Biopsy psoriasis. Comprehensive diagnosis of psoriasis, what to do with the first symptoms

Diagnosis of psoriasis is the most important key to prescribing effective treatment. modern medicine offers an integrated approach in both diagnosing and treating this disease. Unfortunately, this type of dermatosis still remains on the list of incurable diseases, however, progressive methods of treatment give stable remission and return the patient to a full life.

Psoriasis or psoriasis is a serious non-infectious autoimmune pathology that affects the skin, nails and joints. Psoriasis is a chronic disease, the causes of which are not precisely established. The disease manifests itself in the form of a rash and loose scaly plaques that become inflamed, itchy and flaky. In the acute stage, the crust peels off and a lot of bleeding ulcers become visible on the skin. This disease delivers not only physical, but also psychological suffering to the patient.

Psoriasis is diagnosed by a dermatologist.

Causes of scaly lichen

The true causes of the disease have not yet been established, however, medicine identifies several versions that play a significant role in the diagnosis of psoriasis:

• Autoimmune failure. This is due to the increased concentration of T-lymphocytes in the blood. As a result, the immune system, which must fight foreign cells, attacks its own;
• endocrine factor. It is based on dysfunction. endocrine system and its regulatory function, as a result of which there are violations of the internal secretion systems, the pituitary gland and thyroid gland;
• Violation of metabolic processes in the body. One of the causes of scaly lichen may be a failure in lipid-nitrogen metabolism. This may also include elevated level cholesterol in the blood and imbalance of the work of metabolism;
• genetic predisposition. Alas, the disease can be inherited. So if someone in your family was sick, then you are at risk. However, if you protect yourself from provoking (triggering) factors, then the development of the disease can be prevented.

How to identify Psoriasis

It is not possible to diagnose psoriasis at home, because its symptoms often coincide with those of other skin diseases. At the same time, there are a number of signs that may serve as a reason for an urgent appeal to a dermatologist or infectious disease specialist:

• The appearance of reddish spots on the skin, which at first glance can be mistaken for acne, irritation or an allergic rash;
• The rash causes anxiety and a feeling of itching, and the area of ​​​​the lesion increases;
• Periodically, blisters or weeping sores on the palms and feet may appear;
• Redness of the skin and its peeling, as well as the formation of whitish scales;
• Changes in the condition of the nails for the worse. The nail plate may change color, begin to exfoliate, or vice versa unnaturally harden.

Initial signs and symptoms of Psoriasis

Most often, the first signs of scaly lichen are found in the places where the limbs are bent, as well as along the hairline at the back of the head and behind the ears. There is a feeling of itching and dryness of the skin, then the scales of the dead epidermis begin to accumulate, turning into multilayer islands. Scales are separated from the skin easily, like shavings, and removing them, you can find bleeding and weeping wounds and ulcers. If at this stage you do not sound the alarm and do not turn to a dermatologist, then the disease will progress. Islands of wounds will merge with each other, and spread further through the body, forming the so-called psoriatic plaques. Timely methods of diagnosing psoriasis will help to start treatment on time and stop its further development.

How to get an accurate diagnosis

Having made an appointment with a dermatologist, get ready for detailed questions from the doctor and a comprehensive diagnosis of psoriasis. To make a correct diagnosis, it is necessary to collect a complete history, which will take into account the following factors:

1. Patient complaints;
2. Presence of chronic diseases and health problems;
3. Genetic predisposition and hereditary diseases, in particular, a history of psoriasis in family members;
4. Features lifestyle and the presence of a stress factor;
5. destructive habits;
6. The progressive stage of the Koebner phenomenon (the formation of fresh rashes at the sites of irritation; the acute phase of the manifestation of the disease);
7. Test for the psoriatic triad.

Diagnostics

If you suspect signs of an illness, you should immediately contact a dermatologist. To diagnose psoriasis, you need a comprehensive approach, and it is highly desirable to pass all the necessary tests prescribed by your doctor. This will help identify "pain points" in your body and prescribe the most effective treatment regimen.

In the diagnosis of psoriasis, standard and additional methods research. The standard includes blood tests (general and biochemical), urine and feces. Additional methods are more informative: skin biopsy, bacteriological culture, radiography and ultrasound. They are assigned as needed.

A blood test will show whether there is an inflammatory, autoimmune or rheumatic process in the body. During the diagnosis of psoriasis, endocrine or biochemical disorders will be detected, and auxiliary diagnostic methods will help to recreate the most accurate clinical picture.

The standard set of tests for the diagnosis of psoriasis includes:

• General analysis blood will show indicators of leukocytes;
• Biochemical analysis will show the level of protein in the blood;
• Stool analysis to detect or exclude the presence of helminths and intestinal infections;
• A blood test for HIV will help determine the state of immunity;
• Additionally, studies of the kidneys may be needed.
• Urinalysis, which will show the state of the water-salt balance;

Instrumental diagnostics

Dermoscopy is a non-invasive method for diagnosing psoriasis, which is used to identify a number of common dermatoses such as scaly, red lichen planus, precancerous skin diseases, seborrheic dermatitis, vasculitis and others.

If the clinical picture of psoriasis looks fuzzy, then it becomes necessary to resort to biopsy skin. A biopsy is a procedure during which a small affected area of ​​the skin is excised for histological examination using a microscope. This method of examination is prescribed in the early and middle stages of the course of the disease. Taking a biopsy does not require special preparation, but implies a temporary rejection of those that reduce blood clotting (anticoagulants and anti-inflammatory drugs). If necessary, biopsy can be taken from the skin of the face and scalp. The manipulation takes place within 30 minutes, after which the patient is bandaged or a bactericidal patch is glued. The answer of the histological examination will have to wait from 7 days to one and a half months.

scraping from a conglomerate using a special glass slide is carried out to analyze the signs of the so-called psoriatic triad. After removing the scales from the papule, you can see a shiny smooth surface of the skin. During manipulation, droplets of blood may appear (the so-called "blood dew syndrome").

To exclude the presence of a fungal infection, a study using potassium hydroxide is prescribed. This is necessary in cases where the suspicion of psoriasis is controversial and there is a possibility of confusing it with another type of skin disease.

For the diagnosis of psoriasis, the UV radiation method (wavelength 308 nm) can be used. An excimer laser is placed on the conglomerate or papule, which begin to glow under the influence of the beam.

If suspected, an ultrasound of the affected area or radiography is performed.

When diagnosing psoriasis, a special scale for assessing the severity of psoriasis is also used. This scale takes into account the area of ​​the affected areas of the skin, the dynamics of the course of the disease and the level of its activity. In this case, the PASI index (Psoriasis Area and Severity Index) is used in the diagnosis, which is the main tool for measuring the severity of the disease.

Differential Diagnosis

The first sign of the development of scaly lichen is the presence of papules with a diameter of 2 mm or more and pathological changes in the affected areas of the skin. The doctor diagnoses psoriasis according to psoriatic triad- three characteristic signs of the disease:

1. Stearin stain. The doctor scrapes the affected area of ​​the skin and examines its surface for separation of white scales from the psoriatic papule. At the same time, there is an increase in peeling and desquamation of dead epidermis;
2. Terminal film. This sign is characterized by the convergence of a thin film from the papule, which covers the entire papule. The doctor acts by friction on the film, which is easily removed from the upper layer of the dermis, exposing the very surface of the skin;
3. Symptom of "blood dew". This is a manifestation of the smallest droplets of blood in places of scraping. This symptom is the final one in the psoriatic triad.

