Exacerbation of psoriasis

This non-contagious chronic dermatosis during the exacerbation brings a lot of physical and psychological discomfort, itchy rashes (often on a large surface of the body) do not give rest day or night. Recurrent psoriasis due to a variety of reasons. Very often the patients themselves are lost in conjecture, which provoked another aggravation.

Studies of this disease are usually carried out on anamnesis of hospitalized patients with severe form of this disease. The results of these observations are very contradictory, and so far there are no general recommendations for getting rid of psoriatic exacerbations.

However, some of the most common factors that provoke a relapse of the disease are now known.

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

Epidemiology

More than 2% of people on Earth suffer from psoriasis. Nevertheless, not everyone is equally susceptible to this disease. Representatives of the white population of the planet are sick much more often than Asians, even black people from Africa suffer less from psoriasis, and red skinned (North American and South American Indians and Eskimos) - psoriasis is unknown.

In economically developed countries, this disease affects more than 4% of the population. In the US, according to the data of the last year, psoriasis is sick with 7.5% of the population, in Ukraine - about 3.5%. The prevalence of psoriasis is higher in countries located farther from the equator.

They can get sick both a woman and a man from the first to the last years of life, but about half of the debuts of the disease occur between 15 and 25 years. The disease is complicated by psoriatic arthritis in about 10-30% of patients with psoriasis, and the manifestations of this complication become noticeable about ten years after the first manifestation of the disease.

[5], [6], [7], [8], [9], [10]

Causes of the exacerbation of psoriasis

Many patients note that their exacerbations occur at certain times of the year. More common is the winter type of psoriasis (exacerbation occurs always in winter), less often - summer. There is a third type that does not depend on the season.

Patients with psoriasis should try to avoid sudden changes in the climatic zone. For example, when you meet the New Year in Egypt or Tunisia, you can almost certainly get a bonus in the form of exacerbation.

People with this problem are categorically contraindicated in the use of alcohol, salted, sweet, fatty foods, and overeating in general. For the prevention of exacerbations it is necessary to adhere to dietary nutrition, which will be discussed below.

One possible cause of exacerbation may be nervous and physical overexertion - it is desirable to avoid stressful situations and try to increase their stress resistance.

Care should be taken when applying household chemicals, at least always wear gloves.

Exacerbation of psoriasis can provoke vaccinations and some medications, in particular, for the treatment of infectious diseases of the respiratory system, antibiotics, immunomodulators, individual antidepressants, anticonvulsants, preparations for malaria, vitamin complexes and even preparations for psoriasis. Perhaps exacerbation of psoriasis from Kartalin, ointment on a plant basis, positioned as a remedy for serious dermatoses, incl. From psoriasis. This exacerbation at the initial stage of treatment is stipulated by the manufacturer in the instructions, over time the skin condition should be normalized.

[11], [12], [13], [14], [15], [16]

Risk factors

The risk factors for a new exacerbation are smoking, infectious, immunopathological and endocrine factors, any new cosmetics and perfumes.

Most often, psoriatic rashes on exacerbation occur on the ground with a drier and thinner skin that has undergone mechanical or chemical attack. People with dry skin are more prone to this disease, in contrast to the owners of oily and well-moisturized skin.

Psoriasis can be regarded as idiosyncrasy for any external influences. Sometimes he spontaneously exacerbates and can also disappear, leaving the patient puzzled at the cause of the exacerbation. This is a very individual disease.

Currently, there are two main assumptions about the pathogenesis of psoriasis.

The first relates it to primary dermatosis with a disruption of the function of the epidermal layer and its cells, in which individual areas of the epidermis are characterized by forced division and formation of keratinocytes.

Proponents of the first assumption consider secondary autoimmune attack of T-lymphocytes and macrophages on keratinocytes, evaluating it as an immune response to an overabundance of pathologically transformed skin cells.

The second assumption considers the pathogenesis of scaly lichen as an autoimmune pathology, when the overproduction of skin cells is caused by their autoimmune damage.

Both these assumptions have a right to exist, since they are confirmed by some facts of the positive results of treatment emanating from any hypothesis. There are also research results that partially refute each of them.

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

Symptoms of the exacerbation of psoriasis

The first signs of relapse are the appearance on the different parts of the body with a drier skin (for example, the limbs, the head, in the lower back) papules of a reddish color of 1.5-2 mm. They are clearly limited, covered with loose large-scale scales, prone to growth with the formation of scaly pale gray psoriatic plaques. Their size varies from small (up to 1 cm) to significant surfaces - with the palm and more.

