Author of the article: Liliya Sentsova Dermatologist of the highest category. Work experience - 17 years. One of the leading specialists of the Ryazan Regional Clinical Dermatovenerological Dispensary.
October 19, 2018
2569
6
Anyone can experience the initial signs of psoriasis. The disease, according to experts, can have a variety of causes and provoking factors for its occurrence - from a severe stressful situation to dietary disorders. Therefore, not every person can promptly recognize and correlate a suddenly formed pink spot with scales on its surface with psoriasis at an early stage. You can't do it without the help of a specialist. Timely treatment and subsequent implementation of all the doctor’s instructions are the key to a quick recovery.
Causes of rashes
Psoriasis is a dermatosis that is accompanied by the appearance of typical papular-desquamous (or tuberculate-scaly) elements on the skin. They are called plaques. In fact, these are red papules that rise above the surface of the skin.
They progress according to the same principle, but may have different appearances.
Characteristics of rashes
Psoriasis rashes begin to progress in the same way. Due to the action of T-lymphocytes in combination with metabolic disorders and endocrinological disorders (not always), the first conglomerates of keratinocytes appear.
First, single pink or red papules appear. They rise above the surface of the skin by 1–3 mm. Often covered with silvery scales. Because of this, the second name for psoriasis is lichen planus.
Some scientists admit that the formation of plaques is the result of a modified protective reaction. By growing new layers of skin at the expense of papules, the body tries in this primitive way to isolate itself from negative environmental factors.
The features of psoriatic rashes are highlighted, which help in the differential diagnosis of psoriasis with other dermatological diseases:
- Stages of progression of pathological elements. The stages of their development will be discussed below.
- Merger trend. If left untreated, papules grow over time and unite into entire “paraffin lakes” or “islands”.
- Concentric growth.
- Evenness of the edges of the skin element. This feature is optional. In some forms of psoriasis, fuzzy and ragged boundaries of the rash appear.
- Itching. An unpleasant symptom occurs in 50% of patients with typical plaques.
It is important to note that rashes during psoriasis rarely develop as a generalized process. More often, one papule appears, then several, which over time (if left untreated) spread further throughout the skin.
The simultaneous progression of a large number of plaques at once indicates the severity of the disease and the weakening of the patient’s body.
Kinds
There are several approaches to grading pathology. The most commonly used method is based on dividing psoriasis according to the form of its occurrence.
So, the disease happens:
- Pustular.
- Non-pustular.
In turn, each of these forms is divided into several types.
Pustular psoriasis is classified as:
- Generalized. Skin rashes cover almost the entire surface of the body. Treatment of the pathology is difficult.
- Palmoplantar. Skin changes are observed on the soles of the feet and palms. Timely treatment is required, otherwise the localization of the pathology will subsequently spread to other parts of the body.
- Psoriasis occurs as annular centrifugal erythema.
The non-pustular form includes:
- Ordinary psoriasis, characterized by the appearance of plaques on the skin. It occurs in almost 90% of patients. The plaques appear primarily on the elbows and knees, but they are also common on other parts of the body, including the face. Over time, these formations merge with each other, occupying a large area. In some cases, such psoriasis develops into generalized psoriasis.
- Psoriatic arthritis.
There are other types of psoriasis that are not included in the main classification.
Factors that provoke the appearance of plaques
In addition to the above causes of psoriasis, there are a number of factors that can become a trigger (provocateur) for the progression of rashes. They are optional, that is, optional, and do not always lead to the formation of pathology, but increase the risk of its occurrence.
The more factors simultaneously affecting a person, the higher the chance of psoriasis, rashes and other typical symptoms of the disease. If the first signs occur, you should immediately consult a doctor for help.
Triad of symptoms
The disease is not very common. Globally, 2–5% of people suffer from psoriasis. The number of patients is growing every year. Therefore, it is important to diagnose the pathology in time and begin treatment.
