Pustular psoriasis - treatment and photos. Pustular psoriasis: Barber form, treatment with folk remedies

Among the existing types of psoriatic disease, the most severe form of skin dermatosis is pustular psoriasis. The disease is accompanied by abundant exudative rashes in the form of pustules covered with a purulent crust, which causes symptoms of severe itching, burning and painful abscesses. All these manifestations are dangerous, since there is a possibility of infection in the open wounds of the affected areas. Therefore, in order to avoid irreversible consequences, you should promptly contact qualified specialists who can prescribe effective treatment.

Main reasons for development

The nature of pustular psoriasis is not fully understood, so there are various hypotheses regarding the appearance of this type of dermatosis. Modern researchers identify several factors contributing to the development of pustular psoriasis:

weakened immunity due to long-term use of potent drugs that stop cell growth;
predisposition;
metabolic disorders due to hormonal imbalances in the body;
smoking and alcohol abuse;
nervous system disorder;
severe infectious and bacterial diseases;
high dose of ultraviolet radiation;
calcium deficiency in the blood.

Also, in the pustular form of psoriasis, the triggering factors for the disease are a severe form of hepatitis, which causes disruption of the liver and suppresses the body’s immune system.

Features of the course of the disease

Forms of the disease:

widespread generalized;
localized.

Stages of development:

regressive stage;
a progressive stage in which the number of rashes increases;
stable stage, turning into a chronic form of the disease.

The symptoms of Barber's psoriasis appear gradually and affect areas of the body on. Pustular psoriasis is manifested by peeling of the skin, then rashes appear in the form of blisters, which subsequently merge into separate inflamed islands of a red hue.

Over a long period of time, rashes may appear only occasionally and do not cause much discomfort to the patient. But if the body is exposed to irritating factors, the disease will develop more intensively.

Pustular psoriasis is easily diagnosed because it affects only certain areas of the body. The photo shows pustular psoriasis, which is localized mainly on the palms and soles.

In severe cases of the disease, pathological processes such as:

disruption of keratin production in epidermal cells with parakeratosis;
fusion of epithelial cells and formation of foreign cells in agranulosis;
disruption of intercellular connections in Munro microabscesses;
development of uneven papillomatosis.

Treatment methods

For effective treatment of pustular psoriasis, a comprehensive examination by a dermatologist should be prescribed. When diagnosing pustular psoriasis, treatment should take place in an inpatient setting, which includes a number of medical measures:

taking medications to remove toxins from the body;
with medications from the diuretic group to reduce the fluid content in the tissues and serous membranes;
a course of antihistamines to suppress acute symptoms;
taking hormonal medications;
local treatment using special ointments and creams against psoriasis;
well ;
diet therapy with limiting the consumption of salty and peppery foods that cause an allergic reaction in patients;
a course of physiotherapeutic procedures;
a course of drugs to normalize the nervous system;
systematic implementation of therapeutic and mud baths in sanatorium-resort conditions (especially recommended in the remission stage).

For local treatment, dermatologists prescribe several effective drugs:

hormonal ointments and creams that have a calming effect;
anti-inflammatory lotions for wiping affected areas of the body;
non-hormonal ointments to relieve acute symptoms and swelling.

Timely comprehensive treatment of pustular psoriasis allows you to achieve stable remission of the disease, quickly suppress intolerable symptoms, and also normalize metabolism within the body.

Due to the cyclical course of pustular psoriasis and frequent relapses, patients suffering from a chronic form of the disease require regularly undergo a course of treatment and preventive procedures for the normal condition of the whole organism.

Generalized psoriasis is one of the most complex and severe forms of psoriatic disease, in which pustules look like large spots of a pinkish or red hue, appear in waves on the body and cover a large volume of tissue. Accompanied by an increase in temperature, deterioration in general health, pain, itching, burning in the area of skin lesions. In the absence of timely and competent treatment, such a disease leads to arthritis of varying degrees of severity and, as a result, disability.

Generalized pustular psoriasis

With Zumbusch psoriasis, large pustules are found on the patient’s body, which slightly rise above the skin and are clearly demarcated from healthy skin. In this case, the lesions become covered with crusts, the stratum corneum becomes denser. After the acute process of the disease is completed (as a rule, symptoms subside after 4-8 weeks), rashes that are characteristic of ordinary psoriasis may remain on the skin.

Main symptoms:

temperature increase;
and burning;
weakness;
malaise;
the presence of “purulent lakes” on the surface of the skin;
profuse rashes that are located in the genital area, on the bends of the knees, joints, on the back, stomach, arms, chest, and in some cases on the scalp, nails, mucous membranes;
brown crusts that cover large pustules;
erosions and ulcers at the sites of damage to rash foci;
large erosions on the skin.

Generalized pustular psoriasis is treated by taking the following measures:

detoxification therapy (drips are used to remove toxins from the body);
taking antihistamines;
use of sorbents;
taking anticytokine drugs;
a course of taking glucocorticoid hormones;
taking retinoids;
use of immunomodulators;
taking sedatives;
use of cytostatics;
photochemotherapy;
course of vitamins;
plasmapheresis;
hemosorption;
local therapy using emollients and gels, as well as corticosteroid drugs, compositions containing salicylic acid.

Barber's pustular psoriasis

Barber's psoriasis is a localized form of the disease that affects the soles and. This form is most often found in female patients.

Barber's psoriasis occurs over a long period of time. Very often, the disease occurs in waves - acute symptoms either worsen, then subside, then again become acute. Only an experienced doctor should diagnose such a disease, since the signs of the disease are very similar to eczema or fungus, and improper treatment can lead to a worsening of the condition.

The disease is accompanied by the following symptoms:

a spot with clear boundaries that peel off;
flat pustules with internal contents, which are localized deep in the skin;
inflammatory foci are located near the big toe, on the lateral surface of the foot or palm, arches of the feet and heels;
itching and burning in the area of pustules;
general deterioration in health.

As experts in the field of dermatology note, none of the types of Barber or Zumbusch psoriasis can be completely eliminated, but it is always possible to reduce the manifestation of the disease, make the period of remission longer, and improve the patient’s quality of life.

This type of pustular psoriasis often leads to disability, even disability. It is almost always accompanied by exudative psoriasis. Severe symptoms of the disease force intensive treatment of pustular psoriasis.

What does pustular psoriasis look like?

