- high penetration;
- unpredictability, Novitatis and variation in flow;
- the appearance of the first clinical symptoms of predominantly young age;
- increasing in the last 10-15 years among young people;
- increase the percentage of severe forms of the disease, which is associated with serious psychological disturbances and sleep disorders;
- the deterioration of the quality of life of patients;
- difficulty of care;
a significant increase in the number of patients who have a disability, such as sickness absence and incapacity for work, especially young men.
According to various sources, the disease was 2, 7% of the population. The structure of the skin diseases of psoriasis is 3-5%, and in patients with skin-hospitals — up to 25%.
This information is for some reason incomplete: the difficulty to identify the severe forms, such as psoriatic arthritis, a rare portability of medical institutions for patients with mild forms etc.
Causes of psoriasis and its pathogenesis
Despite the advantage of local cutaneous manifestations of most forms of the disease, its causes and the nature of the violations in the body the disease is of a systemic nature.
During the course of the disease involved joints, blood vessels, kidneys, liver. There is also a large risk of diabetes, obesity and high blood pressure persons with psoriasis, especially in women.
20-30% of patients later develop a syndrome of metabolic disorders with high concentration of triglycerides in blood, obesity, mainly abdominal, psoriatic arthritis.
Also in recent years revealed a number of biological markers, showing a direct connection, psoriasis, Crohn's disease, rheumatoid arthritis, cardiovascular disease, angina, and increased mortality of myocardial infarction.
For these and other reasons, a growing number of researchers are inclined to the system definition of the Skin condition such as "psoriaattista disease" and not just "psoriasis."</1_img>
If passed, the psoriasis hereditary?
Despite the large number of hypotheses, and the research the moment it is still difficult, the answer to the question is psoriasis transmitted by inheritance. However, it is generally accepted that the disease is genetically determined. Because of the disease in both the parents is found only 4.7% of children. When the disease one of the parents, the child's risk of Developing it is increased to 15-17%, both parents — 41%.
At the beginning of psoriatic disease can be at any age, but in most cases, the peak observed in the ages of 16-25 years (type I psoriasis) and 50-60 years (type II psoriasis). Psoriasis of the I-th type can be traced back to a hereditary disease, joint damage and incidence of lesions of varius. Type II disease have a more favorable course.
The mechanism of development (pathogenesis)
The most important link in the pathogenesis (mechanism of development) disease that causes lesions on the skin, is an increase in the mitotic (cell division) activity and rapid proliferation (growth) epidermalibus cells. The result — cells of the skin, without orogovet, out of the cells to the underlying layers of the skin. This phenomenon is accompanied by excessive flaking and is called Hyperkeratosis.
Possible free communication and contact with patients, i.e. can you get? All the studies related to this disease, refute this assumption. The disease has not spread to other people by droplets or direct contact.
Implementation of a genetic predisposition to the disease (according to the genetic theory of psoriasis) it is possible, when there is a disruption of the regulatory mechanisms of the following systems:
mentis.Mental instability affects the disorders of the activity of the autonomic nervous system. The latter is one of reflex units for the implementation of certain emotional factors effect through alpha - and beta-receptors on the vascular system, the skin, and therefore its Overall condition.
Psychological trauma is a significant (if not primary) role in the mechanism of the disease, and the frequency and duration of exacerbations. At the same time, skin disorder causes disturbances in the functional state of the psyche. Endocrine.
psoriatic diseaseis a manifestation of the violation of adaptive mechanisms, the most important role that play the endocrine glands (hypothalamus, pituitary, adrenal glands), of the regulation, which is carried out not only declinare, way (through the blood), but also the participation of the nervous system. /For adaptation of the hypothalamic-pituitary-adrenal system is switched on (in response to environmental changes, extreme and accentus factors) by increasing or decreasing the secretion of hormones, which change the cell metabolism. </2_img>
Immune. The mechanism of realization of genetic predisposition to PSORIASIS which is involved in the immune system occurs through genes controlling the cellular immune response and the immune system cells interact with each other (HLA-system). The immune system psoriasis is also changed, either genetically or under the influence of internal or external factors, as evidenced by the violation of all components of the skin immune regulation.
Genetically determined disorders of cell metabolism leads to accelerated growth and proliferation of immature cells of the epidermis, which leads to the release of biologically active substances (BAS) lymphocytes, immature skin cells, activated keratinocytes and macrophages. The latter are the media marketplace, inflammation and the immune response.
These substances are protease, protein informational molecules called cytokines (tumour necrosis factor, interleukins, interferons, and different subtypes of lymphocytes), polyamines (hydrocarbon radical). The mediators in turn promote the growth of defective cells of the skin, changes in the walls of small blood vessels and the appearance of inflammation.
