Diagnosis of psoriasis: what tests need to be taken

Psoriasis (scaly lichen) is one of the most common and poorly studied diseases of our time. Thus, at least 4% of the planet’s population suffers from its characteristic skin manifestations. Moreover, this disease is a systemic one - it affects not only the skin, but can also spread to joints, nail plates, and be localized on the scalp.

It is noteworthy that in extremely severe advanced cases, psoriasis affects all internal organs, affecting their functions.

How psoriasis manifests itself and its causes

Numerous studies have proven that psoriasis is a not entirely adequate response of the human body to the influence of irritating environmental factors.
From a biological point of view, with psoriasis, the process of skin cell division is disrupted. Normally, this process takes from three to four weeks; with psoriasis, skin cell division occurs over 4-5 days and the cells literally “layer” on top of each other. .

The causes of psoriasis are not fully understood. According to doctors, psoriasis is caused by a whole range of factors. These include changes in the functioning of the immune system, hormonal disorders, neurological disorders, as well as changes in the functioning of the endocrine system.

Additional examination

A blood test for psoriasis does not always help determine this disease in adults and children.

In these cases, additional examinations are prescribed:

• Psoriatic arthritis is detected using x-rays. Thanks to her, it is possible to understand how badly the joints are affected by the disease.
• Spinal lesions are detected using MRI.
• To determine neutrophilic leukocytosis, it is necessary to examine the synovial fluid of the joints.
• Sometimes psoriasis occurs in an atypical form, which makes it difficult to diagnose. In this case, a skin biopsy from the affected areas is indicated. To carry it out, the epidermis of 6 mm of skin is examined.
• To exclude a fungal infection, a potassium oxide test is prescribed.
• Women expecting a child are tested for prolactin, which helps determine whether there is a genetic predisposition to psoriasis or whether hormonal imbalances are the cause of the disease.
• Psoriasis rashes can be confused with a syphilis rash. To exclude this venereal disease, a blood test is taken for the Wasserman reaction.
• Other diseases are excluded by taking a culture test for the microflora of the mucous membranes.

Type of psoriasis

There are several classifications of the disease. One of the most common classifications of psoriasis is the division into:

1. Winter psoriasis, exacerbations in patients occur mainly in winter, while in summer symptoms are minimized. This form of psoriasis is believed to be the most common;
2. Summer psoriasis, exacerbation occurs in the summer and subsides with the onset of more moderate temperatures;
3. Indeterminate psoriasis does not have clearly defined seasonal changes.

In addition to this division, there is a classification according to the severity (area of ​​the skin surface affected by the disease) of the disease. This classification is quite often used by doctors, since it gives a fairly clear idea of ​​the degree of problem of the disease.

A specialist can diagnose psoriasis even during an external examination.

In medical practice, several types of disease are distinguished, which have their own characteristic signs.

According to the international classification of diseases, psoriasis is assigned the code L40. The forms of the disease depend on the clinical manifestations.

International classification of psoriasis:

1. A simple form without complications. This form includes coin-like and plaque-like types.
2. Generalized form. It includes impetigo herpetiformis and Zumbusch syndrome.
3. Acrodermatitis Allopeau.
4. Palmoplantar form.
5. Drop-shaped.
6. Arthropathic form.

Psoriasis appears as pink plaques that rise above the surface of the skin. The rashes have the appearance of frozen paraffin. Their surface is covered with peeling and numerous white scales. The classic localization of rashes is the scalp, extensor surfaces of the joints, buttocks, genitals, and umbilical area.

Depending on the form, psoriasis can be complicated or uncomplicated. The pustular variant is characterized by the appearance of papules and pustules with purulent contents, having a red rim. Joint damage (arthropathy) is characterized by painful symptoms. Arthropathy is irreversible, therefore, to prevent this complication it is necessary to adhere to treatment standards.

How to distinguish the symptoms of psoriasis on the body

Psoriasis is a chronic disease that affects the skin. But how can you understand that a person has psoriasis? Knowing the first signs of the disease will help make a preliminary diagnosis.

• Noticeable changes
• Characteristic features of etiology and pathogenesis
• The first signs of the disease
• Manifestations of psoriasis on the head
• Manifestations of psoriasis of the palms and feet
• Manifestations of nail psoriasis
• Stages of the disease
• The impact of psoriasis on internal organs
• Symptoms of the heart and blood vessels
• Liver symptoms
• The first signs of damage to the joints and kidneys

Noticeable changes

The first signs of psoriasis, noticeable externally, are rashes and peeling of the upper layer of the epidermis. The detailed clinical picture depends on what type of psoriasis is, what stage it is, and whether there are concomitant pathologies. Skin injuries reduce its barrier function and local immunity; bacterial and fungal infections easily penetrate through wounds. The inflammatory process significantly changes the external manifestations of the disease: rashes become bright scarlet, peeling becomes profuse. It is difficult for a person unfamiliar with skin diseases to correctly determine whether it is psoriasis, fungus or eczema. Treatment should be carried out only after a correct diagnosis.

Characteristic features of etiology and pathogenesis

Psoriasis differs from other skin diseases by the wave-like nature of remissions and relapses. The onset of the disease at puberty often coincides with menarche. By its nature, the disease is associated with a violation of the division of skin cells, and the inflammatory process is a secondary sign of the disease. Unlike fungus or lichen vera, psoriasis is not contagious. If pathological skin changes appear in two unrelated people, most likely we are not talking about psoriasis.

For your information! In patients, skin rashes worsen during menstruation. Fungus and other infections do not respond to the menstrual cycle.

