The way psoriasis manifests itself depends on the stage of the development of the disease. In clinical dermatology, there are three main stages of psoriasis: progressive, stationary and regressive. Although some share the course of psoriasis in four stages - with the allocation of the initial or early stage.
Progressing stage of psoriasis
The progressing stage of psoriasis only at the first manifestation of the symptoms of this chronic disease can be defined as the initial stage of psoriasis, since only the stage of progression is repeated in the psoriatic cycle.
At the initial stage, the main symptom of ordinary plaque psoriasis (which is diagnosed in more than 80% of cases) are red or intensely pink papular patches of rounded shape on the elbows and knees, as well as on the skin of the lumbar region and the scalp - in the form of small thickened plaques, which are squamous, that is, covered with scales (dry silvery-white plates of keratinized epidermis). Often the erythematous elevations are framed by a narrow dark red border (a whisk of growth), behind which the skin is perfectly healthy.
In addition to the itching of different intensity, the rashes that show the initial stage of psoriasis have three characteristic features. Specialists call them psoriatic triad. First, the horny platelets are easily slouched, if the plaque is slightly scraped (this dermatologists call the symptom of the stearin stain).
Secondly, after the forced desquamation on the plaque, a thin, shiny layer resembling a film is clearly visible. For medical professionals this feature is called a terminal (borderline) film. Studies have shown that this is evidence of a significant decrease or absence of a granular layer of the epidermis.
And, finally, the last sign: a dotted appearance of blood ("bloody dew") on the film of the psoriatic plaque with further mechanical action.
The initial stage has a different duration, and the further course of the disease may for a time slow down at the level of the initial rash and the presence of so-called "on-call" plaques. And the progressing stage of psoriasis can continue - with the increase in the size of existing plaques, the appearance of new spots around the body and their fusion. When the rashes are solid and cover large areas of the skin, we are talking about psoriatic erythroderma.
Stationary stage of psoriasis
The stage of the development of the disease, on which the appearance of new spots stops, old plaques do not increase in size and become flatter and pale (with a cyanotic shade), is defined as a stationary stage of psoriasis.
But the intensity of desquamation is greatly increased. At the same time, if at the initial stage of the disease the peeling was concentrated in the center of the plaques, then at the stationary stage the entire keratin surface is covered with a layer of keratinized keratinized particles.
Also, many patients have such a sign as a pseudoatrophic corolla - a slight lightening of the skin around the plaque.
The duration of this stage is different for different patients, but even if there are not enough new rashes for a long time, this does not mean that psoriasis "passed".
The course of this chronic disease is unpredictable, and the stationary stage of psoriasis can either be replaced by a regressive stage, or the stage of exacerbation of psoriasis develops. This is due to the individual characteristics of the organism and the activity of the congenital and adaptive immune system, the hypertrophied response of which to various triggers and leads to stimulation of accelerated proliferation of keratinocytes.
Regressive stage of psoriasis
The regressive stage - or, as it is not quite accurately called, the last stage of psoriasis - comes after a stationary stage.
In fact, it is characteristic of many chronic diseases, a period of significant easing of symptoms and even their temporary disappearance, that is, the stage of remission.
At this stage, the morphological elements of the psoriatic eruptions are resolved: the plaques gradually cease to peel off, all scales are sloughed, the spots become flat (the seal disappears first in the center, and then along the edges of the plaques); itching passes.
Also, the regressive stage is manifested by temporary dyschromia, a violation of the pigmentation of the skin at the site of the disappeared papuloscentus foci. Usually the skin becomes lighter (in the form of secondary leukoderma), rarely there is secondary hyperpigmentation.
To date, to achieve a stable remission and retention of the disease at this stage, in fact, and reduces the treatment of psoriasis.
And the definition of the stage of psoriasis, which is carried out on the basis of skin symptoms, is crucial for the selection of medications and physiotherapy to reduce the intensity of the manifestation of the disease.
Last update: 01.06.2018
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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