Some forms of psoriasis have symptoms and signs similar to other skin diseases. The task of a dermatologist is to conduct a differential diagnosis based on a comparison of scaly lichen with other types of diseases such as:

1. Other types of dermatosis and seborrheic eczema;
2. Flat and pink deprive;
3. Lupus erythematosus;
4. Neurodermatitis;
5. Papular form of syphilis;
6. Reiter's syndrome.

The patient must remember that for the diagnosis of "psoriasis" is not enough alone laboratory tests. In most cases, consultation with an infectious disease specialist, immunologist, nephrologist and other specialists will be required.

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. In blood tests for psoriasis, an increased level of leukocytes, proteins and a high erythrocyte sedimentation rate are found.

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 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.

The skin is an organ that protects us from the penetration of foreign substances and pathogens into the body. Unfortunately, the skin is also prone to various diseases, and psoriasis is one of the most difficult to treat. In addition, the disease gives patients a lot of trouble.

What is psoriasis

The word "psora" in Greek means "skin itching, scabies." This name reflects the main symptom of the disease. Also, psoriasis is sometimes called psoriasis for its external form. From a scientific point of view, psoriasis is one of the pathologies of the skin - dermatoses. The disease changes the appearance of the skin, causes suffering to the patient, expressed, first of all, in severe itching.

Interesting fact:

Psoriasis was known in antiquity, but then it was often confused with other skin diseases. Medicine recognized it as an independent skin disease in 1799. Currently, doctors tend to consider psoriasis not even as a skin disease, but as a systemic disease, since it affects not only the skin, but also the immune, nervous and endocrine systems.

The mechanism of development of psoriasis

Psoriasis is a violation of the process of cell regeneration of the upper layer of the skin (epidermis). If normally epidermal cells (keratocytes) are updated every month or every three weeks, then with psoriasis this process takes much less time - only 3-6 days. It is also important that the cells of the stratum corneum of the skin in this case are undeveloped and are not able to perform their functions. As a result, intercellular connections are lost, the skin layer does not have time to properly form and take root. This is how psoriatic formations on the skin are formed - papules, pustules and plaques. Excessive angiogenesis is observed in them, that is, a lot of small vessels are formed. The lower layers of the skin are not affected. In the mechanism of the occurrence of pathological formations on the skin, cells also take immune system human T-lymphocytes.

Some features of the course and occurrence of psoriasis

Psoriatic skin rashes often form in places where the skin has been injured or cut, in places of burns, calluses, abrasions and even injections. A similar phenomenon is called the Koebner phenomenon, after the German dermatologist Heinrich Koebner, who first described this phenomenon in 1872. The Koebner phenomenon is characteristic of psoriasis in about half of the cases and in 90% of cases of severe psoriasis.

Psoriasis is characterized by a seasonal course. In most patients during the cold season, the manifestations of the disease on the skin become more noticeable. In some patients, on the contrary, heat contributes to the progress of the disease.

How is psoriasis spread?

By modern ideas, this skin disease is not contagious, that is, it is not transmitted by contact with another person, even if the affected skin area touches the skin healthy person. Transmission of the disease through the blood has not been recorded. Also, you can not get psoriasis through contact with animals or pick up the disease from environment. The cause of the disease lies exclusively in the patient's body, although some adverse external factors can also have an impact.

Epidemiology

It is estimated that the number of cases worldwide is between 2% and 4%. In some regions of Russia, the number of cases reaches 11%. In other regions, the incidence of psoriasis is low and is less than 1%.

Who has psoriasis

Psoriasis is slightly more common in women. The disease develops mainly at a young age (up to 25 years). Most dangerous period- from 16 to 20 years, at this time signs of the disease appear in 70% of patients. Although older people can also get sick. However, usually in old age, the symptoms are not so pronounced. On the other hand, in childhood(up to 16 years) the disease also occurs infrequently (about 4% of patients). There are also racial differences in incidence. Most often, representatives of the white race are sick, and in some groups, for example, among the Indians of South America, the disease does not occur at all.

The reasons

Despite the undoubted progress of medicine, science still has no answers to many questions. This mainly concerns the causes of the development of many pathologies. This also applies to psoriasis. The interest in this case is by no means academic. After all, if you understand how this skin pathology is born, then you can find ways to completely cure it. And since scientists do not have complete clarity on the etiology of psoriasis, it remains incurable. In this case, incurability only means that the patient cannot get rid of skin psoriasis until death. Although in most cases psoriasis is not the direct cause of death. Treatment methods can curb the development of psoriasis and prevent the occurrence of complications.

There are several theories explaining the occurrence of this skin disease, but none of them completely suits scientists:

• autoimmune,
• genetic,
• hormonal,
• viral,
• neurogenic,
• metabolic.

There are other theories, such as those associated with vasculitis ( chronic inflammation vessels). It is possible that psoriasis is a multifactorial disease, the development of which is caused by several factors at once.

autoimmune theory

The main theory is autoimmune. According to her, skin cells are attacked by cells of the immune system T-lymphocytes (primarily T-killers and T-helpers). This leads to the release of a large number of inflammatory mediators and attracts other cells of the immune system, in particular macrophages and neutrophils, to the skin. This is what leads to the appearance of pathological formations. This theory is supported by the fact that there is an excess of lymphocytes and macrophages in the skin. In scaly formations on the skin there are certain antigenic complexes that are absent in other parts of the body. On the other hand, the patient's blood contains antibodies to these antigens. In addition, treatment with immunosuppressants in psoriasis has some effect.

However, critics of the theory point out that lymphocyte aggression is secondary. And the basis of this reaction is a primary skin disease - a pathological violation of the development of skin cells. This assumption is supported by the fact that drugs that inhibit the division of epidermal cells and improve their development have a positive effect in psoriasis. In addition, animal studies show that skin symptoms similar to those observed in psoriasis can occur in the absence of T-lymphocytes in the body. Another objection is that AIDS patients, who also have a reduced number of immune cells, are most susceptible to psoriasis.

Another version of the theory is the assumption that immune cells attack antigens contained in skin cells, which lymphocytes mistakenly take for antigens of viruses or bacteria. In particular, the antigens of some types of streptococci responsible for the development of acute respiratory infections are similar to the proteins contained in skin cells. The immune system fights the streptococcal infection, and as a result, "innocent" skin cells are under attack. This fact explains the fact that exacerbations of psoriasis are often observed simultaneously with infections of the respiratory system or shortly after the completion of their treatment.

Of course, autoimmune processes are not the only ones that lead to skin pathology. Its development is most likely unlikely without disturbance barrier function skin as a result of injuries, exposure to the skin of aggressive substances, abnormal temperatures, etc.

genetic theory

Proponents of this theory argue that psoriasis is caused by breakdowns in the genetic code. And some research shows this. In particular, genes have been identified that may be responsible for the appearance of psoriasis symptoms. For example, the locus (chromosome region) PSORS1, located on chromosome 6, occurs in 3 out of 4 patients with guttate psoriasis and in half of patients with psoriasis vulgaris. A total of 9 loci were found that may be responsible for the disease.

