Limited psoriasis

Psoriatic rashes can have strict localization and all the time appear in the same places on the body. The clinical course of this form of the disease is usually easier. Nevertheless, it is characterized by frequent and persistent exacerbations. With limited psoriasis, usually no more than 10% of the total body surface is affected, some authors call a more significant percentage of damage - up to 40. The main thing is that the localization of the rashes is strictly constant.

[1], [2], [3], [4], [5], [6]

Epidemiology

The population frequency of psoriatic disease in most studies of researchers is estimated from 1 to 5% with significant fluctuations, depending on the climatic conditions of the region. For example, in the developed countries of the Scandinavian Peninsula and among the indigenous population of the Far North of Russia, the incidence rate is estimated at about 4%. In Kuwait, this figure is 0.11% and is recognized as the lowest in the world. The prevalence of the disease is affected not only by the climatic conditions of living, the likelihood of developing psoriasis is determined by heredity and is determined by subpopulation characteristics. For example, according to observations of American dermatologists, African Americans suffer from psoriasis much less often than Caucasian Americans, it practically does not occur in American Indians. Although in general, in the United States more than 7% of the population had psoriatic disease.

According to some accounts, the indigenous population of Africa is not affected by this disease, although in Uganda the proportion of scaly lichen is 2.8% of cutaneous pathologies, which corresponds to the European prevalence level.

The majority of patients with this disease (3/4) suffer from genetically determined psoriasis type I. This type of disease manifests at a young age, its course is more severe. Type II disease is not determined by hereditary predisposition, they become ill with persons of mature age and it is characterized by an easier clinical course.

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

Causes of the limited psoriasis

The etiology of psoriasis, including limited ones, is still unclear. There are a lot of assumptions about the origin of the disease, a significant place in them is given to the genetic predisposition, genes are found that increase the probability of disease in their carriers. The share of heredity in the formation of pathology is given up to 70%, the role of external factors is estimated at 30%. Psoriasis, determined by genetic predisposition, is found in most cases, and the first manifestation of it is observed at the age of up to 25 years. The absence of a genetic predisposition does not guarantee security, simply under the influence of a number of external factors the disease can develop at a more mature age.

Risk factors for the development of the disease are very diverse. It is believed that the first manifestation provokes more than one factor, but their combination, at some bad hour weakening the human immune system. Sometimes the patient himself can not name the reasons visible to him, and they remain unknown.

So, in addition to heredity, the onset of the disease can be provoked by changes in the hormonal background (pubertal period, pregnancy, menopausal disorders, treatment with hormonal drugs). One of the leading roles belongs to stressful situations, associated with strong physical and / or mental overstrain. Trauma of the skin surface, foci of chronic infections (pharyngitis, sinusitis), vaccination, drug therapy with some types of drugs (antipsychotics, cytostatics, immunostimulants and others) can provoke the first manifestation of psoriasis. In the risk group, alcoholics and smokers, allergic people and diabetics, people who are overweight and have chronic diseases, have changed their climate.

It is assumed that bacterial or viral infections carried by the patient can cause gene mutations, a link between race and disease is also traced.

The causes of the onset of the disease so far are hypothetical, however, the effects and effects on the skin, as well as the rest of the body systems have been studied quite well.

[13], [14],

Pathogenesis

The pathogenesis of the disease is associated with disorders in the functioning of the immune system. But whether they are primary or it is the immune response of the body to the inflammatory process in the dermis is not known for certain.

A healthy human skin is renewed every four weeks - during this period new cells mature, and old ones die, performing their functions, and peel off. On sites with psoriatic rashes, this process occurs at an accelerated pace - the skin is renewed every three to four days. The newly formed immature cells rush to the surface, almost immediately dying and forming a massive thickened layer. In places of rash, many active T-lymphocytes, macrophages and other immune cells are found, hyperproliferation of skin cells that do not have time to form properly. The active pro-inflammatory mediator that is found on the damaged skin areas are histamine, hydrolase enzymes, prostaglandins and other products of arachidonic acid metabolism. Their overproduction is hypothetically provided by cytokines synthesized by macrophages or keratinocytes. In these areas, the barrier function of the skin does not work, and they become vulnerable to adverse effects.

