It is known that up to 80% of patients with psoriasis have a greater or lesser degree, to the injury of the skin on the scalp. In some cases, the hairy part of the head is the only location in psoriatic flare-up. Whereas, a special "social relevance" of the scalp, in the presence of a chronic disease, in the zone, to essentially violate the quality-of-life, and 80% of the patients.
In a recent study, it has been observed in the impact of psoriasis on patients (n=723), of which 97% have pointed to the violation of the daily way of life. 28% of the patients with psoriasis participated in this study in 2005, a point out any problems with the receipt of services at the beauty salon. In patients with psoriasis, low self-esteem, which adversely reflected in the mass media. According to a study in psoriasis is significantly correlated with mental health status (p < 0.01).
The specific signals, which may contribute to the susceptibility to PWCG
- Along with the presence of a long terminal, and a high level of sebum production sebum in the scalp is different than the enhanced shedding of Horny phosphate group is connected to the cell. The high concentration of hair follicles, in the absence of sunlight, thereby limiting the impact of UV, which usually reduces the development of psoriatic lesions.
- They cause inflammation of microorganisms in patients with PWCG has been isolated from the fungus of sort Malassezia globosa, and it has also been suggested that the relationship with the severity of the disease.
- The recurring friction and damage to the scalp as possible (the phenomenon of Koebner) when the brush or the application of the tools on this job).
The clinical presentation of psoriasis in the scalp
Psoriasis of the scalp that is accompanied by the appearance of the skin, a characteristic of acne, is represented by a spot or more of the plates of a pale pink to a brown-red color. In the majority of cases, the elements of the itching, infiltration of at least minimally significant in the sampling of exaltation above the level of the healthy skin, the severity of the infiltration of more than 1 mm in diameter.
Dubitandum questions:
- the psoriasis and/or seborrheic dermatitis;
- psoriasis and hair loss;
- the psoriasis and scars;
- psoriasis, and hair growth;
- psoriasis – back or on the phenomenon of Koebner Reinbek
The psoriasis and/or seborrheic dermatitis (MD)
In the diagnosis may occur some difficulties in the localization of a disease process, exclusively in the scalp. Many patients with psoriasis, which was initially diagnosed as SJ.
The differential diagnosis, and the symptoms of psoriasis, and SJ.:
- for psoriasis, the opposite of the DM, which is characterized the most expressed of the infiltration of the elements of the rash by a and the over-proliferation of the cells of the epidermis;
- most of the rainfall when the psoriasis is often transferred to the outside of the skin of the scalp, the forehead (the so-called "psoriatic crown"), in the neck, the ear and the shell;
- the bark, when the psoriasis dry season, when the scale of more fat;
- strong itching can occur when you have;
- it also needs to be carefully examined and consult with a patient, the search from the center of the nails and joints that you can talk on the behalf of the psoriasis and the impact of other tactics of treatment.
In spite of some differences in the clinic, it is not always in the clinic, it is possible to demarcate these two disorders. A great help in that you have dermatoscopy.
The characteristics of the clinical picture and the treatment of psoriasis of the nails?
It is a useful tool in the assessment of psoriasis of the scalp, especially in the low-to-moderate forms, it is difficult to subject to clinical review. Dermatoscopy is contributing to the early detection, differential diagnosis, observation, and selection. It takes into account the stage of the hair scalp his psoriasis, and the presence and morphology of vascular imaging, erythema, and scaling.
They were very skin-friendly populations, a rain shell, characterized by the appearance of "red spots", which represent a tie to the vessels in papillary dermis, extended to the bottom of the a's and psoriatic arthritis the inflammation.
Please also be aware of the possibility of a combination of psoriasis and it does the same thing for the patient, some of the authors are the same who are in this state, the term 'sebopsoriasis". In some cases, the DM may precede the psoriasis, or even in those states are able to co-exist. The appearance of the psoriasis can also occur due to a phenomenon of Koebner, in the middle of the lesions of the skin, SJ.