The hereditary nature of the disease also speaks in favor of the theory. It is known that people who have one or both parents with psoriasis are more likely to get sick. If one of the parents is sick, the probability is 24%, if two - 65%. If one of the identical twins suffers from psoriasis, then with a probability of 70% it is also found in the other twin. It is also known that pathology can be traced in a family history for 3-5 generations. 60% of patients have one or more relatives suffering from the disease. However, skin pathology can also appear in children whose parents never suffered from it.

However, most researchers believe that genetic predisposition cannot be the only cause of the disease. We need unfavorable factors - triggers that trigger its development.

virus theory

If this theory were proven, then treatment could be greatly facilitated. It would be enough to develop a cure for the desired virus. In particular, retroviruses act as "suspects". Despite the fact that some facts speak in favor of the theory, for example, an increase in lymph nodes near those places where the most obvious manifestations of the disease are observed, however, there is no serious evidence of it. No virus has been found to be responsible for the disease. And most importantly, not a single case of transmission of psoriasis from person to person has been recorded. This is the way most viruses spread.

neurogenic theory

Among people who are far from medicine, there is a saying that all diseases are from nerves. Doctors are usually skeptical about this theory. However, in some cases it is not far from the truth. One such exception seems to include psoriasis. Some studies suggest that stress, nervous experiences, overwork, insomnia often (in about 40% of cases) can cause manifestations of psoriasis (a manifestation of the disease or its exacerbation). And studies on childhood psoriasis say that 90% of children develop exacerbations as a result of stressful situations.

In most cases, patients claim that the development of psoriasis began in them after some kind of nervous shock. This is not at all surprising, because our life is oversaturated with various stresses - problems at work, in the family, in personal life. However, many questions remain in this theory. What is the mechanism of the development of the disease in this case is still not entirely clear. Perhaps stress leads to a change in the work of the autonomic nervous system, resulting in reduced peripheral vessels, including those supplying blood to the skin. And this disrupts the formation of new skin tissues, and ultimately leads to the appearance of psoriatic plaques on the skin.

Hormonal theory

This theory states that hormonal disorders, diseases of the pituitary gland and the thyroid gland play a leading role in the development of the disease. In particular, psoriasis has been found to be favored by a lack of testosterone in men and progesterone in women. And in some women, skin pathology is provoked by an increased synthesis of estrogens. On the other hand, exacerbations of psoriasis can also be observed in women with reduced level estrogen (during menopause).

During pregnancy, some women (about a third) experience an increase in skin symptoms, while the rest, on the contrary, are in remission.

Also, with psoriasis, there is a decrease in the synthesis of other hormones, in particular, melatonin, an increase in the level of growth hormone, prolactin and an increase in insulin resistance of tissues, and a decrease in thyroid function. However, the role of specific hormones in the development of psoriasis has not yet been fully elucidated.

Metabolic disease

Skin pathology is often accompanied by such a phenomenon as a decrease in body temperature. Consequently, in some patients, the metabolism may be slowed down. Also, with psoriasis, there is an excess of cholesterol in the blood. This circumstance makes it possible to consider psoriasis as cholesterol diathesis. Patients may also have a lack of vitamins of groups B, A and C, trace elements - zinc, copper and iron, which also indicates a metabolic disorder.

Psoriasis and obesity

The appearance of psoriasis is often characteristic of overweight people. Patients with psoriasis are 1.7 times more likely to be obese than those without psoriasis.

Proportion of patients who are obese:

• Light form - 14%,
• Medium form - 34%,
• Severe form - 66%.

Thus, excess weight contributes, if not to the appearance of symptoms, then at least to the fact that they take the most severe forms. However, such a relationship cannot be called one-sided. After all, psoriasis itself causes stress, which many people struggle with by eating more and more food. Thus, it would be plausible not only to say that obesity leads to psoriasis, but, conversely, that psoriasis leads to obesity. In addition, it was found that in overweight patients, the effectiveness of the treatment of the disease is reduced.

Factors contributing to the development of the disease

This category should include phenomena that cannot directly be the cause of psoriasis. However, if there is a tendency, for example, a hereditary predisposition, these factors can become a trigger that triggers a pathological mechanism. In particular, it has been noticed that people with thin, dry and sensitive skin get sick more often. This is due to insufficient secretion of the sebaceous glands, due to which irritants, in particular streptococci, can penetrate deep into the skin tissues.

There are quite a few factors that contribute to psoriasis:

• smoking;
• alcoholism;
• wounds, injuries and cuts of the skin;
• skin burns, including sunburn;
• bites of insects or other animals;
• stress;
• malnutrition, abundance fatty foods, sweet, lack of fruits and vegetables, increased consumption of caffeinated drinks;
• taking certain medications, primarily antibiotics, NSAIDs, antihypertensive drugs, vitamin complexes, antidepressants, antimalarial and anticonvulsant drugs;
• taking lithium preparations (lithium disrupts the synthesis of keratocytes);
• lack of vitamins in the body;
• infectious skin diseases (fungus, lichen, dermatitis, furunculosis, acne);
• systemic infections or infections of the respiratory system (, acute respiratory infections);
• infection with Helicobacter pylori, Yersinia, staphylococci;
• vaccination;
• moving to other climatic zones;
• hypothermia or cold microclimate;
• food poisoning;
• reduced immunity, including AIDS;
• exposure to the skin of aggressive chemicals, including detergents, cosmetics, perfumes;
• too frequent washing of the skin, destroying the beneficial microflora;
• violation of the digestive tract,.

Most of these factors are external. And this means that any person is able to prevent their effects on the body in order to avoid the development of the disease.

Types

The most common type of psoriasis is psoriasis vulgaris. It accounts for approximately 90% of cases.

The main types of psoriasis

Few people know that psoriasis can affect not only the skin, but also the joints and nails. Many people with skin psoriasis also have nail psoriasis (psoriatic onychodystrophy) or psoriatic arthritis(joint disease).

Psoriatic arthritis usually affects the small joints of the hands and feet. However, the pathology can also spread to large structures, affecting the spine. This threatens the patient with disability.

Also, psoriasis can be divided into mild, moderate and severe, depending on what percentage of the skin is affected.

Psoriatic arthritis refers to severe psoriasis, regardless of what percentage of the skin is affected. This form is observed in 15% of patients.

The most severe type of psoriasis is psoriatic erythroderma (2% of cases). Also a severe form is pustular (1% of cases). Nail psoriasis is observed in a quarter of patients. This type of psoriasis may not be accompanied by the appearance of rashes on the skin.

Guttate psoriasis usually occurs after infections (acute respiratory infections, influenza). In 85% of patients with guttate psoriasis, antibodies to streptococcus responsible for the development of angina are detected in the blood, and 63% of patients with this type of psoriasis have pharyngitis shortly before exacerbation. Pustular psoriasis usually occurs in overweight people.

There is also a psoriasis severity rating scale (PASI). This index takes into account the various manifestations of the disease:

• skin redness,
• skin itch,
• skin thickening,
• skin hyperemia,
• peeling,
• area of ​​skin lesions.

All these factors are summed up and expressed in points from 0 to 72 (the most pronounced symptoms).

stages

Psoriasis - chronic illness undulating skin. This means that periods of improvement (remissions) are replaced by periods of exacerbations.

