psoriasis

Psoriasis is a chronic inflammatory disease of a multifactorial nature that affects the skin and nails and is often associated with pathology of the musculoskeletal system.

If you are concerned about red, dry, flaky, and itchy patches of various shapes and sizes on the skin, make an appointment with a dermatologist.

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

There are also provoking factors, including:

• Chronic infectious diseases (most often caused by streptococci);
• alcohol abuse, chronic alcoholism;
• weather conditions (dry or cold climate);
• trauma to the skin (scratches, insect bites, sunburn);
• Frequent emotional stress;
• Taking certain medications (e. g. lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
• Abrupt discontinuation 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 three stages of the disease:

• Progressive – it is characterized by an increase in the number of rash elements, the fusion of papules and the appearance of new elements in injured areas. The plaques are bright pink and covered in scales. The rate of cell division in new lesions increases tenfold;
• Stationary – no fresh elements are observed, the plaques have a stagnant red color, there is practically no flaking, the 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 edges 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 the same time that are at different stages of development.

Symptoms of the disease

The dermatovenereologist first pays attention to the presence of the psoriasis triad. These are pinpoint hemorrhages, end film symptoms, and stearin spots.

If you scratch the plaques, a "stearin spot" is formed - you can observe increased sloughing, and the surface of the papules resembles a crushed drop of stearin.

When the scales are completely removed, the so-called final film is visible - a wet, thin, shiny film forms on the surface.

Pinpoint bleeding (Auspitz symptom) – visible on the skin when the scales are 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 the type, but there are common features:

• Rashes – they are always present in one form or another;
• Feeling of tension in the skin at the site of psoriatic elements;
• Itching of varying intensity.

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

• The scalp (with this arrangement of plaques we speak of seborrheic psoriasis);
• knees and elbows;
• Skin folds and flexural surfaces – elbows, knee joints, groin, armpit area, under the breast (this localization allows us to speak of inverse psoriasis);
• lumbar spine, sacrum;
• Palms and feet – or in palmoplantar psoriasis;
• Nail psoriasis – pitting of the nail plates, subungual bleeding, detachment of the nail from the nail bed (onycholysis).

In addition to skin symptoms, psoriasis also causes other symptoms. For example, the arthropathic form involves pain in the joints and their swelling (most often these manifestations are localized in the feet, hands, ankle and knee joints).

Types of psoriasis

Dermatologists differentiate between different types of diseases:

Vulgar(Plaque, common) is the most common, accounting 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. In appearance it resembles a garland or a geographical map.

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

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

Exudative– occurs more often in patients with endocrine diseases (obesity, diabetes, etc. ). The lesions produce exudation and yellowish-gray crusts.

teardrop-shaped– As the name suggests, numerous papules in the form of bright red droplets are observed on the skin, flaking and infiltration are minimal. It occurs primarily in children and adolescents after streptococcal infections. 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 area, 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 skin rashes, represented by superficial pustules.

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

Pustules also occur in generalized Tsumbush psoriasis. This type of disease is characterized by bright erythema (redness) and the appearance of superficial pustules. There is burning and pain in the area of the rash. The lesions grow rapidly, merging and covering larger areas of skin. In Tsumbusha psoriasis, the epidermis (upper layer of skin) detaches and so-called "purulent lakes" form. Patients feel a general malaise and are plagued 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 affects all or almost all of the skin. It becomes rough, tight, covered with scaly elements and the skin turns red.

Many of our patients complain of subfebrile fever and malaise. There is an enlargement of the peripheral lymph nodes. Erythroderma can develop as a result of improper treatment of psoriasis (bathing, too intense tanning, high concentration of medicinal ointments, etc. ). In other cases, the process develops in healthy people when psoriasis has just begun and is progressing 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 in parallel with skin rashes, in some cases even beginning earlier and is a harbinger of psoriasis.

The small joints of the feet and hands are particularly affected, but sometimes the hand and ankle joints are also involved in the inflammatory process. Patients are concerned about joint pain, swelling, deformity and limited mobility.

diagnosis

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

There is an opinion that one must undergo a large number of tests to make a diagnosis. However, 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 it is the psoriasis triad: pinpoint bleeding, end film symptoms and stearin spots. Very often patients suffer from varying degrees of itching. The presence of psoriasis in relatives is also important.