In addition to the above features of the rashes, they have three classic symptoms that help doctors make a diagnosis:
- The “stearin stain” phenomenon. After removing the outer scales, a peculiar stain appears underneath them, which resembles paraffin. It is formed due to the accumulation of air in the scratched area due to changes in lipid synthesis.
- The phenomenon of “terminal film”. With further scraping of the contents of the plaque, a shiny surface appears. It resembles polyethylene. This is the last element that can be removed from the skin.
- The phenomenon of "blood dew". With further scratching of the plaques, multiple droplets of blood appear. They progress due to damage to microvessels located in the affected area.
Similar symptoms are typical only for psoriasis.
These signs help distinguish psoriasis from a number of other dermatoses. It is necessary to clarify that scraping is carried out with a blunt scalpel or the back of a knife, as well as with a glass slide. The nail is not suitable for this purpose.
What changes on the mucous membrane
Psoriasis on the mucous membranes of the body occurs simultaneously with the course of psoriasis as a whole. A rash with psoriasis on the mucous membrane usually affects the inner parts of the cheeks, tongue, and mucous membranes of the genitals. The conclusion of the acute course of the disease is accompanied by the extinction of the rash on the mucous membrane.
The affected mucous membrane of the lips has a pinkish tint, is prone to peeling, and exhibits a burning sensation.
In the oral cavity, the psoriatic lesion forms a noticeable border with a layer of white-grayish scales, which are rejected when they are lightly scraped off. Speaking about the rash affecting the oral cavity, we can confidently say about pustular lesions of the mouth. Such lesions cause swelling of the mucous membrane, its suppuration and the formation of ulcers.
Knowing the features of this very delicate disease, you can distinguish it from other dermatological pathologies and begin treatment in a timely manner.
Stages of rashes
Rashes during psoriasis have a standard stage of development. This fact also helps to distinguish dermatosis from other human skin diseases. Psoriasis progresses in waves. Much depends on the time of year.
There are three stages in the development of psoriasis:
- Progressive.
- Stationary.
- Regressive.
Each phase has its own characteristics in relation to rashes and the intensity of the pathological process. Depending on this, the approach to treating the patient differs. Below we will discuss the characteristic nuances of each of them.
Progression phase
The initial period of psoriasis development. It starts more often after severe stress, illness, etc. Features of the period:
- Constant appearance of new rashes. The intensity of their progression depends on the severity of the process, the individual characteristics of the body and the treatment performed.
- Increase in size of old elements (if any). Concentric growth of plaques occurs. They merge into “stearic lakes” and “islands”, capturing more and more areas of the skin.
- Positive Koebner's sign. Its essence lies in the formation of rashes on healthy skin after mechanical damage. Therefore, during the progression phase, doctors recommend that patients avoid any irritating factors.
- Peeling plaques. The rashes are covered with silvery scales, which gradually peel off. The exception is papules in the growth zone. There, keratinocytes have not yet had time to acquire scales and are distinguished by bright, inflammatory edges.
- The presence of a triad of symptoms characteristic of all psoriasis rashes.
With intensive initiation of treatment, it is easy to stop progression. Due to this, it will be possible to prevent the spread of pathological elements to new areas of the body. The main thing is to see a doctor in time.
Stabilization phase
Over time, typical rashes stop growing for a while. This is due to both the natural course of the disease and well-chosen treatment. Next comes the stationary stage, which is characterized by the following features:
- The progression of new rashes stops - they do not appear.
- Old pathological elements stop concentric growth.
- Koebner's symptom becomes negative. Damage to healthy areas of the skin does not lead to the emergence of new pathological elements.
- Peeling and itching subside. They do not disappear, but they disturb the patient less.
- Formation of pseudoatrophic Voronov's rim. A characteristic shiny ring appears around the plaques. It is evidence of the beginning of a gradual regression of autoimmune inflammation and rash during psoriasis.
- The triad of symptoms persists.
