Psoriasis

Psoriasis is a chronic inflammatory disease of a multifactorial nature that affects the skin and nails, and is usually accompanied by pathology of the musculoskeletal system.

If you are concerned about red, dry spots of different shapes and sizes on your skin that are scaly and itchy, make an appointment with a dermatologist.

Our doctors treat psoriasis in an integrated way, using both medicinal treatment methods (ointments, gels, sprays, tablets and drug injections) and proven excimer light treatment using an Italian laser device.

Causes of psoriasis

Doctors cite several reasons for the development of psoriasis:

• Genetic predisposition: scientists have described a series of genes whose presence predisposes to the appearance of the disease;
• Malfunctioning of the endocrine, immune and nervous systems;
• Negative effects of certain environmental factors.

There are also provoking factors, including:

• Chronic infectious diseases (most often caused by streptococci);
• Alcohol abuse, chronic alcoholism;
• Climatic conditions (dry or cold weather);
• Skin trauma (scratches, insect bites, sunburn);
• Frequent emotional stress;
• Taking certain medications (for example, lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
• Sudden withdrawal from systemic hormonal drugs.

You should not trust the myths that dry skin and excessive hygiene can cause psoriasis; This is absolutely false!

Stages of psoriasis

Currently, doctors distinguish 3 stages of the disease:

• Progressive - characterized by an increase in the number of rash elements, fusion of papules and the appearance of new elements in injured areas. The plates are bright pink and covered with scales. The rate of cell division in new lesions increases 10-fold;
• Stationary - no fresh elements are observed, the plates have a stagnant red color, there is practically no peeling, the itching is almost not bothersome;
• Regressive: weakening of the color intensity of the rash, the elements of the rash are pale, new ones do not appear, there is no peeling, no subjective signs are noted. White pseudoatrophic borders form around the plaques, and healthy skin appears in the center of large plaques. Colorless spots remain at the site of the rash.

In some cases, patients have skin elements in different stages of development at the same time.

Symptoms of the disease

The dermatovenerologist first pays attention to the presence of the psoriatic triad. These are punctual bleeding, terminal film symptoms, and stearin staining.

A "stearin stain" appears when the plates are scratched; Increased peeling can be observed and the surface of the papules becomes similar to a drop of crushed stearin.

The so-called terminal film can be seen if the scales are completely removed: a wet, thin, shiny film will appear on the surface.

Spot bleeding (Auspitz symptom): it is exposed on the skin when the scale is removed.

Dermatologists also highlight the Koebner phenomenon - the appearance of psoriatic rashes at the site of skin trauma (scratches, injuries).

The symptoms of psoriasis depend on its type, but there are common points:

• Eruptions: always present in one form or another;
• Feeling of tightness in the skin in the location of psoriatic elements;
• Itching of variable intensity.

Plaques in psoriasis appear in a variety of places, but there are also areas with a typical localization:

• The scalp (with this arrangement of plaques we speak of seborrheic psoriasis);
• Knees and elbows;
• Skin folds and flexor surfaces: elbow, knee joints, groin, armpit, under the breast (this localization allows us to talk about inverse psoriasis);
• lumbar, sacrum;
• Palms and feet, respectively, with palmoplantar psoriasis;
• Nail psoriasis: pitting of the nail plates, subungual hemorrhages, separation of the nail from the nail bed (onycholysis).

In addition to skin manifestations, psoriasis also causes other symptoms. For example, in the arthropathic form there will be pain in the joints, their swelling (most often these manifestations are localized in the joints of the feet, hands, ankles and knees).

Types of psoriasis

Dermatologists distinguish several types of diseases:

Vulgar(plaque, ordinary) is the most common and represents 90% of all psoriasis cases. In this type of disease, flat inflammatory elements (papules) of pinkish red color protrude from the surface of the skin and have clear boundaries.

They usually fuse and form plates of different sizes, covered with silver scales. In appearance it looks like a garland or a geographical map.

Psoriatic elements are mainly found on the scalp, on the extensor surface of the elbows and knees, on the skin of the lower back and sacrum, but can also be found in other places.

Elbow psoriasis is treated as a special case (a permanent plaque remains on the elbow and when it is injured it begins to worsen).

exudative– occurs more frequently in patients with endocrine diseases (obesity, diabetes, etc. ). In the lesions there is exudation, as well as yellowish-gray scabs.

teardrop shaped– As its name indicates, numerous papules in the form of bright red droplets are observed on the skin, peeling and infiltration are minor. It occurs mainly in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis degenerates into ordinary psoriasis.

seborrheicIt differs in its location: the elements are found in the folds behind the ear and nasolabial folds, on the chest, in the interscapular region and on the scalp. The color of the scales is yellowish, sometimes they extend to the skin of the forehead and a "psoriatic crown" is formed.

