Severe psoriasis: classification, features, aggravating factors, treatment.
Modern medicine does not completely cure psoriasis, but the symptoms of the disease can be alleviated at any stage. Moreover, a severe form of psoriasis requires immediate intervention by a dermatologist, since uncontrolled complications can lead to the death of the patient.
1 Classification of psoriasis;
2 Types of severe forms of psoriasis and their features:
2.1 Exudative psoriasis;
2.2 Pustular psoriasis;
2.3 Psoriatic erythroderma;
3 How to determine the severity of the disease?
4 What is the danger of severe psoriasis with complications?
5 Factors affecting the transition of severe psoriasis;
6 differential diagnosis;
7 Treatment of severe psoriasis.
Each disease in medical practice has its own nomenclature number, which is established according to the ICD-10 international system. This number designation indicates typical signs of the disease. For psoriasis, this is L40 and an additional value after the point (for example, L40.3).
There are such types:
L0 – common form of psoriasis;
L1 – generalized pustular psoriasis;
L2 – persistent acrodermatitis;
L3 – psoriasis of the feet and inner side of the palms;
L4 – teardrop-shaped psoriasis;
L5, L6, L7 – forms of arthropathic psoriasis affecting the joints;
L8 – other forms;
L9 – undefined type;
There are also 2 more international classification systems: the US National Medical Fund and the international PASI index. The first determines the disease depending on the extent of damage to the skin and is considered insufficiently complete (does not classify information about the degree of spread or relative to the course of the disease).
It has only three points:
- foci affected 2% of the total body area – mild;
- psoriasis affected up to 10% of the skin – the average form;
- foci of the disease cover more than 10% – a severe form of psoriasis.
The international PASI index relies in its classification on the following factors:
- the number of foci on the body;
- the presence of peeling, the factor of exfoliation of dead particles;
- the area of damage to the skin;
- characteristic signs (erythema, rash, papules, etc.);
- localization of lesions.
Information on the international index is systematized in an extensive table with several sections. This allows you to determine the type of psoriasis more accurately and prescribe the correct treatment.
Also, this disease, depending on the form, is divided into two large groups:
- traditional form with early or late onset;
- erythroderma psoriatic.
- generalized form (herpetiform empedigo, Tsumbush’s disease, etc.);
- a disease proceeding in the form of a centrifugal annular erythema;
- palmoplastic form (palms and feet).
But there are also types of psoriasis that are not included in the main groups. Among them:
- Napkin’s disease;
- exudative type;
- seborrheic form;
- a disease caused by the use of certain groups of drugs;
- atypical form, when the lesion extends to the folds of the skin and flexion zones of the limbs.
Psoriasis can be mild or severe in severity. The latter is characterized not only by skin lesions, but also by systemic manifestations (for example, the development of joint arthritis).
Types of severe forms of psoriasis and their features.
With a severe form of this disease, damage to the skin is at least 5%. Psoriasis affects the joints and nail plates, and secondary infections and other systemic manifestations may also occur.
Most often, this form occurs in those who have been diagnosed with one of the following diagnoses: obesity, diabetes mellitus, thyroid disease, disorders of the endocrine system as a whole, and any malfunctions in the immune system.
A feature of the exudative type is the appearance of scales with a loose structure on the surface of psoriatic plaques. The flakes themselves form a continuous crust of yellow color, saturated with exudate, and their edges are hyperemic.
This form is characterized by burning, intense itching and inflammatory processes. After removal of the yellow peel, the active secretion of exudate begins, and the surface of the papules becomes moist and bleeding.
It affects the skin of the palms and feet, while it can be localized or generalized. The pustular form usually accompanies ordinary psoriasis and is characterized by the presence of purulent segments.
The cause of this type of disease can be:
- taking medications (glucocorticoids, some antibiotics);
- hormonal failure (treatment with hormonal drugs, the use of hormonal contraception);
- stress, systematic fatigue;
- chronic infectious diseases.
