Psoriasis

Psoriasis is a chronic inflammatory disease of a multifactorial nature that affects the skin and nails, and is often accompanied by pathologies of the musculoskeletal system.

If you are concerned about red, dry patches of various 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 medicinal treatment methods (ointments, gels, aerosols, tablets and drug injections) and the proven excimer light treatment using an Italian laser device.

Causes of psoriasis

Doctors name several reasons for the development of psoriasis:

• Genetic predisposition: scientists have described a series of genes, the presence of which predisposes to the onset of the disease;
• Malfunctions of the endocrine, immune and nervous systems;
• Negative effects of some environmental factors.

There are also provoking factors, which include:

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

You should not trust the myth 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: is characterized by an increase in the number of eruptive 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, the itching is almost not annoying;
• Regressive: weakening of the color intensity of the rash, the elements of the rash are pale, new ones do not appear, peeling is not observed, subjective signs are not noted. Pseudoatrophic white 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 at different stages of development on their skin at the same time.

Symptoms of the disease

The dermatovenerologist first pays attention to the presence of the psoriatic triad. These are punctate bleeding, terminal film symptoms, and stearin staining.

When scratching the plaques, a "stearin stain" appears: increased peeling can be observed, and the surface of the papules becomes similar to a drop of crushed stearin.

If the scales are completely removed, you can see the so-called terminal film: a wet, thin, shiny film will appear on the surface.

Localized 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, lesions).

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

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

Plaques in psoriasis 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 flexural surfaces - elbow, knee joints, groin, armpit area, under the breast (this location allows us to speak of inverse psoriasis);
• Lumbar, sacrum;
• Palms and feet – respectively, with palmoplantar psoriasis;
• Nail psoriasis – pitting on the nail plates, subungual hemorrhages, separation of the nail from the nail bed (onycholysis).

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

Types of psoriasis

Dermatologists distinguish several types of diseases:

Vulgar(plaque, ordinary) is the most common and represents 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 plates of different sizes, 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 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 it is injured it starts to get worse).

exudative– occurs more often in patients with endocrine diseases (obesity, diabetes, etc. ). In the lesions there is exudation and yellowish-grey crusts.

teardrop shaped– as the name suggests, numerous papules in the form of bright red droplets are observed on the skin, flaking and infiltrations are minor. It occurs mainly in children and adolescents after streptococcal infectious diseases. In some cases, guttate psoriasis degenerates into ordinary psoriasis.

Seborrheicdiffers in its localization: the elements are located in the folds 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 on the skin of the forehead and a "psoriatic crown" is formed.

Pustular– manifests itself as limited (on the palms of the hands and soles of the feet) 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, fusion of pustules with crusting. The disease often also 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 rapidly, coalesce, and cover larger areas of the skin. In Tsumbusha psoriasis, detachment of the epidermis (upper layer of the skin) occurs and so-called "purulent lakes" are formed. Patients feel 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 flaky elements, and the skin turns red.

Many of our patients complain of fever rising to 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 begun and progresses rapidly.

If psoriatic erythroderma has existed 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 and in some cases begins 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, deformity and limited mobility.

Diagnostics

The main task of diagnosis is to determine the percentage of skin lesions throughout the body. This is necessary to evaluate 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 dermatovenerologist is sufficient. Psoriasis has characteristic manifestations, so visual diagnosis is not difficult.

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

However, there are skin symptoms that should 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 will need to make sure that it is psoriasis and not rheumatoid polyarthritis.

Often psoriasis occurs together with other diseases, so doctors talk about concomitant diseases. For example, psoriasis may be associated with coronary heart disease, diabetes, depression, or gastrointestinal conditions.

If a dermatologist diagnoses psoriasis, she will definitely refer the patient for 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, especially blood tests).

The diagnostic basis of the modern clinic is 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. Diagnostic ultrasound doctors examine patients using advanced ultrasound machines.

In the radiology department, equipped with the most modern medical technologies, it is possible to undergo x-rays and mammography. An MRI or CT scan of any organ can also be performed at the clinic.

Doctors of the functional diagnostics department have the opportunity to conduct all the necessary studies: ECG, EEG, echoencephalography, daily monitoring of ECG, daily monitoring of blood pressure, 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 goal of treatment is to control the disease and bring it into remission (easing or disappearance of symptoms). In the treatment of psoriasis, doctors use several directions at once: drugs (ointments and other dosage forms for external use, as well as tablets for systemic therapy) and excimer light phototherapy.

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 dryness of the skin, moisturizing and emollient creams 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 drugs. These drugs are often given in small doses (once a week) to treat common, hard-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 subsides, the frequency of use of external agents and oral medications decreases.

Note that some drugs have a negative effect on fetal development (for example, selective immunosuppressants), so 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 with unproven effectiveness.

Our doctors urge 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 Dermatovenereology Center offers you an effective method to treat 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 skin inflammation. The thickness of the plaques decreases.

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

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

The dermatovenerologist first identifies indications and contraindications to 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 for the procedure, these include:

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

Why you should pay attention to the treatment of the system 

Dermatovenerologists 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 obtain a stable remission;
• Prescribed to patients of any age (starting from 3 years);
• Treatment with the laser system does not require hospitalisation, it adapts easily to any working schedule;
• Effective for a variety of forms of psoriasis;
• Minimum restrictions.

How is the treatment procedure performed?

At the 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 for an appointment, where the doctor determines the most appropriate test result. That is, the doctor will individually select the radiation power, which is 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 manifests itself after a few procedures, and about 5-10 procedures (in some cases 15) will be needed for a stable remission.

The duration of a procedure varies from 10 to 20 minutes, depending on the area to be treated and the number of areas affected.

Psychological assistance

We always ask you to remember that psoriasis is not contagious! Yet, patients are often worried not so much about the discomfort resulting from 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 consultation with a psychologist or even a psychotherapist.

Benefits of treating psoriasis in a clinic

Patients choose to treat psoriasis for a variety of reasons:

• Experienced and qualified dermatologists and cosmetologists;
• Simultaneous elimination of dermatological and aesthetic problems;
• Innovative treatment methods, in particular through the use of a laser system;
• The most modern diagnostic methods;
• Possibility to consult doctors of various specialties.

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

Prevention of psoriasis

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

• Stress prevention;
• Prevention of colds;
• Control over outbreaks of chronic infection;
• Refusal 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 will spread and fill the skin more and more. A transition to the erythrodermic type is possible, which is much more difficult to treat.