Biopsy psoriasis. Ways to effectively diagnose psoriasis disease

Psoriasis is non-infectious chronic illness skin, the etiology of which is not fully understood. About 4% of the world's population suffers from it, the vast majority of whom are under 45 years old. Let us consider in more detail what tests you need to pass for psoriasis in order to clarify the diagnosis.

Specificity of the disease

The most widespread is the autoimmune theory of the occurrence of psoriasis, according to which the following factors can provoke it:

Psoriasis appears on the skin in the form of red spots covered with small scales of gray-white color, and is accompanied by severe itching.

The most common localization of psoriasis spots are:

• elbow and knee joints,
• scalp under hair
• lower back,
• Hands,
• feet.

The disease can affect the mucous membrane, appearing on inside cheeks, tongue and lips, as well as affect the nail plates.

One of the complications of the disease is psoriatic arthritis affecting the joints of the extremities. Some patients develop uveitis - inflammation of the choroid of the eyes, in which a bloody rim appears around the pupil.

Diagnostic principles

If you notice the first symptoms of psoriasis on the skin, you should make an appointment with a dermatologist. Recovery clinical picture diseases require a thorough examination of the skin. During the interview, the patient finds out:

• patient complaints,
• information about the presence of dermatological diseases in the next of kin,
• detection of chronic pathologies internal organs,
• details of the patient's lifestyle (diet, bad habits, working conditions).

In the presence of lesions of other organs, the patient is referred for additional consultations to the following specialists:

• ophthalmologist,
• rheumatologist,
• orthopedist,
• gastroenterologist,
• neurologist,
• endocrinologist.

Characteristic symptoms psoriasis - the presence of spots, scaly plaques and protruding drops of blood when they are scraped off - usually do not raise doubts about the correctness of the diagnosis.

But in some cases, differentiation is required, since the same signs may have the following diseases:

• lichen planus,
• systemic lupus,
• seborrheic eczema,
• atopic dermatitis,
• microbial eczema,
• papular syphilis.

A correct diagnosis allows you to determine the method of treatment of the disease using medical preparations, physiotherapy procedures and folk recipes.

Treatment approaches

The treatment regimen for psoriasis is selected individually for each patient, taking into account the identified causes of the disease and the main symptoms. First of all, these are preparations for external use:

• based on tar: Antipsorin, Colloidin,
• based on solidol: Cytopsor, Solipsor,
• oil-based: Losterin, Naftaderm.

Medications for internal use are divided into the following groups:

• retinoids: Soriatan, Acitretin,
• immunosuppressants: Methotrexate, Sandimmun Neoral,
• corticosteroids: Prednisolone, Betamethasone.

Physiotherapeutic procedures are indicated for patients: ultrasound therapy, electrosleep, UVB irradiation. Mud and seaweed wraps, salt baths, ozone therapy are also used.

One of the conditions effective disposal from the manifestations of psoriasis is to follow a diet with the exception of products that can provoke an exacerbation of the disease. The patient is also advised to change his lifestyle, give up bad habits more to be outdoors.

What tests need to be done

It is not always possible to diagnose psoriasis only by external manifestations. Therefore, sometimes the doctor sends the patient to laboratory tests. Analyzes can also be prescribed during the treatment process to determine changes in the clinical picture and confirm the correctness of the chosen technique.

General examination

To find out if external symptoms belong to psoriasis, you can use the following studies:

The list of mandatory laboratory tests also includes a blood test for HIV in order to discard the influence of this virus on the course of the disease.

Additional examination

Sometimes, to clarify the picture of the development of psoriasis and determine the causes that provoked it, the following procedures are required:

1. A skin biopsy is a study of a small fragment of the dermis taken from one or more affected areas.
2. Bacteriological culture is required if psoriasis is found on the mucous membranes.
3. A blood test for syphilis, which, if negative, will rule out the disease.
4. Testing with potassium oxide is performed when the presence of mycotic flora is suspected.

Diagnosis of psoriasis in children does not require special laboratory tests, as in adults. Usually it is limited to taking a scraping from the affected area for a biopsy.

Changes in the joints, which are one of the manifestations of psoriatic arthritis, are detected using x-rays.

What other studies can the doctor prescribe

The symptoms of psoriasis are manifested in each patient individually and may be atypical for the disease. Therefore, some patients have to take such tests:

1. Allergy blood test (Ig E).
2. Analysis synovial fluid from the joint.
3. Immunological research.

Diagnostic results reveal side factors that affect the course of the disease, and adjust the method of its treatment.

Tests for pregnant women

The appearance of symptoms of psoriasis in women during pregnancy is most often due to hormonal changes in the body and reduced immunity. Diagnosis is carried out on the basis of examination, examination of the epicrisis and laboratory tests.

Most of the tests a woman passes immediately after registration in the antenatal clinic. If psoriasis is suspected, an additional blood test for prolactin is prescribed to identify a genetic predisposition to the disease.

Preparation for analysis

To make a diagnosis, it is very important that all laboratory parameters are reliable and do not distort the true picture of the disease. Therefore, there are several rules for those who are tested for psoriasis:

• not to accept medications within 10 days before the study,
• before taking the material for a biopsy, do not use ointments, creams and other external agents,
• on the eve and on the day of the tests do not smoke or drink alcoholic beverages,
• avoid excessive emotional stress.

Before taking blood tests, you must refrain from eating for 8-10 hours.

Where to get tested

Examination can be done in a dermatovenerological dispensary. There you can pass all the necessary tests and undergo the prescribed procedures. In addition, such studies are done in private clinics, as well as in specialized laboratories.

Test results for psoriasis are the most effective way making an accurate diagnosis and identifying secondary pathologies and complications that may accompany this disease.

Despite the fact that psoriasis is a common and long-known disease, it has not yet been fully studied. And patients most often do not know at all that psoriasis is not a bacterial infection or fungus, but a non-standard reaction. immune system triggered by unknown causes. Information about the causes and symptoms of psoriasis will be very useful to patients, as they will help to defeat the disease.

What is this disease?

Lichen scaly is another name for psoriasis, and this name perfectly characterizes this disease. Psoriasis is manifested by the formation of inflamed plaques of different sizes on the skin, they are densely covered with thick skin scales.

