Psoriasis

Psoriasis is a multifactorial, chronic inflammatory disease 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 different 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 drug treatment methods (ointments, gels, aerosols, tablets and medicated injections) and the well-proven excimer light, Italian laser device.

Causes of psoriasis

Doctors name several reasons for the development of psoriasis:

• Genetic predisposition - scientists have described many genes, the presence of which predisposes to the development of the disease;
• Dysfunctions of the endocrine, immune and nervous systems;
• Negative effects of certain environmental factors.

There are also provoking factors such as:

• Chronic infectious diseases (most often caused by streptococcus);
• Alcoholism, chronic alcoholism;
• Weather conditions (dry or cold climate);
• Traumatizing the skin (scratches, insect bites, sunburn);
• Frequent emotional stress;
• taking certain medications (such as lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
• Abrupt withdrawal of systemic hormonal drugs.

Don't 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 - it is characterized by an increase in the number of rash elements, the merging of papules and the appearance of new elements in the damaged areas. The plaques are bright pink and covered with scales. The rate of cell division of new lesions increases 10-fold;
• Stationary - fresh elements are not observed, the 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 detected. White pseudoatrophic rims form around the plaques, and healthy skin appears in the middle of the large plaques. Colorless spots remain at the site of the rash.

In some cases, the skin of patients has elements in different stages of development at the same time.

Symptoms of the disease

First of all, the dermatovenerologist pays attention to the presence of the psoriasis triad. These are pinpoint bleeding, terminal film symptoms, and stearin stain.

When the plaques are scratched, a "stearin spot" appears - increased peeling is observed, and the surface of the papules resembles a crushed drop of stearin.

The so-called terminal film is visible when the scales are completely removed - a wet, thin, shiny film appears on the surface.

Pinpoint bleeding (Auspitz's sign) - visible on the skin when the scale is removed.

Dermatologists also highlight the Koebner phenomenon - the appearance of rashes caused by psoriasis at the site of skin damage (scratches, injuries).

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

• Rashes - always present in one form or another;
• A feeling of skin tension at the site of psoriatic elements;
• Itching of varying intensity.

The plaques that form in psoriasis appear in many places, but there are also areas with typical localization:

• The scalp (with this arrangement of plaques, we are talking about seborrheic psoriasis);
• Knee and elbow;
• Skin folds and bending 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 palmar-plantar psoriasis;
• Nail psoriasis - rash on the nail plates, subungual bleeding, separation of the nail from the nail bed (onycholysis).

Psoriasis causes other symptoms in addition to skin manifestations. For example, in an arthropathic form, this will be joint pain and swelling (most often these manifestations are localized on the legs, hands, ankle and knee joints).

Types of psoriasis

Dermatologists distinguish several diseases:

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

They tend to coalesce and form plaques of various sizes covered with silvery scales. In its appearance, it resembles a garland or a geographical map.

Psoriatic elements are mainly found on the scalp, the extensor surface of the elbows and knees, the skin of the waist and the 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 if it is damaged, it will get worse).

Exudative- occurs more often in patients with endocrine diseases (obesity, diabetes, etc. ). The lesions have exudate and a yellowish-gray crust.

teardrop shaped– as the name suggests, numerous papules appearing in the form of bright red drops can be observed on the skin, with little exfoliation and infiltration. It mainly occurs in children and adolescents after infectious diseases caused by streptococcus. In some cases, guttate psoriasis degenerates into regular psoriasis.

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

Pustular- manifested as limited (on the palms and soles) or extensive rashes represented by superficial pustules.

Barber palmoplantar psoriasis is also distinguished from pustular tups, in which pustules cover the soles and palms. It is characterized by severe itching, coalescence of pustules and formation of a crust. The disease often affects the nails as well.

Pustules can also be found in generalized Tsumbusch psoriasis. This type of disease is characterized by the appearance of bright erythema (redness) and superficial pustules. There is a burning sensation and pain in the area of the rash. Lesions grow quickly, merge and cover a larger area of skin. In the case of Tsumbusha psoriasis, the epidermis (the top layer of the skin) detaches and so-called "purulent lakes" are formed. Patients experience a general malaise, fever, burning sensation, 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 affects all or almost all of the skin. It will be rough, covered with tight, flaky elements, and the skin will be red.

Many of our patients complain of fever rising to a subfebrile level and malaise. The number of peripheral lymph nodes increases. Erythroderma can develop due to improper treatment of psoriasis (bathing, too intense tanning beds, highly concentrated medicated ointments, etc. ). In other cases, the process develops in healthy people when psoriasis has just started and is progressing quickly.

If erythroderma psoriatic 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 simultaneously with the rash, and sometimes it starts even earlier, and is a precursor to psoriasis.

Small joints of the feet and hands are mainly affected, but sometimes the joints of the wrists and ankles are also affected in the inflammatory process. Patients are concerned about joint pain, swelling, deformation and limited movement.

Diagnostics

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

There is an opinion that in order 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 skin rash by a dermatovenerologist is sufficient. Psoriasis has characteristic manifestations, so visual diagnosis is not difficult.

