Psoriasis on the hands

Psoriasis can be localized on different parts of the body, and the hands are no exception. Threats to life the disease does not carry, but greatly affects the quality of life. If the disease has passed into a severe form, complications arise: impaired mobility of joints, psoriatic arthritis may develop. And this is a very serious problem, affecting the motor function and even capable of leading to disability. To cure psoriasis on the hands, you need to have a lot of patience: it will take a long time. But people suffering from this disease are willing to spend both time and energy to cope with it. Psoriasis usually affects the wrists, elbows, trunk, scalp. Can be localized on the folds of the limbs, in the groin, at hand. Manifestations of psoriasis on the hands are difficult to hide curious views in everyday life, they look frightening for others, so this is also a matter of social adaptation.

[1], [2]

Epidemiology

The total number of psoriasis patients on the planet is about 100 million. The first signs are noted quite early: on average, at 16 years for women and at 22 years for men. This type of psoriasis, affecting at an early age, develops in 75% of patients and is classified as type 1. In this case, the transmission of psoriasis to offspring can spread to 3-4 generations. More than half of the patients have blood relatives who also suffer from psoriasis.

Psoriasis type 2, which develops in people of adulthood - is 25% of the total number of patients. The average age when this type of psoriasis is manifested is 56 years. In such cases, the development of the disease is not associated with a genetic predisposition or with impaired immunity. In such cases, the disease first affects the joints and nail plates.

It is interesting that the disease is less common in areas where there are many fish in the diet (for example, in Japan). This is explained by the fact that the fish contains a large number of ω3-polyunsaturated fatty acids, which are known to have anti-atherogenic properties.

[3], [4], [5]

Causes of the psoriasis on the hands

The main cause of psoriasis on the hands is hereditary addiction. Relatives of the first degree of kinship, seeming at first sight healthy, often find a hidden form of psoriasis, when the structure of the capillaries changes in the epidermis. At half of patients exacerbations of disease are connected with stresses.

[6], [7]

Risk factors

In addition, there are other risk factors that can trigger the chain of the disease:

• Violation of the body's immunity;
• The consequence of infectious diseases;
• Hormonal diseases (hyperthyroidism, diabetes mellitus);
• Metabolic disorders;
• Stresses, emotional shocks;
• Propensity to allergic reactions;
• Mechanical skin injuries;
• Exposure to aggressive substances (household chemicals, solvents, paints).

All these factors indicate that there is no reliable data on the etiology and pathogenesis of the disease, as there is no evidence of the retroviral nature of psoriasis.

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

Pathogenesis

In pathogenesis, T-cell hyperactivity is assumed. In particular, the epidermis infiltrated with a large number of activated T cells which are capable of inducing the proliferation of keratinocytes, the synthesis of various cytokines (e.g. Tumor necrosis factor α [TNF-α], interferon gamma, interleukin-12), pro-inflammatory mediators (IL-17 / 23).

In the affected skin of patients with psoriasis, clogging and a change in the cycle of epidermal cells are observed. Epidermal hyperplasia leads to improper maturation of cells.

The genetic predisposition to the disease is studied. The gene locus is responsible for psoriasis in the process of studying.

Psoriasis is associated with certain alleles of the human leukocyte antigen (HLA), in particular human leukocyte antigens CW6 (HLA-CW6). In some families, psoriasis is an autosomal dominant trait.

A multicenter meta-analysis confirmed that the LCE3C and LCE3B genes are a common genetic predisposition factor to the development of psoriasis in different populations.

[13], [14], [15], [16], [17], [18], [19],

Symptoms of the psoriasis on the hands

The first signs of psoriasis are single inflammations on the skin. The affected hands of different patients also look very different. Some have spots of different areas, others have psoriasis of the nails on their hands, when the nail plate exfoliates. With psoriasis, you can usually notice swelling of the joints. At the same time, and the skin dries up, new cracks appear on it, which then turn into inflammation.