Surely, almost everyone has heard about such a disease as psoriasis. And this is not surprising, since scaly lichen is quite widespread. This disease is diagnosed in 4-10% of the world's population. Moreover, statisticians who collect information about the prevalence of psoriasis claim that the number of patients is steadily growing.

Known for scaly lichen to people from the most ancient times, even doctors in Ancient Greece tried to cure this disease. The modern history of the study of psoriasis has about 150 years. But over this fairly solid period, researchers have not been able to learn much about the causes and treatment of psoriasis.

Widespread, uncertainty of etiology (causes of appearance), not enough effective treatment- all this characterizes psoriasis as one of the most difficult problems of dermatology.

Today, dermatologists consider psoriasis as a complex systemic disease associated with disorders in the functioning of the immune system, with the failure of metabolic processes and the appearance of trophic disorders. The result of these failures are specific changes in the skin.

Therefore, when answering the question of what psoriasis is, a modern dermatologist will answer that these are violations of trophism and metabolic processes in the skin caused by a malfunction in the functioning of body systems. Today, two theories about the etiology of psoriasis are considered the most likely: genetic and viral.

• The genetic theory has many supporters, since psoriasis often acts as a hereditary or familial dermatosis. A thorough study of the patient's family history in 60-80% confirms the presence of psoriasis in one form or another in the patient's relatives. However, in some patients it is not possible to confirm the fact of the hereditary origin of psoriasis. This circumstance is the reason for the allocation of these cases to a special group, in which the main cause is not genetic, but phenotypic failures.
• The viral theory, according to which psoriasis develops as a result of infection, has its supporters. Confirmation of information about the viral origin of psoriasis is the detection of antibodies in the blood of patients, as well as "elementary bodies" in the cells of the epidermis. According to this theory, psoriasis develops not only in case of infection with a virus, but also in the presence of certain conditions.

There are other theories that explain the appearance of psoriasis. For example, endocrine, neurogenic, metabolic, etc. Naturally, all these theories are not without foundation and their study allows us to get more important information about psoriasis. However, today it is already known for sure that the state of the endocrine and nervous systems, as well as the work of the digestive tract do not cause psoriasis, but have a significant impact on the course of this disease.

For example, pathologies affecting the liver lead to the fact that the quality of blood purification carried out by this organ is greatly reduced. And this, in turn, can provoke the appearance of various skin manifestations, including psoriasis.

Pathologies affecting the liver (hepatitis, primary cirrhosis, etc.) lead to the fact that the tissues of this organ are reborn, that is, the liver is gradually replaced by connective tissue. As a result, the liver ceases to cope with its cleansing functions. Outwardly, this is manifested by yellowing of the mucous membranes and skin, and possibly more developed skin diseases, including psoriasis.

There is also an inverse relationship, psoriasis is often accompanied by fatty degeneration that affects the liver. Therefore, in the treatment of this skin disease it is important to follow a diet so as not to overload the liver unnecessarily. Patients are advised to limit fatty foods, completely eliminate alcohol.

Thus, despite numerous studies, it was not possible to obtain an exact answer to the question of what psoriasis is. However, work continues, so there is a chance that the mystery of this mysterious disease will be solved, and we will learn a lot about the skin disease psoriasis.

Classification according to the international system

The disease psoriasis manifests itself in various forms. To make it easier for specialists to navigate, the generally accepted classification of psoriasis is used.

Psoriasis has also been included in the International Classification of Diseases (ICD). To date, the 10th revision of the international registry of diseases is already in use, therefore the abbreviation ICD 10 is used. Work began on the 10th revision of the international classifier of diseases in 1983, and completed in 1987.

In fact, ICD 10 is a standard assessment tool used in medicine and the field of health management. The 10th revision of the handbook is used to monitor the prevalence of various diseases and other health problems in the population.

Using version 10 of the ICD, it is possible to compare morbidity and mortality data in different countries, which allows you to get statistical data and systematize diagnostic information. By agreement of WHO members, ICD 10 is used to assign codes to various diseases. In version 10 of the classifier, alphanumeric codes are adopted, with the help of which it is convenient to store information in electronic form.

All types of psoriasis are included in the ICD 10, and each of them is assigned a specific code. In dermatology, the following forms and types of psoriasis are distinguished:

• Common psoriasis(synonyms: vulgar, simple, plaque-like). The disease was assigned an ICD 10 code - L-40.0. This is the most common form, it occurs in 80-90% of patients. The main symptoms are the formation of plaques raised above the surface of the unchanged skin, covered with white-gray scales of the skin. This form is characterized by slight flaking of scales. After their removal, inflamed red skin opens, which is very easily injured and begins to bleed. As the inflammatory process progresses, plaques can increase significantly in size.
• Reverse psoriasis. This is a disease that affects the skin folds (flexion surfaces). For this form of the disease, ICD 10 adopted the code L83-4. Dermatosis appears with the formation of folds of smooth or minimally flaky spots on the skin. The condition worsens when the skin is injured by friction. The disease is often complicated by an associated streptococcal infection or fungus.
• Guttate psoriasis. This form of psoriasis is characterized by the formation on the skin a large number small specks of red or purple, shaped like water droplets. According to the 10th version of the international classifier, such a disease received the code L4. Most often, guttate psoriasis affects the skin of the legs, but rashes can occur on other parts of the body. At the same time, it is known about guttate psoriasis that it develops as a complication after streptococcal infections - pharyngitis, tonsillitis, etc.
• Pustular or exudative psoriasis- this is a severe cutaneous form, according to ICD 10 it is assigned the code L1-3 and L 40.82. It is characterized by the formation of blisters or pustules. The skin in the foci is edematous, red, inflamed, easily exfoliates. If a fungus or bacteria penetrates into the pustules, the contents of the pustules become purulent. Pustular psoriasis often affects the distal extremities, but in the most severe cases, it is possible to develop a generalized process with the spread of rashes throughout the body.
• Arthritis psoriatic or arthropathic psoriasis. According to version 10 of the ICD pathology, the code L5 was assigned. Manifested by inflammation of the joints. Arthropathic psoriasis can affect all types of joints, but in most cases, the joints on the phalanges of the toes and hands become inflamed. The knees, hips, or shoulder joints. Lesions can be so severe that they lead to disability of the patient. Therefore, you should not think about psoriasis that this disease is exclusively skin. Severe varieties of psoriasis can lead to systemic lesions, disability or even death of the patient.
• Erythrodermic psoriasis. A rare but severe variety of psoriasis, according to ICD 10, this disease received the code L85. Erythrodermic psoriasis often manifests itself in a generalized manner, the entire or almost entire surface of the skin can enter the affected area. The disease is accompanied by severe itching, swelling, soreness.
• Onychodystrophy psoriatica or nail psoriasis. According to version 10 of the ICD, the disease was assigned the code L86. Pathology is manifested by changes in the appearance of the nails on the toes and hands. Nails can change color, become thicker, begin to break down. Perhaps the complete loss of nails.