The first signs of the disease

People usually experience symptoms of psoriasis in childhood or adolescence; the vast majority of patients learn about their diagnosis before the age of 25. Those patients who immediately recognized how psoriasis began and began treatment suffered the least damage to their health.

The disease begins with the appearance of scaly papules of a rich pink or dark red hue. The word papules means blisters or swellings on the skin filled with fluid. In the initial stages, the size of papules can reach several millimeters, and subsequently increase to several centimeters.

Scaly, dry plaques appear on the surface of the papules, which are very easily removed and peeled off. Initially, the scales appear on the central part of the plaque, and then gradually spread over the entire area of ​​the damaged area of ​​the skin. These are nonspecific signs of the disease that can be found on any part of the body. According to the condition, patients complain:

• for itching;
• for discomfort and a feeling of skin tightness;
• for dry skin and flaking;
• for skin cracking after taking a bath or shower.

According to statistics, psoriatic plaques are most often located:

• on the outer surface of the joints;
• on the back and stomach;
• on the front of the thighs and forearms.

This is different from eczema, in which the rash affects the inside of the limbs and the folds between the fingers. The speed of spread of psoriasis rashes can be very different: from very slow to lightning fast. Much depends on the reasons that provoked the manifestation of the disease and subsequent relapses. Correctly identifying causes and triggers is a necessary condition for normalizing well-being with the help of ointments, injections or other treatment.

Important! For an accurate diagnosis, you need to contact a dermatologist and conduct a laboratory test of skin scrapings.

Manifestations of psoriasis on the head

In people with short hair, it is easier to detect the onset of a pathological process than in those who wear long hair. In women, due to long hair, psoriasis can occur secretly. Many patients initially mistake psoriasis symptoms for an allergy to hair dye and mistreat them with antihistamines.

From the scalp, plaques gradually move to the forehead, face and neck. This clinical picture suggests that the disease is progressing. Patients suffer:

• from burning of the scalp after washing hair with shampoo;
• from itching and painful wounds;
• from dandruff, excessive flaking of scales;
• from a sharp exacerbation of the disease after hair coloring.

In older women who often cover their gray hair, psoriasis manifests itself more profusely and treatment is more difficult. Subsequently, if the person does not receive medical help, hair loss develops. This is a reversible process, and if the treatment is chosen correctly, the body will be able to compensate for baldness. There can be many reasons for hair loss, but in patients with psoriasis, alopecia is most often associated with a systemic metabolic disorder.

Fact! It is useless to use hair masks or traditional medicine for psoriasis. Only competent help from a dermatologist will give results.

Manifestations of psoriasis of the palms and feet

Signs of psoriasis on the feet and palms manifest as thickening of the skin in this area. The skin becomes rougher and cracks form. Epidermal cells divide quickly, actively die and flake off. It is the top dry layer that cracks, forming a painful crust.

At the initial stage of the disease, pustules with watery contents are formed, which are initially completely transparent and then become whitish. Chronic trauma to the skin leads to scars, pigmentation spots and scars.

Manifestations of nail psoriasis

How nail psoriasis manifests depends on how long the disease has been. At first, the signs of psoriasis resemble needle prick marks, in which the nail plate becomes covered with small dimples. The depth of such dimples reaches 0.2 - 0.5 mm. Then the disease becomes similar to nail fungus. Nails become dull, change color, noticeably thicken and begin to peel. Through the nail plate you can see a papule surrounded by a red rim, resembling an oil stain. Damage to the nails is one of the most popular reasons for visiting a dermatologist, because the patient is mistakenly diagnosed with a fungal infection. Many even begin useless treatment for fungus.

Stages of the disease

The overall clinical picture and symptoms of psoriasis vary significantly depending on the stage of the disease. Dermatologists distinguish 3 stages that develop sequentially:

1. Progressive. New skin lesions constantly appear, and there is also an active spread of existing plaques with severe peeling and itching.
2. Stationary. The growth of papules on the body stops slightly, new formations do not appear, but thickened folds appear on the surface of the skin, near the plaques.
3. Regressive. The spread of the disease and an increase in peeling are not observed. As the signs of psoriasis subside, areas with significant pigmentation remain on the body.

The alternation of these stages gives rise to the wave-like nature of relapses and remissions. One patient may have different stages of the disease in different areas of the skin. When describing the clinical picture and when selecting medications, the doctor takes this into account.

The impact of psoriasis on internal organs

Psoriasis negatively affects the condition of internal organs, causing various pathologies. To reduce the negative impact of psoriasis on the body, it is necessary to carry out timely treatment, because over time the pathological process can become irreversible. How quickly complications begin to appear cannot be predicted in advance. Sometimes 1-2 years pass from the moment psoriasis begins until the patient dies.

Symptoms of the heart and blood vessels

With psoriasis, metabolism is disrupted and the blood picture changes. High cholesterol levels lead to problems with heart rhythm and worsen the condition of blood vessels. One of the common causes of death in patients with psoriasis is heart failure. The first signs of this pathology:

• pressing sensations behind the sternum;
• shortness of breath;
• dizziness;
• headaches, especially severe in women;
• angina pectoris.

In order to protect your heart, you need to be diagnosed and treated by a cardiologist.

Liver symptoms

In most cases, the liver does not suffer immediately, but after many years of psoriasis. But recently the number of patients with both alcoholism and psoriasis has increased. In such people, signs of functional liver failure will appear very quickly, already in the first 1-2 years from the onset of psoriasis. What patients complain about:

• complexion turns yellow;
• pigmentation of psoriatic plaques increases;
• the skin condition is rapidly deteriorating;
• digestion is disrupted;
• The quality of hair and nails deteriorates sharply.