Of the total number of patients, about 25% manifest psoriasis on the hands and on the feet. The clinical signs of psoriasis are similar to mycosis and eczema, therefore the final diagnosis can be established only by results of a biopsy.

The lesions appear as rounded plaques with easily separable scales. The foci of lesions are bright red and very prominent on the skin.

The main symptoms of psoriasis: the over-dried surface of the skin, in the lesions it is reddened and thickened, small cracks can be seen. On such skin formations are formed, similar to corns with a rim. In the future, they can unite among themselves and form significant lesions in the area of eyes.

Is psoriasis contagious?

In medicine, there is no consensus on this issue. But most physicians tend to believe that psoriasis is a hereditary disease, the trigger mechanism for which are viruses, infections and other factors. Is psoriasis contagious? Definitely, no!

Of course, contact with a patient with psoriasis can cause unpleasant feelings based on aesthetic and hygienic considerations, but one can not get infected from such a person.

Stages

The development of the disease passes through the following phases:

1. Progressive. For the initial stage, the emergence on the healthy areas of the epidermis of many small elements that have in the center light scales and erythematous curb. Then there is a proliferation of rashes and the emergence of psoriatic plaques.
2. Stationary. This stage is characterized by the fact that rashes on the skin no longer occur, the existing plaques do not grow, the entire surface of the rashes is scaly.
3. Regressing. Psoriatic plaques become flat, the scaling is not so strong and the elements even resolve, and on these sites the skin remains without pigmentation.

[20], [21], [22]

Forms

There are many kinds of psoriasis, but all of them can be divided into two groups, and in them to distinguish a number of subgroups:

1. Pustulose appearance, covering:
   • generalized form;
   • palmar-plantar form;
   • psoriasis by the type of annular centrifugal erythema.
2. Non-pustulous appearance, including:
   • classic psoriasis with late or early debut;
   • psoriatic erythroderma.
3. There are also types of psoriasis that are not included in this classification:
   • seborine-like form;
   • exudative form;
   • psoriasis, provoked by drugs;
   • Napkin's disease;
   • atypical psoriasis, when the lesions are localized on the folds of the limbs.

[23], [24], [25]

Differential diagnosis

Due to the variety of clinical manifestations, the diagnosis of psoriasis on the hands is complicated by the fact that the disease must be differentiated from a variety of types of dermatoses, for example, red lichen, syphilis, parapsoriasis, seborrheic and atopic dermatitis, Reiter's disease.

For certain conditions, it is easier to conduct differential diagnosis, based not on diagnoses, but on the form of the disease. So, for example, psoriasis on the palms and feet is differentiated with dermatophytosis, dyshidrotic eczema, and keratoderma.

Eruptions resembling psoriasis may occur due to drug toxemia.

Arthropathic psoriasis must be differentiated with arthritis and arthrosis.

Generalized pustular psoriasis should be distinguished from bacteremia. For this, one of the methods of instrumental diagnostics is used: sowing blood on bacteria.

Sometimes it is required to pass HIV tests, since psoriasis can manifest due to the human immunodeficiency virus.

[26], [27], [28]

Treatment of the psoriasis on the hands

Today, there are many different means for treating the disease. Time-tested tools are widely used, and the latest developments are only beginning to receive wide recognition. Some of them are worthy of special mention. Let's try to provide complete information about both, and about others.

To eliminate the manifestations of psoriasis, it will take considerable time and complex measures. Cure psoriasis is completely modern medicine can not. Operative treatment is used only in extreme cases - when the joints are badly affected and endoprosthetics are required. And in this case it proves to be ineffective if, for example, it is compared with the effectiveness of operations in patients with rheumatoid arthritis.

The main goal of the treatment is to reduce lesions and to ensure that the disease enters the stage of remission. Complex treatment maximizes the number of targets to achieve a better result. Complex measures include general, local treatment and treatment with physiotherapy methods.

Medications are selected based on data on the prevalence of inflammation, the phase of psoriasis, the age of the patient and other available chronic diseases.