A local variety of the pustular form is called the “Barber type” and is characterized by the appearance of purulent rashes on the arch of the foot, palms or sole. The development mechanism is as follows: first red spots appear, in the place of which pustules with transparent contents appear over time. Within a few days, the contents of the vesicles become purulent.
During the progression of the disease, some pustules dry out and become covered with a brown crust, and new vesicles form in place of other red spots. The peculiarity is that pustular elements are recessed into the skin, as it were, and do not rise above its surface.
This severe form of psoriasis develops due to improper treatment of vulgar psoriasis and is a complex toxic and allergic skin reaction. But a complication of this type can also provoke other external factors:
- overheating of the body with prolonged exposure to the sun;
- stress, mental and physical exhaustion of the body;
- taking certain honey. drugs;
- alcohol and nicotine abuse.
The first stage of erythroderma is characterized by redness of the skin and a feeling of tightening. Then there is a burning sensation, severe itching, and pain. Puffiness of the skin, peeling is manifested. The patient’s condition deteriorates sharply: the temperature rises, the lymph nodes increase, the joints begin to hurt.
With the development of the disease, symptoms of general intoxication intensify: the patient complains of debilitating headaches, indigestion, general weakness. Erythroderma accompanying psoriasis is one of the most dangerous complications that can lead to the death of a patient. The generalized inflammatory process of extensive lesions leads to skin exfoliation. If secondary infection occurs in this situation, then this threatens with sepsis and subsequent death of a person.
How to determine the severity of the disease?
Only a dermatologist can determine the degree and form of psoriasis. To do this, he conducts a thorough examination of the skin, scalp, nails, mucous membrane. In some cases, a biopsy is required (a skin sample is taken for examination under a microscope).
Also, the doctor must know the patient’s complaints and compare what he heard with the results of the examination. When examining, it is important to determine the following factors:
- localization of the rash;
- appearance and shape;
- the location of the fragments of the rash relative to each other.
After collecting information about the psoriatic rash, the doctor compares it with data from international classifications. There are 3 degrees of severity of the disease:
- Light (damage up to 2%). The expressed clinical picture is absent. Psoriatic plaques are not observed in this case or have a single character of location. The skin at the site of the lesion is moderately red; mild itching present. Desquamation (peeling) of the skin is minimal; inflammation is absent or mild.
- Moderate (defeat up to 10%). The clinical picture becomes clear. The symptoms listed above are: single psoriatic plaques, peeling and inflammation of the skin. Itching and burning are shown.
- Severe (defeat more than 10%). The thickness and diameter of the plaques is much larger in comparison with a moderate degree. The elasticity of the skin decreases, redness, swelling, peeling of grayish crusts is observed. Itching and burning become painful for the patient.
What is the danger of severe psoriasis with complications?
As a chronic dermatological disease, psoriasis occupies one of the leading positions. Its complications are dangerous in that joints and vital internal organs are involved in the pathological process: heart, kidneys, liver and vascular system.
When psoriasis becomes severe, the patient loses the ability to perform daily work, take care of himself, go to work. In this case, we can talk about assigning him the category of disability.
In addition, serious psychological problems develop. This is typical for those cases when lesions are located in open areas of the body (face, hands, head). Significant physiological and psychological discomfort is caused by a disease localized on the genitals, which interferes with normal sex life. The severe form of psoriasis in the photo looks depressing, but in life it causes discomfort.
All these factors lead to impaired social adaptation, the patient becomes confident in his unattractiveness, neurosis, prolonged depression, suicidal tendencies are manifested. In this case, be sure to contact a specialist.
