Teardrop psoriasis

Psoriasis or scaly lichen is a chronic, chronic non-infectious disease. It has the appearance of inflamed parts of the body, which consist of individual spots of the skin (papules), merging they form plaques. Teardrop-shaped psoriasis is one of its many varieties. Its name was given for the shape of lesions of the skin. On the skin, the papules of drop-shaped psoriasis are dry, pale pink, sometimes red, sometimes lilac circles, dots or droplets raised above the surface of healthy areas. As a rule, these rashes seize a large area of the body.

Epidemiology

The epidemiology of teardrop psoriasis indicates an insignificant prevalence (2-4% of the total population). However, among all kinds of psoriasis, he is in second place. The special propensity of any gender to the disease is not revealed. In a third of cases, its first manifestations appear at the age of 15-25 years, but may appear in another period of life. In the adult age, a flash of teardrop psoriasis, as a rule, occurs against the background of vulgar psoriasis.

[1], [2]

Causes of the teardrop-shaped psoriasis

Studies have not yet led to an accurate definition of the causes of teardrop-shaped psoriasis. It is believed that the onset of the disease is associated with an autoimmune disease of the body, triggered by the increased production of killer cells that destroy healthy cells. This process is associated with the presence of infection in the body. It is proved that the drop-shaped psoriasis progresses with exacerbation of infectious and viral infection. Analysis of the culture of the smear taken from the papule during this period confirms the presence of an infectious agent. Often for the first time the disease occurs after the transferred streptococcal infections (sore throats and pharyngitis).

[3], [4]

Risk factors

Among the possible risk factors for the appearance of drop-shaped psoriasis, both genetic factors and the influence of the patient's habitat are called. The genetic factor dominates, as evidenced by the large number of patients whose relatives had a similar disease. Investigating other factors that affect the occurrence or worsening of the disease, identified a few of the most common:

• disorders of neurological properties (suffered severe stress and neuropsychiatric trauma 49% of newly infected patients and 41% with exacerbations);
• infectious and viral diseases (15% and 21%, respectively);
• injuries of the skin (14% and 12% respectively);
• hormonal disorders (6% in each group);
• adverse climatic effects (5% for the first time ill and 4% with exacerbations);
• intensive drug intake (3% and 6%, respectively);
• other factors (8% and 10% respectively).

[5], [6]

Pathogenesis

With all that psoriasis is complex and poorly studied pathogenesis with relapses, teardrop-shaped psoriasis is almost the only of all its species has a scientifically proven connection with exacerbations of chronic infections or the transferred infections. But all the theories of its occurrence, as well as of other types of psoriasis, remain only suppositions that have not yet been scientifically proven. There are two main hypotheses that explain the processes leading to the disease. The first claims that psoriasis is the primary skin disease associated with disorders at the cellular level. There is an excessive division and growth of cells, as a result of which the overgrown tissues become inflamed and a border appears separating this focus from neighboring tissues. Functions of the epidermis are violated. The second hypothesis of the emergence of drip psoriasis is associated with the effect of various viral and bacterial infections on the immune system, and skin manifestations are considered secondary. In any case, in support of this hypothesis, says the fact that 80% of patients with drop-shaped psoriasis have streptococcal infections. It is known that psoriasis is a genetic disease. People who have relatives of psoriasis patients are at high risk. But the cause-effect relationships of these genes with the microorganisms that cause the outbreak of infection have not yet been studied.

[7], [8],

Symptoms of the teardrop-shaped psoriasis

The first signs of a drop-shaped psoriasis are characterized by a suddenness factor. Appears skin itching and in any place of the body there are small spots in the form of dots, droplets, circles (papules). 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 typical for this disease include extensive lesions, which are most often localized in the region of thighs, shoulders and forearms, neck, back, scalp. Palms, soles of the feet and fingernails teardrop-shaped psoriasis does not strike. The most characteristic symptoms of drop-shaped psoriasis include unstable rashes. Papules can suddenly disappear and give the patient hope for a full recovery. After a while they appear in a completely different and unexpected place and with greater intensity.

