Psoriasis

Psoriasis is a chronic inflammatory disease of a multifactorial nature 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 on your skin that are scaly and itchy, make an appointment with a dermatologist.

Our doctors treat psoriasis with an integrated approach - using both medical treatment methods (ointments, gels, aerosols, tablets and drug injections) and well-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 number of genes whose presence predisposes to the onset of the disease;
• Disorders in the work of the endocrine, immune and nervous systems;
• Negative effects of certain environmental factors.

There are also provoking factors, which include:

• Chronic infectious diseases (most often caused by streptococcus);
• Alcohol abuse, chronic alcoholism;
• Weather conditions (dry or cold climate);
• Traumatization of the skin (scratches, insect bites, sunburn);
• Frequent emotional stress;
• Taking certain medications (for example, lithium salts, adrenergic acid blockers, oral contraceptives, antimalarials);
• Abrupt discontinuation 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 elements of the rash, the fusion of papules and the appearance of new elements in the injured areas. Plaques are bright pink and covered with scales. The rate of cell division in new lesions increases 10-fold;
• Stationary - fresh elements are not noticeable, the plaques are stagnant red in color, there is practically no peeling, itching is hardly bothersome;
• Regressive - weakening of the intensity of the color of the rash, elements of the rash are pale, new ones do not appear, there is no peeling, no subjective signs are observed. White pseudoatrophic edges form around the plaques, and healthy skin appears in the center of the large plaques. Colorless spots remain at the site of the rash.

In some cases, patients have elements on their skin 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 pinpoint bleeds, terminal film symptoms, and stearic stains.

"Stearin stain" appears when you scratch the plaques - you can notice increased peeling, and the surface of the papules becomes similar to a crushed drop of 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.

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

Dermatologists also emphasize the Koebner phenomenon - the appearance of a psoriatic rash at the site of skin trauma (scratches, injuries).

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

• Rashes - they are always present in one form or another;
• Sensation of skin tightening at the site of psoriatic elements;
• Itching of varying intensity.

Psoriasis plaques appear in various places, but there are also areas of typical localization:

• Scalp (with this arrangement of plaques, we are talking about seborrheic psoriasis);
• Knees and elbows;
• Skin folds and flexor surfaces - elbows, knee joints, groin, armpit area, under the breast (this localization allows us to talk about inverse psoriasis);
• Lumbar, sacrum;
• Palms and feet - with palmoplantar psoriasis;
• Nail psoriasis – indentations on 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 (most often these manifestations are localized on the feet, hands, ankles and knee joints).

Types of psoriasis

Dermatologists distinguish several types of diseases:

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

They tend to merge and form plaques of different sizes, covered with silvery scales. It looks like a wreath or a geographical map.

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

Psoriasis of the elbow is treated as a special case (there is a permanent plaque on the elbow, and when it is injured it starts to get worse).

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

in the shape of a tear- as the name suggests, numerous papules in the form of bright red droplets are observed on the skin, peeling and infiltration are insignificant. It occurs mainly in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis degenerates into simple psoriasis.

Seborrheait differs in its localization - the elements are located behind the ears and nasolabial folds, on the chest, in the interscapular region, on the scalp. The color of the scales is yellowish, sometimes they spread to the skin of the forehead and a "psoriatic crown" is formed.

Pustular- manifests as a limited (on the palms and soles) or extensive rash, represented by superficial pustules.

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

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 quickly, coalesce and cover larger areas of the skin. In Tsumbusha psoriasis, the epidermis (the top layer of the skin) separates and so-called "pus lakes" are formed. Patients experience general weakness, fever, burning and tingling in the affected areas.

Psoriatic erythroderma

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

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

If psoriatic erythroderma persists 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 parallel to the rash, and in some cases it starts earlier and is a sign of psoriasis.

Small joints of the feet and hands are mostly affected, but sometimes the wrist and ankle joints are also involved in the inflammatory process. Patients are concerned about joint pain, swelling, deformities and limited mobility.

