Psoriasis — a chronic non-communicable disease, a skin disease, which mainly affects the skin. Psoriasis usually causes the formation of excessively dry, red spots on the skin surface. However, some patients with psoriasis have no visible damage.
Patches caused by psoriasis called psoriatic plaques. These places are areas of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin and excessive angiogenesis (formation of new small capillaries) the subject layer of the skin. Excessive proliferation of keratinocytes in psoriatic plaques and skin infiltration of lymphocytes and macrophages leads to the thickening of the skin of the affected areas, its height from the surface of healthy skin and the formation of the characteristic pale, gray or silver spots, which resemble melted wax or paraffin wax ("paraffin lakes").
Psoriatic plaques often first appear vulnerable to friction and pressure areas — the surface of the elbow and knee bends, on the buttocks. However, the psoriatic plaques can occur and located anywhere on the skin, including the skin, the scalp, the surface of the hands and plantar surfaces of the feet, the external genitalia. Unlike eczema rash, usually affecting the inner surface of the knee and elbow joints, psoriasis lesions are often located on the external the extensor surfaces of the joints.
Psoriasis is a chronic disease characterized by usually more than the waves, through spontaneous or caused by a variety of therapeutic effects of remission or improvement and periods of spontaneous or provoked by adverse external influences (alcohol, intercurrent infections, stress) recurrences or exacerbations.
The severity of the disease can vary from patient to patient and even in one and the same patient during the periods of remission and exacerbation of a very wide range, small local damage, to completely cover the entire body psoriatic plaques. Often there is a tendency to progression of the disease over time (especially if untreated), stress and increased frequency of exacerbations, increase influence in the region, and participation in new areas of the skin. Some patients have continuous disease course without spontaneous remission, or even a continuous progression. Often also affect the nails on the hands and/or feet (psoriatic onychodystrophy). Nail involvement may be isolated and observed without cutaneous lesions. Psoriasis can also cause inflammation of the joints, called psoriatic arthropathy or psoriatic arthritis. 10% to 15% of patients with psoriasis also suffer from psoriatic arthritis.
There are many different means and methods for the treatment of psoriasis, but because of the chronic recurrent nature of the disease itself, and often tends to progress over time, psoriasis is quite difficult to treat the disease. A complete cure is not currently possible (that is, psoriasis is incurable, the current level of development of medicine), but it is possible to more or less long, more or less complete remission (also, life). However, it is always a risk of relapse.
Causes of psoriasis
- Stress, depression;
- Infection of the skin, in particular viruses, bacteria (staphylococcus. Streptococcus), fungi (Candida);
- Genetic predisposition;
- Metabolic disorders that affect the regeneration of skin cells;
- Failure of the endocrine system (hormonal disorders)
- Gastrointestinal disease is enteritis, colitis, dysbacteriosis (dysbiosis);
- Diseases of the liver.
Read more about causes of psoriasis
Impaired barrier function of the skin (in particular, mechanical injury or irritation, friction and pressure on the skin, too much use of soap and detergents, solvents, detergents, alcohol-containing solutions, the presence of infected lesions on the skin or skin allergies, excessive dryness of the skin) also play a role in the development of psoriasis.
Psoriasis is a large extent, a distinctive skin condition. Most patients experience suggests that psoriasis may spontaneously improve or worsen without any apparent reason. Studies of various factors related to occurrence, development or exacerbation of psoriasis is usually based on the study of small, usually in the hospital (not outpatient), that is certainly more severe group of patients with psoriasis. Therefore, these studies often suffer from lack of representativeness of the sample and the inability to identify the cause-and-effect relationships in the presence of a large number of other (including yet unknown) factors may affect the nature of psoriasis. Several different studies found conflicting findings. However, the first signs of psoriasis often appear after a trauma (physical or mental), damage to the skin in places, the first appearance of psoriatic lesions, and/or past streptococcal infection. Conditions, according to several sources, which could contribute to worsening or exacerbation of psoriasis include acute and chronic infections, stress, climate change, and the change of seasons. Some medications, particularly lithium carbonate, beta blockers, antidepressants fluoxetine, paroxetine, antimalarial drugs chloroquine, hydroxychloroquine, anti-epileptic drugs carbamazepine, valproic acid, according to several sources, is associated with exacerbation of psoriasis or even may cause its original appearance. Excessive alcohol use, Smoking, overweight or obesity, poor diet can worsen psoriasis or prevent its treatment, provoke the aggravation. Hair spray, some lotions and hand creams, cosmetics and perfumes, household chemicals can also cause exacerbation of psoriasis in some patients.
