Plaque psoriasis: common, chronic, pustular

Of all the varieties of psoriasis, doctors most often diagnose plaque psoriasis - it is also called simple, ordinary, or vulgar psoriasis. This disease is considered very common and can affect a person at any age, regardless of gender and social status.

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Epidemiology

Plaque psoriasis is considered the most common variety of this disease. It is diagnosed in approximately 88% of patients with psoriasis.

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Causes of the plaque psoriasis

Specialists still can not name the cause of the disease. It is assumed involvement of the hereditary factor, but there is a huge number of cases when plaque psoriasis is diagnosed in people whose heredity is not burdened by the disease. Therefore, scientists have identified a number of theoretical factors that, to varying degrees, can affect the onset of development in the body of plaque psoriasis.

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Risk factors

The risk factors may be as follows:

• severe or chronic stress;
• frequent or chronic infectious diseases, frequent ARVI, ARI, sore throats;
• disturbed nutrition with the predominant use of the so-called "unhealthy", harmful food;
• alcohol abuse;
• diseases of the digestive system, associated, first of all, with bad habits or malnutrition;
• work in harmful industries, chronic intoxications, frequent mechanical damage to the skin;
• chronically weak immunity, beriberi.

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Pathogenesis

To date, specialists have proposed two theories of the pathogenesis of plaque psoriasis:

1. Immune-dependent theory. The cellular structures responsible for immunity change their protective function: they are directed to the surface layers of the skin, where a large number of cytokines are released. As a consequence, the growth of keratocytes is provoked, inflammatory reactions in the skin begin. This theory is justified by the fact that treatment of psoriatic plaques with immunosuppressant drugs leads to a persistent positive effect.
2. Theory of functional intracellular disorders. Disturbed intradermal processes lead to a malfunction of cellular differentiation: uncontrolled cell division begins in the affected cellular structures. As a result, the immune system responds to this disorder and seeks to suppress it. In support of this version, evidence is provided: drugs that have a disastrous effect on the growth and development of keratocytes are successfully used in plaque psoriasis.

It can be seen that the two versions are absolutely contradictory. That is why the search for the exact cause and the correct decision regarding the pathogenesis of plaque psoriasis is still ongoing.

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Symptoms of the plaque psoriasis

Reddish, with desquamation and symmetrical localization, spots are most often found on the extensor side of the hands or feet, on the scalp, in the lumbar region, in the buttock zone, on the external genitalia. Multiple scales and plaques are formed regularly. Insignificant separately located spots can merge, spread to the periphery, take various forms.

Depending on the clinical manifestations, distinguish individual types of plaque psoriasis:

• geographical plaque psoriasis - characterized by the fusion of plaques, whose outlines are similar in appearance to the geographic map;
• plaque psoriasis gyrata - is manifested by the peripheral spread of plaques, which when merged form a form of a spiral or garland;
• annular plaque psoriasis - characterized by partial resolution in the central part of the foci, which gives plaques the appearance of a ring;
• plaque rupoid psoriasis - for him typical appearance of foci of cone-shaped or saucer-shaped;
• plaque oyster psoriasis - manifested by the presence of foci with a concave central part, which in appearance resembles an oyster shell;
• elephant psoriasis is an atypical form of plaque psoriasis, in which it is possible to observe the formation of large plaques with thick thickened scales (more often on legs).

The first signs of plaque psoriasis can appear in a person at any age. However, according to statistics, most pathology finds itself in adolescents aged 14-17 years, or in the elderly - about 60 years.

Stages

• I - stage of progress: spots appear on individual parts of the skin, which gradually grow in size.
• II - hospital stage: spots join together, forming scaly plaques of light-silver color.
• III - stage of regression: plaques gradually turn pale, peeling is minimized. If there was an itch or other unpleasant sensations, then they persist.

Plaque psoriasis has a chronic course, so the stages are repeated periodically: the period of exacerbation is replaced by a period of remission, the duration of which varies from patient to patient.

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Forms

Plaque psoriasis can manifest itself, or in combination with other diseases - for example, the nervous or digestive systems.

First, reddish spots appear on individual areas of the skin, on which light scales gradually form. Such specks at first do not differ in size, but with the progression of the disease they increase and connect with each other, forming plaques.

Spots can itch, but this does not always happen: sometimes the patient does not experience any unpleasant sensation in the affected areas.