Life threatening pustular psoriasis(photo 1) always starts suddenly. Bright red erythema develops in a matter of hours. Pustular psoriasis against this background is manifested by small grouped superficial pustules. Increasing in size, they gradually merge and form purulent lakes. Purulent elements can also be found on already formed foci of psoriasis. An eroded surface is observed under the crusts.

Pustular psoriasis causes headache, arthralgia, nausea, and myalgia. Another type of disease is pustular psoriasis of the palms and soles. In this case, small pustules containing sterile liquid appear on the inflamed areas. The morphological structure of the skin is located in the deep palmar surfaces. Pustular psoriasis of the palms has large pustules with yellow contents.

What does exudative psoriasis look like?

Many sources mistakenly attribute exudative psoriasis(photo 2) to the same variety as pustular. This is fundamentally incorrect, since exudative psoriasis is characterized by the absence of papules. It has an overly pronounced exudative element that permeates the accumulations of scales. The exudative form of psoriasis is more often observed with immune and endocrine disorders. After removing the crusts, erosions remain on the body. Inverse type rashes can often be observed.

Exudative psoriasis scales are grayish-yellow, sometimes there are massive greenish crusts - scales glued together by leukocytes. The favorite place for the disease to appear is skin folds and legs, so this type is not observed, although the presence of crusts in severe forms is similar in appearance.

Forms and types of pustular psoriasis

Pustular dermatoses have several forms:

generalized pustular psoriasis;
subcorneal;
Apollo acrodermatitis;
Endus bacteride;
pustular psoriasis of the soles and palms of Barber, which is more common than others.

Barber's pustular psoriasis(photo 3) sometimes accompanies vulgar psoriasis. Its characteristic rash can be found on the feet and hands. The first symptoms that indicate it can be detected simultaneously with the appearance of pustules. That is why it is called palmoplantar pustular psoriasis. Gradually drying out, the pustules turn into a dense brown crust. Any pustular form of psoriasis poses a danger to the patient’s life. According to statistics, pustular psoriasis of the palms and soles most often affects the fair sex of humanity.

Pustular psoriasis and treatment

Towards complete recovery treatment of pustular psoriasis will not lead. Medicine can only achieve stable remission. Treatment for pustular psoriasis depends on the severity of the inflammation and the area affected. Local therapy is carried out with ointments: with salicylic acid, corticosteroids, vitamin D3. It is also quite difficult, since they are constantly in contact with clothing. Pustular psoriasis also requires treatment with the following drugs:

immunosuppressants;
vitamin complexes;
antihistamines;
cytostatic agents;
mild sedatives.

Exudative psoriasis and its treatment

Treatment of exudative psoriasis involves the use of phytotherapeutic sessions. Many experts admit it, but under close supervision. In severe cases, exudative psoriasis requires treatment with immunomodulators, and a strict diet is prescribed. The remission stage involves special sanatorium-resort treatment and rehabilitation.

One of the rare forms of endocrine diseases is pustular psoriasis. Let's consider its features, symptoms, methods of diagnosis, treatment and prevention.

Exudative or pustular psoriasis, according to many scientists, is a contact dermatitis of allergic etiology. According to the International Classification of Diseases, 10th revision, it falls into this category:

XII Diseases of the skin and subcutaneous tissue (L00-L99)

Papulosquamous disorders (L40-L45)

Psoriasis L40

L40.0 Psoriasis vulgaris
L40.1 Generalized pustular psoriasis
L40.2 Acrodermatitis persistent
L40.3 Palmar and plantar pustulosis
L40.4 Guttate psoriasis
L40.5 Arthropathic psoriasis
L40.8 Other psoriasis
L40.9 Psoriasis, unspecified

In most cases, the defect develops spontaneously or due to the use of strong medications. The pathology falls into the category of chronic and incurable, manifested by round red or pink rashes with peeling. It can occur on any part of the body, but most often affects the scalp, elbows, knees, palms and soles.

The disease affects people aged 10 to 50 years. It refers to systemic disorders, as it affects not only the skin, but also mucous membranes, nails, musculoskeletal system, and hair. The disease is not contagious and is not transmitted by contact, but may be associated with hereditary factors.

ICD-10 code

L40 Psoriasis

Epidemiology

Psoriasis is a polyetiological disease; genetic predisposition and immune system disorders play a huge role in its development. Epidemiology indicates its widespread prevalence. According to medical statistics, about 3% of people worldwide suffer from this defect.

Most often, the disease is diagnosed at a young age, that is, before 30 years of age: in women before 16, and in men after 22. Very often it develops in people with diabetes, obesity, and hypothyroidism. The number of patients is higher among populations with a high atherogenic nutritional profile. That is why psoriasis is rarely found in countries where large amounts of omega 3 polyunsaturated fatty acids (fish, seafood) are consumed, which have an antiatherogenic effect.

Causes of pustular psoriasis

The disease is one of the most severe pathologies of the epidermis, but the exact causes of pustular psoriasis are unknown. There are many theories about its etiology and pathogenesis. It is associated with genetic factors and a number of other reasons. Let's consider the main ones:

Endocrine system diseases
Digestive tract diseases
Nervous strain
Low blood calcium levels
Jaundice
Psychoneurological disorders
Allergic reactions of various etiologies
Dysfunction of the endocrine glands
Immune system disorders

To establish the exact cause of the defect and the factors that provoke it, the patient will undergo a complex of various diagnostic studies. The type of treatment and its duration depend on their results.

Risk factors

Exudative psoriasis is a multifactorial disease. Hereditary predisposition, weakened immune system and metabolic disorders play a huge role in its development. There are exogenous and endogenous risk factors, let’s consider them:

Hormonal disbalance
Infectious diseases
Pregnancy
The use of potent external drugs
Nervous strain and stressful situations
Contact with chemicals
Prolonged exposure to ultraviolet radiation
Irrational use of drugs

According to medical statistics, about 40% of cases occur suddenly. But most often the disorder develops due to aggressive treatment of the vulgar form of the pathology and other chronic pathological processes in the body.

Pathogenesis

The mechanism of disease development is based on impaired proliferation and differentiation of keratinocytes. Pathogenesis indicates a shortened cell cycle and increased production of keratinocytes. Because of this, the epidermis layer thickens and many scales form. There are several theories about the origin of pustular psoriasis:

Hereditary
Viral
Neurogenic
Hypothesis of congenital instability of lysosomes, defects in epidermal capillaries, disorders of keratinization and lipid metabolism.