Psoriasis of the scalp and loss of hair
A common complaint of patients who have psoriasis on the scalp is hair loss, however, is the root cause of the majority of the cases, it is considered to be the loss of hair, triggered an injury, which is caused by the itch-focus (traction alopecia).
It was, therefore, examined the status of 47 patients with psoriatic alopecia: the follow-up period, 41 patients was 7 years, and in 34 patients (83%) was observed for the resumption of the growth of the hair, when you resolve psoriatic lesions. The reports of telogen effluvium it is not directly related to the psoriasis.
Dermatological status:
- it was observed a decrease in the density and thinning hair with a receding hairline more pronounced in the central-parietal and right scalp;
- in the absence of the follicular mouth;
- erythematous-infiltrative pockets of the skin.
Dermatoscopic signs of psoriatic arthritis, of scarring alopecia is usually the following: it is the presence of interfollicular twisted red loops, and is specific to PWCG, and in the absence of holes, the follicular. Postolatii, or of the growth of the hair, the beams is not observed.
The slicers horizontal areas of a biopsy sample when the PWCG show the following:
- the sebaceous gland has not been shown, however, that they were present in the individual muscles, raising hair, and it was also observed in perifollicular fibrosis;
- the analysis of the vertical cut-off showed skin changes, which can be compared with that for psoriasis, and a moderate chronic inflammatory infiltration around the blood vessels and the sweat glands, accompanied by the formation of fiber bundles;
- at the dermal-epidermal level of any of the inter-layer changes, or lesions of the follicular epithelial has not been observed.
- The results of the biopsy specimen, when PWCG is consistent with the scarring alopecia, which is accompanied by psoriasiform epidermal changes.
Psoriasis, and secondary scarring alopecia
The more common factors associated with the development of psoriatic arthritis in scarring alopecia, is the high duration of the disease, and the severity of the psoriasis.
Since these changes to one degree or another is common to all lymphocytes scarry sometimes, we have no reason to believe that psoriatic alopecia is a secondary clinical change to the parent process, and it is not exclusive to histopathological status.
It has a high frequency of occurrence of this complication, even authentically it is not known, and therefore, in order to avoid the progression of the development of scarring alopecia, there is a need for better control of psoriatic inflammation.
Psoriasis and hair growth
The observations indicate that the sequence of events when the psoriasis is correlated with the activation of anagenic hair growth. Seen a surprising analogy between the kinetics, the epidermal cells when the psoriasis and the proliferation of keratinocytes from the extracellular matrix during the phase of anagen.
It is carried out a comparison between Koebner's phenomenon and the renewal of anagenic growth, t. e., the process of wound healing. Both phenomena might have the same "run" of the engine.
A method for the treatment of psoriasis the laser?
Since he is clinically active in psoriasis and suppresses the GNezding ALOPetion (HA). The distribution of the scale in psoriasis in the scalp that stops at the border of the home ACRES. With the resumption of hair growth, and psoriasis on the head can occur after the immunotherapy to contact you when you HA. The phenomenon of Reinbek, demonstrates the normal hair growth in psoriatic arthritis to service, the attendant QUOTATION.
The factors that determine the choice of therapy for psoriasis
- old.
- the type of psoriasis;
- the extent of the injury, the nature and location of the rash;
- the earlier the therapy;
- the co-morbidities.
In a group of drugs for a tOPICetion treatment of psoriasis:
- tOPICeskie glucocorticoid;
- analogues of vitamin D3;
- tOPICeskie calcineurin inhibitors;
- keratolytic;
- other retinoids, FitODAepairts, drugs of the tar sands, which is a combination of drugs).
In the treatment of psoriasis of the scalp
Injury of the scalp, and is assigned to the lotion 1 time per day, and has anti-inflammatory properties, peeling off the stock.
When mild manifestations of skin, and a light WelуWeresearch Institute it is recommended that the shampoo and the lotion 1-2 times a day until the disappearance of clinical signs.
Psychosomatic: psoriasis - a physical reflection of the mental health issues?