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Common plaque psoriasis

If the skin surface covered with psoriatic plaques exceeds 10% of the entire surface of the trunk, then talk about common plaque psoriasis - this is a serious form of the disease that requires immediate medical intervention.

A common form can affect large areas of skin, including the scalp. These patients have an increased risk of joining a microbial or fungal infection. Especially often, complications occur in patients with psoriasis-affected lower limbs, as fungal diseases usually occur on the legs, abrasions and injuries occur, varicosity and trophic ulceration occur, which creates a favorable background for plaque infection.

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What is vulgar plaque psoriasis?

The term "vulgar psoriasis" is a synonym for other names of the disease: plaque, plaque, plaque, common, common, scaly psoriasis. All these terms are applied to the same form of psoriasis, and therefore they should be perceived identically.

The name comes from the Latin word "vulgaris" ordinary, ordinary.

Chronic plaque psoriasis

If you do not take timely measures to treat plaque psoriasis, the disease will progress and become chronic. As a rule, in most cases plaque psoriasis is aggravated wavy, with periodic relief of the patient's condition.

In severe periods, remission may not be at all: the disease spreads, psoriatic arthritis develops, nails and even internal organs are affected.

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Papular plaque psoriasis

Papular-plaque psoriasis is a disease in which, along with reddish patches (scaly patches), papules appear on the skin. What is a papule? This is a shallow, superficial, slightly convex formation, prone to transient reverse development. Otherwise, the papule is also called a nodule.

In psoriasis, papules can expand into the periphery, "melt" in their central part, forming a characteristic ring-like element. In this case, they often talk about ring-shaped plaque psoriasis - in fact, they are different names for the same disease.

Complications and consequences

The consequences of plaque psoriasis depend on how bad the disease is. For example, patients with severe disease have an increased risk of developing lymphoma.

Plaque psoriasis causes patients to experience significant psychological discomfort, due to constant feelings about their appearance. This is manifested in low self-esteem, in minimizing social ties, which necessarily affects the patient's ability to work and personal life. Long-term psychological stress leads to the development of depressive states and neuroses, right down to suicidal thoughts. We can say that plaque psoriasis itself does not pose a threat to life, but it can significantly affect its quality.

As a result of constant stress in patients often develop such secondary complications as hypertension, cardiovascular pathology, diabetes mellitus.

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Diagnostics of the plaque psoriasis

Plaque psoriasis can be easily determined by external pathological signs. However, if necessary, the doctor can appoint additional confirmatory methods of diagnosis - according to the results of the research a more accurate treatment plan will be drawn up.

Analyzes are included in the standard set of studies for psoriasis:

• Blood analysis (general and biochemical) - pay attention to the level of leukocytes, hemoglobin, uric acid (rheumatoid factor).
• Cal for the presence of helminths.
• Urine for the assessment of water-electrolyte balance.

Instrumental diagnosis is used to clarify the diagnosis:

• Biopsy - microscopic examination of affected tissues.
• Radiography is a study for the lesion of psoriasis of the joint tissues.
• Tests and scrapings to exclude fungal and syphilitic skin lesions.
• Bacterial sowing is the study of psoriatic lesions of mucous tissues.

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Differential diagnosis

Differential diagnosis of plaque psoriasis is carried out, basically, with such diseases:

• with discoid eczema;
• with cutaneous lymphoma;
• with smooth skin dermatophytosis;
• with squamous cell carcinoma;
• with Paget's disease.

In addition, it is desirable at the same time to exclude diseases such as red hair follicles, lichen, epidermal nevus, seborrheic dermatitis, subacute lupus erythematosus, erythrokeratodermia, candidiasis, Hailey-Heli disease, etc.

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Treatment of the plaque psoriasis

Treatment regimens with plaque psoriasis are made taking into account a wide range of external and systemic medicines. The main thrust of the treatment is immunomodulation - restoring the broken links of immunity, cell functions and ensuring the usefulness of the ongoing reactions.

Choosing drugs for a particular patient, the doctor compares the severity of the disease and the condition of the patient as a whole. Since plaque psoriasis is a chronic pathology, it is important to consider the safety of the selected drugs for long-term use.

Many medications - for example, Calcipotriol or Methotrexate - are best suited for prolonged use. This can not be said about external preparations based on corticosteroids, as well as on cyclosporine - these medications are prescribed by short courses, or as part of complex rotational therapy.