After the onset of an exacerbation or after its first occurrence, skin pathology usually goes through three stages - progressive, stationary and regressive. The difference between them lies in the dynamics of the development of pathological manifestations on the skin. The frequency of exacerbations averages once a month. The severity of skin symptoms in each period of exacerbation can vary significantly even in one patient. Most often, in the absence of treatment, there is a tendency for a gradual increase in the severity of skin symptoms during each exacerbation.

Progressive stage

The progressive period is observed when the number of plaques on the skin increases and they grow. It can take from 1 to 4 weeks. Each new skin plaque has a red border around its edges. This means that she continues to grow. During this period, the Koebner phenomenon may appear, which consists in the fact that each new formation occurs in those places where the skin was injured. Aggravation can occur as a result of cuts, burns and abrasions. At this time, even such actions as visiting the bath and sauna, washing with hot water in the shower are dangerous. All this can have a negative effect on the skin, leading to a deterioration in its condition.

Stationary stage

However, in the future, the progressive period may be replaced by a stationary stage. During this period, no new formations appear on the skin. The red line at the edge of the skin plaques becomes pale. The Koebner phenomenon does not appear.

regressive stage

Then there is a period of lessening of the symptoms, when the number of plaques on the skin decreases. First, the center of the formation disappears, then its edges. In place of the disappeared plaques, depigmented areas of the skin appear. Then skin pigmentation is restored. Psoriatic plaques do not leave scars on the skin. This is due to the fact that psoriasis affects only the top layer of the skin - the epidermis.

There is a period of remission. Although in some patients no remissions are observed, and the plaques remain on the skin permanently.

Symptoms

The manifestations of psoriasis on the skin are seasonal. In most patients, deterioration occurs in the cold season.

Depending on the size of the plaques, psoriasis is divided into coin-shaped, teardrop-shaped, dotted. With punctate psoriasis, the size of plaques on the skin does not exceed the size of a match head, with teardrop-shaped psoriasis they resemble small droplets of water, with coin-shaped plaques, the size of the plaques is about 5 mm.

The appearance of formations on the skin is accompanied by severe itching. If there are a lot of spots, then they can merge. The hair on the affected part of the skin is preserved. Therefore, if psoriasis occurs on the scalp, it does not lead to baldness. Then the plaques begin to peel off and silver-white scales appear. The scales on the surface of the plaques are easily torn off, as they are composed of dead skin cells. Scales are formed initially in the center of the plaque, and then spread to its edges. If you tear off such scales, then droplets of blood appear under them.

Where do psoriatic formations occur?

Formations appear on the skin mainly in the area of ​​extensor surfaces - on the knees, elbows. Plaques can also affect the scalp. Most of them occur along the hairline. The skin of the palms and soles, inguinal folds, abdomen, lower back, lower leg, inner and outer surface may be affected. auricles. If papules appear on the skin of the face, then the areas of the eyebrows and eyes are more often affected, less often the lips.

In general, psoriasis formations can appear on any part of the skin. In rare cases, they can occur not on the skin, but on the mucous membranes.

Manifestations of psoriasis vulgaris

With psoriasis vulgaris, small papules are observed on the skin. These are small, slightly raised bright red spots or plaques. Skin plaques vary in size from a few mm to 10 cm and can be either nearly round or slightly elongated. If skin plaques tend to increase, then they can merge with each other. As a result, so-called "paraffin lakes" form on the skin. Such a plaque can be easily torn off. The skin underneath is bleeding heavily. Psoriasis vulgaris is rarely severe. It usually proceeds in a mild or moderate form.

Manifestations of psoriasis of the flexor limbs

Flexor psoriasis differs from psoriasis vulgaris in that it develops in the folds of the skin. Peeling in this type of disease is insignificant. The usual locations for this type of psoriasis are:

• skin of the groin and genitals,
• skin of the inner thighs,
• armpit skin,
• skin folds,
• skin folds of the mammary glands.

This type of psoriasis often progresses as a result of rubbing, sweating or injury, often accompanied by a fungal or streptococcal skin infection.

Manifestations of guttate psoriasis

They are somewhat different from the symptoms of psoriasis vulgaris. This type of disease is accompanied by the formation of many fluid-filled pustules on the skin.

With guttate psoriasis, the skin appears a large number of small plaques of lilac, red or purple. Skin plaques in this case are similar in shape to drops (hence the name) or simple dots. A feature of this form of the disease is the defeat of large surfaces of the skin.

The skin of the thighs is most commonly affected. Also guttate psoriasis can be observed on the shins, shoulders, forearms, scalp, neck, back

The trigger for the development of guttate psoriasis is usually a streptococcal infection.

Manifestations of pustular psoriasis

Apart from these types of disease, there is also pustular psoriasis. This form is characterized by the appearance of small formations on the skin - pustules. They are small bubbles, slightly raised above the surface of the skin, filled with exudate. The skin around the pustules is red and inflamed. Subsequently, the exudate may turn into pus.

Pustular psoriasis can be either localized or generalized. With a localized form, pustules are most often located on the skin of the palms or soles, shins or forearms.

With generalized pustular psoriasis, the number of purulent foci on the skin increases. Also, the patient may have a fever, signs of intoxication of the body. This form of psoriasis is very dangerous, in some cases it can be fatal.

Manifestations of nail psoriasis

With psoriasis of the nails, small dots or longitudinal grooves are observed on the nails or under the nails. Nails may turn yellow, gray or white. The nail itself or the skin underneath may thicken. In some cases, psoriasis affects only one of the nails, in others - all nails at once. Changes in the nail usually start at the edge of the nail and move towards its base. The nails become brittle and brittle, the nail plate can generally come off.

There are three main symptoms that allow us to speak with confidence about nail psoriasis:

• thimble symptom (small pits, resembling holes in a thimble),
• subungual hemorrhages (spots under the nails of red, brown or black color),
• trachyonychia (roughness, dullness, depression and flattening of the nail plates).

Psoriatic onychodystrophy can also be accompanied by the appearance of plaques on the skin, but this is not always the case.

Manifestations of psoriasis of the joints

The most commonly affected joints are the small joints of the hands and feet. However, the following may also be affected:

• shoulder joint,
• hip joint,
• knee-joint,
• vertebrae.

The main symptom of psoriatic arthritis is joint pain. However, pain in psoriasis is not as pronounced as in rheumatoid arthritis. Joints change their shape. Also, the joints may be characterized by swelling, inflammation, and limited mobility.

With psoriatic arthritis, fever, general weakness, and fatigue are not uncommon.

Manifestations of psoriatic erythroderma

This type of disease is usually generalized. There is extensive inflammation, in which red spots cover the entire skin. Pathology is accompanied by severe itching, peeling and detachment of the skin, swelling of the skin and subcutaneous tissue. This form of the disease can be fatal due to a violation of the barrier and thermoregulatory functions of the skin, sepsis. Localized erythroderma, however, may occur as the first stage of psoriasis, and subsequently transform into psoriasis vulgaris. Or it can develop due to improper treatment of psoriasis, for example, with sudden withdrawal hormonal drugs. Also, this form can be triggered by alcohol intake, stress, infections.