Teardrop psoriasis in children

According to the incidence of diseases among chronic dermatoses in children, psoriasis ranks second. Almost half of all diagnosed psoriasis falls on teardrop (postinfectious) psoriasis. This is explained by frequent infections of children (respiratory diseases, chickenpox, measles, rubella, tonsillitis, otitis), common in places where children gather - kindergartens, schools. As a rule, 2-3 weeks after the transferred infectious disease on the limbs, the trunk, on the head in the places of the baby's hair, there appear papules of a drop-shaped shape. Their rash is accompanied by severe itching. Plaques can persist for a long time. After their disappearance, there comes a remission, which has a different duration, up to ten years. The onset of a new flash is unpredictable, because there are no precise mechanisms for detecting the disease.

An exacerbation of teardrop psoriasis

An exacerbation of drop-shaped psoriasis can not be predicted, but most often it is associated with the transmitted infectious diseases. Sometimes during an exacerbation there are severe forms of acute psoriasis, in which serious complications and the transition to another kind of psoriasis are possible. Erythroderma is one of such forms, it affects more than 90% of the skin surface and causes a high temperature. There may be pustular psoriasis (mainly in people 45-50 years old), which is characterized by the appearance of many yellow and white pustules, increased body temperature, tachycardia. Pustular psoriasis in combination with erythroderma leads to Tsumbush psoriasis. The patient has muscle weakness, weight loss, fluid retention in the body. Often, when severe forms of acute psoriasis occur, hospitalization of the patient is required.

[9]

Stages

In the development of drop-shaped psoriasis, there are several stages that determine by means of such factors:

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

At the initial stage of the disease there are single rashes on the skin and the lesion 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 coloring of papules increases, the skin in the lesions thickens. Doctors define this condition as a moderate psoriasis. With more extensive skin disorders, a severe form of psoriasis occurs with laboratory confirmation, a deterioration in the general condition and quality of life of the patient. With a drop-shaped form, it is impossible to predict the stage of the disease. The outbreak can occur several times a year, mainly in the spring-autumn period, when viral infections become more active and the body's defenses are weakened. Distinguish the acute form of drip psoriasis, which can go into a chronic form, 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 teardrop-shaped psoriasis are associated with the risk of concomitant diseases.

It is possible to single out in one group complications leading to a metabolic disorder:

• insulin-dependent diabetes mellitus;
• obesity;
• diseases of the cardiovascular system;
• hypertension;
• development of atherosclerosis, due to increased levels of "bad" cholesterol.

It is also possible the occurrence of such diagnoses as:

• celiac disease (disruptions in the operation of the small intestine due to gluten);
• cancer (mainly lymphoma and skin);
• psoriatic hepatitis and arthritis;
• kidney diseases;
• lack of folic acid.

There are also psychological and social aspects of the consequences of the disease. Often, rashes occur on open areas of the skin and patients, afraid to face a cautious, distrustful, and sometimes disgusting attitude to themselves, fear of becoming infected, self-isolated. Often people leave their jobs, do not dare go out, limit the circle of communication. All this psychological press combined with physical discomfort can lead to a nervous breakdown, depression, and this is fraught with a new outbreak of exacerbation.

[10], [11], [12]

Diagnostics of the teardrop-shaped psoriasis

Diagnosis of teardrop psoriasis is based on the analysis of anamnesis (information about heredity, transferred diseases, injuries, operations, allergic reactions, living conditions, etc.), general examination of the patient, as well as clinical and laboratory studies. Psoriasis, like other skin diseases, the competence of a dermatologist. Sometimes a visual examination is enough to determine to recognize the ailment. If there are doubts, they resort to other studies.

[13], [14], [15]

Analyzes

To exclude the presence of a fungal infection in the body, a test with potassium hydroxide (KOH) is performed. The procedure is not complicated. The doctor at the site of skin lesions with a special slide will do scraping. In the laboratory, the resulting tissue is mixed with potassium hydroxide, which kills healthy cells and does not destroy fungal cells. Examine the fluid from the papules for the presence of staphylococcal and streptococcal infections, which are satellites of teardrop-shaped psoriasis. Also take a smear from the throat to check for pharyngitis. And resort to the study of blood and urine tests (for example, to detect antibodies to infectious agents). Can take skin samples for allergic reactions.