In psoriasis, the classification of the disease takes into account not only the types of the disease, but also the severity of the symptoms:

• limited psoriasis is a disease in which less than 20% of the skin is affected;
• widespread psoriasis affects more than 20% of the body surface;
• with the defeat of almost the entire surface of the skin, we are talking about universal psoriasis.

If we consider all types of the disease, then common psoriasis is more common than other forms.

Flow stages

Limited or widespread psoriasis in its course goes through three stages: progressive, stable and regressing.

For the progressive stage of psoriasis is characterized by the following:

• the appearance of new rashes;
• growth of pre-existing plaques;
• the appearance of new elements of the rash at the site of skin injuries (scratches, abrasions);
• profuse desquamation of existing plaques.

For the stationary stage of psoriasis, the following symptoms are characteristic:

• lack of appearance of new elements;
• moderate peeling of elements;
• no signs of element growth.

The appearance of folds in the stratum corneum around the elements is a sign of the transition of the stationary stage to the regressing one.

The following types of symptoms are characteristic of the regression stage:

• reduction in the intensity of peeling;
• element resolution.

After the resolution of psoriatic plaques, hypo- or hyperpigmented spots remain in their place.

For scaly lichen is characterized by a long course with periodic exacerbations. There are the following types of psoriasis:

• winter (with exacerbation in autumn and winter);
• summer (with exacerbations in the warm period);
• off-season psoriasis is the most severe variety, since there is no clear relationship between relapses and seasons of the year, periods of remission may be practically absent.

Features of diagnostics

If psoriasis has a typical clinical picture, then the diagnosis will not be so difficult. However, this disease is often disguised as other pathologies.

For example, psoriasis of the nails is often mistaken for nail fungus, since the external manifestations on early stage these diseases are very similar. However, the fungus and nail psoriasis have a completely different nature, so the treatment should be different.

A layman may mistake for a fungus and skin psoriasis. Since skin mycoses (skin fungus) are manifested by similar symptoms - the formation of scaly plaques. Therefore, having noticed suspicious symptoms on the body or nails, you do not need to self-diagnose yourself and read to treat the fungus using pharmacy or folk remedies.

If the diagnosis is erroneous, and in fact, the cause of the symptoms is not a fungus, but psoriasis, then the treatment will not bring benefits, but, on the contrary, will aggravate the symptoms.

When contacting a dermatologist, an analysis will be made for the fungus, a scraping from the nail or skin will be taken. Then the resulting material is placed in nutrient media. If the fungus is present in the material, then a large colony will grow in the test sample in a few days. By appearance material, it will be possible to understand what type of fungus provoked the infection.

Sometimes psoriasis is complicated by the addition of secondary infections, it can be a bacterial infection or a fungus. Therefore, patients with a change in the clinical picture (appearance of purulent discharge, discoloration of plaques, etc.) will have to be periodically tested for fungus and other infectious agents.

In the process of diagnosis, a certain role is assigned to the totality of phenomena, which are called the psoriatic triad. Phenomena appear sequentially, when scraping the element of the rash.

The psoriatic triad manifests itself as follows:

• when scraping the element of the rash, the scales are removed in the form of “chips”;
• after removing the chips, a thin transparent film similar to polyethylene opens;
• when the film is damaged, spot bleeding opens.

A dermatologist diagnoses psoriasis, but if necessary, the doctor can refer the patient for consultations to other specialists - a rheumatologist, gastroenterologist, surgeon, etc.

People have known about the disease psoriasis since ancient times. Even the very name of the disease came into our language from ancient Greek. During the prosperity of Ancient Hellas, the word "psora" denoted all skin diseases that are manifested by peeling and itching.

The first person to write a detailed treatise on psoriasis was a Roman named Cornelius Celsus. In the fifth volume of his work "De medicina" there is an extensive chapter devoted to this disease.

In Ancient Russia, they knew about psoriasis, but this disease was not unambiguously assessed, since it was called either “imperial” or “devilish” disease.

Of course, the ancient healers knew very little about psoriasis. Until the 19th century, this disease was often mixed with other skin ailments. First

psoriasis was isolated as an independent nosological form in 1799. This was done by the English dermatologist Robert Willan, who singled out psoriasis from a large group of skin diseases that are manifested by itching and flaking.

Not only ordinary people, but also prominent political figures knew about psoriasis firsthand. For example, Winston Churchill, who suffered from this disease, promised to erect a solid gold monument to a man who could learn everything about psoriasis and offer an effective treatment for this disease.

Modern ideas about the disease

It must be said that modern science does not know enough about this mysterious disease. There are various theories about the origin, course and treatment of psoriasis.