Other manifestations

Of the common manifestations of psoriasis, not related to the condition of the skin, it should be noted the deterioration of the psycho-emotional background, depression, weakness. Often, skin pathology is accompanied by depression. There is an assumption that depression is caused by the same genetic abnormalities as psoriasis itself. But another explanation is also possible - the effect of inflammatory mediators, such as cytokines, on the patient's nervous system. In general, the disease is more severe in women than in men.

Types of psoriasis and their characteristic manifestations

When should you see a doctor?

It is usually difficult for a person far from medicine to separate psoriasis from another skin disease. However, there are a number of signs that are cause for concern:

• painful microtrauma or cracks in the skin;
• change in the shape of the nails, their delamination, the appearance of spots on them;
• blisters on the feet and palms;
• excessively flaky skin;
• spots on any parts of the skin, especially the face, knees and elbows.

Nevertheless, it is not necessary to make a diagnosis on your own and, moreover, treat psoriasis. It is necessary to see a doctor so that he examines the skin and prescribes treatment.

Complications

Psoriasis is not a fatal pathology. The main danger is the addition of a bacterial and fungal infection of the skin. Also, in some cases, psoriasis can become generalized and affect the entire surface of the skin. Especially dangerous are such types of generalized skin lesions as psoriatic erythroderma and generalized pustular form of the disease. Psoriatic arthritis can affect not only small joints, but also the spine. In this case, the joints and spine can be deformed, which leads to the patient's disability.

Less often taken into account the difficulties that psoriasis brings with it are psychological problems. Pathology has its negative impact on the quality of life in much the same way as hypertension and diabetes.

Approximately 71% of patients consider psoriasis a serious problem in their lives. People, especially young people, who have psoriatic plaques on visible parts of the body, primarily on the face, may experience difficulties in communication, which leads to low social adaptability, the inability to do a certain job or arrange a personal life. And this, in turn, leads to psychological problems, neurosis, depression, alcoholism. Which, in turn, further aggravates the patient's condition. It turns out a vicious circle, getting out of which is not easy.

Diagnostics

Usually, the pathology is easily diagnosed by a doctor during examination. Psoriasis plaques on the skin have a characteristic appearance and are difficult to confuse with signs of other skin pathologies, including those of an allergic nature. With psoriasis, edema on the skin is usually not present, but with allergic dermatitis, this is a common occurrence.

With the exception of severe forms of the disease, there are no specific systemic parameters, for example in blood tests, by which an unambiguous diagnosis can be made. In severe psoriasis, blood changes are observed that are characteristic of intense inflammatory process ( , elevated ESR etc.).

A skin biopsy may be performed to exclude other dermatological pathologies. Also, a biopsy reveals immaturity of keratocytes, an increased content of T-lymphocytes and macrophages in the skin. Increased fragility of blood vessels (Auspitz syndrome) is observed at the sites of injury.

It should also be borne in mind that there are forms of psoriasis that are not similar to vulgaris, such as drip, pustular and erythroderma. The patient can often take them for manifestations of allergies on the skin and be treated incorrectly. Nail psoriasis can be confused with fungal infections.

Psoriatic arthritis is similar to rheumatoid arthritis in many ways. However, when diagnosing rheumatoid arthritis, special tests are made, therefore, if their result is negative, then there is reason to suspect psoriatic arthritis.

When diagnosing psoriasis, the doctor identifies signs of the presence of the psoriatic triad:

• stearin stains,
• terminal film,
• spot bleeding.

This means that the surface of the skin plaques feels oily and similar to stearin. After removing the plaque, a thin and smooth film is observed under it, on the surface of which small drops of blood appear (“blood dew”).

Psoriasis in children

In children, this skin pathology is less common than in adults. However, the main manifestations in childhood are about the same as in adults. Localization of rashes in children - the skin of the knees, elbows, scalp. Treatment of the disease in children is basically the same as in adults. However, the systemic use of corticosteroids has to be abandoned, since they can cause irreparable harm to a growing organism.

Should psoriasis be treated?

Since psoriasis is not fatal, many patients do not always treat it with due attention. Moreover, as you know, it is not contagious, and the patient cannot infect others. But in fact, psoriasis is incurable. This is not furunculosis, which can go away on its own. And in the case of psoriasis, even the right treatment can not always guarantee the result.

And, nevertheless, the treatment of psoriasis is necessary - to reduce the severity of skin symptoms, to prevent complications, such as a generalized form. In the absence of treatment, each exacerbation will proceed more and more severely, an increasing surface of the skin will be involved in the inflammatory process. Remissions will occur less and less and, eventually, may disappear completely.

However, in addition to the possibility of complications, there is another circumstance. Many people with psoriasis experience discomfort with their appearance, fear of rejection, embarrassment or shame. These are not only subjective complexes of patients. After all, most people who are far from medicine, seeing, for example, some strange plaques on the scalp or on the hands of a person, will decide that he is sick with a contagious disease, and will not want to have anything to do with him, will not approach him, communicate and etc.

And this leads to a decrease in social activity, problems with personal life. The patient may be disturbed sleep, he loses the opportunity to engage in certain activities.

Treatment

Methods for a complete cure for psoriasis have not yet been developed. This is largely due to the fact that there is still no generally accepted theory of the etiology of the disease. Therefore, treatment is mainly symptomatic.

It has two main strategies - the fight against T-lymphocytes penetrating the skin and the fight against cytokines and other inflammatory mediators. In the treatment of simple psoriasis, the treatment designed to compensate for the lack of vitamin D in the body is recognized as the most effective. In particular, the use of cholecalciferol (vitamin D3) can bring the pathology into remission in 70% of patients.

Treatment includes both medications and non-pharmacological methods.

Which doctor to contact

Psoriasis is a disease treated by doctors of various specialties. First of all, this is a dermatologist - a specialist in skin diseases. You may also need to consult a neurologist, allergist, endocrinologist.

What criteria is guided by the doctor prescribing treatment:

• age and gender of the patient;
• whether the symptoms occurred for the first time, or there is an exacerbation;
• a form of psoriasis;
• the presence or absence of systemic symptoms (temperature, swollen lymph nodes, changes in blood parameters);
• the rate of progression of skin symptoms;
• localization of skin lesions;
• the duration of the illness;
• anamnesis;
• general state patient health;
• influence of professional factors.

Medications

Medicines used in the treatment of psoriasis are divided into two main groups: external and internal. External applied directly to the skin, to the area of ​​​​inflammation. Internal are taken orally or (in severe cases) are administered as injections.

Among medicines most commonly used:

• local anti-inflammatory drugs;
• skin moisturizing ointments;
• ointments that reduce skin peeling;
• systemic anti-inflammatory (glucocorticosteroid) drugs;
• cytostatic drugs (to reduce the rate of division of keratocytes);
• immunosuppressive agents;
• non-steroidal anti-inflammatory drugs (indomethacin, diclofenac).

Local funds

They are applied directly to the skin and act most quickly. There are three main forms local preparations- creams, gels and ointments.

Most often, ointments are used for psoriasis. Them active ingredients stay on the skin for a long time. For the treatment of psoriasis, ointments can be used to reduce peeling and inflammation. They contain substances such as:

• dithranol,
• salicylic acid,
• sulfur,
• urea.

Also in the treatment are used:

• naftalan ointment 5-10%,
• sulfur-tar ointment 5-10%,
• ointments with vitamin D.