Due to hyperproliferation, skin inflammation worsens. In lesions, cells produce interleukin-1, which is similar to epidermal T-lymphocyte activating factor produced by keratinocytes. Interleukins and interferons can act as mediators of inflammation, contributing to the chronicization of the pathological process.

Pathogenesis is directly related to the cause and factors that provoked the disorder. Treatment tactics depend on it. The course of the disease is significantly aggravated by emotional stress, taking medications, injuries to the epidermis, streptococcal infections, alcohol abuse and poor diet.

Symptoms of pustular psoriasis

Pustular lesions of the epidermis are observed in 1% of patients with psoriasis and are most often localized in the area of the palms and soles. Symptoms of pustular psoriasis are cyclical and depend on the form of the disease, its type and stage.

At first, hyperemia and inflammation appear. After this, symmetrical rashes-pustules gradually appear on the skin. The patient complains of itching and burning. Unpleasant symptoms intensify at night and when using household chemicals (soap, shampoo).
The pustules contain sterile fluid, some of them drain, forming large lesions. When the blisters burst, the open wound becomes infected. Because of this, the disease becomes festering in nature.
Against this background, erythroderma may begin. Some patients develop ring-shaped, serpiginating and other types of erythematous-pustular rashes on the skin and mucous membranes. Dystrophic changes can affect the nails, face, scalp, joints and even the kidneys.

The disease develops over several months with constant exacerbations of symptoms. During this period, the patient suffers from general malaise, weakness, chills and fever.

First signs

In terms of its symptoms, the exudative form differs from the clinical picture of a simple type of rash. The first signs appear as focal inflammation, itching and burning. Gradually, papules with liquid form on the surface of the epidermis, which burst, forming large wound areas. When you try to remove them, a bleeding surface appears, which turns into scales when healing.

In its classic manifestation, the disease is characterized by a triad of the following symptoms:

“Stearin stain” - when the skin is lightly scraped, peeling intensifies, which makes the papules look like a drop of stearin.
“Thermal film” – forms after the scales are removed, leaving a damp, thin surface.
“Blood dew” – appears when the thermal film is damaged. Pinpoint drops of blood appear on the skin caused by trauma to the plethoric papillae of the dermis.

The pathological condition is characterized by increased rashes due to mechanical or chemical irritation. The rash appears within two weeks. On the elbows, knees, and scalp it persists for a long period of time, without spreading to other areas.

Stages

Pustular psoriasis has several stages of development, which differ in their symptoms. Let's look at them:

Initial - a rash appears on the body, which quickly grows. The plaques are oval or round in shape and pink in color, covered with whitish scales on top.
Stationary – occurs 7-21 days after the onset of the pathological process. The plaques are light-colored, ring-shaped, their surface is covered with silvery scales.
Fading - the plaques acquire a skin tone, the itching is less intense, and a ring of keratinized skin forms around the rash. This period lasts from several months to a year or more.

Depending on the stage of the disease, the nature of the rash and its location, a treatment plan is drawn up.

Forms

Many dermatological diseases have several stages, forms and types. The types of pustular psoriasis depend on the location of the rash and its nature. The disease is divided into two large types: generalized and localized, let’s consider them:

Generalized – occurs both in healthy people and in those who already suffer from other forms of the disorder. It is characterized by the sudden formation of erythema with severe itching and burning.

Tsubmusha most often occurs in completely healthy people. Erythema appears on the body - inflamed areas that are hot to the touch. Gradually they turn into pustules, which unite with each other, affecting large areas of the body. This type is recurrent.
Acrodermatitis Allopeau is a dermatosis with pustules of unknown origin. The rash is localized in the acral areas, that is, on the soles of the feet and hands. The disease occurs in the form of small rashes with clear boundaries. As the pustules grow, they open up, forming erosive areas with purulent crusts. The disease is chronic, progressive with scleroderma-like changes and atrophy of the epidermis.
Impetigo herpetiformis - in most cases occurs in pregnant women, less often in children and men. It develops sharply, the rashes are painful pustules, localized in the groin area, on the inner thigh, in the armpits.

Localized (limited) – affects up to 10% of the total body surface. It is strictly localized on certain parts of the body, for example, on the soles of the feet or palms. It occurs more easily than the generalized form.

Localized form of Acrodermatitis Allopo - occurs in the pubic area, can occur with vulgar psoriasis.
Barber's psoriasis is a chronic, relapsing form. Affects hands and feet. The pustules gradually dry out, forming dense brown crusts.

The limited type is much easier to treat; topical remedies are sufficient to eliminate it. While in the generalized form, the patient awaits long-term complex therapy with various forms of medications, diet therapy, and physiotherapy.

Pustular psoriasis of the palms

Exudative rashes on the palms indicate a serious dermatological disease. Pustular psoriasis of the palms is quite common. It can occur both locally and in combination with rashes in other parts of the body, including damage to the joints. The peculiarity of this form is that due to the lack of diagnosis, it is very often taken and treated as a fungal disease.

The disease affects people of different ages, but most often occurs in patients 30-50 years old. It is based on hereditary predisposition. Provoking factors are regular mechanical or chemical irritations of the hands, prolonged contact with water, various infectious diseases (scarlet fever, sinusitis, tonsillitis), intoxication, damage to the endocrine system and a number of other factors.

The palmar form of psoriasis has two types:

Plaque-fan-shaped - a red rash, located in a fan shape, clearly standing out among healthy tissues. Gradually, silvery scales appear on the papules, which merge into plaques, creating the appearance of cracks.
Calloused - characterized by excessive growth of the stratum corneum of the skin, that is, layering of the epidermis on the palms. The areas of layering are most often located on the lateral surfaces of the palms and can merge with each other.
Circular - manifests itself as large foci of peeling in the form of rings and circles.

Nails may be involved in the pathological process. Patients complain of severe itching and burning, which cause insomnia and neuroses. The treatment is long and difficult. Difficulties begin in the diagnostic process, since the disease must be differentiated from pathologies with similar symptoms.

During therapy, ointments with corticosteroids are used, but the body very quickly gets used to such drugs, making the treatment ineffective. Therefore, patients are prescribed combination agents that contain several active components. After the acute period is stopped, I prescribe drugs to patients to accelerate tissue regeneration, that is, skin restoration.

Pustular psoriasis of the soles

A dermatological disease characterized by the formation of pustular pustules on the feet is pustular psoriasis of the soles. The disease is cyclical, periods of exacerbation are often followed by complete remission. Most often it affects people aged 25 to 50 years. Pathology develops due to inflammatory processes in the body, various allergic reactions and intoxication. Smokers and people with chronic alcoholism are at risk.

