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 dry, red patches of various shapes and sizes on your skin that are scaly and itchy, make an appointment with a dermatologist.

Our doctors treat psoriasis using an integrated approach - using drug treatment methods (ointments, gels, aerosols, tablets and drug injections) and the 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 series of genes whose presence predisposes to the onset of the disease;
• Dysfunctions 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 streptococci);
• Alcohol abuse, chronic alcoholism;
• Climatic conditions (dry or cold weather);
• Skin trauma (scratches, insect bites, sunburn);
• Frequent emotional stress;
• Taking certain medications (e. g. lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
• Abrupt withdrawal of systemic hormonal medications.

Don't trust the myths that dry skin and excessive hygiene can cause psoriasis - it's not true!

Stages of psoriasis

Currently, doctors distinguish 3 stages of the disease:

• Progressive - characterized by an increase in the number of exanthematic elements, fusion of papules and the appearance of new elements in the injured areas. The plates are bright pink and covered in scales. The rate of cell division in new lesions increases 10-fold;
• Stationary – no fresh elements are observed, the plaques are stagnant-red in color, there is practically no peeling, itching is almost not bothersome;
• Regressive - weakening of the intensity of the color of the rash, the elements of the rash become pale, new ones do not appear, there is no peeling, no subjective signs are observed. White pseudoatrophic borders 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 skin elements 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, terminal film symptoms and stearin stain.

A "stearin spot" appears when you scratch the plaques - you may notice increased scaling 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:

• Skin rashes - are always present in one form or another;
• Sensation of tightness in the skin at the site of psoriatic elements;
• Itching of varying intensity.

Plaques in psoriasis appear in several locations, but there are also areas with a typical location:

• 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 location allows us to speak of inverse psoriasis);
• Lumbar, sacral;
• Palms of the hands and feet – respectively, with palmoplantar psoriasis;
• Nail psoriasis – corrosion of 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, there will be pain in the joints, swelling (most often these manifestations are localized in the feet, hands, ankles and knee joints).

Types of psoriasis

Dermatologists distinguish several types of diseases:

Vulgar(plaque, common) is the most common and represents 90% of all cases of psoriasis. With 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 plates of different sizes are formed, covered with silvery scales. In appearance, it resembles a garland or a geographic 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 locations.

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

Exudative– occurs more frequently in patients with endocrine diseases (obesity, diabetes, etc. ). In the lesions there is exudation, in addition to 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 common psoriasis.

Seborrheicdiffers in location - 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 over the skin of the forehead and a "psoriatic crown" is formed.

pustulate– manifests as limited (on the palms of the hands and soles of the feet) or extensive rashes, represented by superficial pustules.

Among the pustular types, Barber's palmoplantar psoriasis also stands out, in which pustules cover the soles of the feet and the palms of the hands. It is characterized by intense itching, fusion of pustules with the formation of crusts. The disease also frequently 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 pain in the areas of the rash. The lesions grow quickly, merge and cover larger areas of the skin. In Tsumbusha psoriasis, the epidermis (upper layer of the skin) detaches and so-called "purulent lakes" form. Patients experience general malaise, are tormented by fever, burning and tingling in the affected areas.

Psoriatic erythroderma

Doctors focus specifically 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, tense, covered with scaly elements and the skin turns 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 inadequate treatment of psoriasis (bathing, very 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 alongside rashes, and in some cases it starts 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.

Diagnosis

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

There is an opinion that to make a diagnosis it is necessary 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 dermatovenereologist 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 spot. Often, patients are bothered by itching of varying degrees of intensity. The presence of psoriasis in family members is also important.

However, there are skin symptoms that must be differentiated 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, an impaction that rises above the level of the skin and is covered with scales.

In the arthropathic form of psoriasis (when there are no rashes), the dermatologist will need to make sure it is psoriasis and not rheumatoid polyarthritis.

Often psoriasis occurs together with other diseases, so doctors talk about comorbid diseases. For example, psoriasis can be associated 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, mainly 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 most modern medical technology, you can undergo x-rays and mammograms. In the clinic you can also do MRI or CT scan of any organ.

Doctors of the functional diagnostics department have the opportunity to carry out all necessary studies: ECG, EEG, echoencephalography, daily ECG monitoring, daily blood pressure monitoring, determination of 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 objective of treatment is to control the disease and put it into remission (weakening or disappearance of symptoms). When treating 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 with excimer light.

External remedies include creams, ointments, gels, emulsions, and sprays containing hormonal medications. Glucocorticosteroids suppress the immune system and relieve inflammation. They are presented in numerous pharmaceutical 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 alleviate the manifestations of psoriasis on the scalp, the use of special shampoos is prescribed.

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

In systemic therapy, doctors prescribe immunosuppressive medications. These medications are often given in small doses (once a week) to treat common, difficult-to-treat 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 slows, the frequency of use of external agents and oral medications decreases.

Please note that some medications have a negative effect on fetal development (for example, selective immunosuppressants), therefore 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 recommend that you do not self-medicate and do not stop (prescribe) several medications, as this can only aggravate the situation and cause an increase in rashes!

Treatment of psoriasis with a laser device 

The Dermatovereology Center offers 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 with xenon-chlorine compounds and emits light in the UV range. Only rays of a certain length penetrate the skin and reduce skin inflammation. The thickness of the plates 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 by plaques. In this way, a stable remission is achieved and, in many cases, treatment with excimer light allows the abandonment of hormonal medications.

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

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 the color of scars;
• Eczema.

There are very few contraindications to the procedure, including:

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

Why you should pay attention to system treatment 

Dermatologists note a number of undeniable advantages of excimer light treatment:

• The effect is local, only on psoriatic plaques, the rays do not reach the entire body;
• In mild cases, it is enough to prescribe only phototherapy and photosensitizers to obtain stable remission;
• Prescribed to patients of any age (from 3 years old);
• Treatment with a laser system does not require hospitalization, 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 perform an examination for you, during which he will determine your skin phototype and determine the minimum dose of ultraviolet radiation.

The next day you come for a consultation, where the doctor determines the most appropriate test result. In other words, the doctor will individually select the radiation power 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 a stable remission, approximately 5 to 10 procedures (in some cases, 15) will be required.

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

Psychological assistance

We always encourage you to remember that psoriasis is not contagious! And yet, patients often worry not so much about the discomfort caused by the presence of rashes, but 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 a psychologist or even a psychotherapist.

Benefits of treating psoriasis in a clinic

Patients choose to treat psoriasis for several reasons:

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

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

Psoriasis prevention

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

• Stress prevention;
• Prevention of colds;
• Control of chronic infection foci;
• Refusal of rough, tight clothing that hurts 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, which is much more difficult to treat, is possible.