Zinc ointment is also used for psoriasis. Effective for psoriasis and hydrogen peroxide, which is used in the form of compresses. Hydrogen peroxide is able to saturate skin tissues with oxygen.

Often, a bacterial or fungal infection can join psoriasis on the skin. In this case, it is best to use antibiotics and antifungal drugs.

There are also combined external preparations - for example, ointments containing GCS and salicylic acid.

Dithranol

In the treatment of psoriasis, skin ointments and creams based on dithranol - Psorax and Cygnoderm - are widely used. They have an anti-inflammatory effect. Treatment with these drugs is best done with a mild form. Apply the ointment to the skin 1-2 times a day. The ointment must also be used in short courses, as they can cause allergies.

Naftalan ointment

The composition of the ointment includes naftalan oil. It has an antiseptic, anti-inflammatory and analgesic effect, dilates peripheral vessels. Treatment with naphthalon ointment is used for regressive and stationary forms. The ointment helps to get rid of itching and inflammation on the skin.

Salicylic ointment

It has a softening and anti-inflammatory effect. The course of treatment with this ointment contributes to the speedy removal of skin flakes. Ointments of various concentrations are used - from 0.5% to 5%. The ointment is applied in a thin layer to the affected areas of the skin. Do not apply a thick layer of ointment to the skin if there is severe inflammation on it. Apply salicylic ointment can be 1-2 times a day.

Ointments based on glucocorticosteroid drugs

The most commonly used skin ointments are hydrocortisone, prednisone, and dexamethasone. The doctor should tell the patient which ointment to choose, since all GCS have different indicators efficiency, as well as the level side effects. In 70% of cases, treatment with GCS-based ointments relieves itching and inflammation within 2 weeks. Ointments can be applied to the skin 2-3 times a day.

Popular skin hormonal ointments:

• flumethasone,
• triamcinolone,
• hydrocortisone.

Folk remedies and herbal medicines

Treatment with folk remedies is effective mainly for mild psoriasis. Folk remedies include linseed oil, birch tar, strawberry and celandine juice, egg ointment, meadowsweet root ointment, decoctions and infusions from:

• celandine,
• raspberries,
• series,
• chicory,
• cranberries,
• Hypericum.

Systemic therapy

At lung treatment psoriasis is usually limited to topical and least toxic drugs. If this technique does not lead to success, then ultraviolet treatment is used. BUT systemic treatment with drugs taken by mouth, it is usually prescribed for skin lesions greater than 20% or for psoriatic arthritis.

Inside taken cytostatics, such as methotrexate. These funds are designed to stop the division of skin cells. They are appointed at severe forms psoriasis. Also inside (orally or parenterally) can be taken:

• retinoids,
• hormonal drugs,
• immunosuppressants (cyclosporine, timodepressin, efalizumab, alefacept),
• anti-cytokine drugs (infliximab, adalimumab, etanercept, ustekinumab),
• multivitamin complexes,
• calcium gluconate,
• antidepressants and tranquilizers.

When treating with certain drugs, for example, based on GCS, care should be taken, as an abrupt cessation of the course of treatment can lead to a withdrawal syndrome. At the same time, new manifestations of pathology may develop or old ones may intensify. Or a more severe form of psoriasis may develop.

Treatment with non-drug means

From non-pharmacological means The most widely used treatment is physiotherapy:

• irradiation with an ultraviolet lamp,
• electrosleep,
• radiotherapy,
• ultrasound therapy,
• cryotherapy (exposure to temperatures up to –160 °С),
• magnetotherapy,
• laser therapy.

Plasmaphoresis (blood purification) is also used.

Treatment with electrosleep is useful for strengthening the nervous system of the patient, stabilizing his psychological state. As already mentioned, nervous factors have a great influence on the development of psoriasis. And magnetotherapy helps to reduce skin itching, stabilizes the patient's psycho-emotional state, and stimulates regeneration processes.

Ultrasound treatment

It's relative new method treatment, which gives good results with a mild form. For ultrasound treatment, oscillations with a frequency of 800-3000 kHz are used. A beam of ultrasonic waves is directed directly to the affected area. Ultrasound treatment helps to reduce inflammation, pain and itching.

Photochemotherapy

The method of photochemotherapy (PUVA) is effective. This is a method of treatment in which skin irradiation is combined with the use of drugs that increase sensitivity to light. Ultraviolet radiation improves immunity, improves metabolism and stimulates the production of vitamin D. The patient's skin is irradiated with UV radiation with a wavelength of 320 to 420 nm.

The duration of the course of treatment is 20-25 sessions. There are 3-4 sessions per week, so the full course of treatment takes 5-6 months. However, there are contraindications for PUVA therapy:

• acute infectious diseases,
• exacerbation of chronic pathologies,
• pathology of cardio-vascular system in decompensated form
• severe stage of diabetes,
• severe liver and kidney failure,
• tuberculosis,
• age up to 3 years.

Other types of non-drug treatment

Useful for the treatment of mud baths, swimming in the sea, sunbathing. It is especially useful to visit the Dead Sea resorts, which contain water with a unique composition of dissolved salts, which helps with psoriasis.

It is forbidden to stay in the sun for a long time only with a rare variety of psoriasis, in which ultraviolet rays lead to an exacerbation. Therefore, before starting UV therapy, it is necessary to consult a doctor.

Another exotic alternative treatment is fish therapy. The patient is placed in a pool inhabited by Garra rufa fish that feed on human psoriatic plaques. The rest of the human body is not touched by the fish. As a result, the patient gets rid of the manifestations of psoriasis vulgaris on the skin.

An additional method of treatment that helps to cope with depression and stress is psychotherapy.

diet therapy

Treatment also includes selection proper diet- a method that has shown high efficiency. Diet allows you to stimulate the body's defenses, improves the normal functioning of the digestive tract, rids the body of toxins, normalizes metabolism, which has a beneficial effect on the skin. Normalization of metabolism is very important, given that metabolic disorders play an important role in the development of psoriasis.

The Pegano Diet

It has gained great popularity, developed by John Pegano, author of the book "Treatment of psoriasis - the natural way." The essence of treatment with this method is to remove from the diet those foods that lead to increased acidity of the blood. Lowering the acidity of the blood, in turn, leads to a decrease in the number of antibodies.

What foods are alkaline?

• fruits (recommended apples, dates, apricots, oranges, peaches, raisins),
• berries (except for cranberries, currants, plums, grapes),
• vegetables (excluding legumes, pumpkin, potatoes, tomatoes, Brussels sprouts, peppers and eggplant),
• cereals (buckwheat, wheat, barley porridge, rice are recommended).

List of acid-forming foods:

• cream,
• meat,
• starch,
• sugar,
• oil.

This, of course, does not mean that products from the second group should not be eaten at all. It is just necessary to observe the correct proportion between the products of the first and second groups. 70-80% of the dishes should consist of alkaline-forming foods, and the rest - of acid-forming.

Therefore, the emphasis in this diet is on fresh vegetables and fruits. Recommended beets, carrots, spinach, zucchini, white cabbage, lettuce. Canned vegetables and fruits are undesirable, as is their intense heat treatment. You should also exclude fast food and semi-finished products from the menu.

