- significantly extended;
- Unpredictability, Novitatis and variability of the current;
- the appearance of the first clinical symptoms mostly in the young age;
- Increase in incidence in the last 10-15 years among young people;
- an increasing proportion of severe forms of the disease, accompanied of severe mental disorders, and sleep disorders;
- Impairment of the quality of life of the patient;
- the difficulty of the treatment;
a strong increase in the number of patients with disabilities, such as the sick, and in connection with disabilities, especially in young men.
According to various information of the disease of the world's population registered at 2-7%. In the structure of the skin diseases of Psoriasis is 3-5%, and in patients with dermatological hospitals — up to 25%.
This data is for some reason incomplete, the difficulty of the identification of severe forms, such as psoriatic Arthritis, a rare negotiability in medical facilities, patients with slight forms, etc. are:
Causes of Psoriasis and its pathogenesis
In spite of the advantage of the local cutaneous manifestations of most forms of the disease, its reasons and the nature of the diseases in the body, the disease carries a system nature.
In the course of the disease is the joints, blood vessels, the kidneys, the liver. It is celebrated also at a high risk of Diabetes, obesity and hypertension in persons with Psoriasis, especially in women.
In 20-30% of patients later, the syndrome, metabolic disorders developed with increased content of triglycerides in the blood, overweight, especially in the area of the abdomen, psoriatic Arthritis.
Lately a number of biological markers, to the immediate connection with Crohn's disease, Psoriasis, rheumatoid Arthritis, cardiovascular disease, stroke, and increased mortality as a result of a heart attack.noticed,
For these and other reasons, a growing number of researchers Dermatosis such as "psoriatic disease" and not just "psoriasis is based on the Definition".</1_img>
Is transferred, whether the psoriasis inherited?
In spite of the presence of a large number of hypotheses and research up to the present, it remains difficult to make the answer to the question of transfer, whether the Psoriasis is inherited. Nevertheless, it is generally accepted that the disease is genetically deterministic. If there is no disease in both parents, it is found only in 4.7% of the children. In the case of the illness of a parent, the risk of the disease of the child up to 15-17%, both parents — up to 41%.
The beginning of psoriatic disease can be celebrated at any age, but in most cases, the peak in the age 16-25 years (Psoriasis, type I) and 50 to 60 years of age (Psoriasis type II). In Psoriasis, the I-th type is often traceable hereditary nature of the disease, articular lesion, and the prevalence of various lesions. In the case of type II, the disease has a more than favorable course.
The mechanism of development (pathogenesis)
The most important link in the pathogenesis (mechanism of development of the disease, leading to the formation of lesions on the skin, is the increase in the mitotic (cell division) activity and accelerated Proliferation (Proliferation) epidermalibus cells. In the result, the cells of the Epidermis, not coming to it, orogovet, pushed cells to the underlying layers of the skin. This phenomenon is accompanied by excessive desquamation and hyperkeratosis.
Contagious whether or not the Psoriasis?
It is possible that the free communication and contact with sick, that is to say, whether they be infected? All of the studies, the with this disease, contrary to this assumption. The disease to other people either by droplet infection transmitted by direct contact.
The implementation of the genetic predisposition for the disease (in accordance with the genetic theory of Psoriasis), in the case of disturbances in the regulatory mechanisms of the following systems:
mentis.Mental instability promotes disruption of the function of the autonomic nervous system. The latest is one of the Reflex members in the implementation of certain emotional factors by Alpha - and Beta-receptors on the vascular system of the skin and on your General condition.
Psychic Trauma plays a significant (if not preeminent) role in the mechanism of the development of the disease, but also in the frequency and duration of relapses. At the same time, self-dermatosis violation of the functional state of the Psyche is causing. Endocrine.
psoriatic diseaseis a Manifestation of the violation of the mechanisms of adaptation, in which playing the main role of the endocrine glands (Hypothalamus, pituitary, adrenal), the Regulation is not only declinare, way (through the blood), but also with the participation of the nervous system. For the purposes of adaptation of the organism to the hypothalamic-pituitary-adrenal System the first one is activated (in response to the impact of environmental changes, extreme and accentus factors) with the help of increase or decrease in the secretion of hormones, making the cell metabolism changes. </2_img>
Immune. The mechanism of realization of genetic predisposition to PSORIASIS with involvement of the immune system, and genes in the cellular controlled immune response and Immune interaction of cells with each other (HLA-System). The immune system in psoriasis is also modified, either genetically, or under the influence of internal or external factors due to the violation of all the Links of the skin immune dysregulation.
Genetically deterministic disturbances of cell metabolism lead to an accelerated growth and proliferation of immature cells of the Epidermis leads to the release of biologically active substances (BAS), lymphocytes, immature cells of the skin, activated keratinocytes and macrophages. The latter are media gate, inflammation and immune response.
These substances include proteases, Protein information molecules, called cytokines (Tumor necrosis factor, interleukins, interferons, and various subtypes of lymphocytes), polyamines (hydrocarbon radical). Mediators, in turn, stimulate the Proliferation of defective cells of the Epidermis, change in the walls of small blood vessels and the occurrence of inflammation.