Here are the facts about psoriasis that do not cause doubts among specialists:

• despite the fact that the causes of the disease are unclear, it was possible to learn about the nature of psoriasis. This disease is autoimmune, that is, it is caused by a malfunction of the immune system;
• Another established fact about psoriasis is that the disease can be inherited. However, this is not always the case, even if both parents are sick, the risk of developing the disease in their child is 65%. At the same time, some patients develop psoriasis, although none of their relatives are sick;
• An interesting fact about psoriasis is that this disease is characterized by the Koebner phenomenon. This phenomenon manifests itself in the fact that the elements of the rash form at the sites of skin damage - scratches, burns, frostbite. Sometimes psoriasis appears after some time, at the site of scars;
• An important observation that allows you to get more information about psoriasis is the relationship of this disease with climatic factors. Exacerbations and relapses are often timed to coincide with the change of season;
• Patients probably noticed in practice the connection between exacerbations and stress. All patients should know for sure that the disease recurs or worsens its course against the background of nervous tension and experiences;
• a new fact about psoriasis is that the disease can debut at any age, although it was previously believed that psoriasis manifests itself after 30;
• It is important for all people to know that psoriasis is not a contagious disease. Even with close contact with the patient, there is no risk of infection;
• almost everyone has heard about the incurability of psoriasis, and this is true, since no treatment has been found that could be guaranteed to defeat the disease. But patients should know that psoriasis can be controlled. Adequate and timely treatment allows for long-term remission.

Modern methods of treatment

Speaking about the common disease psoriasis, it is impossible not to talk about the treatment of this common ailment. It must be said that it is impossible to cure psoriasis only with pills or ointments.

In order to forget about the manifestations of psoriasis for a long time, the patient, in close cooperation with the doctor, will need to make an effort. It will be necessary to organize food properly. Some experts argue that you can forget about psoriasis forever only with the help of a properly composed diet and regular cleansing of the body.

The doctor will draw up a preliminary scheme according to which the treatment will take place. As a rule, methods of external (ointments, creams) and systemic (tablets, injections) therapy are used. In addition, physiotherapeutic methods will be used, as well as treatment at resorts. It is recommended to treat psoriasis with the use of healing mud, mineral and thermal water.

The resorts can also offer non-traditional methods of treatment. For example, with the help of fish that live in thermal springs. These little healers effectively remove dead skin flakes and disinfect the skin, helping it to heal faster.

Other methods of treating scaly lichen may be offered at resorts. For example, leech therapy, healing baths and applications, sun treatment, etc.

You will need to be prepared for the fact that the treatment regimen will change periodically. Since not all methods are suitable for a particular patient. If the chosen methods of treatment do not work, they will need to be replaced.

widely advertised and folk ways psoriasis treatment. Indeed, some of them can help in achieving remission. However, when choosing a method, you need to remember common sense so as not to harm your health. If any recipe or recommendation is in doubt, then it is better not to use it. Before using any method of treatment, consult your doctor.

You need to understand that it will be possible to forget about psoriasis forever only if the patient himself and his inner circle are positive. Only faith in success and an optimistic attitude will help defeat this mysterious and insidious disease.

The identification of psoriasis, as well as other skin diseases, is engaged in dermatologist. Most often, a visual examination is enough to make a diagnosis of plaque-like (the most common type) psoriasis. At the first stage, there rash in the form of papules different sizes. Close to each other, they merge to form psoriatic plaques, which have a clear border and a rich hot pink color. In addition, the plaques are covered with a white, gray or yellowish coating - scales that easily peel off when scratched.

Thus, psoriasis is characterized by the presence "psoriatic triad"- spot bleeding, symptom of stearin stain and terminal film. Stearin stain- these are easily removable scales on the surface of the plaque. The spot is formed due to the accumulation of air bubbles in the stratum corneum of the skin and increased lipid secretion. Intercellular connections are weakened, the stratum corneum does not receive nutrition, the cells die. Terminal film- the affected area, represented by thinned inflamed skin under a stearin stain. The film is wet and shiny, very thin and easily damaged. It contains many capillaries that expand during the inflammatory process. They are easily damaged by tearing off the terminal film. Many droplets of blood will come out on the surface - the same pinpoint bleeding.

Psoriasis can affect any part of the body, including the palmar-plantar surfaces and hairy part heads, depending on the type of disease.

However, in some cases, psoriasis can be confused with dermatitis or eczema. In this case, inspection alone is not enough, it is necessary skin biopsy and blood test. Blood tests for psoriasis show elevated level leukocytes, proteins and high erythrocyte sedimentation rate.

Because psoriasis is autoimmune in nature, histological analysis skin should not show the presence of microorganisms (for example, seborrheic dermatitis is characterized by the presence of Malassezia furfur fungi). In addition, a biopsy of the skin affected by psoriasis reveals an accumulation of so-called Rete bodies, thickening of the stratum corneum of the epidermis, accelerated formation of blood vessels in the skin under the plaque, immaturity of young skin cells, and the absence of a granular layer of the skin.

Also, with a progressive (acute) stage of psoriasis, there is Koebner's sign- the appearance of new papules at the site of skin damage: cut, burn, injection, etc.

In addition to the progressive, 2 more stages of the development of psoriasis are distinguished. At stationary stage the appearance of new plaques stops and existing plaques cease to grow. Regressive stage characterized by discoloration of plaques, their flattening, elimination of peeling. Hypo- or hyperpigmentation is often observed in the area of ​​​​previous rashes.

An important task of a dermatologist is the diagnosis of psoriasis. The quality of patient care depends on it. To determine psoriasis by blood tests and other studies is the main responsibility of the doctor.

Differential diagnosis of psoriasis

Psoriasis is a complex autoimmune pathology. Therefore, before making this diagnosis, you need to make sure of it. To this end, each patient must undergo examination for psoriasis. It will help to exclude other pathologies. Differential diagnosis of psoriasis is carried out according to the main syndrome of the disease - skin manifestations. Pathologies that have similar dermatological signs include:

• Various forms of dermatitis (seborrheic, atopic);
• Lichen planus;
• Syphilis;
• Reiter's disease;
• Epidermophytosis of the groin;
• Neurodermatitis.

FROM vascular diseases it is possible to differentiate psoriasis on the legs, which is rarely isolated. In addition to the main syndrome, attention should be paid to the nature of the course of the pathology, the prevalence of skin rashes, general state patient. Dif. Diagnosis of psoriasis should be carried out by a dermatologist. It is based on skin examination data and laboratory tests. Diagnosis of psoriasis in children should be carried out very carefully. This pathology is rarely found in the practice of pediatricians. In some cases, psoriasis develops during pregnancy, and special monitoring is required.