Dermatosis usually accompanies itching. The rashes begin to peel off, the scales on the surface easily peel off and under them remain denser, placed deeper (this explains the other name of the disease - scaly lichen).

Overproduction of keratinocytes and the formation of skin infiltrates in psoriatic plaques cause in these places a thicker raised layer of skin. When scraping scales, the plaques may bleed slightly. On damaged skin can appear cracks and suppuration, constantly felt its tightness.

Scraping the papule, you can observe a triad of specific signs:

• much flaky silvery-gray stain, like a mulched drop of stearin;
• after removing the scales on it, a terminal film is shown, moist and shiny;
• droplets of blood, excreted on the exposed spine-like layer (bloody dew).

The disease is characterized by a wavy current - the latent period alternates with the manifest one, it can be divided into three stages:

• progressing when new bright red papules are stably born, growing into a clear itchy erythema surrounding the primary education;
• stationary, when new primary papules cease to form, the growth of old foci stops, around them appears a dry rim up to five millimeters in width and the papules become covered with scales;
• regressive, when the symptoms begin to disappear in the direction from the center of the foci to their periphery.

Psoriasis has a variety of clinical varieties and flow variants. The most common form is common or vulgar psoriasis, which in turn is divided into subspecies, the main ones are plaque (described above) and drop-shaped.

The usual location of plaques - on the elbows, knees, scalp, less often on the body. The person, usually, remains clean, although sometimes the lesion comes to the forehead. Slight damage to the smooth skin is not itchy, but the scalp is characterized by severe itching. On the head, the foci can be isolated or merge into one continuous surface with cracks and exudation.

In children and adolescents, as a complication of streptococcal angina, teardrop-shaped psoriasis may develop. One to two weeks after the beginning of the angina, small spots appear on the entire body, especially the trunk and limbs. The size of the spots, as a rule, is less than a centimeter in diameter, itches not much. This subspecies of vulgar psoriasis is less common than plaque, it is easily treated with local medications, sometimes in combination with physical procedures by ultraviolet, sometimes it can go by itself, but there is also a transition to a chronic form.

In addition to the usual, they also classify such species as atypical psoriasis (seborrheic, oyster-like, warty, intertriginous, palms and soles, mucous and nails) and complicated (exudative, erythrodermic, arthropathic, pustular).

Seborrheic - localized on the corresponding parts of the body (the scalp part of the head and behind the ears, in the zone of the nose, lips, chest and between the shoulder blades). The outlines of the spots are not distinct, the scales are not stearic, but yellowish. Under the hair on his head, there is a lot of dandruff, which disguises psoriatic spots with a transition to the forehead in the form of a psoriatic crown.

Oyster-like (rupioid) - rounded plaques with many layered large scaly crusts, which makes them look like an oyster.

Warty - the usual places of localization: ankles, wrists, lower third of the shin and lifting of the foot. Papules are rounded, with prolonged exacerbation and mechanical action, the skin in these places is hypertrophied. Probably malignancy.

Intertriginous - located in the area of large body folds (anogenital, axillary, under the breast, between the fingers), psoriatic plaques also have an atypical appearance (there is almost no peeling, the surface of the focus is smooth, bright red, often damp). It is accompanied by soreness. Diagnosis and treatment cause certain difficulties.

Psoriasis of the nails (psoriatic onychodystrophy) - destructive colors - on yellowish, whitish, gray, the surface becomes spotted, striated, coarsening under the fingernail and around it. The process can be delayed to the state of hyper-brittle nails and their absolute absence (onycholysis). Most often the nails are affected with psoriatic arthropathy.

Pustulous or exudative psoriasis is a complicated form of the disease. Psoriatic plaques covered with painful bladder, filled with sterile inflammatory exudate - pustules. The surrounding skin is edematous, inflamed, exfoliating.

Clinical manifestations of this species are palmar-plantar localized psoriasis of Barber and generalized psumbiasis of Zumbush with dissemination of pustules on the skin of all parts of the body and orientation toward unification into more significant elements.

This is a very severe form of psoriasis, a real threat to life. The onset of exacerbation is sudden and rapid - bright red erythema spans almost the whole body, small pustules begin to appear on it, their number increases, they unite the so-called "purulent lakes". This process has a wavy character - while the pustules dry out earlier, the following are formed. The process is accompanied by fever, increasing weakness and leukocytosis. This condition requires immediate hospitalization.