Peculiarities:

The rash affects the arches of the feet, gradually spreading over their entire surface. Small yellow blisters with an inflamed rim, filled with exudate, appear on the skin.
Pustules flake off involuntarily, causing suppuration due to the addition of a microbial infection. An unopened rash dries out, forming brown crusts that peel and form cracks.
The skin on the affected surfaces turns pink and then red-blue. The patient complains of severe itching and pain due to the fact that the pustules are constantly injured.
If the defect involves the toes, the nail plate peels off, but the interdigital folds and the skin on the folds of the toes remain healthy.

Excessive growth of rough skin on the feet leads to calluses, which are located chaotically. Calluses can merge with each other, forming large wound surfaces. But the lesion has certain boundaries that separate it from clean skin. Treatment is long-term and begins with removing foci of infection, taking corticosteroids and broad-spectrum antibiotics.

Generalized pustular psoriasis

One of the most severe forms of skin pathologies is generalized pustular psoriasis. The rash affects almost the entire body, including the nails, accompanied by itching, burning and pain. The disorder begins abruptly; at first, erythema, that is, psoriatic lesions, forms. The inflamed areas are quite large, rise above healthy tissue and cause a burning sensation.

A large amount of the rash is localized in the perineum, genitals and joints. Against the background of dermatological changes, the general condition of the patient worsens. The temperature rises, muscle and joint pain, weakness and malaise occur. A blood test reveals leukocytosis and increased ESR values.
Gradually, blisters and pustules with pus and exudate appear on the inflamed areas. They form very quickly, layering and forming wet surfaces and solid brown crusts. Such areas are easily injured, turning into erosions with gradual epithelialization.

The acute phase lasts from 2 weeks to 2 months. During this period, some crusts dry out, others heal, but the process of formation of new pustules still continues. A bright picture appears on the skin: weeping erosions and brownish crusts. During the period of remission, the epidermis is gradually restored, the former areas of the rash have a bluish-red color.

Tsumbusch pustular psoriasis

Generalized or pustular Tsumbusch psoriasis is a serious and dangerous disease. It is characterized by a rapid onset: large inflamed areas appear on the skin, on which pustules with purulent contents gradually appear. The patient's temperature rises, weakness, pain in the joints and muscles appear. During the healing process, brown crusts form on the skin; if they are injured, they turn into erosions and ulcers that do not heal for a long time.

Most rashes occur in the genital area and skin folds, as well as on the flexor surface of the joints. In some cases, the pathological process involves the mucous membranes, scalp and nails. The treatment is long and quite complex. The patient will undergo a course of drug therapy, diet therapy and a course of physiotherapy. But even such an integrated approach to the problem does not guarantee that it will not recur.

Barber's pustular psoriasis

A localized form of the rash that affects the palms and soles is Barber's pustular psoriasis. Most often, women suffer from this type of disorder. During the acute period, red spots with peeling and clear boundaries appear on the skin. Gradually, pustules form on the rash, which are located in the thickness of the epidermis with sterile contents.

The blisters are localized on the lateral surface of the feet and hands, under the fingers, and can also affect the nail plate. The disease is long-term, occurs in waves and is difficult to treat. Very often during the diagnostic process it is confused with eczema or a fungal infection. To eliminate the acute symptoms of bacterid, a special diet, various topical agents with a softening effect, temporary steroid hormones and a number of other drugs are indicated.

Complications and consequences

Pustular psoriasis is severe, causing discomfort and pain. Its consequences and complications arise when medical recommendations are not followed and during an exacerbation. Most often, patients encounter problems such as:

Malabsorption is a violation of the processes of digestion and absorption of nutrients in the small intestine. Accompanied by the following symptoms: diarrhea, sudden weight loss, anemia, hypovitaminosis, electrolyte imbalance.
Hypocalcemia is a decrease in the level of ionized calcium in the blood serum. It manifests itself as a disorder of electrophysiological processes on cell membranes and occurs in acute and chronic forms.
Pyoderma is a purulent lesion of the epidermis due to infection with pyogenic cocci.
Onycholysis is a pathological disease of the nails, which is characterized by detachment of the nail plate from the tissues of the finger.
Alopecia is complete or partial loss of hair on the head and body, impaired growth of new hair.
Necrosis of the kidney tubules in the case of oligemia is a violation of the separation of cytoplasmic proteins, causing cell destruction. Appears due to the action of pathogenic microorganisms and when the blood supply is disrupted.

If the pathological condition occurs with fever and intoxication, then without appropriate therapy it quickly turns into an acute form, which can be fatal.

Diagnosis of pustular psoriasis

A dermatological disease such as psoriasis has an acute onset and a number of painful symptoms. Diagnosis of pustular psoriasis consists of many different procedures aimed at identifying the cause, the factors that provoked the pathology, and establishing its form and type. The examination begins with a visit to a dermatologist, a visual examination and anamnesis.

When making a diagnosis, the following aspects are taken into account:

Clinical picture of the disorder.
The presence of psoriatic triad (the phenomenon of stearin stain, terminal film, pinpoint bleeding).
Koebner phenomenon in a progressive stage.

If the picture of the pathological condition is ambiguous, then it is necessary to establish whether there are relatives who suffered from this defect, that is, a hereditary predisposition.

Analyzes

In most cases, psoriatic rashes are identified after visual examination. Tests are prescribed when it is impossible to make a diagnosis based on external signs.

Laboratory diagnostics consists of:

A general blood test is performed to exclude allergic reactions. The appearance of the disease may be associated with leukocytosis and anemia. With extensive lesions, the disorder affects the salt balance of the blood, causing dehydration. During the study, the emphasis is on leukocytes and erythrocyte sedimentation rate.
A biochemical blood test is necessary to identify possible causes of rashes and draw up a treatment plan.
Urinalysis - assessment of water-salt balance
Stool analysis - detection of helminth eggs and infectious intestinal lesions.
Antibodies to HIV - the human immunodeficiency virus can trigger psoriasis.
The study of rheumatoid factor - the analysis is aimed at identifying a protein that accompanies inflammatory processes. For psoriasis it should be negative; positive values indicate rheumatoid arthritis.
Analysis of liver enzymes - GTT, AST, ALP, ALT.

After this set of tests, additional studies may be prescribed, and based on their results, the doctor draws up a treatment plan.

