Symptoms of psoriasis

Psoriasis often begins at the age of 20 to 30 years and 75% of patients get it up to 40 years of age. However, in general, the symptoms of psoriasis can occur at any age.

Psoriasis begins in different patients in different ways. Primary rash with vulgar psoriasis is a sharply limited pink color spot of circular shape the size of the head of a pin (a symptom of Pylnov). The color of the rashes can be from bright pink to bright red. Already at the very moment of appearance, the surface of the spot is mostly covered partially or completely with silvery-white scales.

In some cases, the primary element from the very beginning feels like a papule at the touch, but if you completely remove the scaly, this impression usually disappears, because at the beginning of the existence the psoriatic primary eruption is infiltrated so insignificantly that it does not clinically infiltrate palpation. Gradually, the size of the rash increases, the infiltrate increases, the scales become larger and a monomorphic rash in the form of nodules (papules) is formed.

As a result of peripheral growth or fusion of elements plaques of the most different outlines are formed. Preferred location - the extensor surfaces of the upper and lower extremities, especially in the area of elbows, knees, scalp, skin folds, trunk. In some patients, the localization of psoriatic rash is the reverse of normal. This is the so-called reverse psoriasis (psoriasis inversa), since instead of the extensor surfaces, the flexion is also affected. For psoriatic eruption, the following three phenomena are characteristic:

1. a stratification of a large number of silver-white scales, when they are scraped, there is some similarity to the stearic stain-the phenomenon of the stearin stain;
2. after complete removal of the scales, a thin, translucent film opens, covering the psoriatic element - the phenomenon of the psoriatic film;
3. when the integrity of this film is violated by gentle scraping, spot bleeding occurs in places - the phenomenon of the blood race of Polotebnova, or the phenomenon of Auspitz.

In the clinical course of psoriasis, three stages are distinguished:

1. the period of progression, when the elements of the rash increase in size, and this coincides with the appearance of new rashes;
2. stationary period, when the peripheral growth of the rashes stops and the appearance of new elements is suspended;
3. The period of regression, when the reverse development of rashes occurs.

This division is conditional, since in one patient, simultaneously with the regress of the rash, new elements may appear. A pseudoatrophic bezel is characteristic when, around developed, already no longer growing elements of the rash, the skin is somewhat paler, shinier than the surrounding healthy skin, the periphery of the elements is slightly impressed, folded, like a cigarette paper. The presence of the pseudoatrophic rim of Voronov indicates the suspension of growth of the psoriatic element.

In terms of the magnitude of psoriatic rashes, psoriasis is distinguished: punctate, when the rash does not exceed the pinhead; teardrop-shaped, when the rash is somewhat larger than the pinhead; coin-shaped, when the plaque is large and round; figured, which is formed by the fusion of neighboring rashes and plaques, while lesions are diverse in shape and form figures; geographic, when the foci of defeat, merging, resemble a geographical map; ring-shaped, when the rash as a result of fusion or resolution from the center form an annular shape; serpiginous, when the focus of defeat creeps in one direction or another.

A characteristic feature for psoriasis is an isomorphic irritation reaction, or the Köbner phenomenon, when psoriasis papules appear 10 to 14 days later (sometimes later) at the site of a trauma or a scratch. The presence of an isomorphic irritation reaction in the patient indicates the still predisposed skin at that time to the psoriatic rash.

With the localization of psoriasis on the scalp, the transition of the rash to the marginal areas of the forehead is a typical "psoriatic crown".

Mucous membranes are rarely affected, mostly with pustular and severely current arthropathic psoriasis, but this has not significant prognostic or diagnostic significance.

The defeat of the nail plates (often on the hands, rarely - on the legs) is one of the frequent symptoms of psoriasis. The most characteristic is the formation of point impressions that give the nail plate a resemblance to a thimble (a symptom of a "thimble"). In addition, longitudinal and transverse grooves, changes in nail color, turbidity, deformation of the nail plate, fragility of the free margin, onycholysis or onychography can be observed. From the subjective sensations, patients most often complain of itching in the lesions, especially when the scalp is affected, and joint pain with arthropathic psoriasis.

Distinguish the following clinical varieties of psoriasis: normal (vulgar), exudative, seborrhoeic, arthropathic, psoriatic erythroderma, pustular psoriasis and psoriasis of the palms and soles.

[1], [2], [3], [4], [5]

Histopathology of psoriasis

Pathognomonic sign of psoriasis is a significant acanthosis with the presence of elongated epidermal outgrowths, somewhat thickened in their lower part.

Above the tops of the papillae of the dermis, the epidermis is sometimes thinned, parakeratosis is characteristic, and in the old foci - hyperkeratosis. The granular layer is unevenly expressed, there is no parakeratosis under the sections. In the progressing stage, intergalactic and intracellular edema, exocytosis with the formation of focal aggregations of neutrophilic granulocytes, which migrate to the stratum corneum or parakeratotic regions, form the Munro microabscesses in the spinous layer. Mitosis is often found in the basal and lower rows of the spinous layer. Accordingly, the lengthening of epidermal outgrowths papillae of the dermis are elongated and enlarged, sometimes bulbous, edematous, the vessels in them are sinuous, full of blood. In the podsochev layer, a perivascular infiltrate from lymphocytes and neutrophilic granulocytes is noted.