Erythrodermic - characterized by the spread of dermatosis on large surfaces of the body, sometimes generalized, severe itching, swelling of the skin and subcutaneous tissue, painful sensations. This species is often a relapse of ordinary psoriasis with unstable course, usually developing with the interruption of systemic therapy or treatment with topical preparations containing glucocorticosteroids.

Erythrodermal psoriasis can lead to death of the patient, because the thermoregulatory and protective function of the skin is diluted, which contributes to complications - septicemia or disseminated pyoderma.

Localized pustular and erythrodermic psoriasis can be the debut of the disease and change over time into a normal plaque.

For psoriatic arthropathy (arthropathic psoriasis), inflammation of the small joints of the extremities is typical. However, there are arthropathies of any localization (hip, knee, spine). This type of disease is a combination of dermatosis with arthritis, the consequences of which can become a patient's disability or death.

As a rule, during the debut of the disease, small parts of the skin are affected, they eventually increase, and the progression of scaly lichen can begin. An easy degree of disease is the spread of lesions, occupying up to 3% of the body area, the average - from 3 to 10%, heavy - more than 10%.

Often the question arises: can the temperature rise when exacerbation of psoriasis? For vulgar psoriasis, an increase in temperature is not typical, however, with severe forms of the disease - psoriatic erythroderma, generalized pustular psoriasis and psoriatic arthritis, exacerbation is accompanied by a high temperature (≈39 °).

[21], [22]

Exacerbation of psoriasis in pregnancy

According to observations, in pregnant women suffering from psoriasis, in about two-thirds of cases the condition improves (although after the birth the disease is manifested as before), but the probability of relapse during this period can not be ruled out. Changing the hormonal background of a woman can start the process of developing the disease. Exacerbation of psoriasis in the first trimester allows to predict the further situation and the outcome of pregnancy.

The symptomatology of recurrences of the disease in pregnant women depends on the type and severity of the disease.

The most severe relapses are infrequent, however, they should be known. For example, psoriatic arthropathy for a future mother can result in increased joint pain, which is explained by increased load on the joints due to the rapid addition of body weight.

A severe form of exacerbation can sometimes be expressed in the form of generalized pustular psoriasis, caused by hormonal and metabolic changes in the woman's body. Plaques, which usually appear on the abdomen and in the groin, are covered with pustules. The process is accompanied by severe itching, dyspeptic disorders, fever and even mental disorders. The main cause of exacerbation of psoriasis in pregnant women is an increased production of the hormone cortisol by the adrenal glands. It is urgent to seek medical help. In the event of termination of pregnancy, symptoms usually disappear immediately.

In pregnant women, exacerbation can be expressed by herpetiform psoriatic impetigo (impetigo of pregnant women), which in the vast majority of cases develops precisely in this state. Eruptions look like small pustules, usually located in large folds. They are placed in groups or in the form of a ring, the skin is inflamed, edematous, itching is not observed, the pustules are not infected, subsequently the rash spots are covered with brownish crusts. The process can take a chronic form or worsen by going to the mucous membranes.

Provoke the appearance of impetigo of pregnant women allegedly neuroendocrine disorders. According to most experts - this is a form of generalized pustular psoriasis. With the birth of a child, the mother's condition stabilizes, but, usually, the following pregnancies proceed exactly this way.

The consequences and complications of such exacerbations can eventually lead to fetal death and spontaneous abortion, premature birth, birth of a small child and even maternal death.

Scaly lichen during pregnancy is often accompanied by depression, the occurrence of which modern medicine does not explain.

Exacerbation of the disease in a future mother causes difficulties in the selection of medications, since most drugs for treating psoriasis are teratogenic. In this period it is not recommended to use retinol preparations, cytostatics, antibiotics, hormonal drugs.

Women who are expecting a child are recommended to reduce the manifestations of relapse of a means of natural origin, ultraviolet irradiation, cosmetic products on fat basis. For the prevention of depression, you can use herbal teas, SPA-procedures (after a medical consultation), yoga for pregnant women, psychotherapeutic trainings, walks.

If an exacerbation of psoriasis threatens the life of a woman, the issue of abortion is raised, during the feeding of the child - it is transferred to feeding with adapted mixtures, and mothers are prescribed specific drugs.

Psoriasis is not a contraindication to motherhood. A conscious, competent attitude to the upcoming pregnancy, including preparatory measures for conception (vitamin therapy, sanatorium treatment, massages, restorative procedures, yoga, getting rid of foci of infection in the body) reduces the risk of serious complications.