Instrumental diagnostics

An examination for psoriasis using various mechanical devices and devices is an instrumental diagnosis. During the study, the following procedures may be performed:

Skin biopsy is one of the most accurate methods. The doctor takes damaged tissue (no more than 6 mm) and examines it at the microscopic level.
X-ray is a procedure necessary to identify psoriatic arthritis. The doctor examines the joints, determining the extent of bone tissue damage, as it can occur with any form of psoriasis.

In addition to the two main instrumental methods, the doctor may prescribe tissue histology to determine such changes: increased vascularization, absence of the granular layer, thinning of the germinal layer of the epidermis over the elongated ones, Munro microabscesses.

Differential diagnosis

Since psoriasis is similar in its symptoms to many other skin diseases, differential diagnosis is used to identify it. The disease is most often compared with the following pathologies:

Andrews pustular bacterid - develops against the background of chronic bacterial infections: tonsillitis, dental diseases and gallbladder lesions.
Lichen planus - papules have a polygonal shape, an umbilical depression in the center, a waxy sheen and a mesh pattern.
Syphilis - papular syphilides are hemispherical in shape, copper-red in color and are caused by treponema pallidum.
Seborrheic dermatitis does not have a clear infiltration; Kartamyshev’s technique is indicated for differentiation.
Atopic dermatitis is a mild erythema with peeling, severe itching, excoriation on the face, neck, elbow and popliteal fossa, and upper chest.

If the patient has a localized form, that is, Barber pustular psoriasis, affecting the palms and soles, then this condition is differentiated from dermatophytosis of the feet, hands, and dyshidrotic eczema. The generalized form is compared with bacteremia and sepsis through blood culture. An HIV test is mandatory, since a sudden onset and acute course can be caused by the human immunodeficiency virus.

Treatment of pustular psoriasis

Complete recovery from psoriasis, and especially with its pustular form, is almost impossible. The treatment plan is drawn up by the doctor, individually for each patient. The diagnostic results, stage of the disease, form and other features of the pathology are taken into account.

Treatment of pustular psoriasis is a complex of such procedures:

Drug therapy – the patient is prescribed medications of various forms and effects. Treatment begins with topical medications, since their main goal is to cleanse the skin of pustules, soften it and prevent flaking. Systemic agents are also used: corticosteroids, retinoids, cyclosporines, antibiotics.
Physiotherapy - the affected areas are irradiated with ultraviolet light, in combination with the use of tablets, ointments, medicinal baths and other procedures.
Sanatorium-resort treatment is carried out in a state of remission, that is, when the rashes practically disappear. Patients are prescribed the following procedures: aerotherapy, balneotherapy, heliotherapy.
Diet is a very important part of treatment. The patient's diet should include products of plant origin, low-fat dairy products and cereals. During the diet, you must avoid sweets, smoked foods, pickles, fatty foods and fried foods. The diet is indicated both in states of exacerbation and remission.

Regardless of the treatment method, the entire process is quite lengthy and complex. The success of recovery depends on the unwavering adherence to medical instructions.

Medicines

Pustular psoriasis is severe, accompanied by extensive skin lesions and deterioration of the general condition. Medicines are used at all stages of the disease to reduce its unpleasant symptoms. In the generalized form, hospitalization is possible. In any case, the patient will face long and difficult complex therapy.

Medicines for internal use:

Antihistamines - used in acute pathology, reduce the intensity of itching and swelling. They help with deterioration in general health (sleep disturbances, headaches, irritability), as they have a sedative effect.

Diazolin

H1-histamine receptor blocker. It has antiallergic, antipruritic, antiexudative and sedative properties. It is used for severe skin itching, various allergic reactions, eczema, urticaria, hay fever. Prescribed for adults and children over 10 years of age. The daily dosage should not exceed 300 mg, the duration of use is determined by the doctor.

Tablets are contraindicated in cases of intolerance to the active components, during pregnancy and lactation, with gastric ulcers, inflammation in the gastrointestinal tract, prostate hypertrophy and heart rhythm disturbances. With long-term use, adverse reactions and symptoms of overdose are possible: dry mouth, irritation of the gastric mucosa, dizziness, paresthesia, drowsiness, dysuria, tremor. To eliminate them, you need to stop taking the medicine and consult a doctor.

Suprastin

A drug that affects the peripheral nervous system. Used for various allergic diseases and reactions. Effectively relieves itching, burning and other unpleasant symptoms. The dosage depends on the severity of pathological reactions. As a rule, patients are prescribed 250 mg 2-3 times a day; in especially severe cases, intramuscular administration of the drug is indicated.

Main contraindications: glaucoma, pregnancy and lactation, prostate hypertrophy. Side effects: drowsiness, general weakness. In case of overdose, nausea, epigastric pain, and dizziness occur.

Claritin

A selective H1 receptor blocker with an active component - loratadine. It is used for seasonal allergic diseases of various localizations (rhinitis, urticaria, dermatitis, eczema). To reduce painful symptoms, it is recommended to take 0.5-1.5 tablets per day. Main contraindications: intolerance to active ingredients, breastfeeding and patients under 2 years of age. Use during pregnancy is possible only if absolutely necessary.

Main side effects: nausea, vomiting, dry mouth, increased fatigue, headaches and dizziness, drowsiness. In case of overdose, the above reactions have a more pronounced effect. To eliminate them, gastrointestinal tract lavage is indicated.

If the disorder is accompanied by severe inflammatory processes, the doctor prescribes desensitizing drugs for intravenous administration (blocking H1-histamine receptors and suppressing mediators of allergic reactions). Most often it is calcium chloride or sodium thiosulfate.

Hepatoprotectors and enzymes - have immunomodulatory properties and are used in cases of severe inflammation and disruption of the gastrointestinal tract.

Festal

A drug that promotes the breakdown and absorption of foods high in fats, carbohydrates and proteins. It is used for inflammatory processes in the gastrointestinal tract, secretory insufficiency, flatulence, and digestive insufficiency. Recommended dosage: 1-3 tablets 2-3 times a day after meals. Contraindicated for use in hepatitis and obstructive jaundice.

Lycopid

An immunomodulator with the active substance – glucosaminylmuramyl dipeptide. Stimulates the activity of neutrophils and macrophages, enhances cytotoxic and bactericidal activity. It is used for the complex treatment of immunodeficiency conditions, acute and chronic forms of purulent-inflammatory lesions of the skin and soft tissues, infectious diseases of various localizations, chronic viral hepatitis B, C. The medicine is intended for oral and sublingual administration. The dosage regimen and duration of therapy are determined depending on the symptoms of the disease, and therefore are individual for each patient.