Local drug treatment of the disease is aimed at arresting pathological processes in the skin. To do this, use is made of agents containing sulfur, salicylate, urea, naphthalene, tar and topical glucocorticosteroids. These medications are presented in the form of creams, ointments and aerosols.

Glucocorticosteroids

In the progressing phase of the disease, 1-2% salicylic ointment and local glucocorticosteroids are often used. If this is another recurrence with severe inflammation, use more effective ointments from psoriasis on the hands containing fluorinated glucocorticosteroids, for example, betamethasone cream 0.025-0.1%, triamcinolone acetonide cream 0.025-0.1%, or non-halogenated glucocorticoids. However, the use of potent glucocorticosteroids is dangerous because of the high risk of complications and the effect of withdrawal, when the disease worsens when the medication is stopped. Therefore, fluorinated glucocorticosteroids are prescribed in extreme cases. Long-term treatment with these drugs leads to skin atrophy, excessive hair growth that is not characteristic of this area of the skin, the development of other systemic side effects and complications. Therefore, the dosage and duration of treatment should always consult with a specialist and strictly follow its recommendations.

Calcipotriol

A good effect is achieved when using drugs whose active ingredient is calcipotriol. Such drugs give results comparable with the results from the use of glucocorticosteroids, but they do not provoke the development of atrophic processes in the skin and for them the development of the cancellation effect is not peculiar. But calcipotriol in almost all cases causes a burning sensation on the treated skin, because at the initial stage of treatment it is combined with glucocorticosteroids. Later, only calcipotriol is used. This treatment scheme has its own logic. At the initial stage (the first 2-4 weeks), the patient uses calcipotriol and glucocorticosteroids, and after receiving a stable result passes to treatment without hormonal components. Both medications are used once during the day. The maximum daily dose of the drug with calcipotriol should not exceed 15 g. The effect of treatment will be visible after only 1-2 weeks. Duration of treatment should not exceed 8 weeks.

[29], [30]

Preparations based on tar and naphthalan

They are quite effective and relatively safe with prolonged use. In addition, the cost of such treatment to any person will be affordable.

But for the use of these tools, there are some limitations. They are not desirable for psoriasis in the progressing stage and for large areas of the skin: as a result, they can only exacerbate the course of the disease. In addition, drugs based on tar and naftalan can lead to complications of chronic diseases of the organs of excretion.
Many experts believe that optimal treatment is the alternate use of topical preparations, because due to the habituation of the skin to any drugs, they lose their effectiveness in long-term treatment.

General treatment with progressive psoriasis begins with injections of antihistamines. In addition, intravenously administered sodium thiosulfate (3-10 ml every day) or 5% solution of unithiol (3-10 ml every other day) or 10% calcium chloride solution (5-10 ml every day). In addition, sedative medications are prescribed and a course of treatment with vitamins is carried out: vitamin D analogues (for example, calcitriol ointment, calcipotriene, calcipotriene)

In some cases, patients are prescribed infliximab. Since the version of the autoimmune nature of psoriasis is not refuted, this immunosuppressor is recognized as one of the most effective in psoriasis, which affects joints. The drug is administered intravenously, the dosage is 3-5 mg / kg. The duration of treatment depends on the severity of the disease.

In addition, there are also other drugs from the arsenal of "heavy artillery" - aromatic retinoids (for example, tazaroten water gel 0.05% and 0.1%).

Other medicines:

• Immunomodulators (eg, cyclosporine 0.1%, alefacept, ustekinumab).
• Keratolytic agents (eg, anthralin).
• Antimetabolites (eg, methotrexate).
• Inhibitors of TNF (eg, etanercept, adalimumab).
• Inhibitors of phosphodiesterase-4 (for example, apromilast).

After an effective course of therapy, psoriasis from the acute stage becomes chronic. Since it can not be cured definitively, as well as to predict the further development of the disease, it is impossible to make an accurate prediction.

