Plaque psoriasis is the most common form of the dermatological disease that is diagnosed in adults and in children. It is also called psoriasis vulgaris. According to medical statistics, the pathology is diagnosed in almost 90 percent of all the cases of psoriasis. Unfortunately, one cannot get rid of the disease completely but there are ways to make patient’s life absolutely normal.
What is Plaque Psoriasis? Main Peculiarities of the Disease
The most common manifestations of the disease are typical inflamed areas of red color which raise above the healthy skin. These areas are covered with silver-white or grayish layer which can be easily taken off. These lesions are called psoriatic plaques. They tend to increase in size and merge with nearby patches. Sometimes plaque psoriasis is mild and the periods of exacerbations are quite rare. In other cases, the disease gets acute and the lesions occupy large areas of the skin.
Plaque Psoriasis Causes
At the moment, there is no specific explanation of the plaque psoriasis causes. For this reason, the disease is believed to be a multifactorial dermatosis.
The most popular theories that attempt to discover the reasons for the disease development are:
- theory connected with viruses: the results are based on the experiments on rabbits. Introduction of psoriatic material provoked atrophy in the animals. It also caused fibrosis and other changes of organs. Still, the particular virus has not yet been identified.
- theory connected with nerves: psoriasis vulgaris results from a serious psychological trauma.
- theory connected with inheritance: often the disease is diagnosed in several generations of relatives.
- theory connected with exchange processes: psoriasis is explained as the result of metabolic disorders. In particular, it is associated with RNA, DNA, and the exchange of enzymes and cholesterol.
- theory connected with endocrine system: people who suffer from the plaque type of the disease have been diagnosed with various disorders associated of the endocrine system.
There are specific factors that sometimes define the occurrence of the disease (they become a favorable background):
- certain medications;
- skin trauma;
- exposure to chemical factors.
Plaque Psoriasis Symptoms
The disease generally develops gradually, although an acute onset is also sometimes possible. The first plaque psoriasis symptoms appear as a papular skin rash. It may be pink or red. Not all the rash elements may exfoliate but it is easily detected by scraping the surface of the papules. The eruptions are scanty, they are located at the same sites for quite a long period of time. The symptoms of the disease may affect the skin of joints, as well as the scalp, and other areas of the human body.
The disease may be of different degrees of severity. The severity level is based on a number of factors:
- the affected area;
- the activity of the pathological process;
- general symptoms: fatigue, increased erythrocyte sedimentation rate, increased levels of uric acid.
If the disease is mild, the lesions appear on less than 3 percent of the skin. Rashes slightly increase in size. Then the pathological process slows down and the rash begins to fade. The central part of papules gets pale and they become annular. Soon they turn completely invisible.
If we deal with the moderate severity of the disease, the psoriatic elements occupy up to 10 percent of the skin. The initial papules gradually increase in size and form groups. Then they merge with the adjacent papules and make large scaly plaques. Psoriasis turns into plaque type of the disease. Most often it affects the areas of knee joints, elbow joints, extensor surface of lower and upper extremities, as well as lumbosacral area. The plaques may occur in other areas: on scalp, the plantar surface of the feet, and palms.
If more than 10 percent of the entire body is affected, we deal with the severe form of the disease. The plaques become of irregular, bizarre forms. They affect patient’s legs and hands, body, neck, and face. Severe stress, infection, and allergic reaction to medication can aggravate the pathological process and can cause sudden appearance of itchy swollen bright red elements on the entire skin surface.
Lack or improper treating make the pathology process progress. The disease can turn into chronic plaque psoriasis but in the majority of cases the disease is undulating (relapses are followed by remissions). In some cases, the disease turns severe and transforms into erythrodermic psoriasis, pustular psoriasis, or psoriasis arthropica.
Plaque Psoriasis Pictures
There are three symptoms typical of any form of psoriasis including plaque psoriasis. They usually help to diagnose the disease. These symptoms are identified as a result of scraping the surface of the papules with a scalpel.
- The phenomenon of stearin spot. The removal of the scales resembles scratching stearin. This phenomenon is caused by parakeratosis or accumulation of air bubbles in the corneal layer and increase of lipids level. That makes intercellular linkage weaker.