For examination, you should visit a hepatologist. Experienced dermatologists immediately see the onset of complications and give a referral to a specialized doctor.

Stages of the disease

The following stages of disease development are distinguished:

1. Initial. The appearance of the first alarming plaque.
2. Progressive. The formation of new elements that increase in size and merge with each other.
3. Stationary. New plaques do not appear, old ones stop growing, but become covered with scales.
4. Regressive. At the site of the rash, areas of excessive or insufficient pigmentation appear.

An individual treatment regimen is selected for each stage. Before starting therapy, a number of necessary tests are performed.

How to identify psoriasis yourself at home

The first characteristic sign of psoriasis is a rash, but with other skin diseases rashes may also be present. To determine if you have the disease, you need to carefully examine your body and pay attention to the following features:

The rashes are small, red papules that initially resemble a symptom of an infectious disease. After some time, silvery scales appear on the surface of the rash, and the plaques increase in size. If you scrape off the top layer, then underneath there will be smooth skin covered with a film. Removing the film may cause pinpoint bleeding. Plaques are localized mainly in the area of ​​large joints, on the back, head, soles of the feet and palms

Sometimes rashes can be noticed in the groin area, on the inner thighs and in the armpits. You should pay attention to the condition of your nails. The affected nail resembles the surface of a thimble, the nail plate is covered with shallow pits

Thickening and loosening of the nail plate may be observed; people often mistake this sign for nail fungus. But there is one characteristic difference - with psoriasis, there is a red border around the affected nail and if it is picked off, blood may appear.

If you have such signs, you should visit a dermatologist; it is strictly not recommended to treat psoriasis on your own. Accurate diagnosis and a series of laboratory tests are necessary, only then can effective treatment be prescribed.

Diagnostics

The rashes and plaques that appear with psoriasis are similar in appearance to the manifestations of other skin and internal pathologies: lichen, seborrhea, syphilis, erythroderma. At the first visit of the patient, the doctor conducts an external examination and excludes the presence of diseases with similar external manifestations.

An experienced specialist can distinguish psoriatic rashes by appearance, some characteristic features and location. Thus, with psoriasis, rashes are mainly located on the elbows, head, sacrum, feet and palms.

Plaques can be distinguished by the following feature: after removing the top layer of skin, a smooth shiny surface appears; when the plaque is further scratched, small droplets of blood appear. However, in some cases, it can be difficult even for an experienced doctor to establish that skin defects are caused by chronic dermatosis.

Therefore, to clarify the diagnosis, the patient is recommended to undergo a standard examination, including blood, urine and stool tests.

Only a doctor can diagnose the disease. Therefore, if symptoms appear, you should immediately contact a specialist. If psoriasis affects the eyes, you should consult an ophthalmologist, joints - a rheumatologist, and skin rashes - a dermatologist.

Despite the pronounced symptoms, it is difficult to diagnose the disease, since at first glance the disease is very similar to lichen, dermatosis, seborrhea, and erythroderma. With any of these diseases, skin rashes appear that are similar to the disease in question.

Psoriasis can be recognized by its characteristic plaques and their location. Doctors note that they are most often found on the elbows, back, knees, feet, and hands.

The appearance of the wounds also makes it possible to recognize this disease. Sometimes during the early stage, doctors immediately after the examination begin to formulate therapy, but usually they recommend undergoing all the necessary examinations and tests. According to experts, this will make it possible to make an accurate diagnosis and find out about the presence of concomitant diseases.

After examining the patient and making a preliminary diagnosis, the attending physician will tell you what tests need to be taken for psoriasis. There are standard and additional studies. A standard test for psoriasis includes:

1. Blood is donated for a general examination, and a biochemical blood test must also be performed. The disease does not affect the condition of the blood, but this procedure is resorted to to eliminate side effects and allergic reactions when treated with medications. If extensive damage is observed, changes in the salt balance of the blood occur in the patient’s body, which leads to dehydration. A general blood test for psoriasis is done to determine the number of leukocytes, erythrocyte sedimentation rate, and to rule out anemia. Biochemical indicators indicate the level of uric acid, and also exclude rheumatoid factor.
2. A urine test looks at the overall water-salt balance.
3. A stool examination is done to determine the presence of helminths.

Even if the patient is confident in the diagnosis, these tests should not be avoided. A general and biochemical blood test helps to identify the possible cause of the disease.

Methods and means of treating psoriasis depend on many factors:

• degree of skin damage;
• type of psoriatic rash;
• associated complications;
• general condition of the patient.

Therefore, in order to fully see the clinical picture of the disease for a particular patient, it is necessary to conduct a thorough diagnosis. One of the standard research kits is taking tests. They help the specialist not only determine the degree of damage to the skin, but also other related problems caused by psoriasis.

The standard set consists of the following research procedures:

1. Patient's blood tests.
2. Laboratory tests of urine.
3. Examination of the patient's stool.

Diagnosing psoriasis begins with a visit to the doctor and an initial examination. The fact is that despite the fact that the manifestations of psoriasis are obvious, this disease has similar symptoms to dermatosis, seborrhea and lichen.

For this reason, it is necessary to undergo a number of standard and additional tests. Of course, an experienced dermatologist will most likely establish the correct analysis in the case of psoriasis, but even he will definitely send you for tests to determine an accurate diagnosis.

Diagnosis of psoriasis always begins with an external examination. During the examination, the specialist determines the type of psoriasis, the number of plaques that have appeared on the body, their condition, and certainly the accompanying complications of the disease.

