Vulgar psoriasis

Vulgar psoriasis is considered the most common form of this dermatological disease. Also it is sometimes called ordinary or simple.

This pathology is characterized by the appearance on the skin of papules covered with peculiar white scales - particles of horny tissue.

Epidemiology

The results of various statistical surveys have shown that vulgar psoriasis is observed in about 2% of the world population (for example, in Denmark they suffer 2.9% of the population, in northern Europe (together with England) - 2%, in the USA - 1.4% , and in China - 0.37%).

[1], [2], [3], [4],

Causes of the vulgar psoriasis

In our time there is no single theory that could fully explain the causes of vulgar psoriasis. That is why this disease is classified as a multifactorial dermatosis.

Among the most popular explanations for the causes of psoriasis are the following:

• Hereditary cause - most often the disease is diagnosed in 2, as well as 5-6 generations. Transmission occurs in two ways: recessive, as well as autosomal dominant;
• Metabolic causes - the disease occurs due to metabolic disorders. Basically, this concerns the processes of cholesterol metabolism, enzymes, disruption of RNA and DNA replication;
• Viral cause - was identified as a result of individual experiments conducted on rabbits. After implanting the skin particles affected by psoriasis, they developed fibrosis, as well as atrophy and other morphological modifications in the organs. But at the same time, it was not yet possible to determine exactly what kind of virus provoked these violations;
• Endocrine cause - in many patients diagnosed with abnormalities having an endocrine origin. Among these is the disruption of the functioning of the gonads and the hypothalamic-adrenal system;
• A neurogenic cause that explains the development of psoriasis is the presence of serious psychological disturbances in the patient.

Risk factors

Among the risk factors that can create a favorable environment for the development of pathology:

• Diabetes mellitus and atherosclerosis;
• Damage to the skin;
• Exposure to chemicals;
• The use of certain medicines.

[5], [6]

Pathogenesis

There are 2 basic theories explaining the mechanism of the appearance of vulgar psoriasis.

The first of them explains the appearance of psoriasis by a violation of the maturation and division of epithelial cells, which causes their excessive growth and increased proliferation. Thus, in this case, the emergence of pathology occurs as a result of a violation of the function of tissues and keratocytes. It should be noted that the aggressive reaction of mononuclear phagocytes and T-lymphocytes to skin cells, as well as their entry into the skin, is considered a secondary response of the body to the rapid multiplication of the keratocytes changed under the influence of the disease. The confirmation of this theory is that the treatment of this pathology with the help of drugs that prevent the multiplication of keratocytes (showing only a small degree of influence or without any immunomodulating effect at all) gives positive results.

In the second theory, this pathology is considered as one of the types of immunopathological, autoimmune disease, in the development of which the increased growth and multiplication of cutaneous cells are considered secondary with respect to the influence of lymphokines, inflammatory mediators, and cytokines produced by immune cells. The process of the origin of pathology is associated with penetration into the skin of cells that protect the body from the appearance of malignant tumors and infections (so-called T-helpers, as well as T-killers). As a result, a large number of cytokines are released, which are provocators of the inflammatory process and accelerate the proliferation of skin cells (among them, keratocytes).

[7], [8], [9],

Symptoms of the vulgar psoriasis

Usually the development of the disease proceeds gradually, but in some cases there is an acute onset. Among the first signs of vulgar psoriasis - the appearance on the skin of a nodular rash, which has a red or pink color. Such a rash is called papules - limited in area dense knots, on top of which are scales of grayish-white color. Not on each of them there is noticeable peeling, but if you try to scrape off the top of the papule, it will be easy to detect. The rash is usually unattractive and for a long time it is located on the same area of the skin of the skin. It can be localized under the hair on the head, over large joints, etc.

Stages

Vulgar psoriasis has three stages of development: progressive, regressive and stationary, each of which has its own clinical specificity.

In the case of a regressing stage of the disease, the patient is observed:

• Reducing the power of peeling of the skin or the final cessation of this process;
• The gradual disappearance of psoriatic rashes and plaques, after which the development of hypopigmentation begins (sometimes hyperpigmentation begins to develop instead);
• Development of psoriatic triad and negative isomorphic reaction.

Stationary stage

Among the characteristic signs of the stationary stage of the development of the disease are the following manifestations:

• Cessation of growth of new nodules;
• The size and number of already existing papules are preserved, peripheral growth is not observed;
• Moderate degree of peeling of the surface of the rash;
• The formation of a whitish rim that surrounds the nodule of rash with the horny layer begins (this process is called Voronov's symptom) - this indicates that the stationary stage begins to transform into a regressive one;
• Negative isomorphic reaction and the appearance of the psoriatic triad.

