Psoriasis — a chronic non-communicable diseases, dermatosis, hitting basically the skin. Usually psoriasis causes the formation of excessively dry, red, elevated above the surface of the skin spots. However, some patients with psoriasis have no visible lesions of the skin.
Caused by psoriasis patches are called psoriatic plates. These spots are in the nature of sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages, and keratinocytes of the skin, and also excessive angiogenesis (formation of new small capillaries) under the skin layer. Excessive proliferation of keratinocytes in psoriatic plaques and infiltration of the skin lymphocytes and the migration of inflammatory macrophages quickly leads to thickening of the skin in places of the lesion, its breeding is above the surface of the healthy skin and to the formation of the characteristic bright, gray, or silver spots, resembling a frozen wax or paraffin wax ("paraffin lake").
Psoriatic plaques often first appear on exposed to the friction and pressure places — surfaces of the elbow and the knee bend over, on the buttocks. However, psoriatic plaque may occur, and to settle anywhere on the skin, including skin of scalp, the surface of the brush, the plantar foot surface, the external genital organs. Unlike rashes in the eczema, often affects the inner surface of the knee and the elbow joint, the psoriatic plaques are often located on the outside, the extensor surface of the joints.
Psoriasis is a chronic disease characterized by usually in the course of the waves, with periods of spontaneous or provoked by those or other medicinal effects of remission or improvement and periods of spontaneous or provoked by adverse external effects (drinking alcohol, intercurrent infections, stress) relapse or exacerbations.
The severity of the disease may vary in different patients, and even in one and the same patient in the period of remission and exacerbation in very wide limits, ranging from small local lesions until complete coverage of the entire body psoriatic plates. We often observe a tendency to the progression of the disease over time (especially in the absence of treatment), for weighing and frequent exacerbations, larger areas of the lesion and involvement of new areas of the skin. In individual patients is observed a continuous course of the disease without spontaneous remissions, or even permanent progression. Often also affects the nails on the hands and/or feet (psoriatic onychodystrophy). The defeat of the nails can be isolated and observed in the absence of skin lesions. Psoriasis can also cause inflammatory defeat of the joints, called psoriatic arthropathy or psoriatic arthritis. From 10% to 15% of patients with psoriasis also suffers from psoriatic arthritis.
There are many different means and methods for the treatment of psoriasis, but due to the chronic relapsing nature of the disease itself, and often an observable trend towards progression in the course of the time, psoriasis is difficult to treat the disease. A complete cure is currently impossible (it is psoriasis incurable at the current level of development of medical science), but it is possible to more or less long, more or less complete remission (including life). At the same time, however, there always remains a risk of relapse.
Broken the barrier function of the skin (in particular, mechanical injury or irritation, friction and pressure on the skin, abuse of soap and water, washing substances, the contact of the solvents, household chemicals, alcohol solutions, the availability of infected foci on the skin or skin allergies, excessive dryness of the skin) also play a role in the development of psoriasis.
Psoriasis — it is largely idiosyncratic skin disease. The experience of the majority of the patients talks about that psoriasis may spontaneously improve or, on the contrary, it will increase for no apparent reason. Study of different factors related with the emergence of, development of, or worsening of psoriasis, tend to be based on the study of small, usually a hospital (not outpatient), which of course is harder, the group of patients with psoriasis. Therefore, these studies often suffer from lack of representativeness of the sample and of the inability to detect causal relationship in the presence of a large number of other (including unknown) factors, able to affect the nature of the flow of psoriasis. Often in the different surveys identified, are in conflict with each other findings. However, the first signs of psoriasis often appear after suffering a stress (physical or mental), damage to the skin in places of the first appearance of psoriatic rash and/or a prior strep infection. Conditions, according to several sources, which may contribute to the worsening or exacerbation of the flow of psoriasis, include acute and chronic infections, stress, climate change and the changing of the seasons. Some medications, particularly lithium carbonate, beta-blockers, antidepressants fluoxetine, paroxetine, antimalarial drugs chloroquine, rugpokcuchlorochin, the anticonvulsants carbamazepine, valproate, according to several sources, are associated with the deterioration of the flow of psoriasis, or may even cause its primary occurrence. Excessive alcohol consumption, smoking, overweight or obesity, poor eating habits can weight the course of psoriasis or restrict its treatment, provoking deterioration of. Hairspray, some creams and lotions for the hands, cosmetics and perfumes, household chemicals can also trigger a worsening of psoriasis in some patients.