Patients suffering from HIV or AIDS often suffer from psoriasis. This seems contradictory to the researchers of psoriasis, as treatment aimed at reducing the number of T cells or their activity as a whole contribute to the treatment of psoriasis, and HIV infection or AIDS is accompanied by a reduction of T-cells. However, over time with the progression of HIV infection or AIDS by increasing the load and reducing the number of circulating CD4+ T-cells, psoriasis in HIV-infected patients or AIDS patients will deteriorate or swell. In addition to this mystery, the HIV infection is usually accompanied by a strong change in the cytokine profile towards Th2, whereas psoriasis vulgaris from uninfected patients is characterized by a strong change in the cytokine profile towards Th1. According to the currently accepted hypothesis is that the reduced number and pathologically modified activity of CD4+ T-lymphocytes in patients with HIV infection or AIDS causes hyperactivation as well as CD8+ T-lymphocytes, which are responsible for the development or exacerbation of psoriasis in HIV-or AIDS-patients. However, it is important to know that most of psoriasis patients with respect to healthy carriers of HIV, and HIV is responsible for less than 1% of cases of psoriasis. On the other hand, psoriasis in HIV-positive occur, according to different sources, with a frequency of 1-6 %, which is about 3 times higher than the prevalence of psoriasis in the general population. Psoriasis in patients with HIV infection and AIDS in particular often occurs very hard and responds poorly or not at all amenable to standard therapies.
Psoriasis most often develops in patients with initially dry, sensitive skin than patients with oily skin, and is much more common in women than in men. One and the same patient of psoriasis often occur first in areas more dry or thin skin than in areas where there is oily skin, and most often appears in places, damage to the integrity of the skin, including scratches, scuffs, scratches, cuts, in places exposed to friction, pressure or contact with aggressive chemicals, detergents, solvents (this is called the phenomenon of kebne your). It is assumed that this phenomenon will damage psoriasis mainly dry, sensitive or injured skin associated with infection, because the infection (probably the most common Streptococcus) easily penetrates the skin with minimal secretion of sebum (which, in other circumstances, protects the skin from infections) or skin lesions. Favorable conditions for the development of psoriasis, thus, the opposite conditions favorable for fungal infection of the foot (the so-called "athlete's foot") or the armpits, groin area. The development of fungal infections is the most favorable humidity, wet skin, psoriasis, on the contrary, dry. Penetrated into dry skin infection causing dry chronic inflammation, which in turn causes the symptoms characteristic of psoriasis, such as itching and increased proliferation of skin cells. This in turn leads to further dryness of the skin due to inflammation and enhanced proliferation of keratinocytes, and due to the fact that the infection consumes the moisture, which otherwise could serve to moisturize the skin. Avoid excessive dryness of the skin and reduce the symptoms of psoriasis patients with psoriasis is not recommended to use washcloths and scrubs, especially difficult, because they not only damage the skin, leaving microscopic scratches, but scraped the skin of the upper protective stratum corneum and sebum, usually to protect the skin from drying out and the penetration of micro-organisms. It is also recommended to use talc or baby powder after washing or bathing to absorb excess moisture from the skin, which otherwise "get" the infection. In addition, it is recommended to use the funds, moisturizing and nourishing the skin, and creams, which improve the activity of the sebaceous glands. Not recommended to abuse of soap, detergents. Should try to avoid skin contact with solvents, household chemicals.
The symptoms of psoriasis
- Severe itching on the skin;
- The appearance of the skin small skin rash to the development of more fluid, reveal, form a crust, then joined one of the inflammatory diseases and covered with a grayish-white, sometimes with a yellowish tinge (the so - called psoriatic plaques);
- Blood platelets;
- Nail psoriasis first thickens, then delaminates and the nail is lost;
- Possible pain in the joints.
The quality of life in patients with psoriasis
It has been demonstrated that psoriasis can impair quality of life in patients to the same extent as other serious chronic diseases, such as depression, myocardial infarction, hypertension, heart failure, or diabetes mellitus 2 type. Depending on the severity and location of psoriatic lesions, patients with psoriasis can occur with significant physical and/or psychological pain, difficulty with social and vocational adaptation, and even need to injury. Strong itching or pain can interfere with performing basic living functions, such as self-care, walking, sleep. Psoriatic plaques exposed parts, hands or feet can prevent patients work certain jobs, to do some sports, take care of family members, Pets or house. Psoriatic plaques on the scalp often cause patients with special mental problems and has caused considerable distress and even social phobia, such as pale plaques on the scalp can be mistaken for other dandruff or the result of the presence of lice. The second major psychological problem, cause the presence of psoriatic lesions on the face, earlobes. Psoriasis treatment can be expensive and take a patient a lot of time and effort, interferes with work and/or study, socialization of the patient, the device personal life.
Psoriasis patients can also be (and often are) too concerned about their appearance, pay too much attention (sometimes to the extent that it is staring at, almost body dysmorphic disorder), suffer from low self-esteem, which is associated with fear of public rejection and the rejection or fear of not finding a sexual partner because of problems with appearance. Psychological anxiety, combined with pain, itching and immunopathological disorders (increased production of inflammatory cytokines) can lead to the development of severe depression, anxiety, or social phobia, significant social isolation and maladjustment of the patient. It is also noted that comorbidity (combination) psoriasis and depression as well as psoriasis and social phobia, occur more frequently in patients who do not experience subjective psychological discomfort in the presence of psoriasis. It seems likely that genetic factors influence susceptibility to psoriasis and a tendency to depression, anxiety states, social phobia to a large extent overlap. It is also possible that in the pathogenesis of both psoriasis and depression the role of a common immunopathological and/or hormonal factors (for example, depression also show elevated inflammatory cytokines, increased cytotoxic activity of glial cells).