- a prevalence of significant;
- the unpredictability, Novitatis and inconsistency of the chain;
- the emergence of the first clinical signs, predominantly, at a young age;
- the increased incidence in the last 10 to 15 years, among young people;
- an increase of one per cent, in the severe forms of the disease, followed by severe psychological disorders, and sleep disorders;
- the deterioration of the quality of life of patients;
- the difficulty of the treatment;
a significant increase in the number of patients with loss of working capacity, such as by больничным sheets, and in connection with disability, especially among young males.
According to several sources the disease is registered with 2-7% of the population of the Earth. In the structure of diseases of the skin: psoriasis is 3-5%, and among patients in dermatological hospitals — up to 25%.
These data, for some reason, are incomplete: the difficulty of identification of severe forms, such as, for example, the psoriatic arthritis, the rare negotiability in medical institutions for patients with milder forms and др.
The causes of psoriasis and its pathogenesis
Despite the advantage, the local skin manifestations in most forms of the disease, for their own reasons and the nature of disturbances in the organism, the disease takes is systemic in nature.
In the course of a disease involved joints, blood vessels, kidneys, liver. There is also higher risk of diabetes, obesity and hypertension in individuals with psoriasis, especially in women.
Has 20 to 30% of patients later developed the syndrome of metabolic disorders with a high content of triglycerides in blood, obesity, especially in the region of the belly, psoriatic arthritis.
Also recently, unveiled a series of biological markers, pointing to the direct connection of psoriasis with Crohn's disease, rheumatoid arthritis, cardiovascular diseases, angina pectoris and mortality due to myocardial infarction.
For these and other reasons, a growing number of researchers leans to the administrator of the system for definition Dermatosis as "psoriatic disease", not just "psoriasis".</1_img>
It is transmitted psoriasis for inheritance?
Despite the existence of a large number of hypotheses and studies carried out by now, continues to be a difficult the answer to the question about what is transmitted psoriasis by inheritance. However, it is generally accepted that the disease is genetically deterministic. In the absence of disease both parents, it is only 4.7% of the children. When the disease of one of the parents of the risk of disease of the child increases to 15-17%, both parents — 41%.
The beginning of psoriatic disease may be, at any age, but in most cases, the peak observed in years 16-25 years (psoriasis type I) and 50 to 60 years (psoriasis type II). When the psoriasis, I-type are crawled more frequently the character of inheritance of the disease, joint injuries, and the prevalence of various eruptions. II type of disease has the most favorable.
The mechanism of development (pathogenesis)
The main link in the pathogenesis (mechanism of development) of the disease, leading to the appearance of rashes in the skin, and increased mitotic (cell division) activity and accelerated proliferation (expansion) epidermalibus of cells. As a consequence, the cells of the epidermis, are unable to orogovet, pushed by the cells in the underlying layers of the skin. This phenomenon is accompanied by an excess of bark and called Hyperkeratose.
It is contagious and if psoriasis?
There is free communication and contact with the sick person, meaning you can get? All the studies related with this disease, belie this hypothesis. The disease is not transmitted to other people, nor is it air-borne, or as a result of direct contact.
The implementation of a genetic predisposition to the disease (according to the theory of the genetics of psoriasis) it is possible, in the case of disorder of the regulatory mechanisms of the following systems:
mentis.Psychic instability contributes to disturbances of the function of the autonomic nervous system. The last is one of the reflexes of links in the application of certain emotional factors effect through an alpha-and beta-receptors on the vascular system of the skin and, thus, in his general state.
Psychic травматизация plays a (if not the main) is the function of a mechanism for the development of the disease, as well as the frequency and duration of a relapse. At the same time, the own дерматоз cause disturbances in the functional state of the psyche. Endocrine.
psoriatic diseaseit is the manifestation of violation of mechanisms of adaptation, the main role of the endocrine glands (hypothalamus, pituitary, adrenal glands), held that it is done not only declinare, (through the blood), but also with the participation of the nervous system. For the adaptation of the body of the hypothalamic-pituitary-надпочечниковая system of the first league (in response to the impact of environmental change, and extreme accentus factors) with the help of increase or reduce the allocation of hormones resulting changes the cellular metabolism. </2_img>
Immune. The implementation mechanism of a genetic predisposition to PSORIASIS, with the participation of the immune system occurs through genes that control the immune response cell-mediated and immune interaction of cells among themselves system (HLA). The immune system when psoriasis also changed, or genetically, or under the influence of internal or external factors, that proves the violation of all links in the skin of immune regulation.
Genetically deterministic violation of cellular metabolism lead to an accelerated growth and the swelling of the immature cells of the epidermis, which leads to the release of biologically active substances (БАВ) lymphocytes, immature, and skin cells, activated keratinocytes and macrophages. The latter are mediatores, inflammation and immune response.
These substances are protease, protein information molecules, called цитокинами (tumor necrosis factor, the interleukins, the interferons, different subtypes of lymphocytes), polyamines (hydrocarbon radical). Neurotransmitters, in turn, stimulate the growth of defective cells of the epidermis, the shift of the wall of small vessels and the occurrence of inflammation.