Patients who suffer from HIV or Aids, often suffer from psoriasis. It seems paradoxical to workers of psoriasis, because treatment aimed at reducing the number of T-cells or their activity, overall, supports the treatment of psoriasis and HIV-infection, or the more that AIDS is accompanied by a decrease in the number of T-cells. However, in the course of time in the progression of HIV infection or Aids, an increase in viral load and reduction in the number of circulating CD4+ T-cells, psoriasis in HIV-infected patients or in patients with Aids worsens or worsens. In addition to this the puzzle of HIV-infection is usually accompanied by a strong shift of the cytokine profile towards Th2, while vulgar psoriasis in uninfected patients is characterized by a strong shift of cytokine profile toward Th1. To the adopted in the present hypothesis, a reduced amount of and pathologically modified activity of the CD4+ T-lymphocytes in patients with HIV infection or with Aids cause hyperactivation CD8+ T-lymphocytes, which are responsible for the development or exacerbation of psoriasis in HIV-infected or Aids patients. However, it is important to know that the majority of patients with psoriasis health in the context of the carrier of HIV, HIV-infection is responsible for less than 1 % of cases of psoriasis. On the other hand, psoriasis in HIV-infected occurs according to various sources with a frequency of from 1 to 6 %, which is roughly 3 times higher than the frequency of occurrence of psoriasis in the general population. Psoriasis in patients with HIV infection, especially with Aids often takes place very badly, and the wrong fit or do not fit the standard methods of treatment.
Psoriasis most often develops in patients with initially dry, delicate, sensitive skin, than in patients with oily skin, and it occurs much more in women than in men. At one and the same patient psoriasis most commonly first appears on the website is more dry or more of a delicate skin, than on the sections with oily skin, especially often appears in the places of damage to the integrity of the skin sheets, including scratches, scuffs, scrapes, scratches, cuts, in areas exposed to friction, pressure or contact with aggressive chemicals, detergents, solvents (this is called the phenomenon of Kebner). It is believed that this phenomenon of the destruction of the psoriasis especially dry, delicate, or wounded skin is associated with infections, with infection (probably the most commonly strep) easily penetrates into the skin with minimal excretion of sebum (which might, under other circumstances, protects the skin from infection) or in the presence of damage to the skin. The most favorable conditions for the development of psoriasis, therefore, are the most favorable conditions for the development of fungal infection of the feet (called "foot athlete") or the armpits, groin area. For the development of fungal infections the most favorable humid, wet skin, psoriasis, on the contrary, is dry. Penetrated on dry skin infection causes of a dry chronic inflammation, which in turn causes the symptoms characteristic of psoriasis, such as itching and increased proliferation of the cells of the skin. This in turn leads to a further increase in dryness of the skin, as a result of inflammation and increased proliferation of keratinocytes, and consequently, that the infection consumes the moisture that would otherwise be used for moisturizing the skin. To avoid excessive drying of the skin and relieve the symptoms of psoriasis patients with psoriasis is not recommended to use washcloths and scrubs, especially rigid, because they are not only damaging to the skin and leaves microscopic scratches, but scratched with the skin of the upper protective stratum corneum and sebum, the standards, which protects the skin from drying out and against the penetration of microbes. Also, it is recommended to use talc or baby of these the process of comminution after a washing or bathing to absorb excess moisture from the skin, which would otherwise "hold" the infection. It is further recommended the use of the funds, hydrating and are a breeding ground for the skin, and lotions, increases the function of the sebaceous glands. It is not recommended to abuse it with soap, dishwashing liquid. Should try to avoid skin contact with solvents, products for the home.
It has been demonstrated that psoriasis is able to worsen the quality of life of patients to the extent that other serious chronic diseases, such as depression, moved myocardial infarction, hypertensive disease, heart failure, or diabetes mellitus 2-th type. Depending on the severity and location of psoriatic lesions, patients with psoriasis can have significant physical and/or psychological difficulties, difficulties of social and professional adaptation and even need disability. With a strong skin, itching, or pain may prevent to perform basic life functions, such as self-care, walking, sleep. Psoriatic food stamps on the open parts of the arm or leg may impede the patient to work on certain chores, do some sports, take care of family members, pets or home. Psoriatic food stamps on the scalp often pose to patients, specific psychological problem and bring considerable suffering and even social phobia, as pale plaques on the skin of the head may be mistaken for the surrounding dandruff or result have lice. An even bigger psychological problem creates the availability of psoriatic rashes on the skin of the face, the lobes of the ears. Treatment of psoriasis can become expensive and have the patient relatively little time and effort, in work and/or school, socialization of the patient, the device personal life.
Patients with psoriasis can also be (and often occur) too concerned about their appearance, they give it too much importance (sometimes up to the extent of inconspicuous, laying on this, almost dysmorphophobia), suffers from low self-esteem, which is associated with the fear of public rejection and the rejection or fear he did not find a sexual partner due to problems of appearance. Mental distress, in combination with the pain, itching and immunopathological disorders (increased production of inflammatory cytokines) can lead to the development of expressed depression, anxiety, or social phobia, to a considerable social isolation and maladjustment of the patient. It should also be noted that comorbidity (combination) psoriasis and depression, and also psoriasis and social phobia, occur with increased frequency in those patients who do not experience subjective psychological discomfort from the presence of psoriasis. It seems likely that the genetic factors that influence susceptibility to psoriasis, and a predisposition to depression, anxiety states, social phobia is, to a large extent overlap. It is also possible that in the pathogenesis of both psoriasis and depression play a role in common immunopatologickye and/or endocrine factors (so during the depression, also finds increased levels of inflammatory cytokines, increased cytotoxic activity neuroglie).