How to determine: psoriasis or not

Determine the psoriasis on the skin of a patient or some other disease should be as early as possible. This affects the tactics of treatment and prognosis. Find out psoriasis succeeds in specific skin manifestations - plaques (photo 2). They are pink papules that rise above the surface of the skin. The progressive stage is characterized by the spread of spots and the appearance of silver scales on them. The diagnostic algorithm is a sequential execution of studies.

To recognize psoriasis in a child, the same methods are performed as for adult patients. The first step is to examine the skin. It is possible to determine psoriasis in a child only after performing dermatological diagnostic methods. Therefore, the pediatrician should refer the patient to a specialized dispensary. Examination plan for psoriasis includes the following items:

1. Clarification of complaints and examination;
2. Special examination of the affected skin - dermoscopy;
3. Laboratory research - general and biochemical analysis blood, coagulogram, urinalysis;
4. Skin biopsy for psoriasis.

Only after receiving the results can a conclusion be drawn. Diagnosis of nail psoriasis is based on laboratory methods and physical data. To identify the disease, all examinations are important. The greatest significance is the biopsy in psoriasis. It allows you to study the affected tissue areas.

Differential diagnosis of psoriasis

Diagnosis of psoriasis is carried out in a hospital. This is necessary to control treatment and exclude infectious diseases. Differential diagnosis of psoriasis and red lichen planus based on physical examination. Also, dermoscopy is performed. Rashes with lichen have a lilac hue, the center of the pathological focus is depressed inward, the edges of the papules are elevated. Pathological foci are localized on the flexion surfaces, in the inguinal region. Peeling of the skin is not expressed.

Dif. the diagnosis of psoriasis and syphilitic lesions is based on the history of the disease and a special laboratory test - the Wassermann reaction. Papules with this pathology differ in hemispherical shape and the same size. Differential diagnosis of arthropathy psoriasis carried out with Reiter's disease. For this pathological condition characterized by damage to the joints, urinary tract, eyes. Diagnosis in the clinic includes monitoring the patient's condition. With Reiter's disease, rashes pass faster, are localized more often on the genitals and in the oral cavity.

In the literature on dermatology, you can find a special table differential diagnosis psoriasis (photo in gal). It is based on a skin syndrome. Formulation of the diagnosis includes the phase of the pathological process, the degree of severity and clinical form illness. A diagnosis of psoriasis can only be made after an assessment of all indicators and long-term follow-up. Symptoms of this pathology persist for several months.

Blood test for psoriasis

Research on psoriasis begins with laboratory diagnostic methods. They help to quickly eliminate diseases such as syphilis, dermatitis, and allergic skin pathologies. What tests should be done for psoriasis? For diagnosis, it is necessary to perform a study of blood and urine. With their help, it is possible to determine the infectious nature of the pathological condition and the phase of the process. It is impossible to determine psoriasis by a blood test. However, it helps to suggest this diagnosis.

A general blood test indicates the presence of an inflammatory process of bacterial or viral etiology. These findings are non-specific and cannot be used to make a diagnosis. Blood test for psoriasis will show an increase in the number of leukocytes and an acceleration of ESR, in some cases a decrease in hemoglobin is noted. It will help to eliminate viral pathologies and allergic diseases. ESR in psoriasis can be greatly increased. This is due to the presence of chronic autoimmune inflammation. Donate blood for psoriasis should be 2-4 times a year. The study allows you to monitor the activity of the inflammation process.

A biochemical blood test for psoriasis is also not specific. It will show an increase in the fractions of proteins responsible for inflammatory process. Rheumatoid factor must be negative. The most reliable analysis for psoriasis is skin biopsy from the plaque surface. Histological examination allows us to make a final conclusion.

Can I donate blood for psoriasis?

Analyzes hand over at a psoriasis constantly. With the help of these studies, the doctor evaluates the dynamics of the pathological process and treatment. Some patients are interested in the question: is it possible to donate blood with psoriasis? Only the attending physician can answer this question. It all depends on the tests that the patient has at the moment. If there are no changes in them, then you should consult with a transfusiologist.

Often patients are interested in: is it possible to become infected with psoriasis through the blood? The probability of transmission of this pathology is low, but infection is possible. If the inflammatory process is in the active phase, it is forbidden to donate blood with psoriasis. The disease is characterized by the accumulation of immune complexes that are aimed at destroying the skin's own cells. In the active stage of the process, pathological antibodies can cause infection in a person who has not been ill before.

With extreme caution, it is worth prescribing the treatment of psoriasis in children, because hormones that are harmful to a growing organism are used in the treatment of this disease. A dermatologist, together with a pediatrician, should select and change the dosage of medications.

Psoriasis

Psoriasis (scaly) - inflammatory disease skin, characterized by a variety of manifestations. It occurs equally often in men and women.

Risk Factors for Psoriasis

• Mechanical trauma and skin irritation
• Infection (streptococcus)
• Stress
• Endocrine disorders
• Medications (hormones, antimalarials, interferon)
• Alcohol abuse

Manifestations of psoriasis

Psoriasis is characterized by the presence of a homogeneous rash in the form of plaques with a diameter of 1-3 mm to 2-3 cm, pink-red in color, covered with loosely sitting silver-white scales. As a result of marginal growth, elements can merge into plaques of various sizes and shapes, sometimes occupying large areas of the skin. Plaques are usually located on the skin of the extensor surface of the limbs, especially in the area of ​​the elbows and knee joints, trunk and scalp. The appearance of fresh elements is typical at the sites of injuries, scratching. When scraping psoriatic plaques, signs characteristic of psoriasis are found: when scraping, peeling intensifies, causing association with candle stearin; after removing the scales, a shiny wet surface appears; with further scraping, drip bleeding appears. Hair with psoriasis is not affected.

There are the following types of psoriasis: common psoriasis, exudative psoriasis, arthropathic psoriasis, pustular psoriasis and psoriatic erythroderma.

Psoriasis ordinary (vulgar) is characterized by a rash of flat plaques of pink-red color, 0.5 cm or more in size, covered with silvery-white scales.

Exudative psoriasis is characterized by the fact that grayish-yellow cortical scales form on psoriatic plaques due to their impregnation with exudate, weeping is sometimes determined in large folds.