Medications recommended for plaque psoriasis

	Dosing and Administration	Side effects	special instructions
Calcipotriol	Ointment is applied to plaques with psoriatic plaques twice a day. The course of treatment lasts 1,5-2 months.	Rarely - skin irritation, hypercalcemia.	The drug is not used on the face and does not combine with ointments based on salicylic acid.
Methotrexate	Take inside 10 to 25 mg per week, with a gradual increase in dosage.	There may be anemia, nausea, digestive disorders, dizziness, conjunctivitis, convulsions.	Treatment with the drug occurs under the constant supervision of a doctor, with monitoring of the blood picture and the function of the cardiovascular system.
Ephalizumab	The drug is administered subcutaneously, in the initial dosage of 700 μg per kg of body weight, once a week. The total duration of the course is 3 months.	Flu-like syndrome, lymphocytosis, allergy, ecchymosis are possible.	The drug is administered with great care and under the supervision of a doctor.
Lorinden A	Ointment is applied to the affected skin 2-3 times a day, but not more than 3 consecutive weeks.	Treatment can be accompanied by burning, dry skin, atrophy, hyperpigmentation.	Lorinden is not applied to the face. The drug can not be used for a long time, as there can be an addictive and "cancellation" syndrome.
Tacrolimus	The drug is administered in individual dosages, one hour before a meal, or 2-3 hours after it.	Treatment can be accompanied by an increase in blood pressure, tachycardia, dyspepsia, a violation of digestive processes, impaired renal function.	Tacrolimus can not be taken simultaneously with preparations of St. John's Wort or with other herbal preparations.

An additional important condition for the onset of remission of plaque psoriasis is the careful adherence to dietary principles of nutrition. First of all, you need to limit the intake of simple sugars, animal fat and provoking food (chocolate, coffee, spices, marinades, alcohol).

Nutrition with plaque psoriasis should be emphasized on sour-milk products, plant products and oils, cereals.

Improving the patient's condition can also be regular psychotherapy, which helps to alleviate stressful situations and increase self-esteem. In some situations, antidepressant medication may be required.

Vitamins

It is very important for patients with plaque psoriasis to receive a sufficient amount of vitamin D ₃. This vitamin acts by associating with a certain hormonal receptor - it normalizes the development, differentiation and protective properties of cells, stabilizes calcium and phosphorus metabolism. Vitamin D blocks the proliferation of keratinocytes and regulates the differentiation of epidermal cells.

In addition, vitamin inhibits the production of psoriatically altered cytokine cells.

To the analogues of vitamin D ₃, recommended for reception with plaque psoriasis, include Calcipotriol, Maksakaltsitol, Takaltsitol. These drugs are often included in complex schemes, along with external hormonal agents. This combination increases the therapeutic effect of corticosteroids, and also reduces the risk of developing steroid cutaneous atrophy.

Physiotherapeutic treatment

Physiotherapy is an important component of an integrated approach in the therapy of plaque psoriasis. Most experts recommend such procedures:

• magnetotherapy - the effect of low-frequency permanent or pulsed magnetic fields;
• PUVA therapy is a physiotherapeutic method with the use of a photoactive substance, simultaneously with the radiation exposure to the skin of long-wave ultraviolet rays;
• electrosleep - the effect of weak discharges of current on the brain;
• magnetic laser treatment - a method that is used to treat psoriatic joint damage;
• UFO - a method of ultraviolet irradiation of the skin;
• X-ray therapy - X-ray treatment;
• diadynamic therapy is one of the variants of pulse therapy, with the use of an electric current with a frequency of 50-100 Hz.

Alternative treatment

Alternative medicine has a huge number of all kinds of recipes that should save a person from plaque psoriasis - a chronic and sustainable disease. How effective these tools are, it is difficult to say: if one recipe helps one, then others can not cause any effect. Most likely, this is because no one yet knows the true cause of the disease - and these reasons can be many, and in all patients they are different.

However, with plaque psoriasis, the most common are such alternative methods:

• Every day you need to treat the affected skin with cabbage brine. In this wash the brine is not necessary: it is applied constantly to the same place. After 6-8 days, the plaques will begin to flake, exposing clean, healthy skin.
• You can prepare an antipsoriatic ointment: take 150 g of birch tar, 150 g of medical alcohol, 3 raw yolks of eggs, 1 tsp. Camphor oil, everything is mixed. Used to lubricate the affected skin. After treatment for 24 hours, do not wash in the bathroom or take a shower. The drug is used 3 times a week, until the skin condition improves.
• Prepare a mixture of 1 part of aloe juice, 1 part of real honey, 3 parts of eucalyptus juice. The mixture is aged for three days in a dark place and is used to treat skin areas 2-3 times a day.
• Prepare the external remedy from 200 ml of vinegar, 200 g of quality butter, 1 raw egg. The mixture is mixed and kept for 7-8 days in a dark cool place. Finished remedy is used on affected areas several times a day. This ointment has drying and cleaning properties.