Many dermatological diseases have a similar clinical picture, but there are still differences. Knowledge of the peculiarities of the course of various diseases makes it possible to exclude completely inappropriate options even during a visual examination.

But then the doctor needs additional information, which he receives from highly specialized tests. Differential diagnosis is carried out based on the results of histological examination.

The patient needs to take a superficial or deep scraping from an area of ​​pathologically changed skin. To obtain a deep scraping, a sample is taken until droplets of blood appear on the skin.

Parapsoriasis

The classification of parapsoriasis includes two forms of pathology:

1. Teardrop-shaped. After peeling of the papules, areas of hyperpigmentation remain on the skin. With a prolonged course, the difference is the dark brown color of the elements of the rash.
2. Plaque. Elements of the rash of different sizes are characterized by abundant peeling. Is a precancerous disease!

Apart from the similarity in names, everything else in the clinical picture and in the treatment of psoriasis and parapsoriasis will be different. The diagnosis of psoriasis is made on the basis of histological examination of skin scrapings.

Lichen planus

Common signs for these diseases are the presence of papules and peeling. However, the rash with lichen planus has a polygonal shape and an umbilical depression.

The purple color of papules, the waxy surface and intense itching are not typical for psoriasis.

Pityriasis rosea

Pityriasis rosea has a similar clinical picture to the early stages of psoriasis, when skin changes occur without swelling and infiltration. However, during dynamic observation, all doubts disappear - regression in patients diagnosed with pityriasis rosea occurs quickly even without treatment, while psoriasis only progresses. No additional research is required.

Seborrheic dermatitis

An integrated approach is important to make a diagnosis. Psoriasis is treated by a dermatologist, and if internal organs and joints are affected, by a specialized doctor.

Before treating psoriasis, a full diagnosis is carried out.

First symptoms

It is very important to diagnose the disease at an early stage. The main symptom of the disease is a specific rash. Glossy whitish papules appear on the skin. They can be located singly or in conglomerates. Their edges are reddish - this phenomenon indicates the progression of the disease. When scales appear, the growth of plaques stops.

Already at the beginning of the disease, the Koebner phenomenon appears. This is a symptom characterized by the appearance of new rash elements in response to mechanical or physical damage to the skin.

At the stationary stage, the appearance of plaques stops. The existing rash becomes covered with scales and begins to peel off.

The red edge of the papules also becomes covered with peeling. The Koebner phenomenon is already negative.

A pseudoatrophic Voronov's rim appears - a white rim of small width surrounding the elements of the rash. The skin under the plaques becomes hyperpigmented or white.

All these symptoms indicate regression of the disease. Patients are also concerned about itching, brittle nails, and erosion.

When an infection occurs, painful pustules appear on the skin. This form threatens the patient’s life, as it sharply increases the risk of sepsis (blood poisoning).

Lab tests

There are no specific tests to confirm the diagnosis. However, laboratory methods indirectly indicate the presence of inflammation in the body. The list of necessary tests is provided by a dermatologist.

What tests need to be taken for psoriasis:

1. General clinical blood test. There are no specific markers of the disease in the CBC. With psoriasis, ESR increases and the number of leukocytes increases.
2. Biochemical blood test. An increase in the titer of rheumatoid factor, C-reactive protein, and procalcitonin is typical. With liver damage, the titer of AST, ALT, and alkaline phosphatase increases. Kidney damage is manifested by increased concentrations of urea and creatinine. A biochemical blood test for psoriasis gives a complete picture of the disease.
3. Endocrine panel. Skin diseases are often accompanied by various endocrinological disorders.
4. Analysis of feces for helminth eggs. Worm infestation is a common cause of skin rashes and various dermatitis.

Donate blood on an empty stomach. For two days, avoid heavy physical activity, fatty foods, and smoking. In order for tests for psoriasis to be reliable, it is recommended to stop taking medications 2-3 days before. This issue should be discussed with your doctor.

Additional examinations

After examining the patient, the doctor may order a biopsy. The doctor takes a sample of the affected skin and sends it for histological examination. This diagnostic method is the most informative.

During histological studies, Rete bodies, thickening of epithelial cells, their functional immaturity, as well as many immune cells are determined under a microscope. A characteristic sign is a positive Auspitz sign (bleeding of the skin under the plaque after scraping off the keratinized scales). This phenomenon is due to increased capillary fragility.

If there are concomitant diseases, the following studies are prescribed:

• ECG and ultrasound of the heart;
• Ultrasound of the kidneys and abdominal organs;
• MRI and ultrasound of joints (for psoriatic arthropathy);
• general urine analysis;
• urine analysis according to Zimnitsky and Nechiporenko.

Based on the results of the studies, the stage of the disease and the presence of complications are judged.

Differential diagnosis is a method of diagnosis verification that is often used in dermatology.

The doctor’s task is to identify the characteristic signs of a particular disease.

The disease must be differentiated from the following pathologies:

• T-cell lymphoma of the skin. It is a malignant disease of the immune system characterized by a psoriasis-like rash. This diagnosis can be excluded only after a biopsy.
• Lichen planus. Objectively, plaques in both pathologies are similar. However, the localization of the rash with lichen planus is different - around the ankles, wrists and on the flexor surfaces of the hands.
• Simple chronic lichen. This pathology is also characterized by plaques with peeling. However, the scales are larger. The rash is localized mainly on the back of the head, ankles and wrists.
• Eczema. The skin becomes covered with a round rash with clear edges. Papules rise above the surface of the skin. The appearance of bubbles and vesicles is characteristic.
• Pityriasis rosea (lichen Zhibera). A non-contagious disease that goes away on its own. Pityriasis rosea is characterized by a maternal plaque (appears first).
• Seborrhea. Affects mainly the scalp. Differential diagnosis of psoriasis and seborrhea is difficult. In some cases, histological examination is necessary to make a diagnosis.
• Rash due to secondary syphilis. Syphilitic rash often affects the palms and soles of the feet. It is especially important to take this into account when diagnosing palmoplantar psoriasis. To exclude syphilis, it is necessary to take a test to detect Treponema pallidum (the causative agent of the disease).
• Skin fungus. Fungal infection can be confirmed using serological analysis.