[23], [24], [25], [26], [27], [28],

Diagnostics of the exacerbation of psoriasis

Psoriasis has the characteristic features described above, from which it is possible to suspect this disease. For example, the formation of pinpoint hemorrhages and the manifestation of the bleeding of the skin under the plaque due to scraping (a symptom of Auspitz). Together with two other symptoms from the psoriatic triad, they form a clinical picture of psoriasis. The doctor conducts an external examination and a questioning of the patient in order to establish the causes of the disease, assigns the necessary laboratory and instrumental examinations.

With initial and not severe forms of the disease, blood tests, as a rule, are within normal limits.

However, with complicated forms or a large area of damage in blood tests, some indicators significantly exceed the norm and reveal intense inflammation, the presence of systemic and endocrine disorders, rheumatism (rheumatoid factor titers, acute phase proteins, leukocytosis, erythrocyte sedimentation rate, autoantibodies, adrenal hormones and thyroid glands and others).

In some cases, a skin biopsy and histopathological examination are performed to determine the diagnosis, in which the histological immaturity of keratinocytes and their proliferation (Retet's body) are revealed, the impregnation of the epidermis with immunocytes, the accelerated formation of new blood vessels in the skin layer under psoriatic plaques.

Instrumental diagnostics with exacerbation of psoriasis - dermatoscopy.

Additional examinations in order to have an idea of the work of the body and the condition of internal organs (it is prescribed if necessary at the discretion of the attending physician) - electrocardiography, thyroid ultrasound, abdominal organs, radiography.

[29], [30], [31], [32], [33], [34]

Differential diagnosis

Differential diagnosis of psoriasis is carried out with the aim of establishing an accurate diagnosis of the disease and differentiating it from similar diseases. It is carried out on the basis of a complete history, based on external signs, these analyzes and examinations. It is necessary to exclude the presence of cutaneous T-cell lymphoma (except for external differences, sometimes prescribed puncture of cerebrospinal fluid); flat lichen, which is usually localized "bracelets" on the wrists and ankles; pink and simple chronic lichen; numeral eczema; seborrheic dermatitis under the hair; secondary syphilis; dermatophytosis and candidiasis.

Treatment of the exacerbation of psoriasis

The recurrence of this chronic disease, even in a mild form, causes a great deal of discomfort to the patient. In addition to the troubles of the physical plan (itching, painful sensations), the patients suffer psychologically, and with the defeat of the palms and soles it is problematic to simply walk and take something in hand.

First of all, you need to contact a dermatologist. After diagnosis, the doctor prescribes medication.

Treatment of exacerbation of psoriasis is first carried out with creams and ointments that do not contain hormones. Traditional remedies include local preparations based on zinc and salicylic acid: salicylic ointment, salicylic zinc paste, zinc ointment and paste, aerosol and Czinocap cream. This is a proven remedy to relieve inflammation, and the salicylic component of the ointment softens and dissolves the affected layer of the skin, removing the ecdysis.

Czinocap Cream can be used to treat children from the age of one year. The active substance zirconium pyrithione, which besides anti-inflammatory, also has antibacterial and antifungal action. Treatment of affected areas is carried out two to three times a day, the duration of treatment of psoriasis - a month and a half.

For the treatment of squamous lichen, modern local preparations are produced, which are available in the form of cream and solution, Daivonex and Psorkutan, with the active ingredient calcipotriol (vitamin D analogue), which deactivates T-lymphocytes and inhibits the growth of the keratinocyte layer. The therapeutic effect should come in two weeks. They are used both with monotherapy of psoriasis, and together with corticosteroids, cyclosporine, do not apply in combination with salicylic preparations. May cause an allergy.

When relapses of the disease, solutions and ointments are used that include birch, juniper, coal tar, pine tar, for example, Colloidin ointments, Antraminoids, Antrasulfone, Berestin solution. These drugs begin to be used on small areas of the skin. If the drug does not cause irritation, then the area of its use is increased. They are used with caution in the summer, since the tar is phototoxic.

Also used ointments based on solidol, softening the stratum corneum of the epidermis, exfoliating effect (ointment Kartalin, cream-balm Cytospor).

Kartalin's ointment includes extracted string and chamomile, retinol, vitamin D, lavender and eucalyptus oils, saltol, salicylic acid, lysozyme and bee honey. Producer promises with regular application softening of psoriatic plaques, gradual cleansing and restoration of skin. The treatment regimen is phased, given in the manufacturer's instructions. The full course of treatment is from two to four months. At the initial stage, there may be an exacerbation, with allergies, it is possible to combine it with antihistamines in the first month of treatment.