Contraindicated for use in case of intolerance to active components, malabsorption syndrome, during pregnancy and lactation. Not prescribed for patients with hyperthermia and exacerbation of autoimmune thyroiditis. Side effects manifest themselves in the form of hyperemia and mild allergic reactions. Discontinuation of the drug is not required.

Antibiotics are necessary for the acute course of the disease, when the pustules are filled with purulent contents, as well as for extensive weeping wounds. Antibiotics are prescribed when inflammation (tonsillitis, pyelonephritis, sinusitis) that supports the course of the disorder is detected. The choice of drugs depends on the localization of pathological rashes; penicillins, macrolides, and cephalosporins are most often prescribed.
Nonsteroidal anti-inflammatory drugs (NSAIDs) – stop the inflammatory process and reduce pain.

Ketorol

A drug with analgesic properties with an active component – ketorolac. After entering the body, it has an anti-inflammatory, pronounced analgesic and antipyretic effect. Used to relieve severe or moderate pain caused by any reason. Available in the form of injections (10-30 mg once) and tablets (4 pieces per day). The course of treatment should not exceed 5 days.

Adverse reactions occur in many organ systems, but most often patients experience the following reactions: nausea, vomiting, dizziness, muscle pain and weakness, drowsiness, nervousness, tremor. Contraindications: pregnancy and lactation, patients under 16 years of age, intolerance to the components of the drug, bronchospasms, erosive and ulcerative pathologies of the digestive system, dehydration, peptic ulcers, hematopoietic disorders.

Nurofen

An effective anti-inflammatory, analgesic and antipyretic agent. It is used for severe pain syndrome, rheumatoid diseases, infectious and inflammatory lesions. Available in the form of tablets and cream. Tablets are taken at 200-800 mg 3-4 times a day, ointment is applied to the affected area 2-3 times a day. Side effects occur rarely and are manifested by the following symptoms: gastrointestinal disorders, swelling, increased blood pressure, bronchospastic and allergic skin reactions. Contraindicated for use in heart failure, ulcerative colitis, gastric ulcers and extensive wound surfaces on the skin.

Enterosorbents are indicated for long-term defects. They have a detoxification effect, absorbing harmful microflora and their waste products. Such drugs reduce the risk of allergic reactions in the body and have a positive effect on the immune system. Most often patients are prescribed: Hemodez, Polysorb, Enterodes.
Immunosuppressors - the development of the disease is associated with damage to T-lymphocytes, that is, cells of the immune system. To restore them, immunosuppressants are used (Ciclosporin-A, Sandimmune). These drugs have increased toxicity, so their use is possible only in a hospital setting.

External medications:

Corticosteroids are hormonal drugs for external use and are considered the most effective for psoriasis. Quickly relieve inflammation, eliminate itching and burning, and improve overall well-being. Drugs from this pharmacological group must be used for a short period of time. This is due to the fact that with prolonged application, skin atrophy begins and stretch marks appear. Discontinuation of the drug should occur gradually, since the opposite effect is possible when the signs of the disease return and appear much stronger.

Elokom

A synthetic topical glucocorticosteroid with the active ingredient mometasone furoate. It has anti-inflammatory, vasoconstrictor, antipruritic, antiallergic and antiexudative effects. It is used for the symptomatic treatment of inflammation, itching and burning in dermatological and allergic diseases, psoriasis, seborrheic dermatitis, lichen planus. The ointment is applied in a thin layer to the affected areas of the skin once a day. The duration of treatment depends on the severity of the disease.

Contraindicated for use if the components are intolerant and with special caution for treating the face. Side effects manifest themselves in the form of temporary loss of sensitivity, itching and burning. Attacks of nausea, dizziness, dry skin, and stretch marks are also possible. Long-term use causes an overdose - skin atrophy, depression of the pituitary-adrenal system. Correction of water and electrolyte balance is indicated for treatment.

Advantan

Local anti-inflammatory agent. It is used for dermatitis, eczema and psoriasis of various etiologies. The product is applied to the skin once a day, the course of treatment is up to 12 weeks for adults and no more than 4 weeks for children. Contraindicated for use in case of hypersensitivity to active ingredients, viral infections, tuberculosis or syphilis of the skin. Side effects manifest themselves in the form of hyperemia of the skin, itching and burning at the site of application.

Lokoid

Medicine with hydrocortisone. Used for superficial pathological processes in the epidermis without infection. Helps with psoriasis, eczema and dermatitis. The ointment is applied in a thin layer to the site of the rash, 1-3 times a day. The product can be used for exudative and weeping wounds. Effectively dries, cools, moisturizes and disinfects.

To improve the results of therapy, combination drugs can be used. They contain hormones with salicylic acid: Ekolom S, Belosarik or an analogue of vitamin D3 (calcipotriol). Lorinden S and Diprosalik ointments are also popular.

Non-hormonal anti-inflammatory drugs - are used to treat all forms and stages of rashes. Most often, patients are prescribed the following ointments: sulfur, sulfur-tar, dermatol, ichthyol, zinc. They have disinfecting, absorbable, anti-inflammatory and regeneration-accelerating properties.

Tar – the use of ointments with tar allows you to completely clear the skin of pustules within a month. In this case, local application can be combined with tar baths. Tar is a natural cure for dermatological diseases. It has no contraindications and does not cause adverse reactions. Its only drawback is the pungent odor and increased photosensitivity of the skin with prolonged use.
Solidol - ointments based on this substance have analgesic, exfoliating, wound healing, antipruritic, antibacterial, anti-inflammatory properties. The ointments contain not only solid oil, but also various vegetable oils, plant extracts, bee honey and wax. This allows you to normalize metabolic processes in cells and improve blood microcirculation.

Also, non-hormonal drugs can be prescribed: Cytopsor, Psorium, Ivanov ointment, Magnipsor. To eliminate itching and burning, soften the skin, reduce the number of plaques and pustules, urea-based products are prescribed (has moisturizing properties): Lokopeise, Mustela, Topic 10. Advanced stages are treated with herbal remedies that have restorative and softening properties: Plantozan B, Psoriloma, Lomo psoriasis.

Keratolytics are a group of substances that accelerate the process of exfoliation of dead cells. Their activity is associated with the destruction of the connection between the epidermis and keratinized cells. Preparations with keratolytics are effective for dermatitis, neurodermatitis, echthyosis, various mycoses and other dermatological diseases.