How to determine exactly whether it is psoriasis or not?

Unlike other dermatoses, this disease affects not only the skin, but also other organs. In rare cases, Reiter's disease masquerades as psoriasis. This syndrome is characterized by damage to the conjunctiva and joints, as well as urethroprostatitis. Sometimes the disease is accompanied by a rash. A rheumatologist can exclude this diagnosis.

Diseases that have a similar clinical picture complicate the diagnosis of psoriasis. The following diagnostic methods help to distinguish lichen planus from other dermatological problems:

1. Radiography. Will allow you to identify or exclude joint damage in cases of rash and redness at the site of the movable joint. Differential diagnosis is carried out with arthritis, arthrosis, bursitis and other diseases of the musculoskeletal system.
2. Test for syphilis. It is necessary to further evaluate the blood to exclude this disease, since some forms of psoriasis are similar to skin lesions due to syphilis.
3. Using a glass slide, scrape the affected area of ​​skin. This study diagnoses psoriasis or bacterial and fungal infections, and other dermatological problems.
4. A potassium oxide test is used to detect fungal infections.

Psoriasis is a complex autoimmune pathology. Therefore, before making this diagnosis, you need to be sure of it.

To this end, every patient should be screened for psoriasis. It will help rule out other pathologies.

Differential diagnosis of psoriasis is carried out according to the main syndrome of the disease – skin manifestations. Pathologies that have similar dermatological signs include:

• Various forms of dermatitis (seborrheic, atopic);
• Lichen planus;
• Syphilis;
• Reiter's disease;
• Athlete's groin;
• Neurodermatitis.

Psoriasis on the legs, which is rarely isolated, can be differentiated from vascular diseases. In addition to the main syndrome, attention should be paid to the nature of the pathology, the prevalence of skin rashes, and the general condition of the patient.

Diff. Diagnosis of psoriasis should be carried out by a dermatologist.

It is based on data from skin examination and laboratory tests. Diagnosis of psoriasis in children must be performed especially carefully.

This pathology is rarely encountered in pediatric practice. In some cases, psoriasis develops during pregnancy, and special monitoring is required.

The doctor who diagnoses the disease takes into account:

• clinical picture of the disease;
• presence of the Koebner phenomenon;
• symptoms of the psoriatic triad.

For example, papular syphilis, at first glance, resembles psoriasis, but differs from it in the darker color of the plaques, their density, less peeling, limited size of papules, and enlarged lymph nodes.

Seborrheic eczema

When psoriasis is located on the head, at first it manifests itself simply as active peeling without other symptoms; it is easy to confuse it with seborrhea. Later, the plaques in this area are not clearly defined, the scales are not grayish, but have a yellowish tint, this is due to increased secretion of sebum.

They are glued together, so they are difficult to separate. Typical phenomena of psoriasis are weakly expressed, and pinpoint bleeding is manifested by a weeping bleeding surface.

It is distinguished from eczema by the following symptoms:

• the presence of psoriatic crown, when skin lesions spread to the forehead;
• the scales are drier and larger in size.

In this case, dermoscopy helps the specialist.

Microbial eczema

Diagnosis of psoriasis - list of tests and other methods

Pink and red spots appear on the skin, seemingly for no apparent reason. Spots covered with scales. All these are signs of psoriasis. How to recognize psoriasis at the very beginning of its occurrence, so as not to start the disease?

The only correct way out when inexplicable, unprovoked redness on the epidermis occurs is to visit a dermatologist. But there are a number of signs by which the patient himself can recognize the presence of this disease. When diagnosing psoriasis when redness appears on the epidermis, you should not hesitate. In its advanced form, this disease is difficult to cure.

Three stages of psoriasis

1. Stationary (old plaques itch very much, but new ones do not appear);
2. Progressive (during the first three weeks, red spots on the body actively appear and grow);
3. Regressive (there are no new spots, and those that already exist are covered with keratinized skin; where the red, inflamed color is no longer present, hyperpigmentation occurs).

Psoriasis: how to correctly diagnose it

Diagnosis of psoriasis by a dermatologist begins with a simple examination of the patient’s skin. Reddish and pinkish spots attract his attention, and flaky areas of skin are no less interesting to him.

If such signs are detected, the doctor will send you to take a blood test for psoriasis. This analysis will confirm/refute the presence of inflammation. A biopsy is also done to confirm the diagnosis of psoriasis.

Scraping will allow you to detect/not detect Rethe bodies. Only a scraping can explain why, what is the cause, and the nature of the occurrence of psoriasis. And the success of actions aimed at getting rid of, if not the entire disease, then most of its symptoms will depend on the correctly identified cause.

Differential approach

After a standard medical examination and publication of the results of laboratory tests of blood and urine, it is time to begin the so-called differential diagnosis of psoriasis.

This method of diagnosis will make it possible to distinguish psoriasis from diseases with similar symptoms: eczema, syphilis, lupus erythematosus, etc.

To differentiate means to compare, compare.