- Severe psoriasis significantly increases the risk of death. Death occurs precisely from complications that manifest in the form of heart, liver or kidney failure. Death can also occur as a result of the development of Itsenko-Cushing’s syndrome, which manifests itself in the uncontrolled use of corticosteroids. *
A distinctive feature of the disease is the wave-like nature of its course. This means that the symptoms worsen during the period from late autumn to early spring and decrease in summer. In addition to temperature and humidity indicators of the environment, the following factors can influence the exacerbation of the condition:
- unbalanced diet; malnutrition or overeating; the use of illegal foods and alcohol;
- bad habits (smoking);
- lack of sleep, physical and mental exhaustion;
- severe shocks, chronic stress;
- decreased immunity after an infectious or viral disease;
- lack of proper personal hygiene, non-compliance with its rules; excessive attention to the purity of foci of psoriasis;
- A sharp change in the hormonal background as a result of pregnancy, abortion, menopause, taking honey. Drugs;
- wearing tight clothes and shoes; insect bites that the patient combs or rubs due to constant itching;
- contact of chemical compounds with foci of the inflammatory process (household chemicals, decorative cosmetics, etc.).
The most common cause of psoriasis becoming the most severe is the failure to follow the doctor’s recommendations or the wrong therapy. It is important to determine the correct treatment at an early stage.
For a correct diagnosis, it is important to take into account the following points:
- Typical manifestations of the disease: rashes are symmetrical and have bilateral localization. Therefore, it is important to conduct a thorough examination of the skin: the patient may simply not pay attention to some rashes.
- Histology is characterized by certain features: hyperkeratosis (differentiation of keratinocytes has locally limited changes), infiltration (inflammatory infiltrate is formed) and erythema (severe redness).
- The initial signs are a pink or red nodular rash that flakes as a result. Such a rash is called a papule, its gray-white scales cover it. They indicate accelerated keratinization (keratinization of the skin) and peel off first at the very top of the thickened spot, and then on its entire surface.
- Stages of psoriasis – each stage is characterized by a certain type of rash. There may be difficulties:
- reverse psoriasis, where there is no desquamation;
- pustular psoriasis, where pustules are sterile and infiltration is negligible;
- psoriatic erythroderma, when there is no nodular rash.
Therefore, dermatoscopy may not be enough to make a correct diagnosis. In such cases, a skin biopsy is performed, the results of which can provide a histological picture. These data are correlated with clinical manifestations and any laboratory tests.
Treatment of severe psoriasis
- Healing mud baths are one of the most highly active natural remedies for the fight against psoriasis *
To date, there are no such treatments that would completely get rid of any of the severe forms of psoriasis. Therapy in this case is represented by a number of drugs that help reduce the intensity of symptoms, prolong the period of remission and strengthen the immune system.
In case of complications, complex treatment will be used, including the use of internal and external agents:
- Local treatment is carried out with the help of creams, gels, lotions, which have a different spectrum of action – softening the crusts, reducing exudate, combating symptoms such as itching, burning, inflammation and hyperemia.
The composition of such drugs can be hormonal or non-hormonal. The first option is used during the period of exacerbation, and the second – at the time of remission. Means may also be recommended, which include salicylic or boric acids, zinc, tar, naphthalan oil.
- Systemic therapy (monoclonal antibodies and cytostatics). Treatment of severe forms of psoriasis is accompanied by the intake of vitamins B, C, D, E. Be sure to prescribe drugs with retinoids – derivatives of vitamin A. This therapy helps to normalize the processes of keratinization.
- An important role is given to the protection of the liver and the elimination of intoxication products. For this, the patient is prescribed hepatoprotectors and enterosorbents. Antihistamines help reduce itching and burning, and sedatives help fight insomnia and irritability.
Separately, it should be said about traditional medicine and non-medication. Recipes of alternative medical systems can act as adjunctive therapy for mild psoriasis. But when complications develop, their use is prohibited by doctors.
The result is a vacation in resort areas, passing health courses in sanatoriums, a temporary change of climate from cold to warm, preferably marine.
Physiotherapeutic methods of treatment have a positive effect: PUVA, mud baths, ultrasound, cryotherapy, electrosleep, plasmapheresis. Hirudotherapy (leeches) and ichthyotherapy (small fish) are actively used.
Of particular importance is the diet – the patient must abandon simple carbohydrates, sugar, and baking. You should also exclude pickled, smoked and salted dishes. The diet should consist of plant foods and fermented milk products.