Symptoms of exudative psoriasis

Exudative psoriasis differs from the clinical picture of ordinary psoriasis by significant exudation, as a result of which scales and yellowish crusts appear on the surface of psoriatic eruptions. When removing the latter, a bleeding, wetting surface is exposed.

Symptoms of seborrheic psoriasis

With seborrhoeic psoriasis, the eruptions are localized on the scalp and other "seborrheic" areas and have a peculiar clinical picture. The hairy part of the head is affected most often. The process can be isolated for a long time and is not manifested in the form of papular elements or plaques, but with profuse ecdysis without pronounced inflammatory changes. In this case, diagnosis is difficult, if there are no rashes on other skin areas and there is no evidence of the presence of psoriasis in the relatives of the patient. In addition, on the face, in the sternum, especially in persons prone to seborrheic reactions, they discover papules or plaques covered with stratified scales with less distinct boundaries. The psoriatic triad is less pronounced than with ordinary psoriasis.

Symptoms of arthropathic psoriasis

Arthropathic psoriasis is the most severe form of the disease, often leading to disability, and sometimes even to the death of a patient from cachexia. The defeat of the joints in psoriasis testifies to the systemic nature of the process. Men suffer more often than women. The onset of the disease is different. The defeat of the joints often joins the already existing skin manifestations. In other cases, the latter is preceded by articular phenomena, sometimes existing for an isolated long time. Radiologically different changes in the osteoarticular apparatus are found in most patients without clinical signs of joint damage. The most common are osticular articular osteoporosis, articular narrowing, osteophytes, cystic enlightenment of bone tissue, less often - bone erosion often manifested by asymmetric oligoarthritis, limited to one or more joints of hands and feet, often involves the spine (psoriatic spondylitis), mainly thoracic and lumbar departments, sacroiliac joints (psoriatic sacroiliitis). Patients complain of severe spontaneous pain in the joints, aggravated by movement. The area of affected joints in the first period of the disease is hot and swollen. The general condition of patients worsens: body temperature rises in the evening, appetite decreases, gastrointestinal function is disrupted. These phenomena gradually abate and the process passes into a subacute, then into a chronic phase. From time to time there are exacerbations of arthropathy and skin process. In the future, there is restriction, deformation of the joints, and sometimes - ankylosis.

Psoriatic Erythroderma

Psoriatic erythroderma rarely develops and is a complication of psoriasis, which in most cases develops as a result of excessively irritating local treatment or the action of any other adverse local influences (UV, insolation). Erythroderma gradually occupies all or almost all of the skin. The skin becomes bright red and becomes covered with large or small dry white scales. When the patient undresses, a lot of silver-white scales are poured from him. The skin of the face, the auricles and the scalp are sprinkled with flour. The skin is more or less infiltrated, edematous, hot to the touch, sometimes lichenized. Patients complain of more or less pronounced itching, constriction of the skin and burning sensation. Places of clinically unchanged skin or papules and plaques of typical psoriasis are preserved in some places.

Erythroderma significantly worsens the course of psoriasis. The general condition of patients is sharply disrupted, the temperature rises to 38-39 degrees, the lymph nodes (more often the femoral and inguinal) increase.

Symptoms of Pustular Psoriasis

There are two types of pustular psoriasis: generalized pustular psoriasis (Zumbush) and limited palmar-plantar pustular psoriasis (Barber). The generalized form proceeds with difficulty, with fever, malaise, leukocytosis, an increase in ESR. Paroxysmal against the background of bright erythema there are small superficial pustules, accompanied by burning and soreness, located both in the zone of plaques and on previously unchanged skin. Pustular psoriasis of the palms and soles occurs more often than the generalized form. Eruptions, as a rule, are symmetrical and represent intraepidermal pustules against a background of severe hyperemia, infiltration and lichenization. Eruptions are located mainly in the area of the tener and the hypotener, the arch of the feet.

Palms and soles of the hands are more common among people engaged in manual labor, aged 30 to 50 years. In most cases, palms and soles are simultaneously affected. Clinically, the following forms of palmar-plantar psoriasis are distinguished: lenticular, plaque-fan-shaped, circular, horny and calloused. Simultaneously, in other parts of the skin, typical psoriatic eruptions are found. Phenomena of terminal film and spot bleeding are caused with great difficulty than in other areas.

Psoriasis folds

Psoriasis folds are common in children or the elderly, especially in diabetic patients. The foci are most often located in the armpits, under the mammary glands, around the navel, in the perineum. Peeling, as a rule, is insignificant or absent, the outbreaks are sharply outlined, their surface is smooth, saturated red, sometimes slightly moist, macerated. In the depths of folds, sinners can arise.

Differential diagnosis of psoriasis

Symptoms of psoriasis should be distinguished from parapsoriasis, papular syphilis, red flat lichen, erythrodermic form of fungal mycosis, red hair follicles, rheumatoid arthritis and Reiter's disease.

[6], [7], [8], [9], [10], [11], [12]