Psoriasis

Psoriasis is a chronic skin disease that affects the skin. Logos, joints.

Etiology, pathogenesis are unknown. The most common are the viral, hereditary, neurogenic, metabolic theories of the origin of psoriasis, none of which is generally accepted. Apparently, the disease has a multifactorial nature. In pathogenesis, a certain role is assigned to immunological, enzymatic and other biochemical disorders. The disease is observed at any age, non-contagious.

The clinical picture in typical cases is characterized by the appearance of a monomorphic papupemic rash, located mainly on the unbending surfaces of the extremities (especially on the elbows and knees), the trunk, the scalp. Sharply delimited papules from 2-3 mm to 1-2 cm in diameter, pinkish-red in rounded outlines, protrude somewhat above the surface of the skin, covered with silver-white scales. When the papules are scraped, three diagnostic phenomena are revealed: 1) stearin stain (scales, like stearin, easily fall off the surface of papules); 2) terminal film (after removing the scales, a reddish wet shiny surface is exposed); 3) bloody dew (on a smooth, damp red surface, there is pinpoint bleeding). Papules have a pronounced tendency to eccentric growth, which leads to the formation of plaques that merge in turn into continuous lesions with uneven outlines. With the progression of the process around the papules, a bright red rim appears, devoid of scales, the number of new rashes increases; The Kebner phenomenon (isomorphic reaction) is positive; Subjectively itching. When the process is regressed, the intensity of the color, the resorption of the rashes, the appearance of Voronov's rim are characteristic. Plaque dissolution usually starts from the central part, as a result of which the psoriatic elements become ring-shaped or garlandlike. On the ground, there is temporary depigmentation (pseudo-icoderma). In periods of incomplete remissions in individual areas of the skin (more often in the area of ​​the elbows, knee joints) can remain single "on duty" plaques.

Depending on the clinical features, several varieties of psoriasis are distinguished.

Exudative psoriasis often develops in patients with diabetes mellitus and has a pronounced puffiness and brightness of psoriatic papules, the formation of yellow-colored scaly crusts on their surface due to impregnation with their exudate.

The most severe varieties of psoriasis are psoriatic erythroderma and arthropathic psoriasis.

In psoriatic erythroderma, the entire (or almost all) skin is involved in the pathological process. The skin becomes stiffened, coarse, infiltrated, red, with abundant coarse and fine-lamellar desquamation on the surface. The peripheral lymph nodes increase, subfebrile temperature appears, the general condition of patients is disrupted, changes in blood (leukocytosis, elevated ESR), urine (proteinuria) are observed. The development of erythroderma is promoted by irrational, irritating therapy in the progressing stage of psoriasis.

Arthropathic psoriasis is characterized by the lesion of predominantly small joints of hands and feet, less often wrist, ankle, intervertebral, etc., accompanied by sharp pain and swelling of the joints, restriction of their mobility and deformities. X-ray reveals lysis of the distal phalanges of the fingers and joint changes, similar to rheumatoid arthritis. The reaction of Baalera-Rose and the latex test are usually negative. In the blood, leukocytosis, increased ESR, hypergammaglobulinemia. Defeat of the joints can be combined with a skin lesion or be isolated for a number of years.

With all these forms of psoriasis, it is possible to damage the nails in the form of a torn nail plate ("thimble" phenomenon), their opacification or thickening up to onychriphysis. The course of the disease is chronic wavy. Usually expressed seasonality of the process - deterioration in the winter with a significant improvement in summer (winter type), less often - on the contrary (summer type).

With a typical clinical picture of psoriasis, his diagnosis is not difficult. A psoriatic triad (a symptom of stearin stain, terminal film, pinpoint bleeding) is characteristic. Differential diagnosis is performed with papular syphilis, distinguished by copper-red hues, density and great depth of occurrence, absence of a pronounced tendency to peripheral growth and psoriatic triad, as well as the presence of other clinical signs of syphilis and positive serological reactions. Known difficulties are the differential diagnosis of arthropathic psoriasis with rheumatoid polyarthritis, especially in the absence of skin rashes. Correct diagnosis can be facilitated by indications of the presence of psoriasis in relatives, the absence of a rheumatoid factor in the blood and the lesion of large joints.

Treatment. Diet with restriction of animal fats and carbohydrates, exclusion of spicy dishes, alcohol. In the progressing stage of psoriasis, antihistamines (suprastin, tavegil, phencarol) and hyposensitizing drugs (gluconate and calcium chloride, sodium hyposulphite, magnesium sulfate in injections), vitamins (B6, B12, A, C), cocarbocose-silase, sedatives Bromine, valerian, elenium, etc.). Outer cream of Unna, 2% salicylic ointment, on separate sites - "Flucinar", "Fluorocort," "Lorinden-A" and other corticosteroid ointments. In the stationary stage, especially in the torpid current, auto-therapy, pyrogenal, injection of staphylococcal anatoxin or antifagin (in the presence of foci of chronic infection), ultraviolet irradiation are shown. Externally: keratoplastic ointments: 5-10% ichthyol, 2-5% sulfur-tar, 10-20% naphthalan with addition of corticosteroids. Resort treatment is shown - hydrogen sulphide and radon sources (Matsesta, Tskhaltubo, etc.), sun baths and sea bathing. In severe forms of psoriasis, corticosteroid hormones are used, cytotoxic immunosuppressants (biosupressin, methotrexate, etc.). In recent years, photochemotherapy, hemosorption, plasmapheresis has been widely used to treat psoriasis.

Prevention. Patients should be under dispensary supervision and receive maintenance therapy in the winter and early spring time.