The whole process is accompanied by the accumulation of the epidermis and the papillary layer of the dermis one - and many-celled leukocyte. Predisposing and triggering factors The key pathological manifestation of psoriasis is the excessive growth of defective cells of the skin. Therefore, fundamental elucidation of the mechanism of the disease and decide how to deal with psoriasis, it is since the establishment of the factors. Main:
Psychological— the effect of short-term severe stress, and unexpressed, but time-consuming or repetitive negative psychological effects, moral dissatisfaction, sleep disturbances, depressive states.
Metabolic disorders in the body, malfunction of the gastrointestinal tract, especially the liver and exocrine function of the pancreas. Disease or dysfunction of the endocrine glands (hypothalamus, thyroid, parathyroid tissue and glands, the endocrine activity of the pancreas). The immune system (allergichekie reactions and immune system diseases).
Presence in the body of chronic foci of infection (tonsillitis, rhinosinusitis, inflammationibus profuere, etc.). Pathogenic and conditionally pathogenic micro-organisms, especially Staphylococcus aureus, streptococci and fermentum mushrooms, their toxins, the skin cells become damaged, these micro-organisms are effective antigens, can trigger the immune system attack against them, modified, and healthy cells of the body.
Mechanical and chemical damage to the skin, long-term use of antibiotics or glucocorticoids in any disease, giperinsolyatsiya, Smoking and alcohol abuse, acute infectious diseases (respiratoriorum virus infection, influenza, angina, etc.).
Symptoms and types of psoriasisAccepted clinical classification of psoriatic disease does not exist, but traditionally there are the most common clinical form. They are in some cases so different from each other, that they are considered separate diseases.
The development of the disease has three phases:
The progression of the process, which can be up to 1-2 mm appear in large numbers in new areas. They transformirovalsya typical psoriatic plaque.
The stationary phase— the lack of the appearance of "fresh" elements, keeping the size and appearance of the existing plaques, completely covered with peeling skin.
Stage regression— reduction and flattening of the plaques, reducing the severity of peeling and disappearance of elements, resorption, which begins in the middle. After their complete disappearance usually remain foci of depigmentation.
Psoriasis vulgaris(ordinary) It seems, monograph (homogeneous) eruptionibus in the form of plaques or papules — nodules of a reddish or pink color, towering above the skin surface. Papules are clearly demarcated from healthy areas and covers the stater to the dolo has a silvery white color. The size of their diameter can be 1 to 3 mm, 20 mm and more. Them the three characteristic phenomenon that occurs after their poskablivanii surface: </3_img>
the symptom of "stearin spot" — to strengthen the peeling after light poskablivanii, whereby the surface of the pimples comes to a similar drop oppress the wax; this is due to parakeratosis (thickening of the epithelium), Hyperkeratosis (thickening of the stratum corneum of the skin, i.e. the stratum scale), the accumulation of fat and sicut crassus, part of the outer epidermis; the symptoms of the "terminal film" district-scale view of the slimy epidermal layer in the form of a thin, velvety, shiny, wet surfaces; the symptom of "blood dew", or the phenomenon Auspittsa-Polotebnova — not coalesce droplets of blood in the form of dew, which operate on a shiny surface when the light poskablivanii it is injury plenur sanguinis, skin papillae.
Favorite places localization rash pellis are part of the head, a symmetrical arrangement is the extensor of the treaty indici of the surface area of the large joints — elbows, knees. The localization of plaques can be a long time to be only in these areas. So they are called "guard" or "officium". Rarely affects the nails, skin in the area of other joints, genitals, face, soles and palms, large folds.
Another characteristic symptom is the appearance of psoriatic lesions in areas of mechanical or chemical damage to the skin (the phenomenon of Kebne.). Such injuries can be scalpendi, cuts, chemical irritation by acids or bases.Depending on the localization of the elements and clinical course, psoriasis vulgaris, is divided into several varieties:
- Hand-quadratus plantae.
- The nail psoriasis.
Seborrheic psoriasis.It occurs in areas of skin with lots of sebaceous glands on the forehead, the scalp, the BTE region, in areas of facial folds (nasolabial and nososchechnyh), between the shoulder blades and the upper part of the front surface of the chest.
If the face, back and chest rash is the nature of red pimples, which belong to the squama of the convolvens large sheets of silver-white color, the ears it is similar to the rash of seborrheic dermatitis, complicated by joining the infection.
Surface of the seborrheic spots and papules of the ear sinks more bright and edematous, compared to other regions. It is covered with a stater of dolo in yellowish-white or grayish-white color and serosum vehentem-purulent crust (because dargan on), which fits closely to the skin. Almost always rash accompanied by severe itching.