[10], [11], [12]

Progressive stage

Progressing stage of psoriasis is characterized by such manifestations:

• Periodic appearance on the skin of a new rash that has a specific erythematous fringe, on which there are no plaques (while on the rash they are);
• The already existing nodules grow in size due to peripheral growth (they look like a hyperemic rim around the rashes);
• The so-called Kebner reaction gives a positive result - new nodules appear on the damaged parts of the skin (a trauma can be caused by scratching, pricking a needle, sunburn or using an irritating ointment);
• Psoriatic rashes are strongly flaky, except for the area of growth of the nodules themselves;
• Positive triad.

Vulgar plaque psoriasis

Plaque psoriasis is the most common type of disease in which the skin becomes inflamed, reddens and flakes. According to statistics, approximately 4 out of 5 people with a diagnosis of psoriasis have just a plaque form (it is also sometimes called psoriasis normal). This pathology is characterized by thick red-violet plaques, on top of which appear silvery scales. Such a rash can appear on any part of the body. The occurrence of rashes causes pain and itching.

Limited and common vulgar psoriasis

Vulgar psoriasis is limited, and also common. With limited form, the rash appears on separate areas of the skin, capturing a maximum of 40% of the entire cover. In the case of damage to a larger area of the skin, pathology is referred to a common form.

Complications and consequences

Vulgar psoriasis can provoke the appearance of complications in the area of joints or nails. Nails are struck multitudinously, on them there are pinholes. Often over time, they exfoliate and completely fall away. Under the nail plate hyperkeratosis begins - this symptom is also called an "oil stain".

Complications of the joints from psoriasis can be quite serious. Various arthropathies develop, because of which the patient is more difficult to give movement, especially in the morning, after sleep. There is deformation of the joints, mainly between the phalanges of the fingers - there is a curvature, they atrophy, because of which a person loses the ability to perform even ordinary movements.

On the part of the National Assembly, complications such as depression, apathy and constant oppression, along with indifference to everything, are quite common. Complexes can develop (especially in a small child), so it is necessary to observe a psychologist.

[13], [14]

Diagnostics of the vulgar psoriasis

Usually diagnose the chronic form of vulgar psoriasis is simple - the disease has a characteristic external manifestations, so the diagnosis does not cause difficulties. Specific procedures for diagnosis, as well as blood tests for this disease does not exist.

A typical manifestation of the chronic form of vulgar psoriasis is that scraping the plaque easily causes bleeding.

[15], [16], [17]

Analyzes

In the case of an extensive form of the disease, or if it is at a progressive stage, the deviations can be detected by taking blood tests, after which the study reveals the presence of inflammatory, autoimmune, and rheumatic processes (development of leukocytosis, and in addition an elevated level of ESR, determination of C-reactive protein, etc.), and in addition to this endocrine and biochemical disorders.

To confirm the diagnosis and exclude other dermatological pathologies, a skin biopsy can be performed. In this case, the following can be identified:

• Immaturity and thickening of the keratocyte layer;
• Signs of accelerated reproduction of keratocytes, as well as immunocompetent formations;
• Massive penetration into the damaged skin of macrophages, branched cells, and also T-lymphocytes;
• The process of the appearance of new blood vessels in the skin layer under the plaques of psoriasis is accelerated.

[18], [19], [20]

Differential diagnosis

Vulgar psoriasis should be distinguished from dermatoses: nodular syphilis, flat red lichen, and Reiter's syndrome; In addition, with seborrheic eczema and dermatitis, pink lichen and neurodermatitis. It should also be distinguished from follicular or parafollicular keratosis and parapsoriasis, mushroom granuloma in the infiltrative-plaque phase and DKV.

[21], [22]

Treatment of the vulgar psoriasis

Vulgar psoriasis can be treated in a variety of ways. All questions about the choice of methods of treatment and its scheme, as well as the selection of medications, dosages and other details are decided for each patient individually. For each, the severity of the course of the disease and its prevalence, the absence / presence of any concomitant diseases, as well as contraindications, etc., are taken into account.

In hospital mode, the treatment process includes such procedures:

• Detoxification of the patient's body;
• Systemic use of medicines;
• Implementation of local therapy.

If the disease occurs in a localized form or has an average severity, therapy can be performed on an outpatient basis. In this case, mostly local drugs are used. Selection of specific medications occurs depending on the stage of the disease. Used can be both hormonal and non-hormonal drugs.

Medications

In the stationary mode, the following treatment is performed.

If a patient experiences high blood pressure, he is given intramuscularly magnesium sulfate.

If psoriasis develops in exudative form, diuretics are prescribed.

If a patient has severe itching and a tendency to an allergic reaction, one should use antihistamines such as Suprastin, Tavegil or Dimedrol.

Systemic treatment of glucocorticosteroids in our time is almost not used, as this increases the risk of adverse reactions and complications. Therefore, they are prescribed only in cases when other methods did not give a positive result.