Differential diagnosis of psoriasis is a process during which the doctor compares external factors and the results of laboratory studies of blood composition in order to separate the disease we are describing from similar symptoms (with similar symptoms) ailments that affect the skin. Psoriasis of the palms is very similar to a disease such as dermatophytosis of the hands. And psoriatic erythroderma is differentiated from lichen. Arthropathic psoriasis is differentiated from arthritis.

A differential diagnosis table, which every self-respecting dermatologist has, will help you find out exactly whether a patient has psoriasis.

It helps to quickly make a correct diagnosis and, with proper therapy, if not cure the disease completely, then significantly alleviate its symptoms - for sure. As part of this type of diagnosis, a clinical examination is carried out, which depends on the location of the disease.

Localization is the location of psoriasis spots, plaques. These can be skin folds of the head, abdomen, neck, nails.

What causes psoriasis

Psoriasis is a disease that is not only poorly studied, but also difficult to treat. Therefore, the reasons for its occurrence are difficult to establish. But experts say that there are trends associated with the progression of psoriasis, namely:

• Stress;
• Skin injuries (including mechanical);
• HIV;
• Infectious diseases (chronic and acute);
• Use of low-quality cosmetics;
• Allergies provoked by drugs of chemical origin;
• Climate change.

Stress Skin injuries HIV Infectious diseases Allergies Climate change

Laboratory tests for psoriasis

Only a dermatologist knows how to determine psoriasis, so do not make a diagnosis for yourself based solely on your own speculation. Traditional tests taken from the patient's epidermis for the presence of allergens cannot be done by patients with psoriasis.

A routine blood test for psoriasis will determine the presence of this disease, which has arisen against the background of low hemoglobin in the blood, diabetes mellitus and other ailments.

This type of analysis will ensure that psoriasis is not confused with rheumatoid arthritis.

Laboratory blood test for ESR

This kind of analysis will determine the pustular type of the disease we are describing (or erythroderma). In both of these diseases, the erythrocyte sedimentation rate changes in a certain way.

Laboratory testing of the amount of urea

The amount of urea more than normal indicates the progress and severity of psoriasis.

Biochemistry

This test for psoriasis gives a chance to find out about malfunctions in the body’s functioning within the framework of water and salt balance and records the activity, performance and functionality of vital organs.

Laboratory blood tests for antibodies

Makes it possible to monitor the state of the immune system and detect disruptions in the hormonal system.

Tests for other types of psoriasis

Stool analysis, x-rays, blood tests for allergies, photographs of skin rashes - all these tests for psoriasis will help the doctor make the correct diagnosis and prescribe the correct treatment.

Blood test for the amount of IgE (immunoglobulin)

Determining the level of IgE in the blood will help determine the allergic nature of psoriasis. Studying the level of specific IgE to various types of allergens will allow us to understand which allergens provoke pathology.

But identifying a certain type of IgE does not confirm the fact that you are allergic to a certain food. False negative results also occur.

It happens that allergies cause psoriasis without an increase in general and specific IgE.

Studying blood for histocompatibility antigens

The indicators of this study will make it possible to identify joint diseases by the presence of antigens of a certain type. An increased number of antigens indicates the presence of a disease such as Reiter's disease.

As part of the treatment of this disease, you will have to undergo tests for psoriasis regularly. This will allow the doctor to adjust the treatment to obtain the optimal result.

Determining psoriasis in children

Children inherit psoriasis from their parents (even if only one of the parents suffers from this disease). It occurs in any form except the teardrop type. A dermatologist can easily and quickly determine psoriasis in a child by simply looking at his skin.

Rarely, scraping is also used to determine the nature of psoriasis in a child. In this case, there is no need to donate blood for laboratory testing. A dermatologist will be able to detect this disease in a baby based on signs such as the appearance of psoriatic plaques and redness in the skin folds in the diaper area.

In older children, spots appear on the head and limbs.

How does a dermatologist diagnose psoriasis in children?

This is done at the dispensary. According to the regulations for studying the disease and making a diagnosis for psoriasis, the child is subjected to the following types of manipulations (checks):

1. Visual examination of affected skin areas;
2. Dermatoscopy (examination of affected skin using a special instrument that scrapes off scales);
3. Laboratory research (biochemistry and general blood test, urine test, coagulogram, skin scraping).

Psoriasis: pustular or non-pustular

The first type is determined by the presence of a pustule - a vesicle with a transparent substance inside. Such blisters are located around the skin, which takes on an inflamed, red appearance. It happens that a patient suffers simultaneously from two types of psoriasis – pustular and non-pustular. Different types should be treated in different ways.

Pustular type of psoriasis

The pustular form, more often than the pustular form, is fraught with complications, because at the moment the vesicles rupture, the patient’s skin ceases to have natural protection, which is why it ceases to protect itself from microbes. In symbiosis with infections of different etiologies (origins), this type of disease we describe is fraught with suppuration, and this provokes severe intoxication (poisoning) of the patient.

• Non-pustular type:
• Psoriasis vulgaris;
• Erythroderma is an extremely difficult to treat type that can be fatal.

Unique types of psoriasis

They exist too. The highlight of the disease we are describing is its elementary combination with other types of infections of the human epidermis in a chronic form (various types of fungus, etc.).

Classification

1. Drug-induced (provoked by taking medications);
2. Seborrheic (occurs against the background of seborrhea);
3. Reverse (occurs exclusively in the bend of the elbows and joints).

Any type of psoriasis, unfortunately, is incurable.

But the manifestations of this disease (itching, redness, peeling of the skin) can be alleviated through medications and PUVA therapy, in which the patient is exposed to ultraviolet radiation.