The disease is individual and requires a personalized approach to treatment. Cases of effective treatment of scaly lichen as a primary dermatosis confirm one theory of pathogenesis, however, it does not always succeed. Treatment of psoriasis as an autoimmune process is also successful, often a complex of anti-inflammatory measures is effective.

Contacts with patients are not dangerous, even a blood transfusion from a person suffering from psoriasis, healthy, will not cause a second disease.

All hypotheses so far have the right to life, but there is no unconditional confirmation of any of them, and every theory has enough refutations.

[15], [16], [17], [18], [19], [20], [21],

Symptoms of the limited psoriasis

Localization of rashes corresponds to areas of the body that are characterized by a drier skin (for example, extensor surfaces of limbs (elbows), head, lumbar region of the back). The first signs are a red papular rash whose diameter is about the size of a pinhead. Papules have clearly defined boundaries. They are predisposed to growth with the formation of plaques covered with silvery-gray scaly laminae. The size of psoriatic plaques is very variable - from a few millimeters to 10cm. The affected areas of the body, as a rule, do not itch. Psoriatic plaques are flaky, laminae easily peel off from the surface, and from below - more dense scales (scaly lichen) remain.

Excessive proliferation of keratinocytes in psoriatic plaques is accompanied by the formation of skin infiltrates and promotes thickening of the skin layer raised above the healthy skin. A triad of symptoms that indicate the psoriatic origin of the rashes:

• The surface of the plaque is silvery-gray and resembles stearin stain in appearance;
• if you remove the scaly plates from it, a terminal film is found underneath them, smooth and moist in appearance;
• bloody dew - drop-shaped portions of blood that appeared on the film.

The skin, covered with psoriatic plaques, usually differs dryness, sometimes it cracks, and on it suppurations are formed, for places of localization of rashes characteristic of a feeling of tightness of the skin.

The course of psoriatic disease is wavy, which is typical for all forms of the disease. Limited psoriasis, as a rule, is characterized by frequent and persistent relapses.

Stages

The stages of the manifestation are conventionally divided into:

• progressive - it is characterized by the constant appearance of new bright red rashes, forming in itching erythema with clear boundaries;
• stationary - new rashes do not appear, overgrowth of old foci ceases, bounding rim (up to ≈ 5 mm) dries up and plaques become covered with scaly plates;
• regressing - the rash passes, the disappearance begins from the center of the foci to their periphery.

[22], [23], [24], [25],

Forms

Scaly lichen has several clinical varieties, the most common form of it is a limited vulgar psoriasis. The above description corresponds exactly to this species. Favorite places of localization of psoriatic plaques are external folds of limbs (elbows, knees), scalp part of head, rarely body, for example, in the lumbar region. The face of the rash almost never affects, although occasionally the rash descends on the upper part of the forehead. Small damaged areas of smooth skin are almost not itchy, however, seborrheic eruptions are very itchy. On the scalp part can be located some small plaques, sometimes they merge into one continuous erythema, cracked and with exudate. Rashes on the scalp part of the head and behind the ears, in the zone of the nose, lips, on the chest and between the shoulder blades are called seborrhic psriaz. Plaques of this localization are characterized by indistinct outlines, their color is not silvery-gray, but yellowish. On the scalp - an excess of dandruff, which disguises plaques, they can descend on the forehead and neck (psoriatic crown).

The clinical form of the limited pustular disease is the palmar-plantar psoriasis of Barber. It usually has a benign course, affects most of the people involved in manual work associated with corrosive chemicals. Psoriatic plaques covered with pustules - painful blisters filled with sterile inflammatory exudate, surrounded by swollen, inflamed, flaking skin.

Localized can be any form of scaly lichen, although almost always on the patient's body can be found psoriatic plaques of a different kind in other places.

Reverse (intertriginous) - painful spots are localized in zones where natural large folds (interdigital, anogenital, underarms and under the breast) are located and look atypical. They are practically not flaky, their surface is glossy, shiny, often damp-red. Diagnosis of this form of the disease causes some difficulties.

Papillomatous usually localized around the ankles, wrists, on the rise of the foot and lower third of the shin. Eruptions in the form of round papules, convex over the surface of the skin, prolonged relapses and mechanical friction leads to the fact that in these places hypertrophic changes in the skin are often observed. There is a risk of malignancy.