At this time, a more even distribution in the treatment of psoriasis of the received methods of phototherapy with ultraviolet (UV) rays of the spectrum, B (280-320 nm). The effect of the application of the therapy is based on anti-inflammatory, immunomodulatory, and antiproliferativo action.
The therapy combines nicely with the a guide to the study of the scriptures, the means, and it can also be used as a single agent or a sponsor of a treatment.
The most effective way of applying phototherapy to the skin of the scalp, there are tools that are best for this area. These devices are provided with a comb or a SVetovodAMI, which contributes to the good start of the UV radiation on the skin of the head.
The algorithm of the therapy PWCG
Prior to the commencement of the course of therapy it is best to prepare your scalp for the application of a keratolytic, as well as the abundant and peeling may reduce the effectiveness of the treatment.
It is important to note that the minimization of the tools can not be used directly prior to the fotonteof RAPIeth, because they prevent the access of rays to the skin. However, they can and should be used following each session of therapy, therefore, the sun's UV rays, additionally, it dries the skin.
Phototherapy is the USE of 311 nm is assigned to you 2 to 4 times a week, for 20 to 30 proceedings on the course.
After the completion of a course of treatment, and in some cases, it is recommended that the appointment of a support for therapy 1 time a week.
The role of the tools in the basic care of the skin of patients with PWCG:
- the preparation for the treatment;
- to increase the efficiency of the therapy;
- the reduction of the treatment time and the need for "therapy-active", including by the use of the PCA;
- the lengthening periods of remission, the reduction in the number of exacerbations per year;
- the improvement of the condition of your skin, and the prediction of diseases in general.
The optimization of the therapy can achieve, using a keratolytic, emollient, antandмandкontandкonin.
- Keratolytic is an important step in the treatment of psoriasis. This is to prepare the skin for the treatment methods of treatment. In the composition, keratolytic tools, they are: - urea (10-30%), salicylic acid (2-5%), lactic acid, acetic acid and other organic acids, the acids of alpha-hydroxy and derivatives thereof (cloimid).
- Эмonlents - it has the ability to re-structure the areas lipidnuu cloak-and epidermal-barrier, these drugs are necessary for therapy in the case of the use of the permanent keratolytic funds.
- АntandмandкontICA are used for the hygiene of the scalp (shampoos and lotions ketoconazole, zinc compounds, and t. d.
In the treatment of psoriasis, you can be successful in the application of the anti-psoriatic кonсмeTSeintICA. His success is usually based on a combination of methods, delicate deскinandмandTSandand, hydration, and cleansing of the scalp.
Given the particular nature of the disease, and the specific keratolytic can be done in the way of 2-3 times a week for a one-time use only, and in a month's time.
In the midst of a return to the intensity of the symptoms of keratolytic therapy, it may not be as effective.
From the moisture on the tools can also be used on the skin of the scalp, it is better to give preference to the geleinsм or components of the emulsion.
For the scalp, and are often used in ways sensitive to the shampoo (shampoo and cream), the oil and the nutrients in the masks, balms and oils for the hair, skin, and with a low acidity (less than 5,5).
There is a method of applying the skins moisture after the washing of the head.
A system of therapy in PWCG
The indication for systemic treatment when the psoriasis is to be lifted from the place of treatment and therapy, as well as to take part in the process of a major anatomical landmarks and regions. The need for the allocation of systemic treatment, when the localization of a pathological process only of the scalp is an extremely rare occurrence.
But, in spite of the availability of effective modern methods of treatment of external therapy, it is not always possible to achieve the desired therapeutic effect.
Given the significant impact of the loss of scalp and the quality of life, as in the case of the torpid current of psoriasis it is appropriate to consider systemic treatment, after discussing with the patient the expected benefits and the potential risks.
The system of medicinal products for the treatment of psoriasis include the following:
- in the retinoids;
- TSandtonсtandtICHeskie products;
- andmmуnonбandonlongICHeskie drugs.