Droplet psoriasis

Psoriasis or scaly lichen is a chronic non-infectious skin disease. It looks like inflamed areas of the body, which consist of individual skin spots (papules), merging they form plaques. Guttate psoriasis is one of its many varieties. It got its name for the shape of the skin lesions. On the skin, the papules of guttate psoriasis are dry pale pink, sometimes red, sometimes purple circles, dots or droplets raised above the surface of healthy areas. As a rule, these rashes cover a large area of the body.

Epidemiology

The epidemiology of guttate psoriasis indicates its low prevalence (2-4% of the total population). However, among all types of psoriasis, it ranks second. No particular predisposition of either sex to the disease has been identified. In a third of those affected, its first manifestations occur at the age of 15-25 years, but may also appear at other times in life. In adulthood, an outbreak of guttate psoriasis usually occurs against the background of vulgar psoriasis.

[ 1 ], [ 2 ]

Causes drop-shaped psoriasis

Research has not yet led to an exact determination of the causes of guttate psoriasis. It is assumed that the onset of the disease is associated with an autoimmune disease of the body, provoked by increased production of killer cells that destroy healthy cells. This process is associated with the presence of an infection in the body. It has been proven that guttate psoriasis progresses with an exacerbation of an infectious and viral infection. Analysis of a smear taken from a papule during this period confirms the presence of an infectious agent. Often, the disease first occurs after streptococcal infections (tonsillitis and pharyngitis).

[ 3 ], [ 4 ]

Risk factors

Among the possible risk factors for the development of guttate psoriasis, both genetic factors and the influence of the patient's environment are named. The genetic factor dominates, as evidenced by the large number of patients whose relatives had a similar disease. Studying other factors that affect the onset or exacerbation of the disease, several of the most common were identified:

• neurological disorders (49% of those newly ill and 41% of those with exacerbations experienced severe stress and neuropsychiatric trauma);
• infectious and viral diseases (15% and 21%, respectively);
• skin injuries (14% and 12%, respectively);
• hormonal disorders (6% in each group);
• unfavorable climatic influences (5% of those newly ill and 4% with exacerbations);
• intensive use of medications (3% and 6%, respectively);
• other factors (8% and 10% respectively).

[ 5 ], [ 6 ]

Pathogenesis

Despite the fact that psoriasis has a complex and poorly understood pathogenesis with relapses, guttate psoriasis is almost the only one of all its types that has a scientifically proven connection with exacerbations of chronic infections or previous infections. But all theories of its origin, like other types of psoriasis, remain only assumptions that still have no scientifically proven evidence. There are two main hypotheses that explain the processes leading to the disease. The first claims that psoriasis is a primary skin disease associated with disorders at the cellular level. Excessive cell division and growth occurs, as a result of which the overgrown tissues become inflamed and a border appears separating this lesion from neighboring tissues. The functions of the epidermis are disrupted. The second hypothesis of the occurrence of guttate psoriasis is associated with the impact of various viral and bacterial infections on the immune system, and skin manifestations are considered secondary. In any case, this hypothesis is supported by the fact that 80% of patients with guttate psoriasis have streptococcal infections. It is known that psoriasis is a genetic disease. People who have relatives with psoriasis are in a high-risk group. But the cause-and-effect relationships of these genes with microorganisms that cause an outbreak of infection have not yet been studied.

[ 7 ], [ 8 ]

Symptoms drop-shaped psoriasis

The first signs of guttate psoriasis are characterized by the suddenness factor. Skin itching appears and small spots in the form of dots, droplets, circles (papules) appear anywhere on the body. The color of the papules depends on the stage of the disease and varies from pale pink to purple. They rise above the rest of the surface and look like plaques. Symptoms characteristic of this disease also include large areas of damage, which are most often localized in the area of the thighs, shoulders and forearms, neck, back, and scalp. Guttate psoriasis does not affect the palms, soles of the feet, and nails. The most characteristic symptoms of guttate psoriasis include instability of the rash. Papules can suddenly disappear and give the patient hope for a complete recovery. After some time, they appear in a completely different, unexpected place and with greater intensity.