How to understand whether it is psoriasis or not? The psoriatic triad will help with this. This sign makes it easy to distinguish a psoriasis rash from other rashes.

The triad is defined as follows: as part of getting rid of scales, a thin film appears that covers the plaque, and psoriatic elements look like drops of old.

When the film is removed, bleeding will begin in the form of a bloody race. The symptoms described above exist in areas of rash of different localization.

The procedure for diagnosing psoriasis described above (peeling off the film, removing scales) can only be performed by a doctor using special tools. If you do this with improvised means, you can provoke an increase in the formation of new psoriasis plaques.

Source: https://UdalayPsoriaz.ru/diagnostika-psoriaza.html

Blood tests

The main symptom of psoriatic arthritis is changes in shape and pain in the joints. They may be accompanied by lesions on the skin.

Sometimes it's the other way around. But if you suspect this type of pathology, you need to take tests for psoriatic arthritis, they are as follows:

• Blood tests. They will show an increased ESR and the presence of hypochromic anemia.
• Analysis of urine. It is given by the patient to detect crystallization of uric acid (hyperuricemia).
• Blood for biochemistry. A comprehensive biochemical blood test for psoriasis and its arthritic variety can clarify a lot. The presence of psoriatic arthritis will be indicated by an increased content of acute phase proteins, as well as gamma globulins and alpha2. Acid phosphatase and its activity are considered. With this disease, the indicators are increased.
• Analysis for rheumatoid factor.
• Analysis of synovial fluid in arthritis psoriasis will show necrophilic leukocytosis.
• Immunological tests.

So, we looked at what tests need to be taken for psoriasis and psoriasis arthritis.

If an accurate diagnosis cannot be established, the doctor must prescribe additional tests:

1. The patient is sent for microflora culture testing. This is usually resorted to when the mucous membrane is affected. The test results should exclude acute pharyngitis.
2. A test is scheduled to rule out syphilis.
3. The most accurate research method is a skin biopsy. To do this, a small piece of skin - about 6 mm - is taken from the patient, after which it is transferred to a pathologist, who examines the tissue using a microscope. If the picture also remains unclear, the patient will be referred for a biopsy again. This time the sample will be taken from a different affected area.

4. For psoriatic arthritis, radiography is used. The procedure has no age restrictions, since this type of psoriasis occurs in adults and children. A specialist examines the joints and determines the degree of damage to bone tissue. Psoriatic arthritis is a very serious disease as it leads to irreversible damage to the joints. In addition to the procedure, the patient is sent to the laboratory for blood donation. This is a necessary measure to rule out other types of arthritis;
5. During pregnancy, test results showing prolactin levels are required. This hormone indicates recent stress that has caused an exacerbation of the disease.
6. To identify the fungus, a special test is performed using potassium hydroxide.

You should not neglect the recommendations of your doctor, especially with such a serious illness as psoriasis. There are no medications yet that can cure the disease, but thanks to a timely diagnosis and proper complex therapy, the disease is weakened and goes into long-term remission.

But very often, in order to make sure the diagnosis is correct, the doctor is forced to send the patient to undergo a large number of tests, each of which will allow him to select an effective method of combating psoriasis.

In order for the test results in the process of diagnosing psoriasis to be reliable, you need to take into account several rules for preparing for their delivery:

• You should not use medications for 2 weeks before the examination;
• before taking tissues for histological studies, do not use antipsoriatic and antiseptic ointments;
• blood tests must be taken after 8-10 hours of fasting on an empty stomach;
• On the day of the test, it is advisable to refrain from mental stress and smoking.

Getting tested is one of the surest ways to make an accurate diagnosis. Biochemical and histological studies can reveal the presence of complications and secondary diseases.

Often, research results reveal an infection that previously did not manifest itself symptomatically, but resulted in disorders of the immune system. Also, thanks to the tests, it is possible to identify the presence of contraindications to taking medications and using physiotherapy.

Since many psoriatic patients report worsening of the condition after exposure to an allergen, an immunogram and identification of triggers may be required. In rare cases, research results indicate that consultation with other doctors is required. For example, if you suspect psoriatic arthritis, you will need to be examined by an orthopedic doctor. Information about what tests are performed for psoriasis will be useful.

General tests to diagnose the disease

A general blood test for psoriasis is an integral study that helps diagnose the following blood parameters:

1. Erythrocyte sedimentation rate.
2. Decreased hemoglobin concentration.
3. Leukocyte count.

The likelihood of detecting any deviations from the indicators indicates existing pathologies that need to be treated immediately. Since the etiology of psoriasis is not yet known, any information at the diagnostic stage will be useful.

Important! In case of psoriasis, blood assessment in an in vitro laboratory should be carried out in a timely manner and is used to adjust treatment.

A biochemical blood test is responsible for the following indicators:

• high cholesterol;
• increased urea concentration;
• increase in salt content.

Using a urine test, a specialist determines the following indicators:

• the patient's water-salt balance;
• presence of crystals;
• monitoring the condition of leukocytes;
• urine density.

It is also necessary to have a stool culture tested for dysbacteriosis to exclude malfunction of the gastrointestinal tract. It is worth emphasizing that gastrointestinal disorders in psoriasis are diagnosed in almost all psoriatic patients.

Tests for psoriasis are also recommended for allergens. This is necessary to accurately determine the nature of skin lesions, adjust the diet and create a hypoallergenic environment.

Taking immunogram tests to determine a person’s immune status may be no less important. This will help determine whether the following pathologies are present:

• viral diseases;
• bacterial pathogens;
• malignant neoplasms;
• autoimmune lesions;
• endocrine system disorders;
• heredity.

