Psoriasis

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

If you are concerned about red, dry patches of various shapes and sizes that are scaly and itchy, make an appointment with a dermatologist.

Our doctors treat psoriasis using a complex approach - they use both drug treatment methods (ointments, gels, aerosols, tablets and drug injections) and well-proven treatment with excimer light using an Italian laser device.

Causes of psoriasis

Doctors note several reasons for the development of psoriasis:

• Genetic predisposition - scientists have described a number of genes, the presence of which predisposes to the onset of the disease;
• Dysfunction of the endocrine, immune and nervous systems;
• The negative effect of certain environmental factors.

There are also precipitating factors, which include:

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

You should not believe the myths that dry skin and excessive hygiene can cause psoriasis - this is absolutely not true!

Stages of psoriasis

Currently, doctors distinguish 3 stages of the disease:

• Progressive - characterized by an increase in the number of rash elements, the combination of papules and the appearance of new elements in the damaged areas. The plaques are bright pink in color and covered with scales. In new lesions, the rate of cell division increases 10 times;
• Stationary - fresh elements are not observed, plaques are dull-red in color, practically do not peel off, itching is almost not bothersome;
• Regressive - weakening of the color intensity of the rash, the elements of the rash become pale, new ones do not appear, there is no crusting, subjective symptoms are not noted. White pseudoatrophic rings 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, the skin of patients has elements in different stages of development at the same time.

Symptoms of the disease

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

When you scratch the plaques, a "stearin stain" appears - you can observe increased peeling, and the surface of the papules looks like a crushed drop of stearin.

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

Pinpoint bleeding (Auspitz's symptom) - exposed to the skin when the scale is removed.

Dermatologists also emphasize 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 general points:

• Rashes - they are always present in one form or another;
• A feeling of tightness of the skin where psoriatic elements are located;
• Itching of varying intensity.

In psoriasis, plaques appear in different places, but there are also areas with typical localization:

• Scalp (we are talking about seborrheic psoriasis with the arrangement of these plates);
• Knees and elbows;
• Skin folds and bending surfaces - elbow, knee joints, groin, armpit area, under the breast (this localization allows us to talk about reverse psoriasis);
• Lumbar, sacrum;
• Palms and feet - with palmoplantar psoriasis, respectively;
• Nail psoriasis - holes in the nail plates, subungual bleeding, 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, it will be pain in the joints, their swelling (in most cases, these manifestations are localized in the feet, hands, ankle and knee joints).

Types of psoriasis

Dermatologists distinguish several types of the disease:

Vulgar(plaque, common) is the most common and accounts for 90% of all psoriasis cases. With this type of disease, red-pink flat inflammatory elements (papules) protrude above the surface of the skin and have clear borders.

They tend to coalesce and form plaques of various sizes covered with silvery scales. It looks like a wreath 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 back and sacrum, but can also be found in other places.

Elbow psoriasis is treated as a special case (there is a permanent plaque on the elbow that starts to get worse when injured).

Exudative- occurs more often in patients with endocrine diseases (obesity, diabetes, etc. ). The lesions have exudation as well as yellowish-gray crusts.

it is in the form of a teardrop- as the name suggests, numerous papules in the form of bright red drops are observed on the skin, peeling and infiltration is low. It mainly occurs after streptococcal infectious diseases in children and adolescents. In some cases, guttate psoriasis turns into ordinary psoriasis.

Seborrheicdiffers in localization - the elements are behind the ears and in the nasolabial folds, chest, interscapular region, scalp. The color of the scales is yellowish, sometimes it spreads to the skin of the forehead and a "psoriatic crown" is formed.

Pustules- manifests itself in the form of limited (palms and heels) or extensive rashes represented by superficial pustules.

Among the pustular types, Barber's palmoplantar psoriasis is distinguished, in which the pustules cover the feet and palms. Severe itching is characterized by the combination of pustules with the formation of crusts. The disease often affects the nails as well.

Pustules are also seen in generalized Tsumbusch psoriasis. This type of disease is characterized by the appearance of bright erythema (redness) and superficial pustules. There is burning and pain in the areas of the rash. The lesions grow rapidly, coalesce and cover larger areas of the skin. With tsumbusha psoriasis, the epidermis (top layer of the skin) separates and "purulent lakes" are formed. Patients experience a general malaise, suffering from fever, burning and tingling in the affected areas.

Psoriatic erythroderma

Doctors pay special attention to this type of psoriasis, psoriatic erythroderma. In this case, the pathological inflammatory process covers all or almost all of the skin. It becomes rough, dense, covered with scaly elements, and the skin becomes red.

Many of our patients complain that the temperature rises to a subfebrile level and they feel sick. There is an increase in peripheral lymph nodes. Erythroderma can develop due to improper treatment of psoriasis (bathing, too intensive inoculation, high concentration of medicinal ointments, etc. ). In other cases, if the psoriasis has just started and is progressing rapidly, the process develops in healthy people.