Guttate psoriasis in children

In terms of frequency of diseases among chronic dermatoses in children, psoriasis ranks second. Almost half of all diagnosed psoriasis cases are guttate (post-infectious) psoriasis. This is explained by frequent infections in children (respiratory diseases, chickenpox, measles, rubella, sore throats, otitis), common in places where children congregate - kindergartens, schools. As a rule, 2-3 weeks after an infectious disease, teardrop-shaped papules appear on the limbs, trunk, and head in places of hairiness of the child. Their rash is accompanied by severe itching. Plaques can persist for a long time. After their disappearance, remission occurs, which has a different duration, up to ten years. The onset of a new outbreak is unpredictable, since there are no precise mechanisms for detecting the disease.

Exacerbation of guttate psoriasis

It is impossible to predict the exacerbation of guttate psoriasis, but most often it is associated with previous infectious diseases. Sometimes during an exacerbation, severe forms of acute psoriasis occur, in which serious complications and the transition to another type of psoriasis are possible. Erythroderma is one of these forms, it affects more than 90% of the skin surface and causes high temperature. Pustular psoriasis may occur (mainly in people 45-50 years old), which is characterized by the appearance of many yellow and white pustules, high body temperature, tachycardia. Pustular psoriasis in combination with erythroderma leads to the appearance of Zumbusch psoriasis. The patient develops muscle weakness, weight loss, fluid retention in the body. Often, when severe types of acute psoriasis occur, the patient needs to be hospitalized.

[ 9 ]

Stages

There are several stages in the development of guttate psoriasis, which are determined by the following factors:

• areas of skin damage;
• intensity of inflammation (the color of papules, thickness of plaques, swelling, presence of itching and flaking are assessed);
• general condition (rapid fatigue, high levels of uric acid in the blood, increased ESR).

At the initial stage of the disease, isolated rashes appear on the skin and the affected area is insignificant (less than 3%). This stage of psoriasis is called mild psoriasis. Gradually, the affected area increases and reaches 10%, the intensity of the color of the papules increases, the skin in the affected areas thickens. Doctors define this condition as moderate psoriasis. With more extensive skin lesions, a severe form of psoriasis occurs with laboratory confirmation, deterioration of the general condition and quality of life of the patient. With the guttate form, it is impossible to predict the stage of the disease. An outbreak can occur several times a year, mainly in the spring-autumn period, when viral infections are activated and the body's defense mechanisms weaken. A distinction is made between acute guttate psoriasis, which can become chronic, and psoriasis in remission. The duration of remission is unpredictable and can last from several weeks to several years.

Complications and consequences

The consequences and complications of guttate psoriasis are associated with the risk of developing concomitant diseases.

Complications leading to metabolic disorders can be divided into one group:

• insulin-dependent diabetes mellitus;
• obesity;
• cardiovascular diseases;
• hypertension;
• development of atherosclerosis due to increased levels of “bad” cholesterol.

It is also possible that the following diagnoses may arise:

• celiac disease (malfunction of the small intestine when gluten is consumed);
• cancer (mainly lymphoma and skin);
• psoriatic hepatitis and arthritis;
• kidney diseases;
• folate deficiency.

There are also psychological and social aspects of the consequences of the disease. Often, rashes occur on exposed areas of the skin and patients, afraid of encountering a cautious, distrustful, and sometimes disgusted attitude of others towards themselves, fear of infection, self-isolate. Often people quit their jobs, do not dare to go outside, limit their social circle. All this psychological pressure in combination with physical discomfort can lead to a nervous breakdown, depression, and this is fraught with a new outbreak of exacerbation.

[ 10 ], [ 11 ], [ 12 ]

Diagnostics drop-shaped psoriasis

Guttate psoriasis diagnostics is based on anamnesis analysis (information about heredity, previous illnesses, injuries, surgeries, allergic reactions, living conditions, etc.), general examination of the patient, as well as clinical and laboratory tests. Psoriasis, like other skin diseases, is the competence of a dermatologist. Sometimes a visual examination is enough to determine and recognize the disease. If there are doubts, other studies are used.