It is worth emphasizing that autoimmune disorders are registered in 95% of people with psoriasis, and it is important to identify the problem at an early stage of diagnosis and begin treatment with immunosuppressants.

Diagnosis of psoriasis. How to be prepared for illness?

Psoriasis is one of the most common chronic skin diseases on Earth. The disease affects the skin, creating reddish areas covered with scales. Diagnosis of psoriasis is a basic set of symptoms. The pathology can easily be confused with other serious diseases, so you should familiarize yourself with all types and types of fungus.

Areas affected by psoriasis look like one pinkish plaque. During the development of the fungus, the formations become larger and they unite into large formations. Diagnosis of psoriasis determines the fungus based on several factors:

• Stearic stain (due to deformation of the plaque, scales are obtained);
• Terminal film (after scraping off the crust, the surface area of ​​the affected skin becomes covered with something similar to a film)
• “Blood dew” (at the site of formation, after mechanical damage, droplets of blood appear).

With mechanical damage, a stearin stain, the skin turns pink. The film appears, if it is injured, blood drops are released. The types of symptoms are different for everyone, it depends on the timing of the development of the pathology, the type of fungus and the typicality of the disease.

What is needed for diagnosis?

Only a dermatologist can correctly indicate psoriasis. To make such a diagnosis, the following criteria are taken into account:

• Clinical picture;
• Symptoms;
• Koebner's phenomenon is the formation of a rash at the site of fungal infection.

For a number of disease factors, additional diagnostic procedures may be necessary, in which the following is observed:

• Increased formation and proliferation of blood vessels;
• No granular layer;
• Increase in epidermal processes;
• Thinness of epidermal processes;
• Large-scale increase in blood vessels, accumulations under the skin, lymph cells of non-cancerous origin;
• Definition of Munro's microabscesses.

Analyzes

Tests are an important factor after the initial examination. Subsequent samples of material may need to be examined:

• General blood analysis. Such an analysis actually always determines an increase in ESR, and therefore determines infection on the body. Attention is also paid to the content of leukocytes. In severe stages, anemia occurs;
• Blood biochemistry determines an increase in the level of proteins, during moments of acute replenishment, the condition of the liver is also diagnosed;
• Cholesterol and glucose analysis;
• A urine sample determines whether there is a malfunction in the body’s water-salt balance;
• Stool examination. The condition and presence of viruses in the intestines is determined.

Blood test for skin fungus

The disease is diagnosed after a survey and initial examination by a doctor. There are not obvious factors, due to which it is difficult to identify the fungus by its symptoms. Chemical blood tests help:

• Determine leukocytosis and anemia with a general blood test;
• Determine the protein, the infatuation, which means inflammation, as in rheumatoid arthritis. Arthritis did not appear during the analysis, which means the patient has psoriasis.
• With illness, the level of uric acid becomes higher.

Additional diagnostic methods

To accurately diagnose, a biopsy of the infected skin is performed. Such a test for psoriasis reveals whether the material has an “increase” in the number of dry cells; for this reason, tissue complications are not detected.

Sometimes, to specify the disease, it is necessary to undergo additional diagnostics. These are the following procedures:

• microflora check;
• visit an x-ray specialist;
• Puncture from the affected joint;
• MRI for an infected spine;
• Potassium oxide assay;
• Test for syphilis.

Differential diagnosis

Differential diagnosis is done to correctly prescribe treatment.

This diagnosis determines the standard picture of the disease, discarding other options from the list of similar diseases.

Seborrheic eczema

The formation on the hair of the scalp is often confusing and resembles simple flaking, in terms of symptoms. Later, plaques form; the formations are not gray in color, but yellow. This is due to the enthusiastic secretion of sebum. The scales stick to each other and are difficult to separate from the skin.

At the beginning, seborrheic psoriasis is difficult to distinguish from seborrheic eczema, so additional investigative procedures are required. In general, psoriasis differs from eczema in the formation of a “crown.” This is how the infection zones move from the hair to the frontal part of the face. To accurately identify the causes, a dermal test is performed.

Microbial eczema

Provided that the diagnosis of the infected area has not “found” classical causes, difficulties are created for making a diagnosis. Sometimes eczematous psoriasis is similar to microbial eczema. Why, it’s worth deciding on the primary reasons:

• Purulent formations in the initial period are characteristic of microbial eczema;
• Infiltration of fungal formations is much higher;
• In the fungus, the zones remain clearly definable.

Microbial eczema, according to test results, shows a high content of leukocytes. Associated with inflammation of unhealthy pathogenic microorganisms.

Psychosomatics of the disease

Stress is a factor pushing towards psoriasis (if the patient is genetically predisposed to the disease). It is generally accepted that obvious causes may be nervous disorders, such as banal dissatisfaction with the body, society, or even appearance.

To fight psoriasis more effectively, you need not only drugs, but it is also important to control your nerves. Think more positively, as a result of which the chances of manifestation of the disease are observed less frequently.

Source: https://zen.yandex.ru/media/id/5c7e4e378e101c00b4cc86c6/5c8fee1ad4eea800b2749f6a

Treatment of psoriasis

Treatments for severe and moderate forms of psoriasis include phototherapy, systemic medications, combination therapy, and excimer laser therapy, which are often very effective.

TNF inhibitors reduce the activity of immune factors and help with severe forms of psoriasis, but complications may appear with other infections.

Ustekinumab. This product contains monoclonal antibodies. The remedy helps with severe and moderate forms of the disease. Research on the drug is still ongoing, and so far positive qualities have been identified.