Psoriasis — a chronic non-communicable disease, dermatosis, reaching mainly the skin. Usually psoriasis causes an education excessively dry, red, elevated on the skin surface of blemishes. However, some psoriasis patients have no sign of skin lesions.
Caused by psoriasis, patches are called psoriatic plaques. These spots are, by nature, areas of chronic inflammation and excessive proliferation of lymphocytes, macrophages, and keratinocytes of the skin, as well as the excess of angiogenesis (formation of new small capillaries) programmed for the skin layer. The excessive proliferation of keratinocytes in psoriatic plaque and infiltration of the skin by lymphocytes and macrophages rapidly leads to thickening of the skin at sites of injury, his rise on the surface of a healthy skin and for the formation of features pale, gray, or silver, and spots that resemble frozen wax, or wax ("wax lake").
Psoriatic plaque most often appear for the first time at the exposed to friction and pressure local — surfaces of the elbow and knee folds, on the buttocks. However, psoriatic plaque may occur and be placed in any place of the skin, including the skin of the scalp, the surface of the brush, the plantar surface of the stopper, outdoor sex organs. In contrast with the skin in case of eczema, often surprising, and the inner surface of the knee and elbow joints, psoriatic plaque more reside abroad, the extensor surface of the joints.
Psoriasis is a chronic disease, have, usually, the passage of waves, with periods of spontaneous or caused by these or other medicinal impacts of remission or improvement, and periods of spontaneous or provoked by external causes (alcohol consumption, intercurrent infection, stress) of recurrence or exacerbation.
The degree of severity of the disease may vary in different patients, and even in the same patient during periods of remission and exacerbation in a very wide range, from small local lesions for a total of up to cover the entire body psoriatic plaques. Many times there is a tendency to progression of the disease over time (especially when the absence of treatment), the make and the awakening of exacerbations, the increase of the square of defeat, and the engagement of new areas of skin. That some patients can experience a continuous flow, a disease without spontaneous remission, or even a continuous progression. Often, also, they are surprised with the nails in the hands and/or feet (psoriatic onychodystrophy). The defeat of nails can be isolated, observed in the absence of skin lesions. Psoriasis can also cause inflammatory defeat of the joints, called psoriatic arthropathy or psoriatic arthritis. 10% to 15% of patients with psoriasis also suffer psoriatic arthritis.
There is a wide variety of tools and methods for the treatment of psoriasis, but because of the chronic recurrent nature of the disease itself and, many times, observed the tendency to a progression over time, the psoriasis is a quite difficult for treatment of the disease. The complete cure is not possible at the moment (that is, psoriasis is incurable when the current level of development of medical science), but may be more or less long, more or less complete remission (including lifetime). However, always remains the risk of a relapse.
Impaired barrier function of the skin (in particular, the mechanics of detachment or irritation, friction and pressure on the skin, the abuse of soap and cleaning material substances, contact with solvents, household cleaning products, alcohol slurries, the existence of infected lesions in the skin or allergies skin, excessive dryness of the skin) also play a role in the development of psoriasis.
Psoriasis is largely idiosyncratic skin disease. The experience of the majority of the patients, says that psoriasis can, spontaneously, to improve or, on the contrary, to worsen, for no apparent reason. The study of various factors associated with the occurrence, development or worsening of psoriasis, tend to be based on the study of small, usually hospital (not outpatient), that is, noticeably more heavy, the groups of psoriasis patients. Therefore, these studies tend to suffer from a lack of sample coverage and the inability to identify the causal relationship in the presence of a large number of other (including as yet unknown) factors that may affect the nature and flow of psoriasis. Many times, in different studies are detected conflicting findings. However, the first signs of psoriasis often appear after suffering from stress (physical or mental), skin lesions in areas of the first appearance of psoriatic rash and/or migrated streptococcal infections. Conditions, according to several sources, which can contribute to the worsening or deterioration of current of psoriasis include acute and chronic infection, stress, climate change, and the change of seasons. Some medicines, in particular, lithium carbonate, beta-blockers, antidepressants fluoxetine, paroxetine, antimalarial drugs chloroquine, hydroxychloroquine, anticonvulsant, carbamazepine, valproate, according to a number of sources, are associated with the deterioration of the current psoriasis, or may even lead to its main occurrence. The excessive consumption of alcohol, smoking, overweight or obesity, poor diet can make it more heavy during the psoriasis or make it difficult to your treatment, to cause the aggravation. Lacquer for the hair, some creams and lotions for the hands, cosmetics and perfumes, products of the chemical may also cause the worsening of psoriasis in some patients.