[ 13 ], [ 14 ], [ 15 ]

Tests

To rule out the presence of a fungal infection in the body, a test is performed with potassium hydroxide (KOH). The procedure is not complicated. The doctor will take a scraping from the affected area of the skin using a special glass slide. In the laboratory, the obtained tissues will be mixed with potassium hydroxide, which kills healthy cells and does not destroy fungal cells. The fluid from the papules is examined for the presence of staphylococcal and streptococcal infections, which are companions of guttate psoriasis. A swab from the throat is also taken to check for pharyngitis. Blood and urine tests are also used (for example, to detect antibodies to infectious agents). Skin samples may be taken for allergic reactions.

[ 16 ], [ 17 ], [ 18 ]

Instrumental diagnostics

Instrumental diagnostics of guttate psoriasis includes examination using a dermatoscope, which scans fragments of skin lesions, enlarges them and displays them on a monitor screen. Since the course of the disease can be complicated by serious consequences, ultrasound examination (US), computed tomography (CT), radiography, and magnetic resonance imaging (MRI) are used to detect disorders in other organs.

Differential diagnosis

Differential diagnostics is designed to distinguish guttate psoriasis from other diseases with similar symptoms: secondary syphilis, pink lichen, toxicoderma. Thus, pink lichen has similar plaques, but unlike guttate psoriasis, it can appear on the palms and soles of the feet, in addition, this is an infectious disease and is identified using certain tests. Secondary syphilis is also similar in its manifestations to guttate psoriasis, but has rashes on the soles of the feet and palms, in addition, it can be detected using a special test (RPR test). Toxicoderma is provoked by an allergen, so it is determined using laboratory tests and bacterial cultures.

[ 19 ]

Treatment drop-shaped psoriasis

Treatment of guttate psoriasis involves a comprehensive approach and depends on the stage of the disease and the patient's condition. Diet and quitting bad habits play an important role in treatment. The diet should be dominated by plant-based foods and up to 1.5 liters of liquid per day. Fatty and spicy foods should be excluded, as well as smoking and alcohol. The psychological state of the patient plays an important role. To stabilize it, sedatives are used, which include motherwort, valerian root. If necessary, tranquilizers and antidepressants are prescribed. To soften keratinized papules, reduce inflammation and itching, external agents for local use are used. These agents include ointments, creams, sprays, gels. Ointments are non-hormonal and hormonal. The latter are more effective, but they should be used carefully, following the doctor's recommendations. Weak treatment effects include hydrocortisone and prednisolone ointments, clobetasol and dermovate - strong in their effect on the affected areas of the skin. Another area of external therapy is the use of calcioptril (synthetic vitamin D3) in the form of an ointment, spray, gel, which inhibits the proliferation of skin cells. Local therapy also includes cryotherapy, the essence of which lies in the effect of cold (liquid nitrogen) on the foci of the disease. Effective in the treatment of guttate psoriasis is phototherapy - ultraviolet irradiation of the affected areas. Plasmapheresis can be used. This is a blood purification procedure, which consists of taking blood, cleaning it from toxins and returning it back to the bloodstream. Vitamin therapy, physiotherapy, and drug therapy are also used in the treatment of the disease.

Medicines

Medicines prescribed for the treatment of guttate psoriasis include antihistamines that block inflammation mediators: claritin, diazolin, tavegil, suprastin, telfast.

Suprastin is available in tablet and injection form. Tablets are taken after meals in the following doses: for adults - 75-100 mg 3-4 times a day; for children 3-6 years old - half a tablet 2 times a day; for children 6-14 years old - half a tablet 2-3 times a day. The daily dose for children should not exceed 2 mg per kilogram of the child's weight. The maximum permissible dose is 100 mg per day.

Injections are administered intramuscularly, but in special cases they can also be administered intravenously. Adults are injected with 1-2 ml per day, the dose for children depends on age:

1-12 months — 0.25 ml; 1-6 years — 0.5 ml; 6-14 years — 0.5-1 ml. The duration of treatment is determined by the doctor. Contraindicated for people with hypersensitivity to the drugs included in the drug, with gastric ulcers, with arrhythmia. It is recommended to take precautions when taking the drug by the elderly, weakened people, pregnant and lactating women, people with liver dysfunction, drivers. Side effects include sedation, blurred vision, fatigue, allergic reactions, dizziness, arrhythmia, tachycardia.

