Psoriasis

Description:

Psoriasis — a chronic noninfectious disease, the dermatosis affecting generally skin. Now the autoimmune nature of this disease is supposed. Usually psoriasis causes formation of excessively dry, red, raised over the surface of skin spots. However some patients with psoriasis have no visible damages of skin. The spots caused by psoriasis are called psoriasis plaques. These spots are by the nature sites of a chronic inflammation and excess proliferation of lymphocytes, macrophages and keratinotsit of skin, and also an excess angiogenesis (formation of new small capillaries) in the subject skin layer.

Psoriasis symptoms:

Psoriasis can be shown in diverse forms. Options of psoriasis include vulgar (simple, ordinary) or, otherwise, blyashkovidny psoriasis (psoriasis vulgaris, plaque psoriasis), pustular psoriasis (pustular psoriasis), tear-shaped or dot psoriasis (guttate psoriasis), psoriasis of flexion surfaces (flexural psoriasis). The short description of each kind of psoriasis together with its code on MKB-10 is provided in this section.
Blyashkovidny psoriasis, or ordinary psoriasis, vulgar psoriasis, simple psoriasis (psoriasis vulgaris) (L40.0) is the most often found psoriasis form. It is observed at 80% — 90% of all patients with psoriasis. Blyashkovidny vulgar psoriasis is most often shown in the form of the typical sites of the inflamed, red, hot skin raised over the surface of healthy skin, covered gray or silver-white which is easily exfoliating by scaly, dry and reinforced skin. Red skin under easily dischargeable gray or argenteum is easily injured and bleeds as contains a large number of small vessels. These sites of typical psoriasis defeat are called psoriasis plaques. Psoriasis plaques tend to increase in sizes, to merge with the next plaques, creating the whole plates of plaques ("paraffin lakes").
Psoriasis of flexion surfaces (flexural psoriasis), or "the return psoriasis" (inverse psoriasis) (L40.83-4) usually looks as smooth, not shelled or with the minimum peeling, the skin which are not especially acting over a surface the red inflamed spots which are located exclusively pleated skin at absence or the minimum defeat of other sites of skin. Most often this form of psoriasis strikes folds in external genitals, in a groin, on an internal surface бедёр, axillary hollows, folds under the stomach (a psoriasis pannus) increased at obesity, and on skin folds under mammary glands at women. This form of psoriasis is especially subject to deterioration under the influence of friction, traumatizing skin and release of sweat, and often is followed or complicated by a consecutive fungal infection or a streptococcal pyoderma.
Tear-shaped psoriasis (guttate psoriasis) (L40.4) is characterized by existence of a large number small, raised over the surface of healthy skin, dry, red or lilac (up to violet color), similar in a form on drops, teardrops or small points, circles of elements of defeat. These psoriasis elements usually cover with themselves the big surfaces of skin, most often hips, but can be also observed on shins, forearms, shoulders, a pilar part of the head, a back, a neck. Tear-shaped psoriasis often for the first time develops or becomes aggravated after a streptococcal infection, in typical cases — after streptococcal quinsy or streptococcal pharyngitis.
Pustular psoriasis (L40.1-3, L40.82) or exudative psoriasis is the heaviest of skin forms of psoriasis and looks as the bubbles or blisters filled with not infected, transparent inflammatory exudate (pustule) raised over the surface of healthy skin. Skin under and over a surface of pustules and around them red, hot, edematous, inflamed and reinforced, easily exfoliates. Secondary infection of pustules can be observed, in this case exudate gains purulent character. Pustular psoriasis can be limited, localized, at the same time its most frequent localization are the distal ends of extremities (hands and legs), that is shins and forearms, it is called palmoplantarny пустулёз (palmoplantar pustulosis). In other, more hard cases pustular psoriasis can be generalized, with wide circulation of pustules on all body surface and a tendency to their merge in larger pustules.
Psoriasis of nails, or psoriasis onikhodistrofiya (L40.86) leads to various changes of outward of nails on fingers of hands or legs. These changes can include any combination of discoloration of nails and a nail bed (yellowing, albication or a graying), emergence on nails and under nails of points, spots, cross striation of nails lines, skin thickenings under nails and around a nail bed, stratification and a thickening of a nail, full loss of nails (онихолизис) or development of the increased fragility of nails. The psoriasis erythrosis can be followed by an intensive skin itch, a cutaneous dropsy and hypodermic cellulose, a dermatalgia. The psoriasis erythrosis quite often happens result of an exacerbation of vulgar psoriasis at its unstable current, especially at sudden sharp cancellation of system treatment or local glucocorticoids. It can also be observed as result of provocation by alcohol, a psychological stress, intercurrent infections (in particular catarrhal diseases). This form of psoriasis can be lethal as extremely strong inflammation and a peeling or amotio of skin break ability of an organism to regulation of body temperature and barrier function of skin that can be complicated by a generalized pyoderma or sepsis. The psoriasis erythrosis however limited, localized can even be the first symptom of psoriasis, afterwards being transformed to vulgar blyashkovidny psoriasis.