The most popular and accessible keratolytic is salicylic acid. Medicines with lactic acid, aromatic retinoids (Isotretinoin, Differin) and glycolic acid can also be used. For the treatment of psoriasis, the following drugs are most often prescribed: Baziron AS, Solcoderm, Belosalik, Vipsogal, Lorinden A. They accelerate the healing of damaged skin by softening flaky plaques. Treatment should not last longer than 20 days, since the active components have a cumulative effect and can penetrate the systemic circulation, causing side effects.

Shampoos are another type of medication for psoriasis. They are used for rashes on the scalp. The most commonly used products are tar (Psoril, Friederm), antifungal and antimicrobial (Nizoral, Skin-Cap). Shampoos stop flaking of the scalp, relieve irritation and itching, and speed up the healing process.

All of the above medications for pustular psoriasis should be used only after consultation and prescription of a dermatologist. Self-medication can aggravate the course of the disease, provoking its exacerbation and a number of painful symptoms.

Vitamins

Psoriasis is a chronic disease that significantly debilitates and weakens the protective properties of the immune system. Vitamins are aimed at restoring normal functioning of the body, alleviating the symptoms of the disease and treating it. Vitamins are taken both internally and externally.

Vitamin-containing ointments and creams

The composition of such drugs includes synthetic analogues of vitamin A, D3, E and others. They have moderately low activity, so long-term use from 2-3 months to a year is required to achieve a therapeutic effect. Most often, patients are prescribed the following medications: Daivonex, Kremgen, Tazorac, Zorak. Their action is aimed at suppressing active cell division of the epidermis, moisturizing the skin, and relieving itching and burning.

Vitamins for oral administration

Useful microelements must be obtained from food. For example, vitamin E is an antioxidant that improves the condition of the skin, vitamin A takes part in the synthesis of proteins and lipids, maintaining the normal condition of the skin and mucous membranes.

It is also possible to use special vitamin complexes: Aevit (improves lipid metabolism and blood supply to the epidermis), Omega-3 (regulates the exchange of calcium and phosphorus in the body, has an anti-inflammatory effect), Hexavit (stimulates regeneration processes), Undevit (activates metabolic processes in tissues, accelerates healing), Complevit (complex of vitamins and minerals for skin and nails), ascorbic acid and others.

Physiotherapeutic treatment

Complex therapy for psoriasis allows you to achieve good results in a short time. Physiotherapeutic treatment is aimed at restoring the skin and alleviating painful symptoms. Physiotherapy is carried out at the stationary stage and during the period of remission, that is, in acute cases and the appearance of rashes, it is not used.

Let's look at the most popular and effective methods:

Ultraviolet irradiation - the affected areas are treated using ultraviolet waves. This method is well tolerated and allows achieving stable remission from several months to several years.
PUVA therapy - the skin is treated with UV rays and photosensitizers (drugs for oral use). Improves skin condition and promotes remission. Contraindicated in diabetes mellitus, pregnancy, sun intolerance, and renal or liver failure. May cause side effects: allergic reactions, headaches, nausea.
X-ray therapy – wound areas are treated with X-rays. It has antipruritic, anti-inflammatory properties, accelerates the process of resolution of pustules.
Cryotherapy – reduces the intensity of itching and pain, improves metabolic processes. The skin is treated with a medicinal mixture, the temperature of which is -160°C. To achieve a positive result, 20-25 procedures are required with a frequency of 1-2 times a day, the duration of one procedure is 2-3 minutes.
Hirudotherapy – leeches are used for treatment. They improve local blood circulation and normalize immune reactions.
Fish doctor - this technique is aimed at cleansing the skin of psoriatic rashes. To do this, the patient is placed in water with fish, which during the procedure eat a layer of plaques, eliminating psoriasis.

The use of the above methods depends on the location of the rash, the form of the disease and the general health of the patient.

Traditional treatment

Very often, for psoriasis, not only traditional medicine methods are used, but also traditional treatment. Let's consider several effective recipes to minimize painful symptoms:

Mix birch tar and any vegetable oil in equal proportions. The resulting mixture must be applied to wound surfaces 1-3 times a day.
Rinse 50 g of celandine herb and grind it to a porridge-like state. Mix the plant with goose fat and boil in a water bath for 40-60 minutes. As soon as the ointment has cooled, it can be used to treat rashes, including those on the scalp.
Take 50 g of propolis and 500 g of butter. Grind the propolis, melt the butter in a water bath and mix both ingredients. The resulting mixture must be boiled over low heat until a viscous mass of uniform consistency is obtained. The ointment accelerates the healing of ulcers and erosions.
Mix 300 g of milk and 30 g of flax seeds, crushed grape leaves and burdock root thoroughly. The mixture should be simmered over low heat for 7-10 minutes. As soon as the broth has cooled, it is filtered and used for lotions. Gauze bandages and cotton swabs are applied to the wounds, the procedure is carried out 1-2 times a day.

The folk recipes described above are effective for many forms of psoriasis, and especially for pustular psoriasis. But before using them, you need to consult a dermatologist.

Herbal treatment

Herbal components are included in many effective preparations for eliminating pustules and other rashes. Herbal treatment refers to alternative medicine, and therefore must be agreed with the attending physician.

Mix 100 g of string with valerian root, St. John's wort and celandine leaves, 30 g each. All components must be poured with 500 ml of boiling water and allowed to brew for 15 minutes. After cooling, take the medicine ½ cup 2 times a day.
Pour 100 g of celandine herb into 4 liters of water and boil in a saucepan with the lid closed for 40-60 minutes. Strain the resulting broth and add during water procedures. The water temperature during swimming should be 38°C, it is recommended to carry out the procedure every day for 15-20 minutes.
Take licorice root, celandine and oregano leaves in equal proportions. The ingredients need to be poured into 200 ml of boiling water and boiled in a water bath for 10-15 minutes. Strain the broth, cool and take no more than 100 ml 2-3 times a day.
Take celandine, sage, string, valerian and St. John's wort in equal proportions. Pour 50 g of herbal mixture into 200 ml of boiling water and let it brew for 15-20 minutes. As soon as the infusion has cooled, it should be strained and added to the bath while bathing.

The above recipes help minimize the painful symptoms of the disease, speed up the healing process and can be used during remission.

