Psoriasis

Psoriasis is a chronic inflammatory disease of a multifactorial nature which affects the skin and nails, and which 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 drug treatment methods (ointments, gels, aerosols, tablets and injections of drugs) 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 number 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, including:

• Chronic infectious diseases (most often caused by streptococcus);
• Alcohol abuse, chronic alcoholism;
• Weather conditions (dry or cold climate);
• Trauma to the skin (scratches, insect bites, sunburn);
• Frequent emotional stress;
• Taking certain medications (for example, lithium salts, adrenergic blockers, oral contraceptives, antimalarials);
• Abrupt discontinuation of systemic hormonal medications.

Don't be fooled by 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 elements of the rash, fusion of papules and the appearance of new elements in the injured areas. The plates are bright pink and covered with scales. The rate of cell division in new lesions increases 10-fold;
• Stationary – no fresh elements are observed, the plaques are of stagnant red color, there is practically no peeling, itching is almost not annoying;
• Regressive - weakening of the intensity of the color 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 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 elements in different stages of development on their skin at the same time.

Symptoms of the disease

The dermatovenerologist first of all pays attention to the presence of the psoriatic triad. These include spot bleeding, terminal film symptoms and stearin stains.

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.

Localized bleeding (Auspitz symptom) - exposed on the skin when tartar is removed.

Dermatologists also point out 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 some commonalities:

• Rashes – these are always present in one form or another;
• Sensation of skin tightness at the site of the psoriatic elements;
• Itching of varying intensity.

Psoriasis plaques appear in various 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 flexor surfaces - elbows, knee joints, groin, armpit area, under the chest (this location allows us to talk about reverse psoriasis);
• Lumbar, sacrum;
• Palms and feet – respectively, affected by palmoplantar psoriasis;
• Nail psoriasis – pitting of nail plates, subungual hemorrhages, separation of nail from 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, ankles and knees).

Types of psoriasis

Dermatologists distinguish several types of diseases:

Vulgar(ordinary plaque) is the most common and accounts for 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 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 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 suggests, numerous papules in the form of bright red droplets are observed on the skin, peeling and infiltration are minor. It mainly occurs in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis progresses into regular psoriasis.

Seborrheicdiffers in localization - the elements are found in the furrows behind the ear and nasolabial, 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 skin rashes, represented by superficial pustules.

Among the pustular types, Barber's palmoplantar psoriasis is also distinguished, in which pustules cover the soles of the feet and palms. It is characterized by severe itching, a 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 pain in the areas of the rash. The lesions grow quickly, coalesce, and cover larger areas of the skin. With Tsumbusha psoriasis, peeling of the epidermis (upper layer of the skin) occurs and "purulent lakes" are formed. Patients feel general malaise, they 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 affects 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 reaching subfebrile levels and malaise. 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 started and progresses rapidly.

If psoriatic erythroderma has been present 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, begins even earlier and is a warning sign of psoriasis.

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

Diagnosis

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

There is an opinion that in order 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 enough. 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 staining. 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 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. With psoriasis, the doctor determines the presence of a papule on the skin, that is, a compaction that rises 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 ensure that it is indeed psoriasis and not rheumatoid arthritis.

Psoriasis often occurs at the same time as other diseases, so doctors refer to it as 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 to a consultation with a gastroenterologist, cardiologist, rheumatologist and endocrinologist. And these specialists will prescribe a thorough examination (for each disease there is a standard list of tests, including blood tests).

The diagnostic basis of a 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 devices.

In the radiology department, equipped with the latest medical technology, you can undergo x-rays and mammograms. At 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 studies: ECG, EEG, echoencephalography, daily ECG monitoring, daily monitoring of blood pressure, 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 all stages 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 (a vitamin D analogue) is also prescribed as a local treatment.

In systemic therapy, doctors prescribe immunosuppressive drugs. These medications are often given in small doses (once a week) to treat common types of psoriasis that are difficult to treat. Similar treatment regimens are 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 glucocorticoids are used very rarely and only in particularly difficult cases.

As the process subsides, the frequency of use of external agents and oral medications moves toward a decrease.

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

No alternative treatment leads to positive results. You should not experiment and entrust your health to traditional healers and methods whose effectiveness has not been proven.

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

Treatment of psoriasis using a laser device 

The Dermatovenerology Center offers you an effective method of treating the disease using an excimer laser system. It is the main physiotherapeutic treatment for psoriasis and certain other skin diseases whose effectiveness has been proven.

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 skin inflammation. The thickness of the plates decreases.

The rays only affect "diseased" cells without affecting healthy skin. This therapy reduces the T cell population in areas of the skin covered in plaques. In this way, a stable remission is achieved and, in many cases, excimer light treatment makes it possible to abandon hormonal drugs.

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

The dermatovenerologist first identifies the 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 to the procedure, including:

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

Why should you pay attention to system processing 

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

• The effect is local, only on psoriatic plaques, the rays do not affect the whole body;
• In mild cases, it is sufficient to prescribe only phototherapy and photosensitizers to achieve stable remission;
• Prescribed to patients of all ages (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?

During your first appointment, the doctor will carry out 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 to an appointment where the doctor determines the most appropriate test result. That is, the doctor will individually select the radiation power that is specifically suitable 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 only a few procedures, and for stable remission you will need about 5-10 procedures (in some cases 15).

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

Psychological assistance

We always encourage you to remember that psoriasis is not contagious! And yet, patients are often less worried about the discomfort caused by the presence of rashes than about the reaction of others. It is particularly 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 in-clinic psoriasis treatment

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, in particular using a laser system;
• The most modern diagnostic methods;
• Possibility of consulting doctors of various specialties.

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

Psoriasis prevention

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

• Stress prevention;
• Cold prevention;
• Control of chronic infection foci;
• Refusal of rough and tight clothing that hurts the skin.

Through preventive measures and timely treatment of psoriasis, doctors are able to quickly reduce the severity of the disease and make many symptoms of the disease disappear.

What happens if the disease is not treated?

If left untreated, the rash will spread and fill more and more skin. A transition to the erythrodermic type is possible, much more difficult to treat.