Psoriasis is characterized by damage to the nails in the form of a thickening of the nail plates, pinpoint depressions on their surface, or the appearance of reddish spots under the nail plate.

Diagnosis of psoriasis

Diagnosis of psoriasis is carried out by a dermatologist using laboratory and instrumental methods research:

• General blood test
• Skin biopsy

Treatment of psoriasis

Treatment of psoriasis is aimed at suppressing the inflammatory response of the skin. Treatment of psoriasis is prescribed taking into account the form, stage, prevalence of the process, the presence of concomitant diseases, the age and gender of the patient.

With mild manifestations of psoriasis, in some cases it is enough to prescribe external therapy in the form of salicylic ointment, preparations of naftalan, tar, hormonal ointments. Severe forms of psoriasis require complex treatment with the use of drugs of different groups, physiotherapeutic methods of therapy, external preparations, etc.

Treatment is carried out taking into account the stage of the psoriatic process. Therapy of the progressive stage of psoriasis requires special attention and caution. During this period, hemodez is prescribed intravenously 2-3 times a week, a 30% solution of sodium thiosulfate intravenously, a 10% solution of calcium gluconate, 10 ml each, and various enterosorbents. With a concomitant increase blood pressure appropriate intramuscular injection 25% solution of magnesium sulfate. Emollient creams or 1-2% salicylic ointment are used externally. At the progressive stage of psoriasis for external therapy, the use of preparations containing tar, irritating and highly concentrated agents is contraindicated. Physiotherapeutic procedures are advisable to apply after the subsidence of inflammation.

At the stages of a stable and subsiding course of psoriasis, ointments with naftalan, tar, salicylic acid can be used.

One of the most effective methods Treatment of psoriasis is recognized as PUVA therapy or photochemotherapy. Photochemotherapy is the combined use of ultraviolet radiation (wavelength from 320 to 420 nm) with the ingestion of drugs that increase sensitivity to light. The use of photosensitizers is based on their ability to increase skin sensitivity to ultraviolet rays and stimulate the formation of skin pigment - melanin. The dose of drugs is selected individually, taking into account the weight of the patient. The procedures are carried out 3-4 times a week, 20-25 sessions are prescribed for the course. PUVA therapy is contraindicated in acute infectious diseases, exacerbation of chronic diseases, cardiovascular decompensation, oncology, severe diabetes mellitus, severe liver and kidney damage.

External treatment of psoriasis in order to eliminate inflammation, peeling, itching, softening of the skin is prescribed to all patients. For this purpose, agents are widely used, which include salicylic acid, hormones. Especially popular are drugs containing hormones and salicylic acid(diprosalik, belosalik in the form of an ointment, lotion; lorinden A ointment, elokom, advantan, latikort, lokoid, etc.). Creams are prescribed in the absence of severe inflammation, with exacerbation, in the presence of rashes on the face; lotions - for lesions of the scalp; ointment preparations for psoriasis are most often used, especially on the surface of plaques. Hormonal products should not be used on long time and on large areas of the skin.

An effective remedy is activated zinc pyrithionate (skin cap), which is available in the form of a cream, aerosol and shampoo.

Daivonex is used in the form of an ointment and lotion. The drug normalizes the development of cells. The greatest efficiency is achieved with prolonged, multi-week use of the drug in patients. Daivobet is indicated for severe forms of psoriasis. Reasonably staged treatment of psoriasis, when therapy begins with the use of Daivobet, then combined therapy is prescribed and then switched to treatment with Daivonex. To avoid the development of a withdrawal syndrome, the first and second stages should have the same duration.

Acitretin - used to treat severe forms of psoriasis, usually prescribed at a dose of 10 to 30 mg per day - depending on the severity of the skin process (the more acute the process, the lower the dose of acitretin). The drug is especially effective in combination with PUVA therapy. While taking the drug, it is necessary to monitor liver function, the concentration of cholesterol and triglycerides; in children, monitoring of indicators of growth and development of bones is necessary. When prescribing acitretin to women of childbearing age, the latter should use reliable contraceptives for 4 weeks before the start of treatment, during treatment and for 2 years after its end - due to the effect of the drug that disfigures the fetus.

Methotrexate is used in cases of persistent psoriasis, psoriatic arthropathy and contraindications to other treatments. The drug is very toxic. It is used under strict control of blood parameters, the level of bilirubin and transaminases in the blood serum.

Cyclosporine-A (sandimmun neoral) is prescribed for severe, widespread, psoriasis resistant to other types of therapy. In psoriasis, it is prescribed at the rate of 5 mg per 1 kg of body weight per day in 2 divided doses. Contraindications for the use of cyclosporine-A in psoriasis are infectious diseases, renal dysfunction and arterial hypertension. Treatment should be carried out only in specialized medical institutions. During therapy, systematic monitoring of creatinine, uric acid, bilirubin, liver enzymes, determination of potassium concentration and lipid levels in serum, and control of blood pressure are shown.

For severe, treatment-resistant and disabling forms of psoriasis, infliximab (Remicade) is indicated. The drug is available in 20 ml vials containing 100 mg of powder.

Diet plays a role in the development and treatment of psoriasis. A diet of fresh fruits and vegetables and low in protein is considered beneficial by many experts. On the other hand, diet is a strictly individual matter. Allergies and sensitivities to foods play a role in some patients, contributing to the worsening of the disease. The use of dietary supplements (eg. fish oil) is considered useful for many patients.

Course and prognosis in psoriasis

Psoriasis has an undulating course with a period of subsidence and exacerbation. Exacerbations of psoriasis are more common in autumn and winter (autumn-winter form), less often in summer (summer form). The prognosis for patients with widespread psoriasis is favorable, with severe forms psoriasis (pustular, arthropathic, erythroderma), disability is possible.

Pregnancy can have an unpredictable effect on the course of psoriasis. During pregnancy, the use of ointments containing tar or hormones should be avoided, as well as systemic therapy.

Skin biopsy: indications, technique, results

Medical procedures in many patients cause panic. They do not understand the terms and the essence of the procedure is unclear. Some even refuse the necessary tests, guided by the opinion of homegrown neighbor experts or falling under the influence of stereotypes. But all you need to do is talk to the doctor, ask for a more detailed explanation of the essence of the appointment. For example, if a skin biopsy is offered to a patient, then he should understand that this procedure is prescribed to clarify the diagnosis and to be able to overcome the disease at an early stage.