Homeopathy

To treat psoriasis, methods of different effectiveness and principles of action are used. Homeopathy is alternative medicine. It has a cumulative effect and helps strengthen the immune system. Consider popular homeopathic remedies:

Arsenicum iodatum - used for large pustules and scales. Relieves itching, burning and pain.
Sepia - a remedy indicated for psoriasis with diaper rash, the formation of areas with altered pigmentation, cracks and erosions of the skin.
Arsenicum album – suitable for treating children and elderly patients. Effectively copes with rashes on the scalp, eliminates itching, burning, dry skin. It has a beneficial effect on general well-being and the state of the nervous system.
Sulfur - pustules with purulent contents, itching, burning, frequent relapses of the disease.
Protect your skin from mechanical and chemical damage. To prevent allergic reactions, give preference to clothing and bedding made from natural fabrics.
It is necessary to ensure high air humidity in the living room. The use of conditioner is contraindicated as it causes dry skin.
Carry out seasonal prevention of colds and infectious diseases. Avoid nervous tension, stress and hypothermia.
Stick to a diet that includes avoiding fatty, sweet, salty, smoked, and starchy foods. Avoid drinking alcohol and other bad habits.

Forecast

Psoriasis is an incurable disease that lasts throughout life. The prognosis depends on its form, stage and characteristics of the patient’s body. According to medical statistics, about 17% of patients complain of complications of varying severity, and 2% of cases of the disease are fatal.

Pustular psoriasis does not pose a danger to others, that is, the disease is not transmitted by contact or by airborne droplets. But for the patient, the pathological condition is associated with a high risk of diseases of the cardiovascular system and various inflammatory processes. The disorder has a bad effect on the psycho-emotional state, increasing the risk of exacerbation of chronic disorders, the appearance of diabetes, hypertension and even oncology.

Pustular psoriasis is a fairly rare skin disease. Its first manifestation is a rash on the body, hands and soles of the feet. However, the nature of the rash is not similar to the papules typical of simpler forms of the disease; pustules appear on the human skin - small swollen lumps filled with pus. The appearance of pustules is the most important symptom of this disease.

What is pustular psoriasis?

Pustular psoriasis is one of the severe forms of an incurable disease. At first glance, it may seem to many that rashes and plaques on the skin cannot cause serious harm to the patient, and certainly cannot provoke serious consequences.

But in fact, the clinical picture looks completely different. This disease occurs in two completely different cases: as the next stage in the development of the disease in patients already suffering from vulgar psoriasis and in absolutely healthy people who previously may not have complained of skin problems or health problems.

For mild cases In patients, about 3-4% of the skin is affected, for severe- from 10% and more.

Severe form Without timely treatment, it can progress to another stage - erythroderma. Recently, there has been an opinion among experts that the development of this type of disease is provoked by aggressive methods of treating existing lichen.

However, no one can answer you with complete confidence why it is progressing. Just as no one can explain why in some people the disease is in a state of constant remission, while in others it develops and is difficult to treat.

Doctors identify a number of reasons that can affect the development of pustular psoriasis:

long exposure to direct sunlight;
abuse of bad habits: smoking and alcohol, stress, infections, antibiotic treatment, weakened immunity, hormonal changes, improper treatment of vulgar psoriasis.

Forms and types of pustular psoriasis

Based on location, this dermatological disease is divided into two types: Barber and Zumbusch psoriasis.

The first is localized on the palms and soles, and the second throughout the body.

A third type is also sometimes distinguished - exudative. Due to poor permeability of the walls of blood vessels, blood components begin to leak out of them, which go directly to the site of inflammation.

This leaking liquid is called exudate. The exudate impregnates the scales and provokes the formation of crusts, after removing which open, wet wounds remain, which significantly complicates the treatment process.

This type develops in people with increased body weight, diabetics, allergies and those suffering from pressure changes.

Barber's pustular psoriasis

This type of disease is also called palmoplantar and was first studied and described by the English dermatologist Berber.

This type of disease is characterized by the appearance of a rash on the palms and soles of the feet: especially on the bends of the fingers and in the recesses of the palms.

It is in these places that the skin has a slightly different structure, it is denser, so the pustules are located in the deep layers of the skin.

Exacerbations of this type the diseases are not tied to the seasons, as is often the case in patients with simpler forms of the disease, but become chronic.

Tsumbusha pustular psoriasis

The generalized type was named after the Austrian dermatologist Zumbusch, who diagnosed this form of the disease in his relatives. Thanks to this clear example, he was the first to describe in detail the nature and course of the disease.

This type of disease is characterized by very rapid appearance of a rash throughout the body, up to several hours.

Pustules can appear anywhere, but their location prevails in the genital area and in areas of skin folds: around the mouth, near the eyes, armpits, between the buttocks. The rash does not bypass the arms.

Often pustules are located on the fingers and can even cause detachment of the nail plates. The fatality rate is about 2%.

Symptoms

The rash is the primary symptom; the type of disease is determined by its location. For Tsumbusha psoriasis Characteristic signs in addition to the rash are fever and headache.

Palmoplantar form is characterized by an increased percentage of relapses, however, apart from rashes and burning sensations in their place, the patient’s general health condition remains virtually unchanged.

Diagnostics

This disease can be diagnosed only after the rash appears. Primary symptoms are so mild that they practically exclude early diagnosis.

A slight headache and a slight increase in temperature for a person encountering this disease for the first time are unlikely to be a good enough reason to visit a dermatologist.

For those patients who already suffer from the vulgar form and undergo constant diagnosis by their specialist, it is somewhat easier to identify the progression of the disease.

Treatment of pustular psoriasis

It is currently impossible to completely cure lichen, therefore it is recommended to follow .

Nowadays, the most effective is considered a combined type of treatment, which involves the use of drugs and traditional recipes.

Patients with this form of the disease are often hospitalized. Each patient is prescribed an individual course of treatment depending on a combination of many factors.

Pustular psoriasis of the palms and feet, due to high resistance to many types of drugs, is treated in a complex manner using a course of medications and herbal medicine.

Patients are prescribed a course of treatment, including:

vitamins;
immunomodulators;
antihistamines.

sedatives. Most often, patients take acitretin, methotrexate, cyclosporine and calcipotriol.

The most popular home remedies remain celandine, nettle, oak bark and chamomile.

Herbs infuse and lubricate with a solution of crusts and pustules several times a day. Tinctures have a calming effect and relieve skin irritation. Some people recommend taking baths with these herbs, to which you can additionally add a couple of drops of lavender essential oil.

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