Pustular– manifests itself as limited (on palms and soles) or extensive eruptions, represented by superficial pustules.

Among the pustular types, Barber's palmoplantar psoriasis is also distinguished, in which pustules cover the soles and palms. It is characterized by intense itching, fusion of pustules with crusting. The disease also usually affects the nails.

Pustules are also found in generalized Tsumbusch psoriasis. This type of disease is characterized by bright erythema (redness) and the appearance of superficial pustules. There is burning and pain in the areas of the rash. The lesions grow rapidly, merge, and cover larger areas of skin. In Tsumbusha psoriasis, a detachment of the epidermis (upper layer of the skin) occurs and so-called "purulent lakes" form. Patients experience general malaise, are tormented by fever, burning and tingling in the affected areas.

Psoriatic erythroderma

Doctors focus specifically on this type of psoriasis, psoriatic erythroderma. In this case, the pathological inflammatory process affects all or almost all of the skin. It becomes rough, tight, covered with scaly elements and the skin turns red.

Many of our patients complain of fever that reaches subfebrile levels and malaise. There is an increase in peripheral lymph nodes. Erythroderma can develop due to improper treatment of psoriasis (bathing, too intense tanning, high concentration of medicinal ointments, etc. ). In other cases, the process develops in healthy people if psoriasis has just begun and progresses rapidly.

If psoriatic erythroderma exists for a long time, patients may experience nail damage and hair loss.

psoriatic arthritis

This pathology is also called arthropathic psoriasis. Joint damage can develop in parallel with skin rashes and in some cases begins even earlier and is a harbinger of psoriasis.

Mainly the small joints of the feet and hands are affected, but sometimes the joints of the wrists and ankles are also affected in the inflammatory process. Patients are concerned about joint pain, swelling, deformity, and limited mobility.

Diagnosis

The main task of diagnosis is to determine the percentage of skin lesions throughout the body. This is necessary to evaluate the effectiveness of the treatment in a particular patient.

There is an opinion that to make a diagnosis it is necessary to undergo a large number of tests. But in most cases this is not the case, and a thorough examination of the rash by a dermatovenerologist is sufficient. Psoriasis has characteristic manifestations, so visual diagnosis is not difficult.

In typical cases, this is the psoriatic triad: punctual bleeding, terminal pellicle symptoms, and stearin staining. Very often, patients are bothered by itching of varying degrees of intensity. The presence of psoriasis in family members is also important.

However, there are skin symptoms that should be differentiated when diagnosing the disease. For example, a similar picture is observed with papular syphilis. In this case, the doctor will carry out a differential diagnosis, including serological studies.

Scalp psoriasis is sometimes confused with seborrheic dermatitis. In psoriasis, the doctor determines that there is a papule on the skin, that is, a compaction that rises above the level of the skin and is covered with scales.

In the arthropathic form of psoriasis (when there are no skin rashes), the dermatologist will have to make sure that it is psoriasis and not rheumatoid polyarthritis.

Psoriasis often occurs together with other diseases, which is why doctors talk about comorbid diseases. For example, psoriasis can be combined with coronary heart disease, diabetes, depression or gastrointestinal pathologies.

If a dermatologist diagnoses psoriasis, she will surely refer the patient to a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And these specialists will prescribe a comprehensive examination (for each disease there is a standard list of tests, in particular blood tests).

The diagnostic basis of a modern clinic is represented by the most modern devices and devices. This will allow you to undergo a complete examination for various diseases.

Laboratory studies are carried out using modern biochemical and hematological analyzers. Diagnostic ultrasound doctors examine patients using advanced ultrasound machines.

In the radiology department, equipped with the latest medical technology, you can have x-rays and mammograms. An MRI or CT scan of any organ can also be performed in the clinic.

Doctors of the functional diagnostics department have the opportunity to conduct all the necessary studies: ECG, EEG, echoencephalography, daily ECG monitoring, daily blood pressure monitoring, determine the function of external respiration and other vital indicators.

The widest range of diagnostic tests presented in our clinic allows doctors to identify diseases at almost any stage of development.

Treatment

The main goal of treatment is to control the disease and put it in remission (weakening or disappearance of symptoms). In the treatment of psoriasis, doctors use several directions at once: medications (ointments and other pharmaceutical forms for external use, as well as tablets for systemic therapy) and phototherapy with excimer light.

External remedies include creams, ointments, gels, emulsions and sprays containing hormonal medications. Glucocorticosteroids suppress the immune system and relieve inflammation. They come in numerous pharmaceutical forms; In each specific case, the doctor will select an individual treatment regimen for you.

To reduce itching and dry skin, moisturizers and emollients are used.

