Psoriasis
Psoriasis (psora – peeling, scratching)
Psoriasis ranks among the oldest skin diseases to be described – the first mention was made in Corpus Hippocraticum 100 years after Hippocrates´s death (460-370 BC); only Ferdinand von Hebra, a native of Brno, was the first to define the psoriasis exactly and describe its different clinical forms in Vienna in 1842. |
Definition
Psoriasis is a frequent, non-infectional, inflammatory auto-imunity disease, chronically passing and very relapse-prone.
Epidemiology
About 2 % of central-european population suffer from psoriasis, another 2 - 3 % suffer from its latent form. The number of the diseased goes up and psoriasis is said to rank among civilization diseases. The disease can rise at any age, its rise is most frequent beween the age of 10 and 30, the occurrence is at its height from 16 to 22 years and from 57 to 60 years. The main cause of the disease is yet still unknown. Psoriasis is a hereditary disease, but only a disease disposition is inherited. The psoriasis rise depends on a wide range of both external and internal provocation factors.
Heredity
a rise in the family is stated in about 35 % of the cases, the heredity type was not identified precisely.
Provocation factors:
- a) internal
- infection of horních cest dýchacích, (quinsies among younger patients, viroses among the older ones), dental infection, chronical gall inflammation, etc.,
- taking of some medicaments,
- hormonal alterations (adolescence, post-confinement period, climacteric), normally, the patient gets better at the time of pregnancy,
- way of living (stress, alcohol, smoking, lack of sleep, irregular rhythm of life),
- other diseases (diabetes, gout, obesity, liver diseases, etc.),
- vaccination etc.
- b) external
- physical factors (lesions, friction, pressure changes, UV-radiation, abrupt temperature and climate changes),
- chemical factors (corrosion, skin irritation including an agressive local cure),
- biological (influence of some viruses is taken into account),
Immunity disorder. Nowadays, the psoriasis is perceived as a so-called auto-immunity disease.
Clinical forms of the psoriasis can be classified according to:
- features of skin alterations,
- extent and localization of skin changes
- course of the disease,
- eventual affection of organs (e. g. a joint psoriasis)
I. PSORIASIS VULGARIS
is the most frequent form, it represents about 85 % - 90 %. It has two stadiums:
- a) early (so-called acute exanthematic) stadium
- more frequent among younger patients, mostly after quinsy or influenza,
- it affects skin on trunk and limbs, often a dense occurrence of small centres,
- it is an irritative form that shall be cured by non-irritative external medicaments,
- it tends to heal on by itself,
- sometimes it itches.
- b) chronic (chronically stationary) stadium
- it can rise directly or develop from the acute form,
- it is more likely to occur in middle age, more frequently after external provocation factors,
- skin displays appear on typical body places – elbows, knees, loins, shins, in hair, the centres are sharply demarcated and do not tend to heal,
- an intensive local cure is necessary.
The psoriasis can also appear in other places of the body – in the hairy part of head, on the verge of hair, on palms, foot-flats, inguinae, in armpits, under breast, on genitalia, on nails (there, changes are very frequent – in up to 30 – 50 %, and they can represent the only display).
II. PSORIASIS ERYTHRODERMICA
Is a grave and rare form (1 – 2 %) when the skin of the whole body is red, scaled, general symptoms (fever, jointaches etc.) are present.
III. PSORIASIS PUSTULOSA
Is a psoriasis form in case of which small purulent pimples appear on the skin, either on palms and foot-flats or on the whole skin surface.
IV. PSORIASIS ARTHROPATICA
Is a joint affection accompanied with skin changes. Mostly knuckles are affected. Those joint changes occur among 5 % - 8 % of the psoriatics, but when the skin affection more extended, it can be even 40 – 45 % of cases.
A joint affection occurs as frequently among women as among men, it begins gradually around the age of 40.
V. INTERNAL ORGAN PSORIATIC AFFECTION
Rises in case of grave, generalized psoriasis forms, mostly as a liver or kidney affection.
CURE
Nowadays, the psoriasis is quite easy to cure, but an innate disposition remains even in case of complete recovery and relapses cannot be prevented.
Anti-psoriasis therapy alternatives:
- local therapy (phototherapy included)
- scale removal from the psoriasis centres before use of special medicaments – salycilic acid, urea etc. are used.
- tars (e. g. a tar paste), analogues of D3 vitamin (for moderate and medium grave psoriasis forms – e. g. Psorcutan ung., Curatoderm ung.), retinoids (for moderate and medium grave psoriasis forms, e. g. Tazaroten gel),
- corticosteroids, which have many undesirable effects and are consequently recommended for a short time to moderate irritative displays,
- UV-radiation (phototherapy) is a method chosen for the chronic psoriasis form. A narrow-zoned UVB-radiation or a UVA-radiation combined with psoralens (that make the skin more sensible to this sort of radiation) is used for cure. In consideration of the undesirable effects caused by psoralens, the second alternative is used less and less. Once a wide range of UVB-radiation was used, but this cure is not applied any more. A UV-light cure can be performed by a radiation of the whole body or its parts (including the intact skin) or by a radiation of the disease centres only. When the intact skin is radiated, it is at all risks connected with radiation cure, i. e. especially a risk of skin tumour rise, vice versa the radiation of small centres eliminates those risks. The cure with narrow-zoned UVB-radiation is performed by EXCILITE, a unique device made by Deka Lasers which requires 308 nm exactly and radiates up to 526 sq cm of the affected skin at the same time. The cure is performed 2 – 3 times a week during the first month of the therapy, then once a week. To be entirely healed, the psoriasis centres require only 1 – 15 radiations, according to type of psoriasis.
- a shower or a bath are suitable before every external treatment or radiation, it can be salt baths, tar baths, sulphuric baths, oil baths, herb baths, starch baths etc.
- overall therapy
takes advantage of vitamins, retinoids, immunity-influencing medicaments (methotrexat, cyclosporin A etc.)
- alternative methods
a psychotherapy has an individual effect, autosuggestions, relaxation techniques – yoga, autogeneous training, hypnosis, meditation, group psychotherapy etc. are used.
a diet is useful for obese patients (reduction d.), acute cases (non-irritative d.), generalized cases (special emphasis put on herb teas, mineral waters, rybí tuk, oenophera oil, low-caloric or temporarily vegetarian food), patients affected by other diseases at the same time (diabetes etc.)
THE COURSE of the disease is unforeseeable, often chronic with a great tendency to relapse after effects of provocation factors. A psoriasis rise that comes only once in life or constant displays are rare.
PREVENTION:
Primary prevention (bound to prevent a psoriasis rise) is to avoid having children when both parents are affected by the psoriasis (in such case, a risk for the child is up to 75 %, if one of the parents is affected, the risk is about 25 – 30 %).
Secondary prevention (bound to prevent a relapse) includes a so-called maintenance therapy (skin anointing, use of curative cosmetics (e. g. tar shampoos), healthy lifestyle (diet, regular life-rythm, enough sleep, no stress, alcohol or smoking, psycho-hygiene etc.), a prevention of infections and a consistent infection-cure.