Psoriatic onychodystrophy (psoriasis of the nails) - destruction of the nail structure and perio-osednoe bed, with a protracted process, it is possible the hyperhardness of the nails or onycholysis (disappearance of the nail). Often so manifested psoriatic arthropathy.

Usually, with the first manifestation of the disease, the lesions are always limited and touch small parts of the body. Over time, the affected area increases, and progressive development of the disease is observed. An easy stage of dermatosis is considered when damage affects up to 3% of the body surface, from 3 to 10% - medium, more than 10% - severe.

Untimely treatment of a doctor with the problem of psoriatic rashes, even in a very limited area, can have very serious consequences and complications. In the initial and usually mild stage of the disease, acute exacerbations are achieved by external means of treatment, with the spreading process, more serious therapeutic agents are used.

In addition, inflamed skin can be infected. This will cause suppuration, swelling, erythema, and, accordingly, complicate the diagnosis and treatment process.

[26], [27], [28], [29]

Diagnostics of the limited psoriasis

Diagnostic measures begin with a visual inspection. If signs of psoriatic triad are present, a patient is questioned in order to establish the events preceding the disease. The patient is assigned the necessary laboratory tests. Usually, with limited psoriasis at the beginning of the disease, the test results do not go beyond the norm.

With complications and significant, albeit limited, areas of damage, blood tests show intense inflammation, the presence of disorders of the endocrine system or rheumatism.

Sometimes, to clarify the diagnosis, take a piece of skin for a biopsy. The study should reveal histologically underdeveloped keratinocytes, their hyperproliferation (Rete's body), an excess of immunocytes in the affected area and the accelerated formation of new capillaries there.

The main instrumental diagnosis of psoriatic disease is dermatoscopy. Ancillary diagnostics is performed, if necessary, by the prescriptions of the attending physician in order to make a judgment about the work of other body systems and the presence of diseases of other internal organs - radiography, ultrasound of the abdominal cavity and thyroid gland, electrocardiography.

[30], [31]

Differential diagnosis

Differential diagnostics makes it possible to distinguish psoriasis from similar diseases. It is performed on the basis of a complete history, collected on visual signs, according to the results of the examinations and laboratory tests. Differentiate psoriatic disease from skin cell T-cell lymphoma (except for visualized differences, spinal fluid puncture is sometimes used); flat lichen, the location of which is similar to papillomatous psoriasis ("bracelets" on the wrists and ankles, occasionally touched fingernails); chronic lichen (simple and pink); coin-like eczema; Candidiasis; seborrheic dermatitis; dermatophytosis and secondary syphilis.

Treatment of the limited psoriasis

Local psoriatic lesions of mild degree usually respond well to local therapy. However, it should be remembered that the achievement of a long-term remission is possible only if you have a healthy lifestyle and follow certain rules of nutrition. Canned, fatty, smoked, salty foods, foods that cause allergic reactions, alcohol and smoking are excluded. Since the reaction to the same product varies from person to person, recommendations on dietary intake in patients may not coincide. Nevertheless, the general point of view on the organization of nutrition in psoriatic disease presupposes the predominance of alkali-forming products (70-80%) in the diet, and half of them are preferably consumed raw.

Begin treatment with the appointment of more simple, non-hormonal, external ointments or lotions.

For example, Salicylic ointment, which is part of many drugs from psoriasis. This product has a powerful anti-inflammatory and disinfectant properties, as well as exfoliates exfoliating dead skin scales. In psoriasis, a 2% salicylic ointment is used. Its lack - a strong drying effect, so sometimes it is mixed with petroleum jelly. Do not combine this ointment with other topical topical preparations.

Also, a good effect is given by preparations based on zinc or a combination of zinc and salicylic acid. For example, aerosol Zinokap. This is the most convenient form of release, irrigation of affected areas is done remotely, for seborrheic forms of psoriasis there is a special nozzle. The drug has pronounced antiprofiletic and antiseptic properties, practically does not cause side effects and overdose phenomena. Can be used from the year of age. Sprayed to affected areas twice or thrice during the day. Duration of treatment from a month to a year and a half.