With local treatment of psoriasis, oil preparations are also used.

The most burning question: how quickly to relieve the exacerbation of psoriasis? The fastest, to date, action - for drugs that contain hormones. They are used only for the doctor's prescription and for the treatment of exacerbations in severe form, they have a lot of side effects, they also cancel them in stages. Hormonal preparations in the form of creams and ointments vary in strength of action. The most powerful active glucocorticosteroid is clobetasol propionate - ointment or Cream Dermoveit. A thin layer of the drug is applied once or twice a day. The duration of therapy is no more than four weeks, the weekly dosage is not more than 50 g. Unwanted effect from the use of occasionally may be pustular psoriasis.

Modern hormonal preparations for topical application are relatively safe, but they can only be used according to the doctor's prescription. Their use, usually, gives a quick, but a short-term effect. They are addictive, drug cancellation is made with difficulty, side effects are increasing, and it is worthwhile to seriously think about before achieving such speed.

With ineffective therapy with local medications, physiotherapeutic treatment is later called ultraviolet irradiation of the long-wave and medium-wave range using Psoralen, which increases sensitivity to radiation and enhances pigmentation. This drug is available in two forms: a solution for application to the skin and tablets for oral administration. May cause indigestion, headache and heart pain, increased blood pressure.

Exacerbations of psoriasis, in particular, psoriatic arthropathy is very effectively treated with the use of physiotherapy procedures: laser irradiation of blood; PUVA-therapy; magnetotherapy; electrophoresis with glucocorticosteroids; phonophoresis; therapeutic physical training.

To eliminate severe (medium severity) recurrences of the disease, systemic treatment with the use of preparations of vitamins A and D, glucocorticosteroids, immunosuppressants is used. Such appointments are an extreme measure, as these drugs have a lot of side effects.

Alternative treatment

Psoriasis is a serious chronic disease that has been known and studied for a long time, but even research specialists with knowledge, laboratories and technology did not come to a common opinion about its etiology and did not develop a unified approach to treatment. Independently to try to treat this disease is dangerous, as it is possible to provoke a complication of the disease. Alternative drugs are not always combined with medications prescribed by a doctor, so they can be used in practice only after consultation with the attending physician.

There are many ways to treat psoriasis exacerbations at home. For example, alternative treatment suggests the use of relapses to relieve the condition of the skin and relieve itching home "balneotherapy":

• take baths with the addition of lavender, pink, chamomile, bergamot essential oil;
• take a bath of medicinal herbs, a string or yarrow.

Herbal infusion of all herbs is prepared the same way: the dried ground grass (3/4 handfuls) pour two liters of water at room temperature and press for an hour. Boil and simmer on low heat for a quarter of an hour, let it brew for an hour, drain and wring out, add Bolotov vinegar No. 19 from psoriasis and eczema to the infusion. Pour water (37-38 ° C) into the bath, pour into it infusion. Repeat every other day. Duration of the procedure is 15 minutes. The course of treatment should take from 10 to 12 baths.

You can use mustard: take ½ tsp. Dried mustard and vegetable oil, 2 tsp. Tinctures of eucalyptus; mix tincture with mustard, combine with butter; spread on the affected areas and leave it there; After five to ten minutes, wash off warm, and then - with cold water. Having finished the procedure, provide the skin with hydration and a hypoallergenic cream.

To treat scaly lichen and prevent exacerbations, ointments with honey are used. Therapy begins during the period of remission. Ointments prepared according to the recipes listed below are applied to the affected areas of the skin for two to three months. According to reviews, you can completely cure psoriasis.

• mix in this ratio: medical Vaseline (50 g), fresh (up to 3 days) egg white (6 g), bee honey collected in May (3 g), baby cream (1 g);
• mix 100g of honey beet and one tablespoon of ash from garlic (a similar ointment was used by Avicenna in the treatment of eczema and scaly lichen).

Widely used treatment with herbs, cereals. Quite simply - to eliminate the peeling of the skin rub psoriatic sores with oat flakes for steaming; spread these areas with calendula ointment or sea buckthorn oil, while still taking a teaspoon of oil inside once a day.

Lotion of celandine: for 300g of fresh herb celandine - a quarter cup of red wine; pass the grass through the meat grinder and squeeze the juice, add half of the red wine; moisten in a mixture of cotton swab and lubricate psoriasis plaques, then grease them with the remnants of red wine.