To alleviate the manifestations of psoriasis on the scalp, the use of special shampoos is prescribed.

Calcipotriol (an analogue of vitamin D) is also prescribed for local treatment.

In systemic therapy, doctors prescribe immunosuppressive drugs. These medications are usually given in small doses (once a week) to treat common, hard-to-treat types of psoriasis. Similar regimens are used in patients with rheumatoid arthritis. Administration is oral, intravenous, intramuscular or subcutaneous.

Doctors also prescribe retinoids (drugs with biological properties similar to those of vitamin A).

Systemic glucocorticosteroids are used very rarely and only in particularly difficult cases.

As the process subsides, the frequency of use of external agents and oral medications changes towards a decrease.

Please note that some drugs have a negative effect on fetal development (for example, selective immunosuppressants), therefore they are contraindicated in pregnant women.

No alternative treatment leads to positive results. You should not experiment and trust your health to traditional healers and methods with unproven effectiveness.

Our doctors urge you not to self-medicate or stop (prescribe) various medications, as this can only aggravate the situation and lead to an increase in skin rashes.

Treatment of psoriasis using a laser device.  

The Dermatovenereology Center offers you an effective method to treat the disease using an excimer laser system. This is the main physiotherapy treatment for psoriasis and some other skin diseases with proven effectiveness.

An excimer lamp works with xenon and chlorine compounds and emits light in the UV range. Only rays of a certain length penetrate the skin and reduce skin inflammation. The thickness of the plates decreases.

The rays only affect "sick" cells without affecting healthy skin. This therapy reduces the population of T lymphocytes in areas of the skin covered in plaques. In this way, stable remission is achieved and, in many cases, treatment with excimer light allows hormonal drugs to be abandoned.

This method allows you to forget about the torment that seasonal exacerbation brings to psoriasis patients.

The dermatovenerologist first identifies the indications and contraindications for phototherapy treatment with monochromatic excimer light.

Indications include:

• Psoriasis;
• vitiligo;
• Atopic dermatitis;
• Patchy baldness (alopecia);
• Change in color of scars;
• Eczema.

There are very few contraindications for the procedure, these include:

• Pregnancy;
• Oncological diseases;
• Severe general condition.

Why should you pay attention to system treatment?  

Dermatovenereologists point out a series of undeniable advantages of excimer light treatment:

• The effect is local, only on psoriatic plaques, the rays do not affect the entire body;
• In mild cases, it is enough to prescribe only phototherapy and photosensitizers to achieve stable remission;
• Prescribed to patients of any age (from 3 years old);
• Treatment with a laser system does not require hospitalization, it is easily adapted to any work schedule;
• Effective for a variety of forms of psoriasis;
• Minimum restrictions.

How is the treatment procedure carried out?

At your first appointment, the doctor will perform a test, during which he will determine your skin phototype and determine the minimum dose of ultraviolet radiation.

The next day you go to an appointment, where the doctor determines the most appropriate test result. That is, the doctor will individually select the radiation power that is suitable specifically for your skin.

There are no restrictions during treatment; You will only be advised to limit spicy and fatty foods and drink plenty of fluids.

The effect of phototherapy occurs after a few procedures, and for a stable remission, 5-10 procedures will be needed (in some cases, 15).

The duration of a procedure is 10 to 20 minutes, depending on the treatment area and the number of affected areas.

Psychological assistance

We always encourage you to remember that psoriasis is not contagious! And yet, patients are often worried not so much about the discomfort caused by the presence of rashes as about the reaction of others. This is especially painful for women and children.

Children can behave cruelly towards a sick child. Therefore, it is very important to prescribe treatment in a timely manner, including consultation with a psychologist or even a psychotherapist.

Benefits of treating psoriasis in a clinic

Patients choose to treat psoriasis for several reasons:

• Experienced and qualified dermatologists and cosmetologists;
• Elimination of both dermatological and cosmetic problems at the same time;
• Innovative treatment methods, in particular using a laser system;
• The most modern diagnostic methods;
• Opportunity to consult with doctors of various specialties.

If you are concerned about plaques, itching and peeling skin, please contact the clinic. You can always get qualified medical care.

Psoriasis prevention

The main task of dermatovenerologists is to prevent exacerbation of psoriasis. To do this, they prescribe preventive measures:

• Stress prevention;
• Prevention of colds;
• Control of chronic infection foci;
• Rejection of rough and tight clothing that damages the skin.

Thanks to preventive measures and timely treatment of psoriasis, doctors can quickly reduce the severity of the disease and achieve the disappearance of many symptoms of the disease.

What happens if the disease is not treated?

If left untreated, the rash will spread and take up more and more of the skin. A transition to the erythrodermic type is possible, which is much more difficult to treat.