Also used ointments based on birch tar, for example, Wilkinson's ointment is a combined preparation containing tar, purified sulfur, naphthalan oil, green soap. The effect of the components of the ointment is to resolve the infiltrates and soften the skin, as well as soft analgesia. It has disinfectant and antiparasitic properties, which makes it possible to use it with an attached fungal infection. The presence of sulfur in its composition ensures the formation with organic substances of keratoplasty compounds that repair the damaged skin surface. The agent is applied twice a day for two weeks, then a break for a month is made. Ointment is not used for seborrheic psoriasis.

Modern preparation Daivoniex , the form of release - a cream and a solution. The active ingredient of these agents is calcipotriol (analogue of vitamin D). It inactivates T-lymphocytes and inhibits the hyperproliferation of keratinocytes. The therapeutic effect of the use of this drug is promised quite fast - within two weeks. It can be used alone or in combination with glucocorticosteroids, cyclosporine, not used simultaneously with salicylic preparations.

The speed is provided by hormonal ointments. The most effective is Dermoveit with the active ingredient of clobetasol propionate. Form release - ointment or cream, which treat the rash once or twice during the day. Duration of application - no more than 28 days, the weekly rate should not exceed 50 g. Side effect may be the development of pustular psoriasis.

Medicinal forms for external use containing glucocorticosteroids are positioned as relatively safe. However, they must be used only for the prescription of a dermatologist. Their effect is noticeable almost immediately, but it is characterized by short duration. These ointments and solutions cause addiction, withdrawal syndrome, and it is worth considering before you start hormone therapy.

Any medicines, even based on natural ingredients, can cause allergic reactions and, instead of the expected improvement, lead to an aggravation of the process. Before starting treatment, you can make a skin test on a gentle healthy area of the skin, for example, the inner side of the forearm. Apply a thin layer of ointment for the night and wait until morning. If you do not find redness or rash when you wake up, you can start using it.

In the complex therapy of psoriatic disease, vitamins are used. In the restoration of skin, it is difficult to underestimate the importance of vitamin A. Vitamin D prevents skin diseases, eliminates scaly, the antioxidant properties of vitamins C and E are used in the treatment of psoriasis. If necessary, and according to the indications, vitamins of other groups can be prescribed.

With limited rashes, physiotherapy is successfully used - PUVA therapy, laser therapy, in particular, laser irradiation of blood, magnetotherapy; drug electrophoresis and phonophoresis.

Surgical treatment with limited psoriasis is usually not applied. Surgical reconstructive methods are used in advanced cases of psoriatic arthropathy.

Alternative treatment

Limited psoriasis - a serious disease, it has been tried for a long time, so there are a lot of alternative recipes that ease the patient's condition. Before applying alternative treatment, it is advisable to consult a treating dermatologist, and also to consider that alternative agents can cause allergic reactions.

In the treatment of local psoriatic eruptions, birch tar is a good effect. It is made of birch bark, modern cleaning methods allow its safe use.

Birch tar has a complex composition that provides its ability to soften the outer layer of the epidermis, exfoliating the dead cells and helping to restore the smooth surface of the skin. At the same time, it has an antimicrobial and insecticidal effect, and along with the affected stratum corneum removes the microbes that have settled there. All this contributes to reducing inflammation and normalizing the process of skin cell proliferation. Tar can cause an allergic reaction, so before starting treatment it is necessary to make a test: it is recommended to apply a little tar on the skin inside the elbow with a cotton swab and wait half an hour, if the reaction does not appear, you can use it without fear. To be treated with tar is necessary with observance of simple rules:

1. before the procedure, especially in the case of old rashes, it is desirable to take a bath with medicinal herbs and oils;
2. after application of tar, photosensitivity of the skin increases, it is necessary to be protected from the sun and cover the treated areas with a light breathing tissue;
3. the procedure is recommended to be done daily at bedtime, as the smell of tar remains after thorough washing, and during the night it leaves;
4. during treatment, it is necessary to monitor the performance of the urinary system (periodically pass urine tests).