In case of severe course of the pathology, cytostatics - Methotrexate and Ciclosporin, as well as retinoids - Acitretin are used for treatment.

Also during the treatment now increasingly began to use drugs containing monoclonal antibodies: such as Ephalizumab or Infliximab.

Regarding the same local drugs, their use should be cautious. When the disease worsens, it is impossible to treat irritated skin with ointments of strong action and high concentration. Effectively, such means as ASD-fraction, naphthalan paste and lanolin cream. But hormone ointments should be used only for a short time.

In the outpatient mode, hormonal medications are used, including glucocorticosteroids in the form of gels, creams, and emulsions and lotions (such as Hydrocortisone or Elokom). Also used non-hormonal means - Antralin, Dithranol, Tazaroten and Calcipotriol. Combined local medicines - Lococortentar and Belosalik - also work effectively.

Vitamins

In the course of treatment, the means that improve the cellular metabolism in the body are necessarily used: these are vitamins from groups B and C, and also P and A, E and D.

Physiotherapeutic treatment

Among the methods of physiotherapeutic treatment of vulgar psoriasis are the following:

• electrosleep;
• magneto-, and also magnetic-laser treatment;
• UV-irradiation procedures, as well as PUVA.

If the patient has an acute stage of the disease, UV irradiation procedures are not allowed to be used, and PUVA is carried out in a limited number and with caution.

Alternative treatment and herbal treatment

To make therapeutic therapy more effective, you can use alternative treatment methods. For example, take extra warm baths from extracts and infusions of herbs - such as calendula, chamomile or pine. In this case, you can not use the washcloths while bathing, and also rub yourself with a towel, limiting itself to simply blotting. This is necessary because on the skin due to rubbing, there may be micro-trauma, which increases the risk of exacerbation of the disease, as well as the possible attachment of any secondary infection.

Some more recipes that help in the treatment of psoriasis:

Take 20 g of sassaparilla root and insist them in 1 liter of plain water for 8-10 hours. Then tincture should be cooked for about 20 minutes, and then strain. Half of the broth should be drunk hot, and the second - within 24 hours. The duration of the course is 20 days.

The skin areas affected by psoriasis should be greased with ashes from the hips of wild rose, which before that should be mixed with petroleum jelly in equal proportion.

Tincture of black elderberry (2 tsp add to 5 liters of water). You need to drink 3 r. / Day. On 0,5 stack. Instead of elderberry tincture, fir water can be used.

Grind the young sunflower baskets, then pour the white wine, and then insist for 2 days. Ready tincture strain, and moisten it with inflamed areas of the skin. Also it is possible to impose bandages on them, leaving for 2-3 hours. If rashes have arisen on the face, this tincture can be washed.

[23], [24]

Homeopathy

The homeopathic drug Dulcamara-plus is used in the case of the acute form of vulgar psoriasis.

Among the contraindications: hypersensitivity to homeopathic components of the drug, as well as age under 18 years.

The drug should be taken solely by the prescription of a homeopath. Granules should be placed under the tongue, and then dissolve them for a while. They should not be chewed, just like drinking with water. You need to consume the medicine half an hour before meals or 1 hour after. The dosage is usually 8 pellets three times a day. The treatment course can last up to 30 days, but only after a mandatory consultation with a dermatologist.

Among adverse reactions to the drug - sometimes the patient may experience an allergy. In this case, he will need to consult a dermatologist.

Among homeopathic remedies for psoriasis also help such drugs as Loma Lux Psoriasis (reception depends on the weight of the patient and is 0.5-2 tsp in the mornings on an empty stomach), and Polyderm (consumed three times a day for 3-5 granules for 5-6 months).

Diet

To get rid of vulgar psoriasis it is possible only under condition of normalization of a day mode, and also correction of a food allowance. It is necessary to remove from the diet food products that contain components such as carbohydrates (easily digestible), as well as refractory fats. The diet with vulgar psoriasis also includes the rejection of spicy foods, salt, various spices, semi-finished products and foods with increased allergenicity. In addition, you need to give up food with dyes and food additives, pickled and smoked products, as well as alcohol.

[25], [26], [27]

Prevention

As the prevention of psoriasis, the following measures are taken:

• Avoidance of stress;
• Stabilization of the metabolic process in the body;
• Timely elimination of concomitant diseases;
• Avoiding infection with streptococci, staphylococci, various viruses, etc.

[28], [29], [30], [31]

Forecast

Vulgar psoriasis has a rather favorable prognosis, but one should keep in mind that there is no certainty about the duration of the disease, as well as the periods of exacerbation and remission. Eruptions on the skin can exist for a long time, for years, but usually periods of exacerbation alternate with periods of time when there are improvements and clinical recovery. A considerable part of patients, especially those who did not undergo the systemic intensive care course, experienced prolonged periods of spontaneous clinical recovery.