Diagnostics

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

There is an opinion that in order to establish a diagnosis, it is necessary to undergo a large number of tests. But in most cases this is not the case and a detailed 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: pinpoint bleeding, terminal film symptoms, and stearin spotting. Very often, patients suffer from itching of varying intensity. The presence of psoriasis in relatives is also important.

However, there are skin symptoms that should be distinguished when diagnosing the disease. For example, with papular syphilis, a similar picture is observed. 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 lump that rises above the skin level and is covered with scales.

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

Psoriasis often 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 consult a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And these experts will prescribe a comprehensive examination (for each disease there is a standard list of tests, especially blood tests).

The diagnostic base of a modern clinic consists of the most modern devices and appliances. This will allow you to undergo a comprehensive examination for various diseases.

Laboratory studies are performed using modern biochemical and hematological analyzers. Ultrasound diagnostics doctors examine patients using advanced ultrasound machines.

In the radiology department, equipped with the latest medical technology, you can undergo radiography and mammography. In the clinic, you can also do a magnetic resonance or CT scan of any organ.

The doctors of the functional diagnostics department have the opportunity to conduct all the necessary studies: ECG, EEG, echoencephalography, daily monitoring of the ECG, daily monitoring of blood pressure, determining the function of external breathing 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 disease control and remission (weakening or disappearance of symptoms). In the treatment of psoriasis, doctors use several guidelines at once: drugs (ointments and other dosage forms for external use, as well as tablets for systemic therapy) and phototherapy with excimer light.

External medications include creams, ointments, gels, emulsions, and sprays that contain hormonal medications. Glucocorticosteroids suppress the immune system and reduce 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 dry skin.

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

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

In systemic therapy, doctors prescribe immunosuppressive drugs. These drugs are often given in low doses (once a week) to treat common, difficult-to-treat types of psoriasis. Similar regimens are used in patients with rheumatoid arthritis. Application 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 severe cases.

As the process calms down, the frequency of use of external agents and oral medications changes to decrease.

Keep in mind 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 leads to positive results. You should not experiment and entrust your health to traditional healers and methods with unproven effectiveness.

Our doctors urge you not to self-medicate and not to stop (prescribing) various medications, because this can only worsen the situation and cause an increase in rashes!

Treatment of psoriasis with a laser device 

The Center for Dermatovenerology offers you an effective method of treating diseases with an excimer laser system. This is the main physiotherapeutic treatment of psoriasis and some other skin diseases with proven effectiveness.

The 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 plaques decreases.

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

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

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

Indications include:

• Psoriasis;
• Vitiligo;
• Atopic dermatitis;
• Baldness (alopecia);
• Discoloration of scars;
• Eczema.

There are very few contraindications for the procedure, namely:

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

Why you should pay attention to systemic treatment 

Dermatovenerologists note numerous undeniable advantages of excimer light treatment:

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

How is the treatment procedure carried out?

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

The next day, you come for an examination, where the doctor determines the most appropriate test result. That is, the doctor will individually select the power of radiation, which is suitable especially for your skin.

There are no restrictions on the duration of treatment, you will only be advised to limit spicy and fatty foods and drink plenty of fluids.

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

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

Psychological help

We always encourage you to remember that psoriasis is not contagious! And yet, patients are often worried not so much about the discomfort of the presence of the rash as about the reaction of others. 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 a timely manner, including consultation with a psychologist or even a psychotherapist.

Benefits of treating psoriasis in the clinic

Patients opt for psoriasis treatment for several reasons:

• Experienced, qualified dermatologists and cosmetologists;
• Eliminating both dermatological and cosmetic problems at the same time;
• Innovative methods of treatment, especially using the laser system;
• The most modern diagnostic methods;
• Possibility of consultation 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 a dermatovenerologist is to prevent the worsening of psoriasis. For this purpose, they prescribe preventive measures:

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

Thanks to preventive measures and timely treatment of psoriasis, doctors are able to 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 fill more and more of the skin. A transition to the erythrodermic type is possible, which is much more difficult to treat.