The whole process is accompanied by accumulation in the epidermis and сосочковом layer of the dermis with a and multicellular white blood cells. Predisposing the patient and triggers The key pathological manifestation of psoriasis is the excessive expansion of defective cells of the epidermis. Therefore, the fundamental point in the clarification of the mechanism for the development of the disease and decide about how to treat psoriasis, is the establishment of pills factors. The main of them:
Psychological— the short-term impact of strong tensions, and also невыраженных, but the prolonged time or with frequency of repetition of negative psychological influences, moral dissatisfaction, sleep disturbances, depressive state.
The rates of disorders in the body, disorders of function of digestive organs, especially the liver and внешнесекреторной the functions of the pancreas. Disease or dysfunction of the glands of internal secretion (hypothalamus, thyroid, parathyroid and tissue-glands of the endocrine activity of the pancreas). Disorders of the immune system (allergichekie reaction and diseases of the immune).
The existence in the body of chronic foci of infection (tonsillitis, rhinosinusitis, inflammationibus profuere and др.). Pathogens and probation pathogens, especially staphylococcus aureus, streptococci and fermentum fungi, their toxins, the skin cells damaged by these microorganisms, are powerful antigens capable of causing the immune system to aggression against them, changed, and healthy cells of the body.
Mechanical and chemical damage to the skin, the prolonged intake of antibiotics or glucocorticoids about any diseases, giperinsolyatsiya, smoking and alcohol abuse, in infectious diseases (respiratoriorum-the virus infection, the flu, sore throat and др.).
The symptoms and types of psoriasisRoutine clinical classification of psoriatic disease does not exist, however, traditionally, highlight common clinical form. They, in some cases, are so different from each other, what they consider as the individual of the disease.
In the development of the disease, there are three stages:
The process of progression, in which the precipitation of a value of up to 1-2 mm appear in a large number of new stretches. Later, they turn into the typical psoriatic of the plate.
Fixed phase— the lack of appearance of "fresh" elements, save the size and appearance of the plaques, completely covered in exfoliant of the epidermis.
The phase of regression— reduction and flattening plates, to reduce the manifestations of peel and the disappearance of items, resorption, which begins in the heart. After its complete disappearance, usually, remain the foci of depigmentation.
Psoriasis vulgaris(common, ordinary) It manifests monographia (homogeneous) eruptionibus in the form of plaques or papules — nodules, reddish or pink color, towering above the surface of the skin. Papules clearly demarcated healthy phases and covered with statera to a fraudulent silver-white color. The value of its diameter may be from 1 to 3 mm up to 20 mm or more. They lie, three phenomena that occur after the poskablivanii its surface: </3_img>
the symptom of "stearin spot" — to strengthen the shell, after a slight poskablivanii, causing the surface papules acquires the similarity with a drop of oppressi стеарина; this is explained parakeratosis (thickened skin), Hyperkeratose (thickening of the horny layer of the skin, т. е. напластование scales), the accumulation of fats and sicut crassus, components of the outer layers of the epidermis; the symptom of the "terminal film" — in the area of the scales appears the mucus epidermal layer in the form of thin, velvety, shiny, moist surface; the symptom of a "dew", or the phenomenon of Auspittsa-Polotebnova — no mingling between them the drops of blood in the form of dew, which act on the shiny surface, after a slight their poskablivanii; this is explained травмированием plenus sanguinis, skin papillae.
The preferred location of the rash are pellis part of the head, the layout in extensoris indicis surfaces in areas of large joints — knee, elbow. The location of the plates can prolonged time, limited only to these areas. This are called "сторожевыми", or "officium". Rarely are surprised with the nails, the skin in the area of other joints, genitals, face, soles of feet and palms of the hands, large folds.
Another characteristic symptom — the occurrence of psoriatic eruptions in areas of mechanical or chemical injuries of the skin (the phenomenon Kebnera). Such injuries can be scalpendi, cuts, irritation, chemical acids or alkalis.Depending on the location of elements, and a clinical course, psoriasis vulgaris divided into several types:
- Ладонно-quadratus plantae.
- Psoriasis of the nails.
Dermatitis psoriasis.It occurs on skin areas with many sebaceous glands — on the forehead, on the scalp, in the BTE of the area, in the areas of facial folds (носогубных and nososchechnyh), between the scapulae and in the departments of the front surface of the chest.
If on the face, back and chest rash has the character of the papules of red color, which are covered squamea convolvens large slices of silver-white color, for ушными sinks like a rash for seborrheic dermatitis, complicated to join the infection.
The surface of the seborrheic spots and papules by ушными sinks more shiny and edematous, in comparison with the other areas. It is covered in statera slight yellowish-white or gray-white coloring and serosum vehentem-purulent crust (due to macerari), which is tight against the skin. Almost always a skin rash accompanied by itching sharp.