In typical cases, this is a psoriatic triad: pinpoint bleeding, terminal film symptoms, and stearin spot. Very often, patients are bothered by itching of varying intensity. The presence of psoriasis in relatives is also important.

However, there are skin symptoms that must be distinguished when diagnosing the disease. For example, a similar picture can be observed in the case of papular syphilis. In this case, the doctor performs a differential diagnosis, including serological tests.

Psoriasis of the scalp is sometimes confused with seborrheic dermatitis. In psoriasis, the doctor determines that there is a papule on the skin - that is, a lump covered with scales rising above the skin level.

In the arthropathic form of psoriasis (if there are no skin rashes), the dermatologist must make sure that it is psoriasis and not rheumatoid polyarthritis.

Psoriasis often occurs together with other diseases, in which case doctors talk about co-morbidities. For example, psoriasis can be combined with coronary heart disease, diabetes, depression or gastrointestinal pathologies.

If the dermatologist diagnoses psoriasis, he will certainly refer the patient to a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And these specialists prescribe an extensive examination (there is a standard list of tests for each disease, especially a blood test).

The diagnostic base of the modern clinic is the most modern tools and equipment. This allows a comprehensive examination of various diseases.

Laboratory tests are performed with modern biochemical and hematological analyzers. Ultrasound diagnostic doctors examine patients with advanced ultrasound machines.

X-ray and mammography examinations can be performed in the radiology department equipped with the latest medical technology. At the clinic, you can have an MRI or CT scan of any organ.

The doctors of the functional diagnostic department have the opportunity to perform all the necessary tests: ECG, EEG, echoencephalography, daily ECG monitoring, daily blood pressure monitoring, 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 to control the disease and put it into remission (weakening or disappearance of symptoms). In the treatment of psoriasis, doctors use several directions at the same time: medicines (ointments and other medicinal forms for external use, as well as tablets for systemic therapy) and light therapy with excimer light.

External remedies include creams, ointments, gels, emulsions, sprays containing hormonal drugs. Glucocorticosteroids suppress the immune system and reduce inflammation. They appear in several dosage forms, in each case the doctor selects an individual treatment regimen.

Moisturizers and emollients are used to reduce itching and dry skin.

The use of special shampoos is prescribed to alleviate the manifestations of psoriasis on the scalp.

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

During systemic therapy, doctors prescribe immunosuppressive drugs. These drugs are often given in small doses (once a week) to treat common types of psoriasis that are difficult to treat. A similar regimen is used in patients with rheumatoid arthritis. Administration 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 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 the development of the fetus (for example, selective immunosuppressants), so it is contraindicated in pregnant women.

No alternative treatment leads to positive results. You should not experiment and entrust your health to traditional healers and unproven effective methods.

Our doctors ask you not to self-medicate and not to stop (prescribe) various medicines for yourself, because this can only make the situation worse and cause the rash to increase!

Treatment of psoriasis with a laser device 

The Dermatovenereological Center offers an effective method of treating the disease with an excimer laser system. This is the main physiotherapy treatment for psoriasis and some other skin diseases, which is proven to be effective.

The excimer lamp works with xenon-chlorine compounds and emits light in the UV range. Only certain lengths of rays penetrate the skin and reduce skin inflammation. The thickness of the plaques decreases.

The rays only affect the "diseased" cells, not the healthy skin. This therapy reduces the population of T-lymphocytes in the skin areas covered with plaques. In this way, a 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 exacerbations cause to patients with psoriasis.

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

The indications are:

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

The procedure has very few contraindications, these are as follows:

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

Why you should pay attention to system management 

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

• The effect is local, only in the case of psoriatic plaques, the rays do not affect the whole body;
• In mild cases, it is enough to prescribe only light therapy and photosensitizers to achieve a stable remission;
• Prescribed for patients of any age (from 3 years);
• The treatment with the laser system does not require a hospital stay, it easily fits into any work schedule;
• It is effective for various forms of psoriasis;
• Minimal restrictions.

How is the treatment procedure carried out?

During the first meeting, the doctor will perform an examination on you, during which he will determine the phototype of the skin and determine the minimum dose of ultraviolet radiation.

The next day, you will have an appointment, where the doctor will determine the most appropriate test result. In other words, the doctor individually selects the radiation power that is specifically suitable for your skin.

There are no restrictions during the treatment, it is only advised to limit the consumption of spicy and fatty foods and to drink plenty of fluids.

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

The duration of a procedure is 10-20 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! Despite this, patients are often not so much worried about the discomfort caused by the presence of rashes as about the reactions 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 time, including consultation with a psychologist or even a psychotherapist.

Benefits of treating psoriasis in the clinic

Patients choose psoriasis treatment for a number of reasons:

• Experienced, qualified dermatologists and beauticians;
• Simultaneous elimination of dermatological and cosmetic problems;
• Application of innovative treatment methods, especially a 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 receive qualified medical care.

Psoriasis prevention

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

• 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 spreads and fills more and more of the skin. It is possible to change to the erythrodermic type, which is much more difficult to treat.