Skin biopsy - what is it?

They call it a biopsy diagnostic procedure, in which a piece of living material is taken for further study of it cellular composition. Accordingly, a skin biopsy is an excision to examine a piece of skin.

Material for research can be obtained in several ways:

• shaving;
• trepanobiopsy;
• existential.

The choice of method depends on the suspected disease, but in all cases the procedure is performed with a sterile, most often disposable instrument.

Indications for a skin biopsy

Histological examination of biopsy material (biopsy) may be prescribed in the following cases:

• in the diagnosis of bacterial, fungal, viral diseases;
• to determine benign formations;
• to clarify malignant formation;
• to check the result after removal of the tumor;
• with suspicion of lupus;
• with suspicion of tuberculosis of the skin;
• with psoriatic plaques;
• with scleroderma, amyloidosis, reticulosis;
• in the presence of deep mycosis;
• with a disease of nodular periarteritis;
• for diagnosing Darier's disease;
• as a treatment control.

The maximum number of appointments is the detection of oncological neoplasms. Noticing a change in pigmentation or deterioration in the healing of the integument, the doctor prefers to prescribe a biopsy in order to be able to treat at an early stage of development.

Who makes the appointment?

With skin diseases, you should consult a dermatologist. If the problem is not obvious, but the patient feels discomfort, then he should consult a therapist. After the examination, the therapist-diagnostician will refer you to the right specialist. He will tell you where to do a skin biopsy.

What instrument is used for biopsy?

As already mentioned, there are several methods by which a biopsy is performed. Depending on this, the necessary equipment and tools are selected. In most cases, this is an individual kit that contains a cannula with an opening, a probe, and a movable tube with a protrusion to hold the tissue sample.

Puncture biopsy is performed with a needle of the required diameter. It can be a special thin syringe, an automatic system with a spring mechanism or a vacuum needle.

In many cases, a skin biopsy is performed by curettage. In this case, the instrument is an annular curette or a surgical spoon. These tools differ in the diameter of the gripping surface.

Methodology. Shaving skin biopsy

A shaving biopsy is performed with a scalpel or medical blade. In this case, a superficial cut is performed in the center of thickening. The cut protruding part of the pathological neoplasm is placed in a container with a formalin solution. And the area of ​​manipulation is covered with a sterile napkin. The procedure, as in other cases, is performed under local anesthesia.

Trepanobiopsy

In this case, it is carried out histological examination biopsy material taken from the center of the affected area. A column of skin and subcutaneous fat is pierced with a trepanation needle, rotated and removed. Then it is picked up with tweezers and notched on required level. A sterile patch is applied to the wound surface, not exceeding 3 mm. With a larger diameter of the wound, a suture is applied.

Excisional biopsy

According to this method, the lesion is excised with an adjacent healthy area of ​​\u200b\u200bthe skin. The method is effective for detecting malignant tumors. The remaining wound is covered with a sterile napkin, but if the wound area is large, then it is sutured or covered with a skin graft.

The individual skin biopsy instrument is not reused. All dressings must be sterile. The result of the analysis is ready in 1-4 weeks. The term depends on the complexity of the biopsy processing.

Biopsy for psoriasis

Many patients believe that psoriasis can be diagnosed without testing by its characteristic appearance. However, a skin biopsy in psoriasis is necessary to exclude other pathologies. With a severe course of the process, Reete's bodies are present in the biopsy, which are a manifestation of histological immaturity and a thickening of the keratinocyte layer.

When removing material for research, pinpoint bleeding is noticeable under the plaque. This is evidence of a pathology of vascular permeability at the site of injury. Additionally, it allows to detect accelerated angiogenesis.

Study preparation

Complex preparation for a skin biopsy is not required. Before the procedure, the doctor should be informed about the anti-inflammatory drugs taken, allergic reactions and tendency to bleed. Women should inform their doctor about pregnancy.

Recovery after the procedure

The sampling site may only be touched with thoroughly washed hands with soap and water. The bandage or other surgical material is removed one day after the manipulation.

For washing the wound, soap without dyes and flavoring additives is used. After washing, petroleum jelly or a bactericidal ointment is applied to the wound surface. Re-bandaging of the wound is performed according to the doctor's prescription. If there were no additional instructions, then it is worth applying a sterile napkin or bandage if the wound is located in places that are rubbed with clothes. The place where the skin biopsy was performed must be moistened with special ointments several times a day. This will avoid the appearance of a scab.

If the biopsy trace is reddened or swollen, then you should consult a doctor. This may be a sign of infection.

For at least a week after the procedure, limit your intake of foods with vitamin E, do not drink alcohol, do not take aspirin and ibuprofen. Violation of this requirement may cause bleeding.

Spots of pink and red that appeared on the skin, seemingly without apparent reason. Spots covered with scales. All these are signs of psoriasis. How to recognize psoriasis at the very beginning of its occurrence, so as not to start the disease?

The only correct way out in the event of inexplicable, unprovoked redness on the epidermis is to visit a dermatologist. But there are a number of signs by which the patient himself will be able to recognize the presence of this disease. With the diagnosis of psoriasis, when redness appears on the epidermis, you should not slow down. In its advanced form, this disease is difficult to cure.

Three stages of psoriasis

1. Stationary (old plaques itch very much, but new ones do not appear);
2. Progressive (during the first three weeks, red spots on the body actively appear and grow);
3. Regressive (there are no new spots, and those that already exist are covered with keratinized skin; where there is no longer a red, inflamed color, hyperpigmentation occurs).

Psoriasis: how to correctly establish this diagnosis

Diagnosis of psoriasis by a dermatologist begins with a simple examination of the patient's skin. His attention is attracted by reddish and pinkish spots, scaly skin is no less interesting to him. If such signs are found, the doctor will send you to take a blood test for psoriasis. This analysis will confirm/deny the presence of inflammation. A biopsy is also done to confirm the diagnosis of psoriasis.