[16], [17], [18]

Instrumental diagnostics

To the instrumental diagnosis of drop-shaped psoriasis is research using a dermatoscope that scans fragments of skin lesions, enlarges and displays on the monitor screen. Since the course of the disease can be complicated by serious consequences, ultrasound (ultrasound), computed tomography (CT), radiography, magnetic resonance imaging (MRI) are used to detect abnormalities in other organs.

Differential diagnosis

Differential diagnosis is intended to distinguish teardrop-shaped psoriasis from other diseases similar in its symptoms: secondary syphilis, pink lichen, toxicoderma. So, pink lichen has similar plaques, but unlike teardrop-shaped psoriasis can manifest itself on the palms and soles of the feet, besides it is an infectious disease and is identified with the help of certain analyzes. Secondary syphilis is also similar in its manifestations with teardrop-shaped psoriasis, but it has rashes on the soles of the feet and palms, and can also be detected using a special test (RPR test). Toxicodermia provokes an allergen, so it is determined with the help of laboratory studies and bakposives.

[19]

Treatment of the teardrop-shaped psoriasis

Treatment of drop-shaped psoriasis consists of an integrated approach and depends on the stage of the disease and the patient's condition. An important role in the treatment is the adherence to diet and the rejection of bad habits. In the diet should predominate products of vegetable origin and up to 1.5 liters of fluid per day. Fat and spicy food should be excluded, as well as smoking and alcohol. An important role is played by the psychological state of the patient. To stabilize it, soothing drugs are used, which include Leonurus, Valerian root. If necessary, appoint tranquilizers and antidepressants. To soften keratinized papules, reduce inflammation and itching use external means for topical application. These remedies include ointments, creams, sprays, gels. Ointments can be non-hormonal and hormonal. The latter are more effective, but they must be applied carefully, guided by the doctor's recommendations. To weak on effect of treatment it is possible to carry hydrocortisone and prednisolon ointment, clobetasol and dermovajt - strong on influence on the amazed sites of a skin. Another area of external therapy is the use of an ointment, a spray, a gel of the preparation of calcipotril (synthetic vitamin D3), which inhibits the multiplication of skin cells. Local therapy includes cryotherapy, the essence of which is the effect of cold (liquid nitrogen) on the foci of the disease. Effective in the treatment of drop-shaped psoriasis is phototherapy - ultraviolet irradiation of affected areas. Possible use of plasmapheresis. This procedure of blood purification consists in taking blood, purifying it of toxins and returning back to the bloodstream. In the treatment of the disease also resort to vitamin therapy, physiotherapy, drug therapy.

Medications

The drugs prescribed in the treatment of teardrop-shaped psoriasis include antihistamines, blocking the mediators of inflammation: claritin, diazolin, tavegil, suprastin, telfast.

Suprastin - is available in the form of tablets and a solution for injection. Tablets are taken after meals in doses: for adults - 75-100 mg 3-4 times a day; for children 3-6 years - on a floor of a tablet 2 times a day; for children 6-14 years - on a floor of a tablet 2-3 times a day. The daily dose for children should not be more than 2 mg per kilogram of the child's weight. The maximum allowable dose is 100 mg per day.

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

1-12 months. - 0.25 ml; 1-6 years - 0.5ml; 6-14 years old - 0.5-1ml. The duration of treatment is determined by the doctor. Contraindicated in people with increased sensitivity to drugs that are part of the drug, with stomach ulcers, with arrhythmia. It is recommended to observe precautions when taking the drug elderly, weakened people, pregnant and lactating women, people with impaired liver function, drivers behind the wheel. Side effects include sedative, blurred vision, fast fatigue, allergic reactions, dizziness, arrhythmia, tachycardia.