Treatment of the disease at this stage leads to consolidation of the achieved results. The risk of further progression of psoriasis is reduced. The rashes are already ready to move on to the next, long-awaited stage of development for patients.
Regression phase
The final stage of rash formation is regressive. It marks the end of the exacerbation episode. Do not think that psoriasis will not return after it. Today it remains an incurable disease.
Features of the stage of development of rashes:
- Reducing the number of plaques. They become less noticeable. Visually the skin is cleansed.
- Reducing the intensity or completely eliminating itching and flaking.
- Negative Koebner's sign.
- Preservation of the classic triad of symptoms.
Treatment of psoriasis at this stage is aimed primarily at stabilizing the patient's condition. The main task of the doctor and the patient is to maximize the remission period. The longer new rashes do not appear, the better for a person.
At this stage, it is recommended to use drugs to prevent relapse of the disease. Preference should be given to non-hormonal drugs and physiotherapeutic procedures.
The effectiveness of sanatorium treatment
In sanatoriums, treatment methods such as drinking mineral waters, mud therapy, hirudotherapy, paraffin therapy, diet and much more are used. The climate of the resorts itself has a positive effect on the condition of the patient’s skin. Sea water and air, sunbathing, masks made of clay and therapeutic mud - all this helps restore the health of the dermis, establish metabolic processes, and strengthen the human immune system.
You can learn more about spa treatment of psoriasis from this article.
Features of individual types of psoriasis
Although dermatosis develops according to a standard pattern, and the rashes maintain a given stage, there are some nuances that are worth knowing. Below we will discuss the features of different forms of psoriasis.
Pustular psoriasis
It manifests itself in the formation of not only plaques, but also pustules. A bubble with liquid contents forms in the affected skin area. At first it is sterile, but if mechanical damage occurs, a bacterial infection occurs with the appearance of additional symptoms, such as:
- pain;
- local temperature increase;
- redness;
- edema.
Generalization of the process is dangerous for the patient’s health. This happens rarely, but can cause serious intoxication of the body. Fever progresses. The risk of blood poisoning or the occurrence of purulent-septic complications remains.
The typical localization of the pustular form of rashes is the skin in the genital area and the flexor surfaces of the elbow and knee joints.
Exudative psoriasis
A form of psoriasis is accompanied by intense sweating of blood and intercellular fluid through the affected areas of the skin. In the area of the rashes, or rather, on their surface, dirty yellow crusts appear.
When they are mechanically removed, an open wound surface appears underneath, which serves as an entry gate for infection. This development of events more often occurs in patients with metabolic disorders and endocrine dysfunction (diabetes mellitus, obesity, hypothyroidism).
Psoriatic arthritis
The most difficult form of dermatosis to cure. In addition to rashes, ligaments, joints and tissues located around them are involved in the pathological process. Small joints, such as fingers and toes, are most often affected. Additional symptoms of psoriasis include:
- pain in the affected area;
- swelling and redness of the joints;
- restriction of free movements: stiffness, pronounced in the morning.
Characteristic rashes remain in the old places. They retain their characteristics. This form of psoriasis is difficult to treat and requires systemic therapy.
Erythroderma type rash
In this case, characteristic red circles appear on the surface of the skin. They develop in parallel with typical rashes and are accompanied by:
- local temperature increase;
- severe itching;
- peeling;
- dry skin.
Over time, areas of erythroderma merge with traditional rashes, which significantly worsens the patient’s well-being. To normalize his condition, it is necessary to use systemic drugs.
Plaque psoriasis
Traditional form of pathology. Characterized by the appearance of standard rashes. They are red or pink papules that rise 1–3 mm above the surface of the body and are covered with silvery scales.
Guttate psoriasis
A characteristic feature of the disease remains the appearance of rashes like purple drops. They can be of different shapes. Localized mainly on the thighs. They often progress after a streptococcal infection and are associated with microbial skin lesions.
