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 varying shapes and sizes on the skin that are scaly and itchy, make an appointment with a dermatologist.

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

Causes of psoriasis

Doctors name 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;
• Malfunctions 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 blockers, oral contraceptives, antimalarials);
• Abrupt withdrawal of systemic hormonal drugs.

You should not trust 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 - it is characterized by an increase in the number of rash elements, fusion of papules, and the appearance of new elements in injured areas. The plaques are bright pink and covered with scales. The rate of cell division in new lesions increases 10 times;
• Stationary – no fresh elements are observed, plaques are stagnant-red in color, there is practically no peeling, itching is almost not bothersome;
• Regressive - weakening of the color intensity of the rash, the elements of the rash are pale, new ones do not appear, there is no peeling, no subjective signs are noted. White pseudoatrophic rims 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, patients have elements on their skin at 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 bleeding, symptoms of terminal film and stearin stain.

A "stearin spot" appears when you scratch the plaques - you can observe 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.

Pinpoint bleeding (Auspitz symptom) - exposed on the skin when the scale is removed.

Dermatologists also highlight 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 common points:

• Rashes - they are always present in one form or another;
• Feeling of skin tightness at the location of psoriatic elements;
• Itching of varying intensity.

Plaques in psoriasis appear in a variety of places, but there are also areas with typical localization:

• The scalp (with this arrangement of plaques we are talking about seborrheic psoriasis);
• Knees and elbows;
• Skin folds and flexor surfaces - elbow, knee joints, groin, armpit area, under the breast (this localization allows us to talk about inverse psoriasis);
• Lumbar, sacrum;
• Palms and feet – respectively, with palmoplantar psoriasis;
• Nail psoriasis – pitting on the nail plates, subungual hemorrhages, 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, ankle and knee joints).

Types of psoriasis

Dermatologists distinguish several types of disease:

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

They tend to merge, and plaques of different sizes are formed, covered with silvery scales. In appearance it resembles a garland 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.

Elbow psoriasis is treated as a special case (there is a permanent plaque on the elbow, and when it is injured, it begins to worsen).

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

teardrop-shaped– as the name implies, numerous papules in the form of bright red droplets are observed on the skin, peeling and infiltration are minor. It occurs mainly in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis degenerates into ordinary psoriasis.

Seborrheicdiffers in its localization - elements are found in the behind-the-ear 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 itself as limited (on the palms and soles) or extensive rashes, represented by superficial pustules.

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

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 soreness in the areas of the rash. The lesions quickly grow, merge and cover larger areas of the skin. With Tsumbusha psoriasis, detachment of the epidermis (upper layer of skin) occurs and so-called "purulent lakes" are formed. Patients experience general malaise, they are tormented by fever, burning and tingling in the affected areas.

Psoriatic erythroderma

Doctors specifically focus on this type of psoriasis, psoriatic erythroderma. In this case, the pathological inflammatory process involves all or almost all of the skin. It becomes rough, tight, covered with flaky elements, and the skin becomes red.

Many of our patients complain of fever rising 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 tanning, high concentration of medicinal ointments, etc. ). In other cases, the process develops in healthy people if psoriasis has just begun and progresses rapidly.

If psoriatic erythroderma exists 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 in parallel with rashes, and in some cases begins even earlier and is a harbinger of psoriasis.

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

Diagnostics

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

There is an opinion that to make a diagnosis you need to undergo a large number of tests. But in most cases this is not the case, and a thorough 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, symptoms of terminal film 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 should be differentiated when diagnosing the disease. For example, with papular syphilis a similar picture is observed. 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 compaction that rises above the skin level and is covered with scales.

In the arthropathic form of psoriasis (when there are no skin rashes), the dermatologist will need to make 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 for consultation with a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And these specialists will prescribe an extensive examination (for each disease there is a standard list of tests, in particular blood tests).

The diagnostic base of the modern clinic is represented by the most modern devices 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.

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

Doctors of the department of functional diagnostics have the opportunity to conduct all the necessary studies: ECG, EEG, echoencephalography, daily ECG monitoring, daily blood pressure monitoring, determine the function of external respiration 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 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: medications (ointments and other dosage forms for external use, as well as tablets for systemic therapy) and phototherapy using excimer light.

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

To reduce itching and dry skin, moisturizers and emollients are used.

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

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

In systemic therapy, doctors prescribe immunosuppressive drugs. These drugs are often administered in small doses (once a week) to treat difficult-to-treat common types of psoriasis. Similar regimens are used in patients with rheumatoid arthritis. Administration is oral, intravenous, intramuscular or subcutaneous.

Doctors also prescribe retinoids (medicines 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 changes towards a decrease.

Note that some drugs have a negative effect on fetal development (for example, selective immunosuppressants), so they are contraindicated in pregnant women.

No alternative treatment leads to positive results. You should not experiment and trust your health to traditional healers and methods with unproven effectiveness.

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

Treatment of psoriasis using a laser device 

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

An excimer lamp operates 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 only affect "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, stable remission is achieved, and in many cases, treatment with excimer light makes it possible to abandon hormonal drugs.

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

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

Indications include:

• Psoriasis;
• Vitiligo;
• Atopic dermatitis;
• Patchy baldness (alopecia);
• Change in color of scars;
• Eczema.

There are very few contraindications for the procedure, these include:

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

Why you should pay attention to system treatment 

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

• The effect is local, only on psoriatic plaques, the rays do not affect the entire body;
• In mild cases, it is enough to prescribe only phototherapy and photosensitizers to achieve stable remission;
• Prescribed to patients of any age (starting from 3 years);
• Treatment with a laser system does not require a hospital stay, it easily fits into any work schedule;
• Effective for a variety of 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 your skin phototype and determine the minimum dose of ultraviolet radiation.

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

There are no restrictions during treatment; you will only be advised to limit spicy and fatty foods and drink plenty of fluids.

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

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

Psychological assistance

We always encourage you to remember that psoriasis is not contagious! And yet, patients are often worried not so much about the discomfort from the presence of rashes as about the reaction of others. This is especially painful for women and children.

Children may behave cruelly towards a sick child. Therefore, it is very important to prescribe treatment in a timely manner, including consulting with a psychologist or even a psychotherapist.

Benefits of treating psoriasis in a clinic

Patients choose to treat psoriasis for a number of reasons:

• Experienced, qualified dermatologists and cosmetologists;
• Elimination of both dermatological and cosmetic problems at the same time;
• Innovative treatment methods, in particular using a laser system;
• The most modern diagnostic methods;
• Opportunity to consult with doctors of various specialties.

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

Prevention of psoriasis

The main task of dermatovenerologists is to prevent exacerbation of psoriasis. To this end, they prescribe preventive measures:

• Stress prevention;
• Prevention of colds;
• Control over foci of chronic infection;
• Refusal from 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.