Scraping will detect / not detect Rete bodies. Only scraping will be able to explain why, what is the reason, the nature of the occurrence of psoriasis. And the success of actions aimed at getting rid, if not of the entire disease, then of most of its symptoms, will depend on the correctly identified cause.

Differential Approach

After standard medical examination and publishing the results of a laboratory study of blood and urine, it's time to start the so-called differential diagnosis of psoriasis. This method of diagnosis will make it possible to distinguish psoriasis from diseases with similar symptoms: eczema, syphilis, lupus erythematosus, etc. To differentiate means to compare, compare.

To find out exactly if the patient has psoriasis, the table will help differential diagnosis, which every self-respecting dermatologist has. It helps to quickly make the correct diagnosis and, with the right therapy, if not completely cure the disease, then significantly alleviate its symptoms - for sure. As part of this kind of diagnosis, a clinical examination is carried out, which depends on the localization of the disease. Localization is the location of psoriasis spots, plaques. It can be skin folds of the head, abdomen, neck, nails.

What causes psoriasis

Psoriasis is an ailment that is not only poorly understood, but also poorly treatable. Therefore, it is difficult to determine the causes of its occurrence. But experts say that there are trends associated with the progression of psoriasis, namely:

• Skin injuries (including mechanical ones);
• Infectious diseases (chronic and acute);
• The use of low-quality cosmetics;
• Allergy provoked by drugs of chemical origin;

Laboratory tests for psoriasis

How to determine psoriasis - only a dermatologist knows, so do not make a diagnosis for yourself based solely on your conjectures. Traditional samples taken from the patient's epidermis for the presence of allergens cannot be done by patients with psoriasis.

A routine blood test for psoriasis will determine the presence of this disease, which has arisen against the background of low hemoglobin in the blood, diabetes and other ailments.

Protein analysis

This type of analysis will help not to confuse psoriasis with rheumatoid arthritis.

This kind of analysis will determine the pustular type of the disease we are describing (or erythroderma). Within both of these diseases, the erythrocyte sedimentation rate changes in a certain way.

Laboratory study of the amount of urea

The amount of urea is more than normal, it gives an indication of the progress and severity of psoriasis.

Biochemistry

This analysis for psoriasis gives a chance to learn about malfunctions in the body within the framework of water and salt balance and captures the activity, performance and functionality of vital organs.

Laboratory blood tests for antibodies

It makes it possible to track the state of the immune system and detect disruptions in the hormonal system.

Research on psoriasis of a different kind

Fecal analysis, x-ray, blood test for allergies, photos of the rash on skin- all these tests for psoriasis will help the doctor make the correct diagnosis and prescribe the right treatment.

Determination of the level in the blood
IgE will help determine the allergic nature of psoriasis. A study of the level of specific IgE to various allergens will make it possible to understand which allergens provoke pathology. But the detection of a certain type of IgE does not confirm the fact that there is an allergy to a certain food. There are also false negative results. It happens that allergies cause psoriasis without an increase in total and specific IgE.

Examination of blood for histocompatibility antigens

The indicators of this study will make it possible to identify joint diseases by the presence of antigens of a certain type. An increased number of antigens indicates the presence of a disease such as Reiter's disease.

As part of the treatment of this disease, you will have to be tested for psoriasis regularly. This will allow the doctor to adjust the treatment for optimal results.

Define psoriasis in children

To children, psoriasis is inherited from parents (even if only one of the parents suffers from this disease). It occurs in any form, except for the teardrop type. A dermatologist can easily and quickly identify psoriasis in a child by simply looking at his skin. Rarely, scrapings are also used to determine the nature of psoriasis in a child. donate blood for laboratory research in this case is not necessary. A dermatologist will be able to detect this disease in an infant by signs such as the occurrence of psoriatic plaques and redness in the skin folds in the diaper area. Older children develop spots on the head and limbs.

How a dermatologist diagnoses psoriasis in children

This is done in a dispensary. According to the regulations for studying the disease and making a diagnosis in psoriasis, the child is subjected to such manipulations (checks):

1. Visual examination of the affected areas of the skin;
2. Dermoscopy (examination of the affected skin using a special tool that scrapes off the scales);
3. Laboratory research (biochemistry and general analysis blood test, urine test, coagulogram, skin scraping).

Psoriasis: pustular or non-pustular

The first type is determined by the presence of a pustule - a bubble, inside of which is a transparent substance. Such bubbles are deployed around the skin, which takes on an inflamed, red appearance. It happens that the patient suffers simultaneously from two types of psoriasis - pustular and non-pustular. Treat different types followed in different ways.

The pustular form is often
pustular is fraught with complications, because at the moment of rupture of the bubbles, the patient's skin ceases to have natural protection, which is why it ceases to protect itself from microbes. In symbiosis with infections of different etiology (origin), this type of the disease we describe is fraught with suppuration, and this provokes severe intoxication (poisoning) of the patient.

• Non-pustular type:
• Psoriasis vulgaris;
• Erythroderma is an extremely intractable form, fraught with death.

Unique types of psoriasis

They also exist. The highlight of the disease we are describing is its elementary combination with other types of infections of the human epidermis in chronic form (different types fungus, etc.).

Classification

1. Drug-induced (provoked by medication);
2. Seborrheic (occurs against the background of seborrhea);
3. Reverse (occurs exclusively on the bend of the elbows and joints).

Any type of psoriasis, alas, is incurable. But the manifestations of this disease (itching, redness, peeling of the skin) can be alleviated with medications and PUVA therapy, in which the patient is exposed to ultraviolet radiation.

How professionals define psoriasis

How to understand if it is psoriasis or not? The psoriatic triad will help with this. This sign makes it easy to distinguish a psoriasis rash from other rashes. The triad is defined as follows: within the framework of getting rid of scales, a thin film appears, which covers the plaque, and psoriatic elements look like drops of antiquity. When the film is removed, bleeding will begin in the form of a bloody race. The symptoms described above exist in areas of the rash of different localization.

Only a doctor can perform the above procedure for diagnosing psoriasis (tearing off the film, removing scales) using special tools. If you do this with improvised means, you can provoke an increase in the formation of new psoriasis plaques.