• Recipe number 1. It is preferable for him to choose tar in the pharmacy, packed in a glass bottle (not plastic). Apply tar on the affected area at the beginning of treatment for 10 minutes (several days), then wash off with tar soap. Gradually, the application time is extended for 1-2 minutes to half an hour or 40 minutes maximum. Treatment continue until complete remission. The effect is noticeable in the first days. The skin in places of application because of tar can acquire a darkish shade, which will then come down.
• Recipe number 2. It uses tar with the addition of 2% boric acid. Spread this mixture with a hard brush and rinse after half an hour, then lubricate the lesion with a softening cream based on lanolin.
• Recipe number 3. Mix 50 ml of castor oil and the same volume of tar with 100 g of honey and whipped with proteins from two domestic chicken eggs. Put in the refrigerator for three days. To smear every evening before a dream a thin layer on the amazed places within a month. The second course is held as needed.

Phytotherapy also did not stay aloof. Herbal treatment of scaly lichen is performed both externally and internally.

You can make ointment from dry grass celandine. Grind the grass into powder and mix with turkey fat. Strain this mixture in a water bath for at least an hour, allow it to cool. Apply to affected areas of the skin.

Herbal infusions:

• make a mix of chopped dry herbs in the proportions: three parts of the grass of the string, and one by one - valerian root, celandine and St. John's wort, pour a tablespoon of the mix 200ml of boiling water and douse the water bath for a quarter of an hour, cool, strain and drink half a glass twice a day after food intake;
• pour 400 ml of steep boiling water in a thermos bottle 40 g of violets of tricolor and the same amount of celandine, leave for two or three hours, cool and take two tablespoons three times a day before meals (the infusion is stored in the refrigerator for no more than two days, after this period - pour out and make a fresh one).

In summer, while at the cottage or in another ecologically clean place, you can lubricate every spot with fresh celandine juice, by the end of the summer you can thus achieve remission.

Homeopathy can significantly alleviate the condition of the patient with psoriasis. This is a very effective treatment that can improve the quality of life and virtually lead to a full recovery. Treatment with small doses assumes prolonged treatment, however, minimizes side effects and unwanted reactions. The most effective treatment is appointed by the homeopath physician taking into account all the features of the patient's health condition and his family history. Appointments are absolutely individual, therefore - the therapeutic improvement comes a long time, and if you have the patience and follow the recommendations, relapses can be avoided. In the treatment of limited psoriasis, medicines such as Aquifolium (seborrhoeic psoriasis), Crotoyus horridus (palmar), Manganum and Phosphorus (extensor surfaces) are used, however, not only the localization of the rashes is taken into account in the appointment.

You can apply pharmacy homeopathic medicines, but they are deprived of the main thing - individuality. Although also can be useful, both with monotherapy, and in combination with other medicinal and alternative means.

[32], [33], [34]

Prevention

The main preventive measure with limited psoriasis is a correct lifestyle and healthy diet, and this also applies to latent periods.

It is necessary to conduct regular purification from the toxins of one's body in order to relieve the overload from the skin. Monitor the normal functioning of the intestine, trying not to allow constipation, diarrhea, or alternation.

Patients with seasonal forms of psoriasis, you should consider this feature of your body, for example, to visit the solarium in the winter, physical procedures or to avoid sunlight, covering the body with clothing, umbrellas, hats with fields.

Do not overeat, caution should be exercised with medicinal products in the treatment of other diseases.

Prepare food with sea salt, take a bath with sea salt or spray sea water on the lesions every day.

Regularly use linseed oil, brewer's yeast and nettle (in any form: fresh - in salads and borsch, dried - in tea and infusion), exclude from the diet for a while products with gluten and milk, if the condition improves, then it is necessary to exclude them forever.

[35], [36], [37]

Forecast

Officially, the disease is considered incurable, however, the prognosis, especially in limited psoriasis is relatively favorable. At the present time, it is possible to achieve long latent periods, although for this it is necessary to make efforts, but they are worth it. Pedantic implementation of medical recommendations, adherence to diet and healthy lifestyle gives a significant result. Alternative medicine on the forums promises a complete cure, but the patient's predisposition to psoriatic eruptions remains with him forever.

Many are interested in the issue of the passage of military service by young people who have had manifestations of psoriasis. Limited psoriasis and the army are incompatible concepts, and most likely the young man will be recognized as being limitedly fit for service, that is - in peacetime such do not call. However, this issue remains in the competence of military medical examination.