However, there are skin symptoms that should be differentiated when diagnosing the disease. For example, a similar picture can be observed in papular syphilis. In this case, the doctor carries out a differential diagnosis, including serological studies.

Sometimes scalp psoriasis is confused with seborrheic dermatitis. In psoriasis, the doctor notices that there is a papule on the skin - a compaction that protrudes above the level of the skin and is covered with scales.

In the arthropathic form of psoriasis (when 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; doctors then speak of comorbid diseases. For example, psoriasis can be combined with coronary heart disease, diabetes, depression or gastrointestinal diseases.

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

The diagnostic basis of a modern clinic is represented by the most modern equipment and devices. This allows you to conduct a comprehensive examination for various diseases.

Laboratory studies are carried out using modern biochemical and hematological analyzers. Ultrasound diagnosticians examine patients using modern ultrasound devices.

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

Doctors of the functional diagnostics department have the opportunity to carry out all the necessary examinations: ECG, EEG, echoencephalography, daily ECG monitoring, daily blood pressure monitoring, determining the function of external respiration and other vital indicators.

The widest range of diagnostic tests offered in our clinic allows doctors to detect diseases at almost any stage of development.

Treatment

The main goal of treatment is to control the disease and put it into remission (reduction 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 reduce inflammation. They are offered in numerous dosage forms; In each individual case, the doctor selects 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.

With systemic therapy, doctors prescribe immunosuppressive medications. These medications are often given in small doses (once a week) to treat difficult-to-treat, common forms of psoriasis. Similar therapies 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 taking external agents and oral medications decreases.

Note that some medications negatively affect fetal development (e. g. , selective immunosuppressants) and are therefore contraindicated in pregnant women.

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

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

Treatment of psoriasis with 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 physiotherapy treatment for psoriasis and some other skin diseases with proven effectiveness.

An excimer lamp works with 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 act on "sick" cells without affecting healthy skin. This therapy reduces the population of T lymphocytes in skin areas covered with plaques. In this way, a stable remission is achieved and treatment with excimer light makes it possible to do without it in many casesto hormonal medications.

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

The dermatovenereologist first determines indications and contraindications for phototherapy treatment with monochromatic excimer light.

Indications include:

• Psoriasis;
• vitiligo;
• Atopic dermatitis;
• patchy hair loss (alopecia);
• change in color of scars;
• Eczema.

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

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

Why you should pay attention to systemic treatment 

Dermatovenereologists point out 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 all ages (from 3 years).
• Treatment with a laser system does not require hospitalization and easily fits into any work schedule;
• Effective in a variety of forms of psoriasis;
• Minimum restrictions.

How does the treatment work?

At your first appointment, the doctor will conduct a test for you to determine your skin type and the minimum dose of ultraviolet radiation.

The next day you will come to an appointment where the doctor will determine the most appropriate test result. This means that the doctor individually selects the radiation output that is specifically suitable for your skin.

There are no restrictions during treatment; You are simply advised to limit spicy and fatty foods and drink plenty of fluids.

The effect of phototherapy occurs after just a few procedures and around 5-10 procedures (in some cases 15) are required for a stable remission.

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

Psychological help

We always want to remind you that psoriasis is not contagious! And yet, patients are often less concerned about the discomfort caused by the presence of rashes than about the reaction of others. This is particularly painful for women and children.

Children can behave cruelly towards 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 a clinic

Patients choose psoriasis treatment for several reasons:

• Experienced, qualified dermatologists and beauticians;
• Simultaneous elimination of both dermatological and cosmetic problems;
• Innovative treatment methods, especially using a laser system;
• State-of-the-art diagnostic methods;
• Opportunity to consult with doctors of various specialties.

If you have concerns about plaques, itching and flaking of the skin, contact the clinic. You can seek qualified medical care at any time.

Prevention of psoriasis

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

• stress prevention;
• prevention of colds;
• control over chronic foci of infection;
• Avoid coarse, tight clothing that hurts the skin.

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