The entire process is accompanied by the accumulation of in sosochkovom the layer of the Epidermis and Dermis - and multi-cell leukocytes. Predisposing and triggering factors The key pathological Manifestation of Psoriasis is an excessive proliferation of defective cells of the Epidermis. Therefore, the crucial point in the clarification of the mechanism of the development of the disease and the decision to treat such as Psoriasis, is the fixing of the conditions, factors. The most important are:
Psychological— the influence of short-term severe Stress, as well as невыраженных, but time-intensive or frequently recurring negative psychological effects, the moral dissatisfaction, sleep disturbances, depressive state.
Metabolic disorders in the body, functional disturbances of the digestive organs, especially the liver, and the exocrine pancreatic function. Disease or dysfunction of the endocrine glands (Hypothalamus, thyroid, паращитовидной and tissue glands, the endocrine activity of the pancreas). Disorders in the immune system (allergichekie reactions and immune disorders).
The presence in the body of chronic foci of infection (tonsillitis, rhinosinusitis, inflamma tionibus profuere, etc.). Pathogenic and conditionally-pathogenic microorganisms, especially Staphylococcus Aureus, streptococci fermentum and fungi, and their toxins, the cells of the skin, damaged these microorganisms, are powerful antigens that provoke the immune system to the Aggression against them, the amended and healthy cells of the body.
Mechanical and chemical damage to the skin, prolonged intake of antibiotics or glucocorticoids in respect of any of the diseases, giperinsolyatsiya, Smoking and alcohol abuse, acute infectious diseases (respiratoriorum virus infection, influenza, sore throat, etc.).
Symptoms and types of PsoriasisThe common clinical classification of psoriatic disease it is not, however, traditionally, the most common clinical Form. They are in some cases so different from each other, that you consider how each of the diseases.
In the development of the disease there are three stages:
The progression of the process, in the movements of up to 1-2 mm appear in great numbers from the new blocks. In the future, in the typical psoriatic Plaques.
Stationary Phase— no formation of "fresh" elements, save the size and appearance of the existing Plaques, completely covered with exfoliating the Epidermis.
Phase of the RegressionReduction and flattening of the Plaques, reducing the severity of the shell and the disappearance of elements, the absorption starts in the middle. After their complete disappearance in General, the depigmentation remain lesions.
Vulgar Psoriasis(normal, normal) He manifested mono-graphia (homogeneous) eruptionibus in the Form of Plaques or papules — nodules, reddish or pink color, towering above the surface of the skin. Papules are clearly demarcated from the healthy phases and with statera dolosa silvery-white color. Their size in diameter from 1-3 mm to 20 mm and more. For the three phenomenon, the poskablivanii on their surface: </3_img>
A Symptom of "stearin Spot" strengthening after a light exfoliation poskablivanii, whereby the surface of the papules acquires a similarity with a drop of oppressi stearic; this scales is due to the para-keratosis (thickening of the epithelium), hyperkeratosis (thickening of the Horny layer of the skin, i.e., bedding), the accumulation of fat and sicut crassus, the components in the outer layers of the Epidermis; Symptom of the "End Film" — Remote-dandruff appears slimy epidermal layer in the Form of a thin, velvety, shiny, wet surface; the Symptom of "blood dew", or the phenomenon Auspittsa-Polotebnova — not between drawn a drop of blood in the Form of dew, you poskablivanii on the shiny surface to the light; this is due to the damage to the plenus sanguinis, skin structures papillae.
The most popular places of localization of the rash are pellis part of the head, the symmetrical arrangement on extensoris indicis surfaces in the area of large joints — elbows, knees. The localization of the Plaques can be a long time is limited on this land. That is why they are called "ABD" or "office". More rarely, the nails, the skin in the area of other joints, genitals, face, soles and palms, large folds are affected.
Another typical Symptom psoriatic rash in the areas of mechanical or chemical damage to the skin (the phenomenon Kebnera). Such injuries scalpendi, cuts, chemical irritation from acids or alkalis can.Depending on the localization of the elements and the clinical course of vulgar Psoriasis divided on several types:
- Palmar-quadratus plantae.
- Psoriasis of the nails.
Seborrheic Psoriasis.It occurs on skin areas with many sebaceous glands on the forehead, the scalp, in the area of the BTE, in the areas of facial wrinkles (nasolabial folds and nososchechnyh), between the shoulder blades and in the upper areas of the front surface of the Thorax.
If on the face, back and chest rash character of the papules has a red color with squamea convolvens large plates of silvery-white color, the ear for the sink, it is similar to the rash in the case of seborrheic Dermatitis, complicated присоединившейся infection.
The surface of the seborrheic spots and papules behind the ear-shells lighter and edematous, in comparison with other parts. It statera dolosa yellow covers-white or gray-white coloring and serosum vehentem-purulent crust (due to macerari), which is close to the skin. Almost always rash accompanied by a pronounced itching.