Alternative treatment

Treatment of psoriasis on the hands with alternative methods is aimed at detoxifying the body and restoring the skin with the help of healing baths, creams and compresses.

Good results show the use of products of beekeeping, as well as medicinal plants: marigold, chamomile, celandine, pine needles, oak bark, licorice and string.

To cleanse the body it is recommended to drink special teas: kalinovy, ryabin, raspberry, lemon. A decoction of herbs will not only help the body to clear, but also eliminate inflammation, and will also have a choleretic effect.

Proven recipes of alternative medicine for the treatment of psoriasis on the hands:

1. In the evening, a glass of flax seeds pour a glass of boiling water. In the morning, drink an infusion on an empty stomach.
2. Apply birch tar on affected areas. The compress should be kept for at least one hour, then washed off and treated with a decoction of celandine. Several such compresses will already give a tangible result.
3. To put in the evening before a dream on the centers of an inflammation a solidol.
4. Apply to the affected areas of flax oil, rich in vitamins A and E. This will help to remove the inflammation and will help regenerate the skin.
5. In psoriasis, the acid-base balance is disturbed. To restore it, you can use baking soda.

[31], [32]

Herbal Treatment

When using herbs, it is important to follow the formula and dosage, apply infusions and decoctions exactly as described.

1. Juice celandine is an effective remedy. It is squeezed out of a fresh plant and applied to the affected areas of the skin with psoriasis. The course of treatment is 3 months.
2. Compresses from sunflower. To do this, take young baskets of sunflower, which are then ground. If necessary, you can add a little water. The compress is applied to the affected skin. Sunflower eliminates inflammation and prevents the development of pathogenic flora.
3. Healing baths. In psoriasis, baths with decoction of celandine, lavender, chamomile, mint, linden are shown.

With natural resources, you can experiment: alternate and look for the best recipes. Recipes of alternative medicine as an additional tool in the complex therapy can be quite effective.

Homeopathy and psoriasis

Homeopathic preparations are also a popular method of treatment. Homeopathy is considered with the specificity of psoriasis and its various manifestations and factors that triggered the pathological process, as preparations in homeopathy are selected based on the constitutional structure of the patient. In the process of such treatment, the body is reconfigured, that is, its own body resource is working to restore the balance.

Homeopathic treatment is often combined with organotropic drugs that specifically affect certain organs.

A special place in a number of dermatotropic drugs belongs to the preparations Acidum nitricum, Arsenicum iodate, Calcium carbonium, Kalium arsenicozum, Sepia, Silicea, Sulfur, Tuya.

Prevention

For the prevention of exacerbations it is recommended to adhere to a certain diet, where carbohydrates and polyunsaturated fatty acids are limited, but there are a lot of seafood and vegetables.

The skin of the patient also requires special attention. For everyday care, you should arm yourself with moisturizing creams. They will restore the broken protective mantle of the epidermis. These means must be used daily or even several times a day. It is best to use therapeutic cosmetics intended for atopic skin, and cosmetics that contain salicylic acid and urea.

If the first signs of psoriasis have appeared on the hands, the first thing is to minimize skin contact with aggressive substances and mechanical action. With attention it is necessary to treat the skin on the joints: in these places there are often cracks. In half the cases, the nails are affected with psoriasis of the hands. With psoriasis, the nails become thicker, easier to break down, until complete detachment. If the lesion occurs at the base of the nail plate, it will be difficult to cope with it, because in this case there is almost no air access to the nail. In addition, it should be checked that the skin of the hands does not remain wet after contact with water: moisture exacerbates the inflammation.

Manifestations of psoriasis on the hands, which can vary greatly, and the peculiarities of the disease in each individual case make it difficult to determine the plan of therapy. In some cases, remarkable results are achieved solely by traditional medicine. In other cases, the combination of traditional methods with alternative treatment will be more effective. The last word in choosing the therapeutic measures, optimal in each case, should remain with the attending physician.

[33], [34]