If psoriatic erythroderma is prolonged, patients may experience nail damage and hair loss.

Psoriatic arthritis

This pathology is also called arthropathic psoriasis. Joint lesions can develop in parallel with the rash, and in some cases begin earlier and are a precursor to psoriasis.

Small joints of the feet and hands are mainly affected, but sometimes the wrist and ankle joints are also involved in the inflammatory process. Patients complain of joint pain, swelling, deformity and limited mobility.

Diagnostics

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

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

In typical cases, this is the psoriatic triad: pinpoint bleeding, terminal film symptoms, and stearin stain. Very often, patients are bothered by itching of varying degrees of intensity. The presence of psoriasis in relatives is also important.

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

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

In the arthropathic form of psoriasis (in the absence of skin rashes), the dermatologist must be sure that it is psoriasis and not rheumatoid polyarthritis.

Often psoriasis occurs together with other diseases, then 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, he will certainly refer the patient to a gastroenterologist, cardiologist, rheumatologist, and endocrinologist. And these specialists will prescribe a wide examination (there is a standard list of tests for each disease, especially blood tests).

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

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

You can undergo x-rays and mammography in the radiology department equipped with the latest medical technology. You can also have an MRI or CT scan of any organ 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, determination of external respiratory function and other vital indicators.

The most extensive diagnostic tests offered in our clinic allow doctors to identify diseases at almost any stage of development.

Treatment

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

External means include creams, ointments, gels, emulsions and sprays with hormonal drugs. Glucocorticosteroids suppress the immune system and relieve inflammation. They are presented in numerous dosage forms, in each specific case the doctor will choose an individual treatment regimen for you.

Moisturizers and emollients are used to reduce itching and dryness of the skin.

The use of special shampoos is prescribed to eliminate the manifestations of psoriasis on the scalp.

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

In systemic therapy, doctors prescribe immunosuppressive drugs. These medications are often given in small doses (once a week) to treat common types of psoriasis that are difficult to treat. 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 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 tends to decrease.

It should be noted that some drugs have a negative effect on the development of the fetus (for example, selective immunosuppressants), so they are contraindicated in pregnant women.

No alternative treatment gives positive results. You should not experiment and rely on traditional healers and methods with unproven effectiveness for your health.

Our doctors urge you not to self-medicate and not to stop (prescribe) various medications, as this can aggravate the condition and cause an increase in rashes!

Treatment of psoriasis using a laser device 

The Dermatovenerology Center offers you effective treatment of the disease using the excimer laser system. It is the main physiotherapeutic treatment of psoriasis and some other skin diseases, which has been proven to be effective.

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

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

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

The dermatovenereologist first determines the indications and contraindications for phototherapy treatment with monochromatic excimer light.

Indications include:

• Psoriasis;
• vitiligo;
• atopic dermatitis;
• Patchy baldness (alopecia);
• Discoloration of scars;
• Eczema.

There are very few contraindications for the procedure, including:

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

Why you should focus on systemic treatment 

Dermatovenereologists note a number of undeniable advantages of excimer light treatment:

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

How is the treatment procedure carried out?

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

You come to the appointment the next day, where the doctor determines the most appropriate test result. That is, the doctor will select the radiation power individually, which is especially suitable for your skin.

There are no restrictions during the treatment, only it will be recommended to limit spicy and fatty foods and drink plenty of fluids.

The effect of phototherapy occurs after only a few procedures, and for stable remission you need about 5-10 procedures (in some cases 15).

The duration of one procedure is 10-20 minutes, it depends on the area of treatment and the number of affected areas.

Psychological help

We always encourage you to remember that psoriasis is not contagious! However, patients are often more concerned about the reactions of others than about the presence of the rash. This is especially painful for women and children.

Children can be cruel to a sick child. Therefore, it is very important to prescribe treatment in time, including consultation with a psychologist or even a psychotherapist.

Benefits of treating psoriasis in the clinic

Patients choose psoriasis treatment for a number of reasons:

• Experienced, qualified dermatologists and cosmetologists;
• Simultaneous elimination of both dermatological and cosmetic problems;
• Innovative treatment methods, especially the use of the laser system;
• The most modern diagnostic methods;
• The opportunity to consult with doctors of various specialties.

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

Prevention of psoriasis

The main task of dermatovenereologists is to prevent the exacerbation of psoriasis. For this purpose, they prescribe preventive measures:

• Prevention of stress;
• Prevention of colds;
• Control of chronic infection foci;
• Avoid rough, tight clothes that damage the skin.

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

What happens if the disease is not treated?

If left untreated, the rash will spread and fill the skin more and more. It is possible to switch to the erythrodermic type, which is more difficult to treat.