Herbal Treatment

• Prepare a mixture of equilibrium parts of dry celandine powders, rhizome of sorrel, grass of the string. The dry collection powder is poured with birch tar, maintained for 4 weeks. Use to apply to affected areas daily at night. The effect of the drug will intensify if it is alternated with the application of Vishnevsky ointment.
• Prepare the collection of herbs: 1 tsp. Succession, the same number of celandine, horsetail, roots of calamus, milch grass, elderberry color. The dry grass is poured with a liter of boiling water, aged for 2 hours, filtered. Take inside 75 ml before the main meals. Duration of treatment - up to 1 month.
• Prepare a tincture from the color of the Crimean Sophora: 2 tsp. Colors pour 100 grams of vodka, stand 4 weeks in the dark. Take 1 tsp. Before each meal. Duration of therapy is 2 months.

In addition, it is recommended to take medicinal baths and baths, in which are added tinctures of thyme, sage, walnut leaves, celandine grass. Take such baths for 15-20 minutes. After such treatment, plaques gradually pale and decrease in size, until plaque psoriasis disappears completely.

Homeopathy

Turning to homeopathic treatment, a sick person seeks to stabilize the protective function of his body and direct it to fight the disease - plaque psoriasis.

Before proceeding with the selection of the drug, it is necessary to verify the availability of a certificate of conformity and quality, and always consult a doctor.

The most popular homeopathic remedies for plaque psoriasis are:

• Sulfur - is used in patients with hypersensitive skin;
• Sepia - is used to treat patients with skin prone to hyperpigmentation;
• Silicea - suitable for sensitive, irritable skin;
• Arsenicum albumum - is especially recommended for common plaque psoriasis affecting the scalp;
• Arsenicum iodateum is recommended for the treatment of patients with large plaques and dense scales.

Homeopathic remedies are prescribed according to individual schemes, depending on the stage of the disease, on the general condition of the patient. Selection of drugs and dosage is carried out by a specially trained homeopathic doctor.

Operative treatment

Operation is not the main method of treating plaque psoriasis. Surgical intervention may be relevant in the development of psoriatic arthritis - in this case, you have to remove the affected joint tissues to restore the function of the joint, or implant the implants.

Prevention

The main purpose of prophylaxis in plaque psoriasis is to reduce the frequency of exacerbations and reduce the severity of the symptoms of the disease.

Patients with plaque psoriasis should heed such advice of specialists:

• If you take a shower or a bath, use only a soft washcloth and towel to avoid injuring the damaged skin.
• After water procedures, always apply to the skin any suitable moisturizer - this will protect the skin from damaging and drying up external influence.
• In everyday life, you must beware of various skin lesions. To ensure protection during cleaning, it is recommended to wear protective gloves, and clothes should be chosen from natural cloth (to prevent the development of allergies).
• The room in which you are most often should be sufficiently ventilated and moistened. The presence of an air conditioner is not welcomed, as it excessively drains the air.
• We need to protect our health, beware of contact with patients with cold and viral diseases.
• If possible, take care of the nervous system - do not react to stressful situations, do not allow moral and physical overwork.
• Avoid overcoolings and overheating.
• Forget about the existence of alcohol and cigarettes.
• Pay attention to your food - is it right? If in doubt, read the nutrition guidelines for psoriasis.

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Forecast

For life, plaque psoriasis has a favorable prognosis. A sick person can live a normal life if periodically treated to prevent exacerbations of the disease. But it should be noted that plaque psoriasis tends to persist and spread throughout the body, so it is by no means impossible to leave the disease without attention. Therapeutic courses should be repeated regularly, depending on the periods of exacerbation of the pathology. Sanatorium-and-spa treatment in profile institutions is also welcome.

Sometimes - it's true, only in 15-16% of cases - there is a so-called spontaneous cure, when plaque psoriasis disappears in the same way as it appears. The reasons for this phenomenon are still a mystery.

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