Telfast - tablets, recommended for adults and children over 12 years old, one tablet at a dose of 120 mg or 180 mg once a day. Taking tablets does not depend on food intake and should be accompanied by plenty of fluids. It is important to observe time intervals between taking the drug (24 hours). No serious side effects have been noted, but pregnant women and nursing mothers should consult a doctor.

In severe forms of guttate psoriasis, cytostatics and drugs that suppress the body's immune response (cyclosporine, meothrexate) are used.

Methotrexate is a drug that comes in tablet and injection form. For the treatment of psoriasis, tablets of 2.5-5.0 mg may be prescribed 2-3 times a day once a week or 2.5 mg 3-4 times a day for 5-7 days, with 3-day breaks. Methotrexate may be prescribed with pyrogenal. Side effects include nausea, diarrhea, stomatitis, and in some cases, anemia and toxic hepatitis. The drug is contraindicated for pregnant women and people with kidney, liver, and bone marrow diagnoses.

The same immunosuppressant focus and drugs containing monoclonal bodies. This is a new highly effective generation of drugs, their action is directed at a specific area of damage, in the case of guttate psoriasis - at the excessive growth of damaged skin cells and their inflammation. Such drugs include infliximab, ustekinumab, adalimumab.

Adalimubab - injections, administered subcutaneously either in the abdomen or in the thigh area, 40 mg once every 1-2 weeks. Side effects include headaches, dizziness, insomnia, depression, loss of appetite, anemia, possible edema, glaucoma, allergic reactions. Contraindicated in pregnant and lactating women. Elderly patients should take precautions, with hepatitis B, tuberculosis, and cases of lymphoma development are known.

Antibiotics are generally not used in the treatment of other types of psoriasis, but exacerbation of guttate psoriasis is often associated with the presence of streptococcal infection, so such treatment is appropriate. So-called macrolide antibiotics are most often prescribed, since they can have another positive effect in the treatment of psoriasis that is not associated with antibacterial action. These include erythromycin, clarithromycin, roxithromycin.

Erythromycin is available as tablets, injections, and ointments. Tablets are taken one to one and a half hours before meals. Adult dose is 250-500 mg 4 times a day, but not more than 2 g. Children are prescribed depending on their age: 1-3 years - 400 mg per day; 3-6 years - 500-750 mg; 6-8 years - 750 mg; 8-12 years - 1 g divided into 4 doses. Intravenously, the dose is calculated as 15-20 mg per kilogram of weight. The ointment is applied to the affected area.

Side effects include nausea, dizziness, diarrhea, and adverse effects on the liver. Precautions: taking the drug may be accompanied by drug-induced hepatitis.

Vitamins

Clinical studies have shown that when patients take food supplements or products containing vitamins A, B, E, C, D, their condition improves. If the patient is currently undergoing treatment, it is necessary to consult with the attending physician about the advisability of taking vitamins and their compatibility with other drugs. Medicines containing calcipotril and retinoids cannot be combined with multivitamins, but methotrexate is recommended to be taken with certain vitamins in order to reduce side effects.

Physiotherapy treatment

Physiotherapeutic treatment of guttate psoriasis or physiotherapy is the use of various physical phenomena, such as cold (cryotherapy), electromagnetic fields, light, ultraviolet rays, and alternating electric current. So, to relieve itching, increase blood circulation in the affected area of the skin, darsenvil is used. This procedure is based on the use of high-frequency current. It is prescribed to adults and children over 11 years old. The use of electrophoresis and galvanization also increases blood circulation, relieving pain. Children are prescribed twenty-minute sessions, adults - half an hour. It cannot be used in acute stages of the disease. Microwave therapy and UHF are indicated for inflammation of the lesions. Electrosleep - the effect of electric current on a person by inhibiting processes in the cerebral cortex, enhances the body's metabolic processes, has a calming effect on the patient.

Folk remedies

Along with traditional treatment, folk treatment of guttate psoriasis is also used. It consists of preparing and using various herbal infusions and decoctions for internal use, for preparing baths, and making ointments for external use. Here are some recipes for making ointments:

• one egg white is mixed with 100g of solidol, 10g of celandine, 30g of oak bark ash and crushed rose hips. Everything is mixed and infused for at least two weeks. Lubricate the inflamed areas several times a day;
• mix 60g of honey and solid oil, add 2g of lycopodium and 5g of crushed celandine, apply the resulting mixture several times a day;
• Combine 50g of crushed propolis with 0.5kg of melted butter in a water bath, mix well. The inflamed area should be wiped with hydrogen peroxide, dried, then apply ointment and fix with a bandage, do not remove for two days.