In addition, the diet involves the consumption of a significant amount of water (up to 2 liters clean water in a day).

Fish can be consumed only low-fat varieties and only 4 times a week. From meat, chicken or turkey is preferable. It must be consumed 2-3 times a week. Milk can only be consumed skimmed. Soft-boiled eggs 2-3 per week are also allowed. Vegetable oil is consumed at the rate of 3 teaspoons per day.

Other nutritional guidelines

Vegetarian and paleo diets have also been shown to be highly effective in treating most forms of psoriasis. All diets agree that it is necessary to exclude fried and smoked dishes, foods containing dyes, preservatives, and fast carbohydrates from the menu.

It is undesirable to use chocolate, pepper, dishes containing vinegar. On the other hand, it is useful to use vegetable oils containing polyunsaturated fatty acids, cereals and other foods containing a large amount of vegetable fiber, vitamins, especially group B.

When choosing a diet, it is also important to consider that the body must be cleansed of toxins. To this end, the patient needs to drink as much clean water, tea and juices as possible.

Basic treatments for psoriasis

Forecast

The prognosis is conditionally unfavorable. This means that it is impossible to completely get rid of psoriasis. But if the treatment is carried out correctly, then it is possible to reduce the severity of symptoms and achieve stable remission, improve the quality of life of the patient. However, exacerbation can lead to temporary disability, and in severe cases - to disability.

Prevention

Anyone can get psoriasis. However, no one knows the exact causes of psoriasis. Does this mean that it is impossible to protect yourself from it? Of course no. First of all, the danger should be paid attention to those who have relatives with psoriasis. Such people are at risk. Also at risk are smokers who suffer from diabetes with extremely dry skin.

People at risk are advised to monitor their health and skin condition, to avoid skin injury or injury. After all, pathology can develop even after applying a tattoo in a tattoo parlor. It is also important to follow the principles of proper nutrition, fight infections.

Secondary prevention is the prevention of relapse. This type of prevention is necessary in order to minimize measures to treat exacerbations. Secondary prevention includes skin care, a rational diet, stress management. To combat anxiety and depression, it is recommended to visit a psychotherapist.

clothing

You also need to pay attention to clothing. It should be selected in such a way as not to irritate the skin in the affected areas. Wear clothing made from natural fabrics that prevent increased sweating. Both extremely high and extremely low temperatures should be avoided.

Stress management

An important place in the secondary prevention of psoriasis should be occupied by the fight against stress. After all, about half of the cases of exacerbation of this skin pathology is associated with stressful situations. Therefore, it is necessary to pay attention to the improvement of the psycho-emotional state. Sports, walking, meditation, auto-training are well suited for this. But such methods of raising the mood, like tobacco and alcohol, are unacceptable, since, on the contrary, they can lead to an aggravation.

Refusal of uncontrolled medication

Many cases of exacerbation of psoriasis are caused by taking certain medications. Therefore, people prone to psoriasis should avoid uncontrolled intake drugs. Before using unfamiliar drugs, you should read the instructions for them, since many drugs are contraindicated in case of illness or can exacerbate it.

alcohol for psoriasis

Alcohol is especially dangerous in psoriasis, both during the period of exacerbation and during remission. This is due to the fact that alcohol puts a lot of stress on the liver. Therefore, part of the task of removing toxins from the body takes on the skin. And this can lead to an aggravation. Also, alcohol disrupts metabolic processes in the body. But psoriasis is largely a metabolic disorder.

Nicotine and psoriasis

There is also a link between smoking and the development of psoriasis. It is well known that nicotine has a negative effect on the skin. For those who smoke from 1 to 14 cigarettes a day, the risk of developing this skin disease increases by 1.8 times, from 14 to 25 cigarettes - by 2 times, more than 25 cigarettes - by 2.3 times.

Hygiene procedures for psoriasis

Is it worth taking a bath if a person has psoriasis? Doctors say that it is undesirable to do this. It is best to wash under the shower. Such washing is certainly useful, as jets of water cleanse the skin of small scales of the epidermis. However, hot water should be avoided. For washing, you can not use a hard washcloth, a soft sponge that does not injure the skin is more suitable. As detergent it is better to use a shower gel with a neutral (not alkaline) reaction, rather than a bar soap. Wipe the body should also be careful, you can not rub with a towel. After water procedures, it is recommended to apply an emollient to the body.

During the progressive stage, when a lot of plaques appear on the skin, baths and saunas are prohibited.

Prevention of acute respiratory infections and influenza

Exacerbations are often associated with the flu. Therefore, measures to prevent or treat them are also an excellent way of secondary prevention. Ways to protect yourself from acute respiratory infections and influenza have long been known - do not catch a cold, engage in hardening and strengthening immunity.

Sports and fitness

Is it possible to play sports or fitness with psoriasis? This is not prohibited, moreover, such activities are more than desirable, as they restore health and strengthen the psycho-emotional background of the patient. The only thing is that it is recommended to avoid such activities in the progressive stage, since due to profuse sweating, the number of psoriatic plaques on the skin may increase.

Sunbathing

You can also sunbathe on the beach, avoiding naturally sunburn on the skin. In most patients, ultraviolet rays and sunbathing help reduce the number of exacerbations, contribute to the production of vitamin D, which is useful for strengthening the nervous system. However, there is a small category of patients (approximately 5-20%) for whom tanning is contraindicated, as it leads to an exacerbation of symptoms. This type of psoriasis is called photosensitivity. Also, all patients are not recommended to sunbathe in standard solariums, since the lamps used there can negatively affect the skin, and are not intended for the treatment of skin pathologies. For treatment, special lamps are used, in which the optimal parameters for the intensity and length of UV waves are selected.

Nail care

Nail care is also important. They must be cut short. Long nails can severely injure the skin when combing sores. And when the nails are damaged, care for them becomes mandatory. After all, any injury to the nail can lead to the fact that it can crumble or come off the finger.

Skin care

You should also protect the skin from injuries and cuts. When working with chemically aggressive substances that can cause skin burns or dermatitis, gloves must be worn. Exposure to air-conditioned air should also be avoided, as air conditioners tend to dry out the air, which can be detrimental to the skin. Instead of air conditioning, it is better to use humidifiers.

Diet as a prophylactic

Another method of prevention is the right diet. A patient with psoriasis-affected skin during remission should avoid eating too fatty, fried, salty, smoked and pickled foods, drink more fluids (at least 2 liters per day). Eat plenty of vegetables and fruits, fermented milk products. The method of cooking also matters. It is best to steam or boil rather than fry.

Diagnosis of psoriasis- the first step towards curing the disease. Modern methods studies allow a very accurate diagnosis. In addition to visual examination and history taking, there are a number of instrumental and clinical methods to obtain data on the causes of the disease and determine the stage of its development.

For differentiation, an additional analysis is carried out for psoriasis - the disease has an external similarity with other skin diseases. A specialist can sometimes make a diagnosis even by appearance and localization of rashes, however laboratory methods give unquestionable results.

How to diagnose psoriasis? There are currently no problems with this. The symptoms of the disease are so obvious that doctors have no doubts after a visual examination of the patient.