Tincture of celandine: pour four tablespoons of the sliced roots of the plant 0.5 liter of alcohol, wrap and insist for several hours, lubricate the tincture of psoriatic plaques.

Homeopathy - a therapeutic system for treating small doses of drugs on the principle of similarity should give good results in treating such an individual disease as psoriasis. Especially with long-term treatment, since no harmful side effects in the treatment of homeopathic drugs have been observed. For the treatment of psoriasis in homeopathy apply about 30 drugs, each of them is suitable for some specific cases, so self-medication with homeopathic drugs can only do harm. You must get an appointment from the doctor-homeopath. For example, in the treatment of psoriasis apply:

• Arsenicum album (Arsenicum album) - is used for small itchy scales, when patients feel deterioration in cold weather and in cold rooms, appointed restless, and nevertheless accurate and pedantic patients; children - with psoriasis of the scalp.
• Arsenicum iodatum (Arsenicum iodatum) - is prescribed for coarsely scaly plaques, weakened and old patients.
• Aquifolium (Aquifolium) - with psoriasis of the scalp with a transition to the face and neck.
• Crotalus horridus (Crotalus horridus) - psoriasis of palms with an unpleasant odor.

In cases where there is no opportunity to visit a homeopathic physician, you can use pharmacy products manufactured according to the principle of homeopathic remedies. For example, the homeopathic ointment Psoriaten, containing mahogany padubolistic in homeopathic breeding. The ointment is intended for the treatment of mild forms of the disease, it can be used for children, the elderly, pregnant and lactating women under the supervision of a doctor.

[35], [36], [37]

Operative treatment

Surgical interventions for psoriasis are extremely rare, only when conservative therapy has not coped with the disease in cases of psoriatic arthritis. Operative treatment consists in removal of the affected tissues from the joint for the restoration of its function, prosthetics of large joints, and also fixing them in the correct position.

Diet in case of exacerbation of psoriasis

There are no unambiguous recommendations on the most effective set of products, as different patients respond very individually to the same product. Therefore, each patient is given personal recommendations. However, there is a general principle of building a diet, and it should be followed. The purpose of dietary nutrition in psoriasis is to maintain a certain acid-base balance in the body.

In the diet should predominate alkali-forming products (70-80%), half of them desirable to eat raw in the form of salads. Alkali-forming products are the majority of juicy fruits (except for cranberries, currants, plums and blueberries); most vegetables - almost all varieties of cabbage, celery, salads, spinach, carrots, beets, sweet potatoes, onions; fresh juices from vegetables and fruits.

Vegetables from the family Solanaceae (tomatoes, eggplants, potatoes, paprika, hot peppers) should be removed from the diet, regardless of their acid-base reaction.

Acid-forming products should be 20-30% of the diet. These products are saturated with proteins, starch, glucose, fats - meat and meat products, cereals and potatoes, cheese and cream, sugar and legumes, animal and vegetable oil.

Products provoking exacerbation - nuts, alcohol, spices, spicy, sweet, fatty, salty foods, smoked products, cheese with mold, citrus.

Positively affected by products containing polyunsaturated omega-3 fatty acids, vitamins C, E, PP, group B, carotenoids, calcium and zinc.

[38], [39], [40]

Prevention

Compliance with diet even during remission and an absolute ban on the use of alcohol and tobacco products. Alcohol aggravates the course of the disease, provokes exacerbation and facilitates the transition of an uncomplicated disease to psoriatic erythroderma.

A sick winter form of psoriasis, which under the influence of sunlight exacerbation, you need in winter, after consulting with a doctor, visit the solarium, physical therapy. At the summer form - to try to avoid sun rays with the help of clothes, umbrellas, wide-brimmed hats.

Patients with psoriasis should use caution in the treatment of other diseases.

Psoriasis, like other severe chronic diseases, causes depressive disorders in patients, especially during the period of exacerbation. At the first sign of depression it is good to seek help from a psychotherapist.

[41], [42]

Forecast

This disease is chronic and so far incurable, so the prognosis is relatively favorable. The treatment of psoriasis is currently aimed at achieving long-term remission and improving the quality of life of patients, but does not relieve the disease. Severe forms of psoriasis sometimes lead to disability of the patient.

Over time, the disease slowly develops, with the average and severe form of the disease, it accompanies other pathologies. When the patient pedantically performs the appointment of a doctor, observes a diet and a certain lifestyle, it contributes to the remission of scaly lichen, sometimes very long (up to several years).

[43], [44]