- The phenomenon of the terminal film. After the scales are scraped, a wet shiny surface appears. It resembles a polythene film. The terminal film is the last layer which can be removed from skin.
- The phenomenon of bloody dew or pinpoint bleeding. That happens when the surface capillaries vascular network is injured.
Stages of the Disease
There are three stages of plaque psoriasis. Each of them has its own peculiarities.
- new rash elements periodically appear; they have typical scales-free erythematic rim (the rash itself has scales);
- the existing papules increase in size as a result of their peripheral growth;
- positive isomorphic reaction (the appearance of new papules on the areas of skin irritation (because of sunburns, needle stick, scratches, use of irritating ointments). It is called Koebner phenomenon;
- severe exfoliation of psoriatic elements except papules growth areas;
- a positive Koebner reaction and the triad;
Stationary (stable) stage:
- absence of new papules;
- the number and size of the existing psoriatic elements remains unchanged, there is no peripheral growth;
- moderate exfoliation of the entire surface of the papules;
- a negative Koebner reaction and positive psoriatic triad.
- the psoriatic elements get less exfoliating and then disappear completely;
- hypopigmentation or hyperpigmentation appears;
- a negative Koebner reaction and positive psoriatic triad.
As a rule, the disease lasts for quite a long time. There are also frequent relapses. They may occur several times a year. Here are the possible scenarios of the disease:
- winter type of the disease: the relapses occur in autumn and in winter.
- summer type: periods of exacerbation occur in warm periods of the year.
An all-season type is the worst variant. There is no connection between the exacerbations and time of the year and, therefore, the periods of remission are almost absent. It is the most difficult variant to treat.
Plaque Psoriasis Treatment
Modern medicine offers a number of ways for plaque psoriasis treatment. The necessity to hospitalize the patient, as well as the specific way of treatment for the disease, the doses and medications are very individual. They are always prescribed on the basis of the severity of the disease, the presence of concomitant diseases, and counterindications.
A patient should be hospitalized if:
- plaque psoriasis is of the severe form (abundant itchy rash, areas of exudation, high risk of getting a secondary infection, symptoms of general intoxication (weakness, headache, fever), systemic disorders);
- outpatient treatment was of no use and the disease progresses;
- exacerbation period of the disease occurs.
In-patient treatment of plaque psoriasis includes:
- detoxification of the body;
- systemic administration of medicines;
- local therapy.
Systemic glucocorticosteroids are barely used today because of the increased risk of side effects and complications of the disease. They are only administrated if any other remedies prove insufficient. Severe plaque psoriasis is an indication to use cytotoxic drugs.
As for the local treatment, it has to be used very carefully. During an exacerbation the affected skin cannot be treated with highly concentrated and strong drugs. Hormonal ointments are applied for a short period of time.
When the disease is of moderate or localized form, one may carry out psoriasis treatment at home. The main focus is on the use of local treatment. Specific drugs are chosen on the basis of the stage of the disease. Hormonal and non-hormonal local treatment is usually used.
- Hormonal treatment includes steroids in the form of creams, gels, lotions, and emulsions.
- Non-hormonal treatment. Using a combination of local treatment drugs one can achieve quite a good result.
To cure plaque psoriasis one has to keep to the necessary diet and keep regular hours. One has to avoid foods rich in saturated fats and easily digestible carbohydrates. Patients with plaque psoriasis should not consume salt, spicy food, products that can provoke allergy, food with additives, dyes, pickles, smoked products, and alcohol.
Plaque Psoriasis Natural Treatment
To improve the efficiency of treatment, one may use additional plaque psoriasis natural treatment. Home remedies may include warm baths with infusions and extracts of medicinal plants (chamomile, pine, or marigold).
Natural UV is useful for patients with plaque psoriasis: one may have a 30 minutes sun bath twice a day. As natural remedies in treatment of the disease one may try to swim in salty or fresh water. As an additional therapy in remission doctors practice mud therapy and balneotherapy in special health resorts.
Is Plaque Psoriasis Contagious?
There is no unambiguous answer to this question. Though most physicians tend to think that the disease is transmitted only by inheritance and is triggered by infectious, viral and other factors.
So, psoriasis which is caused by genetic factors is not contagious. Psoriasis is not a sexually transmitted disease. It cannot be transmitted with saliva, through a handshake or skin to skin contact.