Psoriasis reasons:

The psoriasis etiology finally is not found out now yet. At the moment there are two main hypotheses concerning the nature of process which leads to development of this disease. According to the first hypothesis, psoriasis is primary disease of skin at which normal process of maturing and a differentiation of cells of skin is broken, and the excess growth and reproduction (proliferation) of these cells is observed. At the same time the problem of psoriasis seems supporters of this hypothesis as dysfunction of epidermis and its keratinotsit. Autoimmune aggression of T lymphocytes and macrophages against skin cells, their invasion in thickness of skin and excess proliferation in skin at the same time seem as secondary as reaction of an organism to excess reproduction of the "wrong", unripe, patholologically changed keratinotsit. This hypothesis is spoken well by existence of positive effect at treatment of psoriasis the drugs which are slowing down reproduction of keratinotsit and/or causing their accelerated maturing and a differentiation and at the same time not possessing or possessing insignificant system immunomodulatory properties — retinoids (synthetic analogs of vitamin A), vitamin D and in particular its active form, ethers of fumaric acid.
The second hypothesis assumes that psoriasis is the immune mediated, immune or autoimmune disease at which the excess growth and reproduction (proliferation) of cells of skin and first of all keratinotsit are secondary in relation to various mediators of an inflammation, lymphokines and cytokines produced by cells of immune system and/or on the relation and autoimmune damage of cells of skin causing secondary regenerative reaction. At psoriasis T-killers and T-helpery (cells which normal protect an organism from various infections and malignant tumors) are activated, migrate in skin and release a large amount of inflammatory cytokines, in particular, a so-called "factor of a necrosis of tumors like alpha" (FNO-α, TNFα) which cause an inflammation, macrophages and neutrocytes attract in skin, and cause excess reproduction of cells of skin, first of all keratinotsit. At the moment remains to unknown what factors initiate initial activation of T lymphocytes and their migration in skin.

Treatment of Psoriasis:

Psoriasis researches led to emergence of new, highly effective and narrowly targeted (targetny) means and methods of treatment of severe forms of psoriasis in the last decade. Now for treatment of psoriasis modern drugs, including with use of biological agents are used that allows to facilitate considerably course of psoriasis  at many patients and to improve quality of their life. Treatment of psoriasis is directed to reducing formations of cells of a blanket of skin and to make their division normal, and also to suppress the immune responses occurring in skin and to liquidate an imbalance between substances which strengthen and reduce an inflammation (cytokines). Such therapy can be both system, and outside. Dermatologists apply various methods and means to treatment of psoriasis that allows to choose individually the program suitable the specific patient. The program of treatment of psoriasis is formed taking into account all features of an organism and depending on in what form and how hard the disease proceeds. Also localization of rashes, existence of associated diseases, gender and age of the patient sick with psoriasis is considered.
Often medical influences of drugs only of local appointment are not sufficient, especially at extensive defeats of an integument (more than 20% of the area), or at severe forms of a disease. In similar cases drugs of system influence are shown. One of the newest developments of modern pharmacology is biological or as it is called still, antitsitokinovy drug which made considerable break in therapy of inflammatory diseases of the person. Unlike glucocorticoids and tsitostatik, feature of these medicines is selective influence on the main reasons for development of inflammatory diseases, including psoriasis. Medicines of biological therapy work so that selectively to block activity of key activators of the cascade of reactions which, in turn, cause inflammatory changes at psoriasis. Thereby they are capable to interrupt development of all clinical displays of psoriasis. As practice shows, usually, already in a day after administration of drug, joint pains decrease or stop, at the same time the volume of movements increases, and zanchit reception of the anesthetizing drugs is already unnecessary. Noticeable clarification of skin, as a rule, comes by the end of the first week of treatment. To get rid of psoriasis the main thing in time to see a doctor and to receive necessary recommendations about treatment. The correct and regular treatment of psoriasis will help to keep a disease under control.