Telfast - tablets, is recommended for admission to adults and children after 12 years of one tablet at a dose of 120 mg or 180 mg once a day. The intake of tablets does not depend on the intake of food and should be accompanied by a plentiful drink. It is important to observe the time intervals between drug use (24 hours). Serious adverse reactions are not noted, but pregnant women and nursing mothers should consult a doctor.

In severe forms of drop-shaped psoriasis, cytostatics, drugs that suppress the body's immune response (cyclosporine, meotrexate) are used.

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

The same immunosuppressant orientation and drugs that have monoclonal bodies. This new high-efficiency generation of drugs, their action is directed to a specific area of damage, in the case of teardrop-shaped psoriasis - excessive growth of damaged skin cells and their inflammation. These drugs include infliximab, ustekinumab, adalimumab.

Adalimumab - injections, are administered subcutaneously either in the abdomen or in the thigh region, 40 mg every 1-2 weeks. Side effects include headaches, dizziness, insomnia, depression, decreased appetite, anemia, possible swelling, the formation of glaucoma, allergic reactions. Contraindicated in pregnant and lactating women. It is necessary to observe precautions for elderly patients, with hepatitis B, tuberculosis, there are cases of development of lymphoma.

In the treatment of other types of psoriasis antibiotics are generally not used, but teardrop aggravation is often associated with the presence of streptococcal infection, so this treatment is appropriate. More often appointed so-called macrolide antibiotics, tk. They can have another positive effect in the treatment of psoriasis, not associated with antibacterial action. These include erythromycin, clarithromycin, roxithromycin.

Erythromycin - tablet form of injection, injection, ointment. Tablets are taken for an hour and a half before meals. Adult dose 4 times a day for 250-500 mg, but not more than 2 g. Children are prescribed depending on the age: 1-3 years - 400 mg per day; 3-6 years - 500-750mg; 6-8 years - 750 mg; 8-12 years - 1g divided into 4 receptions. Intravenous dose is calculated 15-20 mg per kilogram of weight. Ointment is applied to the affected area.

Side effects are expressed in the form of nausea, dizziness, diarrhea, negative effects on the liver. Precautions: taking the drug may be accompanied by drug-induced hepatitis.

Vitamins

Clinical studies have shown that when patients receive nutritional supplements or products containing vitamins A, B, E, C, D, their condition improves. If the patient is currently taking treatment, then 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 can not be combined with multivitamins, but methotrexate is recommended for taking with certain vitamins in order to reduce side effects.

Physiotherapeutic treatment

Physiotherapeutic treatment of drop-shaped psoriasis or physiotherapy is the use of various physical phenomena, such as cold (cryotherapy), electromagnetic fields, light, ultraviolet rays, electric alternating current. So, to remove the itching, increase blood circulation in the area of skin lesions, apply darsenville. This procedure is based on the use of high frequency current. It is prescribed for adults and children after 11 years. The use of electrophoresis and galvanization also increases blood circulation, relieving pain. Children are prescribed twenty minute sessions, adults - half an hour. In acute stages of the disease can not be used. Microwave therapy and UHF is indicated for inflammation of lesions. Electrosleep - the impact of electric current on a person by slowing down the processes in the cerebral cortex, enhances the metabolic processes of the body, acts soothingly on the patient.

Alternative treatment

Along with the traditional, the alternative treatment of teardrop-shaped psoriasis is also used. It consists in the preparation and use of various herbal infusions and broths for ingestion, for the preparation of baths, the manufacture of ointments for external use. Here are some recipes for cooking ointments:

• one egg white is mixed with 100 g of solidol, 10 g of celandine, 30 g of ash from oak bark and crushed rosehip. Everything is mixed and insisted for at least two weeks. Lubricate inflamed foci several times a day;
• mix 60 g of honey and solidol, add 2 g of lycopodium and 5 g of chopped celandine, the resulting mixture applied several times a day;
• 50 g of ground propolis, combine with 0.5 kg of melted butter on a water bath, stir well. Inflamed site must be wiped with hydrogen peroxide, dried, then apply ointment and fix it with a bandage, do not remove two days.