The main specific symptom is a rash on the skin, which is localized in various parts of the body. At the very beginning of the pathological process, it manifests itself in the form of small seals that are pink in color. Their diameter is 1-2 mm. Gradually, they become like tubercles. In the growth zone, the conglomerates become bright pink and covered with loose white scales. The plaques increase to 7-8 cm. When examining the patient, the doctor makes a scraping. As a rule, these measures are sufficient. Additional studies are used in order to understand what kind of disease we are talking about. There are many diseases that have similar symptoms. To determine which pathology is progressing, differential diagnosis will help.

What tests should be done for psoriasis? First, the KLA (general blood test), OAM (general urinalysis) and, without fail, a stool test for I / worms.

If the clinical picture of psoriasis is fuzzy, then there is a need for skin biopsy. At this study a small plucking of the affected tissue is carried out. This allows you to distinguish scaly lichen from similar diseases that have similar symptoms. Only in this way can you get histological confirmation the established diagnosis.

Among the main diagnostic criteria should be highlighted:

• Clinical manifestations and complaints of the patient;
• The presence of concomitant pathologies and the patient's lifestyle;
• Collection of information about relatives in order to determine hereditary predisposition;
• The presence of psoriatic symptoms: terminal film, pronounced scales and pinpoint bleeding;
• Progression of the Koebner phenomenon.

The doctor prescribes a series of laboratory and instrumental tests to determine the cause of psoriasis. This approach eliminates the possibility frequent relapses illness.

Instrumental diagnostics

Instrumental diagnostics- this is the most informative research method, prescribed mainly in advanced cases with the progression of scaly lichen. This technique is widely used when specific symptoms occur. Tests for psoriasis, such as a potassium oxide test and a biopsy, should be done. It is mandatory to do a crop to determine the microflora, conduct an examination for the presence of syphilide and determine the level of prolactin.

To determine the level of neutrophilic leukocytes (Reete bodies), the thickness of the layer of keratinocytes and their histological immaturity, it is necessary to examine a pinch taken from conglomerates. An increase in the number of macrophages and T-lymphocytes in the blood and other signs are a sure sign of the development of scaly lichen.

Biopsy implies histological analysis pinching under a microscope. If there are a number of signs, the result of the research will be positive:

• The absence of a protective layer of the epidermis, which protects the skin from dehydration;
• Puffiness and elongation of the epidermal processes;
• An increase in the number of capillaries (blood vessels) in the affected area;
• The appearance of microabscesses - accumulations of neutrophilic leukocytes in the stratum corneum;
• Infiltration around vascular structures (lymphohistiocytic).

The main diagnostic methods are scraping from the conglomerate using a special glass slide. In this case, the analysis of the signs of the so-called psoriatic triad is also carried out. They appear in a certain order: first - the phenomenon of stearin spots, then - peeling and the phenomenon of the terminal film.

When removing the scaly layer, you can see a smooth pink surface of the skin, as if polished. With further scraping, the appearance of pinpoint bleeding is observed, which is otherwise called "blood dew".

Special attention is given to the presence of the Koebner phenomenon. It is characteristic only for periods of exacerbation and is the appearance of plaques on those places of the skin that have been injured.

To clarify the diagnosis, you can use UV radiation method(wavelength 308 nm). If you shine an excimer laser on a conglomerate or papules, then the scaly areas begin to glow.

When localized plaques in the area of ​​the location of the articular structures, psoriatic arthritis is called into question. In this case, there is strong pain. To clarify the diagnosis, a blood test is taken and an x-ray or ultrasound is performed in the area of ​​​​the lesion localization.

Clinical researches

Get more accurate information laboratory diagnostics psoriasis. The main methods include the following:

• General blood test (CBC). It makes it possible to determine the general condition of the patient, to identify pathologies such as anemia and leukocytosis. KLA shows ESR (leukocyte sedimentation rate) and other indicators;
• General urine analysis (OAM). Gives information on the water-salt balance of the body;
• Rheumatic tests. Needed to determine the level of protein in the blood. With its increase, we are talking about the presence of a chronic inflammatory process. If we are talking about psoriasis, then these indicators remain normal.

The diagnosis of psoriasis cannot be made on the basis of laboratory tests alone. Additional research is required. The patient is referred for a consultation with specialists such as an immunologist, a nephrologist, an infectious disease specialist and a dermatologist.

Differential Methods

Many forms of psoriasis have similar manifestations to other skin conditions that need to be treated urgently. That is why the doctor prescribes additional studies to determine the true cause pathological change skin cover.

In psoriasis, differential diagnosis is carried out with the following diseases:

• Seborrheic eczema and various dermatoses;
• lupus erythematosus, lichen (flat and pink);
• Reiter's disease and neurodermatitis;
• Papular form of syphilis.

Experienced dermatologists usually determine the type and form of the disease based on the clinical picture. Psoriatic rashes have a peculiar appearance, despite this, more in-depth studies are required to exclude any type of dermatosis.

With psoriasis, the color expression is brighter when compared with papular syphilis. Conglomerates peel off over the entire surface, and with syphilide - only along the edges. In the first case, the lymphatic system does not undergo any changes. If a dispute arises, the patient is assigned serological examination blood.

If we talk about scalp psoriasis, then often there is confusion with such a disease, like seborrheic eczema. In the area of ​​the scalp located on the border of the scalp, yellow peeling appears. There is pronounced itching. To distinguish diseases are assigned histological studies.

Psoriatic plaques may appear on the back of the head. It most often occurs in women menopause. This form of the disease is similar with limited neurodermatitis. Distinctive features of neurodermatitis from psoriasis are the silvery shade of the scales and the absence of infiltration.

Interesting to know! For the differential diagnosis of psoriasis, a histological analysis is prescribed. Examination of a small amount of affected skin under a microscope allows you to determine the presence of a bacterial and fungal infection.

How to distinguish from lichen

differential diagnosis of psoriasis also includes identification with lichen planus (LP). The main differences between pathologies:

• Place of localization: lichen is characterized by rashes on the mucous membranes and in the folds of the skin, rarely in other areas.
• The nature of the rashes: lichen planus, unlike psoriasis, has a darker skin color on the rashes - crimson, sometimes with a dark cyanotic tint.
• Other symptoms: if in psoriasis itching and burning occur in severe stages, then in the case of LP, these signs are observed constantly.

Pityriasis rosea, unlike LP, is contagious and spreads throughout the body very quickly. However, you can recover from it just as easily as from LP - you just need to see a doctor in time.

How to distinguish from dandruff

Dandruff - exfoliation of dead skin particles, the nature of which depends on general health and the means used for care. Although sometimes itching occurs with severe dandruff, scratching does not have any painful consequences.

With psoriasis, the appearance of an inflamed spot on the head with a characteristic silvery sheen can be taken as a manifestation of dandruff only at the beginning. The skin is very thin and vulnerable, when scratched, microcracks appear and bleeding occurs.

Types of analyzes carried out

Among the diagnostic measures for scaly lichen, standard and additional are distinguished. In the first case, we are talking about a blood test (general and biochemical), a study of urine and feces. Studies do not allow to confirm the fact that the patient is sick with this particular disease, but they make it possible to establish the cause of its development and the existing complications.

Psoriasis is a non-infectious chronic skin disease, 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. To restore the clinical picture of the disease, a thorough examination of the skin is necessary.. 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 be prescribed during the treatment process to determine changes in clinical picture and confirmation of the correctness of the chosen method.

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.