Atypical psoriasis
Any variant of non-standard location of rashes with a violation of the usual development mechanisms can be classified as an atypical form. It requires careful differential diagnosis.
Signs of disease on the scalp - photo of psoriasis
Psoriasis on the scalp is a common disease. Its nature can be mild, with not very large lesions, and severe, in which the entire skin on the head , even that which is beyond the hair growth line. In this variant, the areas with lesions are located on the surface of the forehead and neck.
At the initial stage, the disease is accompanied by severe itching and skin irritation. The plaques itch, the scales peel off profusely, and whitish dandruff forms.
Timely medical care will prevent the development of the disease at the initial stage, so if you notice signs of psoriasis, consult a dermatologist.
Stages of psoriasis
Rashes in different locations
Plaques often vary depending on their location on the body. It is known that the skin is not the same in different areas. This determines the progression of psoriasis on the hands, face, chest and other areas.
Arms and legs
The extensor surface of the elbow and knee joints remains one of the most common localizations of psoriasis. The rashes here develop according to the standard pattern. First, individual papules appear, covered with silvery scales.
Over time, the process progresses with the merging of pathological elements into large conglomerates. In the atypical form of psoriasis, rashes are found on the flexible surfaces of the joints.
A feature of this localization of plaques remains their redness due to constant contact with clothing. This is used to differentiate this dermatosis from other skin diseases.
Face and neck
The rashes are often limited in nature. They keep boundaries clear. Typical places for localization of plaques remain the following areas:
- around eyes;
- eyebrows;
- nasolabial folds;
- earlobes.
The rashes look like small papules with all the features characteristic of psoriasis.
Scalp
Such localization is sometimes accompanied by the formation of a psoriatic “crown”. The rashes are localized at the junction of the skin of the forehead and the scalp. A kind of rim appears.
Psoriasis often occurs as seborrhea. The function of the sebaceous glands is impaired. Dandruff progresses. Due to dry skin, large, silvery crusts form.
Body, back
The pathological localization process is more typical for the generalized form of the disease. Typical plaques often appear on the back, less often on the abdomen. The rashes retain their typical features or may take the form of purple droplets.
Breasts, nipples
This localization of psoriasis is especially unpleasant for women who are breastfeeding. The rash is accompanied by the formation of small cracks and wounds in the areola area. This is accompanied by the addition of a bacterial infection.
At the same time, pain, local redness, increased temperature, and swelling occur. The nature of the rash is no different from the plaque form of psoriasis.
Palms and soles
Such localization is typical for localized psoriasis. There is a gradual coarsening of the epidermis. Cracks form on the palms and soles. Fungus and secondary bacterial infection are often associated.
Nails
Rashes during psoriasis often lead to gradual involvement of nails in the pathological process. Psoriatic onychodystrophy develops. It is accompanied by the following symptoms:
- thickening or thinning of the nail plate;
- the appearance of transverse or longitudinal lines on its surface, small pinpoint pits - the “thimble” phenomenon;
- change in the color and consistency of the nail.
It starts to crumble. Visually, the process can easily be confused with a fungal infection. The extreme form of pathology is onycholysis. It is accompanied by complete detachment of the plate against the background of progression of typical rashes. Nail psoriasis rarely occurs in isolation, without skin lesions, just like psoriatic arthropathy.
Places where the disease appears
Arms, elbows, torso, and scalp hair are typical places where psoriasis rashes occur. The surface of the bends of the limbs, the groin area and under the armpits are rarely affected. Professionals divide the disease into two main types , taking into account the cause of its occurrence.
- The first type of disease. If there is a genetic predisposition, it appears in children and adolescents. Psoriasis is inherited through three to four generations. Sixty percent of people with psoriasis have relatives who suffer from this disease.
- Second type. May appear after the age of forty. In this case, the appearance of the disease has no connection with hereditary predisposition or interruptions in the functioning of the immune system. First, damage to the joints and legs will occur.