For internal use, you can use the following recipes for making tinctures:

• put two tablespoons of bay leaf in half a glass of water, boil for 10 minutes, let it brew for 1 hour, drink during the day;
• Add 2 tablespoons of crushed barley malt to a liter of boiling water, let it sit for several hours, take half a glass several times a day, adding honey.

Tar ointments are widely used to treat guttate psoriasis, often in combination with other components (zinc, salicylic acid). They have a strong anti-inflammatory effect, inhibit the proliferation of diseased skin cells. A negative aspect of this treatment is the unpleasant smell of the ointment, it should be used with caution in patients with diseased kidneys.

Herbal treatment

Herbs with anti-inflammatory and soothing effects are actively used to treat guttate psoriasis. Here are some of them: succession, chamomile, valerian root, celandine, mint, lemon balm, sea buckthorn, calendula, sage, hops, etc. Herbs are used to prepare infusions and decoctions for internal use and for baths. For baths, you must first brew the herb in a proportion of a spoonful of pharmacy or two fresh herbs per glass of boiling water and let it brew for at least half an hour. The resulting infusion is poured into the bath. The amount of herbs depends on the volume of the bath, but the water should completely cover the affected area. Baths made from succession, chamomile, sage, birch buds, and coniferous herbs are very effective. Such procedures should be taken with caution by patients with diabetes, hypertension, epilepsy, and pregnant women.

To prepare infusions and decoctions for drinking, you can use the following recipes:

• 4 spoons of succession are poured into a thermos, adding a liter of boiling water, and infused for 2 hours. The cooled infusion is drunk 100 g 3 times a day, adding half a teaspoon of honey;
• herbal collection consisting of one spoon of each component: St. John's wort, succession, celandine, valerian, marshmallow, pour a liter of boiling water, let it brew for several hours, drink 100 ml twice a day;
• take the celandine tincture from the pharmacy together with eleutherococcus (15 drops of each);
• Pour a glass of boiling water over 1 tablespoon of a mixture of herbs: sage, St. John's wort, tansy, wild pansy, and lingonberry, leave for half an hour, take after meals 2 times a day for at least a month.

Homeopathy

Homeopathy has an arsenal of remedies that can help in the treatment of guttate psoriasis. The following have proven themselves to be effective in treating the disease:

• Carduum Marianus - it is based on milk thistle, the effect is aimed at cleansing the liver. It has an anti-allergic effect, improves the hormonal system. No side effects have been identified. It is used in 1, 3 and 6 dilutions;
• Solidago - contains components of animal organisms, plants, minerals. Of the plants, goldenrod is used. It has an antiseptic, anti-inflammatory effect. Patients tolerate it well, it is not prescribed to children under 6 years old. The treatment course is 4-6 weeks;
• Chelidonium - created on the basis of celandine, its action is aimed at cleansing the liver. Side effects include the development of jaundice in some cases. Children are recommended to use the drug from the first to the sixth dilution, adults - from the sixth to the twelfth;
• sulfur - sulfur, affects the human autonomic system, used for various skin lesions. It is recommended to start taking in weak concentrations (12 and above), gradually increasing to 6 and 3. Side effects depend on the individual characteristics of the body, and it is also not recommended to combine with alcohol.

Prevention

The best measures to prevent guttate psoriasis are a healthy lifestyle, excluding smoking and alcohol consumption, and avoiding stressful situations. It is also very important to follow a balanced diet, in which vegetables and fruits should predominate, and meat, dairy and grain products in the patient's diet can take up no more than 20-30%. It is also important for patients with guttate psoriasis to drink plenty of fluids (1.5-2 liters per day). Taking baths containing various herbal decoctions and their collections, which are described above, is also not superfluous for the prevention of the disease.

[ 20 ]

Forecast

The prognosis for curing guttate psoriasis, like other types, is unfavorable, but with timely treatment and adherence to all recommendations, the remission stage can last for a long time, up to ten years.

[ 21 ]