hepatic insufficiency. 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 pustule resolution.
• Cryotherapy – reduces the intensity of itching and pain, improves metabolic processes. The skin is treated with a medicinal mixture, the temperature of which is -160°C. To achieve a positive result, 20-25 procedures are required with 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 reactions.
• Doctor fish – this method is aimed at cleansing the skin from psoriatic rashes. For this, the patient is placed in water with fish, which during the procedure eat a layer of plaques, eliminating psoriasis.

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

Folk remedies

Very often, not only traditional medicine methods are used for psoriasis, but also folk treatment. Let's consider several effective recipes for minimizing painful symptoms:

• Mix equal parts birch tar and any vegetable oil. The resulting mixture should be applied to the wound surfaces 1-3 times a day.
• Wash 50 g of celandine and grind it to a mushy consistency. Mix the plant with goose fat and boil in a water bath for 40-60 minutes. Once the ointment has cooled, it can be used to treat rashes, including those on the scalp.
• Take 50 g of propolis and 500 g of butter. Grind the propolis, melt the butter in a water bath and mix both ingredients. The resulting mixture should be boiled over low heat until a viscous mass of uniform consistency is obtained. The ointment accelerates the healing of ulcers and erosions.
• Mix 300 g of milk and 30 g of flax seeds, crushed grape leaves and burdock root thoroughly. Boil the mixture over low heat for 7-10 minutes. Once the decoction has cooled, strain it and use it for compresses. Apply gauze bandages and cotton swabs to the wounds, the procedure is carried out 1-2 times a day.

The above folk recipes are effective for many forms of psoriasis, especially pustular. But before using them, you should consult a dermatologist.

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Herbal treatment

Herbal components are included in many effective preparations for eliminating pustules and other rashes. Herbal treatment is considered alternative medicine, so it should be agreed with the attending physician.

• Mix 100 g of succession with valerian root, St. John's wort and celandine leaves, 30 g each. Pour 500 ml of boiling water over all the ingredients and let it brew for 15 minutes. After cooling, take the medicine ½ cup 2 times a day.
• Pour 100 g of celandine herb into 4 liters of water and boil in a saucepan with a closed lid for 40-60 minutes. Strain the resulting decoction and add it during water procedures. The water temperature during bathing should be 38 ° C, it is recommended to carry out procedures every day for 15-20 minutes.
• Take equal proportions of licorice root, celandine and oregano leaves. Pour 200 ml of boiling water over the ingredients and simmer in a water bath for 10-15 minutes. Strain the decoction, cool and take no more than 100 ml 2-3 times a day.
• Take equal proportions of celandine, sage, succession, valerian and St. John's wort. Pour 200 ml of boiling water over 50 g of the herbal mixture and let it brew for 15-20 minutes. As soon as the infusion cools down, it should be strained and added to the bath during bathing.

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

Homeopathy

To treat psoriasis, methods are used that vary in effectiveness and principle of action. Homeopathy is an alternative medicine. It has a cumulative effect and helps strengthen the immune system. Let's look at popular homeopathic remedies:

• Arsenicum iodatum – used for large pustules and scales. Relieves itching, burning and pain.
• Sepia is a remedy indicated for psoriasis with diaper rash, the formation of areas with altered pigmentation, cracks and erosions of the skin.
• Arsenicum album - suitable for treating children and elderly patients. Effectively copes with rashes on the scalp, eliminates itching, burning, dry skin. Beneficial effect on 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, purulent rashes, and pronounced roughness.

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

Prevention

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

• During water procedures, the skin can be cleaned only with soft sponges, and dried with a soft towel. Be sure to use moisturizers, this will protect the hydrolipidic shell of the epidermis.
• Protect your skin from mechanical and chemical damage. To prevent allergic reactions, give preference to clothes and bed linen made of natural fabrics.
• In the living space it is necessary to provide increased air humidity. The use of air conditioning is contraindicated, as it causes dry skin.
• Conduct seasonal prevention of colds and infectious diseases. Avoid nervous tension, stress and hypothermia.
• Stick to a dietary diet, which means giving up fatty, sweet, salty, smoked, and floury foods. Eliminate 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.

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Forecast

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

Pustular psoriasis does not pose a danger to others, that is, the disease is not transmitted by contact or airborne droplets. But for the patient, the pathological condition is associated with a high risk of cardiovascular diseases and various inflammatory processes. The disorder has a negative effect on the psycho-emotional state, increasing the risk of exacerbation of chronic disorders, the appearance of diabetes, hypertension and even oncology.

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