Patients who suffer from HIV infection or Aids, frequently suffer from psoriasis. This seems paradoxical to the researchers of psoriasis once the treatment, aiming the reduction of the number of T cells or their activity, in general, contributes to the treatment of psoriasis and HIV infection and / or AIDS is accompanied by a decrease in the number of cells T. however, with the passing of time, when the progression of HIV infection or Aids, the increase in viral load and decrease of circulating CD4+ T cells, psoriasis HIV patients infected or sick of Aids worsens or worsens. In addition, the riddle of being, the HIV infection is typically accompanied by a strong change in cytokine profile in the side Th2, while the psoriasis vulgaris patients not infected is characterized by a strong change in cytokine profile toward Th1. The adopted hypothesis, the reduction of the quantity and pathologically altered activity of CD4+ T-lymphocytes of patients with HIV infection or Aids cause hyperactivation CD8+ T, b lymphocytes, which are responsible for the development or worsening of psoriasis HIV or Aids. However, it is important to know that most of the psoriasis patients, who are healthy in relation to HIV, and HIV infection is responsible for less than 1 % of cases of psoriasis. On the other hand, psoriasis HIV occurs, according to several sources, with a frequency of 1% and 6%, which is approximately 3 times greater than the frequency of occurrence of psoriasis in the general population. Psoriasis in patients with HIV infection and Aids often is extremely difficult, and evil if it provides or does not provide a standard of techniques of therapy.
Psoriasis is more frequently develops in patients with initially dry, thin, sensitive skin, that in patients with oily skin, and is significantly more common in women than in men. Has a patient of psoriasis most commonly appears for the first time in drier areas, or thinner skin, than in areas of oily skin, and, especially, appears many times in local damage to the skin integrity of the integument, including scratching, scuffs, abrasions, scratches, cuts, in areas exposed to friction, pressure, or contact with aggressive chemicals, detergents, solvents (the so-called phenomenon Kebner). It is assumed that this phenomenon lesions of psoriasis, before everything dry, thin, or wound of the skin associated with infection with the fact that the infection (probably, more often than streptococcus) easily penetrates into the skin and with minimal secretion of sebum (which, in other conditions it protects the skin against infections), or in the case of damage to the skin. The most favourable conditions for the development of psoriasis, therefore, contrary to the more favourable conditions for the development of fungal infections of the stop (the so-called "athlete's foot"), or underarms, the groin. For the development of fungal infections are more favourable humid, wet to the skin, for psoriasis, and vice-versa, dry. Penetrated the dry skin infection causes dry chronic inflammation, which, in turn, causes characteristic symptoms for psoriasis, such as itching and increased proliferation of skin cells. This, in turn, leads to further increase the dryness of the skin, as a result of inflammation and enhanced proliferation of keratinocytes, and due to the fact that the infection consumes the moisture, which otherwise, would serve to hydrate the skin. To avoid the excess dryness of the skin and reduce the symptoms of psoriasis, psoriasis patients, it is recommended not to use washcloths and scrubs, especially hard, as they not only damage the skin, leaving microscopic scratches, but and shaved with the upper skin's protective stratum corneum and the sebum, the rate of protecting the skin from dryness and penetration of germs. It is also recommended to use talc powder or a powder after washing or bathing, to soak up the excessive moisture of the skin, which otherwise, the "prize" of an infection. In addition, it is recommended to use moisturizing and nourishing the skin, and lotions, enhance the function of the sebaceous glands. It is not recommended to abuse of soap, detergents. You should take care to avoid skin contact with solvents, tools, household.
It has been shown that psoriasis is able to deteriorate the quality of life of patients, to the same extent that other heavy vehicles, of chronic illnesses, such as depression, suffered a myocardial infarction, heart disease hypertensive, heart failure or type-2 diabetes mellitus. Depending on the severity and location of psoriatic defeats, the patients with psoriasis may experience significant physical and/or psychological discomfort, difficulty in both social and professional, adaptation and even the need of disabilities. Strong itching on the skin or pain can interfere with the perform its vital functions, such as the care of the self, a ride, a dream. Psoriatic platelets exposed parts of the hands or of the feet, can prevent the patient from working in certain jobs, practice some sports, take care of family members, pets or home. Psoriatic plaques on the scalp, many times, represent for the patients special psychological problem and generate distress considerable, and even social phobia, as well as are pale plaques on the scalp can be confused with the surrounding to dandruff or as the result of the presence of lice. It is still a big psychological problem generates the presence of psoriatic rashes on the skin of the person, the wolves ears. The treatment of psoriasis can be expensive and lead the patient has a lot of time and effort to interrupt and/or learning, socialization of the patient, the device personal life.
The psoriasis patients also can be (and often are) are very concerned with their appearance, give a very large value (sometimes even to the point of an obsession of fixing this, almost dysmorphophobia), suffer from low self-esteem, which is related to the fear of public rejection and the rejection or fear of not finding the sexual partner because of problems of probability. Psychological distress in conjunction with the pain, itching and immunopathological impaired (increased production of inflammatory cytokines) can lead to the development of severe depression, a state of anxiety or social phobia, a great social isolation and maladjustment of the patient. It should also be noted that the comorbidity (combination) psoriasis and depression, as well as the psoriasis and social phobia, it is found with greater frequency, even for those patients who do not experience subjective of psychological discomfort of the presence of psoriasis. It seems likely that the genetic factors that influence susceptibility to psoriasis and the predisposition to depression, worrying-compulsive disorder, social phobia largely overlap. It is not impossible also that, in the pathogenesis like psoriasis and depressions play a general role иммatnOPAtlogicheskie and/or endocrine factors (thus, when the depression also detect the elevated levels of inflammatory cytokines, increased qitontonксическatю activity nейрonглии).