For ingestion, you can use these recipes for cooking tinctures:

• half a cup of water put two tablespoons of bay leaf, boil 10 minutes, let it brew for 1 hour, drink during the day;
• per liter of boiling water put 2 tablespoons chopped barley malt, insist a few hours, take half a cup several times a day, adding honey.

To treat drop-shaped psoriasis, tar tar is widely used, often in combination with other components (zinc, salicylic acid). They have a strong anti-inflammatory effect, inhibit the multiplication of diseased skin cells. Negative aspect of such treatment is an unpleasant smell of ointment, it should be used carefully for patients with diseased kidneys.

Herbal Treatment

To treat drop-shaped psoriasis, grasses are actively used that have anti-inflammatory and soothing effects. Here are some of them: turn, chamomile, valerian root, celandine, mint, lemon balm, sea buckthorn, calendula, sage, hops, etc. From the herbs are prepared as infusions and broths for internal use, and for the preparation of baths. For baths, it is necessary to pre-brew grass in the proportion of a spoonful of pharmacy or two fresh herbs for a glass of boiling water and let it brew for a minimum of half an hour. The resulting infusion is poured into the bathroom. The amount of grass depends on the volume of the bath, but the water must completely cover the affected area. Very effective baths from the turn, chamomile, sage, birch buds, conifers. Such procedures should be taken with caution in patients with diabetes mellitus, hypertensive patients, epilepsy, pregnant women.

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

• 4 spoons of turn are covered in a thermos, pouring a liter of boiling water, and insist 2 hours. Cooled infusion drink 100g 3 times a day, adding a half teaspoon of honey;
• herbal collection, consisting of one spoon of each component: St. John's wort, string, celandine, valerian, althea pour a liter of boiling water, allow to stand for several hours, drink 100ml twice a day;
• Pharmaceutical tincture of celandine is taken together with eleutherococcus (15 drops each);
• 1 tablespoon of a mixture of herbs of sage, St. John's wort, tansy, three-colored violet, cranberries pour a glass of boiling water, insist for half an hour, take after meals 2 times a day for at least a month.

Homeopathy

Homeopathy owns an arsenal of tools that can help in the treatment of teardrop-shaped psoriasis. When treating the disease, it is well proven:

• Cardoom Marianus - at its base, milk thistle, the effect is directed to the purification of the liver. Has anti-allergic effect, improves the hormonal system. There were no side effects. It is used in 1, 3 and 6 dilutions;
• Solidography - contains components of animal organisms, plants, minerals. Of the plants, the goldenrod is used. Has antiseptic, anti-inflammatory effect. Patients are well tolerated, children under 6 years are not assigned. The treatment course is 4-6 weeks;
• Helidonium - is created on the basis of celandine, its action is directed to the purification of the liver. Side effects include the development of jaundice in some cases. Children are advised to use the drug from the first to the sixth breeding, adults - from the sixth to the twelfth;
• sulfur - sulfur, affects the vegetative system of man, is used for various cutaneous injuries. It is recommended to start taking in low concentrations (12 and above), gradually increasing to 6 and 3. Adverse events depend on the individual characteristics of the body, and it is also not recommended to combine with the intake of alcohol.

Prevention

The best measures to prevent a drop-shaped psoriasis are a healthy lifestyle that excludes smoking and drinking alcohol, avoiding stressful situations. Very important is also the observance of a balanced diet, in which vegetables and fruits should prevail, and meat, dairy and grain products in the diet of the patient can occupy no more than 20-30%. Also for patients with drop-shaped psoriasis, it is important to drink plenty of liquid (1.5-2 liters per day). Not superfluous for the prevention of the disease and the reception of baths containing various decoctions of herbs and their collections, which are described above.

[20],

Forecast

The prognosis for curing teardrop psoriasis, as well as other types of it, is unfavorable, but with timely treatment and support of all recommendations, the remission stage can last a long time, up to a dozen years.

[21]