Psoriasis Nails
Introduction
Introduction to Psoriasis A A lesion is more common in psoriasis, the incidence of which accounts for 10% to 50%, and the data observed by the author accounted for 30.35%. A change is related to the extensive extent of skin lesions. There are common depressions in the clinic, such as nail sag, nail stripping, thickening under the armpit, tarnishing of the deck, whitening, and splinterhemorrhages, which are mainly used to treat skin lesions. When the lesions are relieved, the lesions of the nails will also improve. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: renal failure
Cause
Psoriasis
Genetic (30%):
According to clinical findings, this disease often has a family history and has a genetic predisposition. Foreign countries have reported 30% to 50% of family history, and even some individuals have emphasized 100%. Domestic reports have a family history of 10% to 20%. Regarding the genetic method, some people think that it is autosomal dominant, accompanied by incomplete penetrance, and some people think that it is autosomal recessive or sexually linked. One of the parents has psoriasis, and the incidence of his descendants is three times higher than that of healthy children. If both parents suffer from psoriasis, the incidence of their descendants is higher.
Infection (25%):
Clinical practice has demonstrated that the onset of psoriasis is associated with upper respiratory tract infections and tonsillitis. 6% of patients with psoriasis have a history of pharyngeal infection. We have found that many children with psoriasis are closely related to tonsillitis. For example, a mother and her three children had acute tonsillitis at the same time. After the disease was controlled, three people developed psoriasis. This patient is effective with antibiotic treatment. After removal of the tonsils, the rash may have a marked improvement or regression, indicating that infection is an important factor in the pathogenesis of psoriasis.
Metabolic disorders (20%):
Studies on psoriasis blood chemistry, skin histochemistry and skin pathophysiology have failed to yield deliberate results. In the past, it was thought that the onset of psoriasis was associated with a disorder of lipid metabolism. At present, the cause of this disease cannot be considered to be caused by a disorder of lipidoid metabolism. More research is done from changes in enzyme metabolism. There are four enzymes in the epidermis of normal people, and two of them are missing in the skin lesions of patients with psoriasis. After the skin lesions are cured, two of the enzymes reappear. It is known that there is a lack of cyclophosphamide (cAMP) in the lesions of psoriasis. This is an epidermal chalone that inhibits epidermal cell division and maintains a balance between cell growth and disappearance. On the other hand, cAMP has the effect of activating phosphorylase and thus also affecting the metabolism of glycogen.
Prevention
Psoriasis prevention
1. Prevent psoriasis and try to avoid using hormone drugs.
2. Proper medication, no medication, no hormones, immunosuppressive drugs.
3. After clinical recovery of psoriasis, its immune function, microcirculation, and metabolism have not fully recovered. It usually takes 2-3 months to recover. Therefore, after the clinical recovery, that is, after the external skin lesions completely disappear, continue to take 2-3 courses of medication for consolidation. After the skin lesions have subsided, do not suddenly stop the drug, and gradually reduce the amount of medication to prevent rebound.
4. Eliminate mental stress factors, patients should try to control their emotions, try to keep their mood calm, avoid being too tired, and pay attention to rest. If necessary, take appropriate doses of sedatives.
5. In daily medication, antimalarials and -blockers can induce or aggravate the condition and avoid using it as much as possible.
6. Avoid colds, tonsillitis, and pharyngitis as much as possible. In the event of a positive symptomatic treatment, it should not increase the psoriasis.
Complication
Psoriasis complications Complications, renal failure
(1) Loss of protein and other nutrients: Due to the large amount of scurf of psoriasis, proteins, vitamins and folic acid, which constitute the skin, are lost. If the skin lesions have been unhealed for many years and spread throughout the body, it can lead to hypoproteinemia or malnutrition anemia. The clinical manifestations are fatigue, burnout, pale complexion, and easy to catch cold. If the nutritional intake is insufficient due to the incorrect "taboo", the above symptoms will be aggravated.
(2) generalized pustular psoriasis causes organ damage: some patients with psoriasis vulgaris will suddenly have high fever, joint swelling and pain, general malaise and increased white blood cells, and the size of the miliary is rapidly appearing on the skin. Pustules. The pustules are connected into large pieces, and after the dryness, new pustules are formed under the skin, which will not retreat for several months. This is the generalized pustular psoriasis. The disease is often complicated by systemic damage such as liver and kidney, and can be life-threatening due to secondary infection, electrolyte imbalance or failure.
(3) Arthritic psoriasis causes joint damage: In addition to psoriasis damage, joint psoriasis also has symptoms of rheumatoid arthritis. Clinical manifestations include joint swelling and pain, limited mobility, morning stiffness, and even joint effusion or deformation. After a long time, the joints can be strong. X-ray examination showed a change in rheumatoid arthritis, but the rheumatoid factor test was negative. Some patients may have an increase in erythrocyte sedimentation rate and may be accompanied by systemic symptoms such as fever. The disease course of arthritic psoriasis is chronic and often difficult to cure over the years.
Symptom
Psoriasis A Symptoms Common Symptoms Nail fragile nails or fingernails under the lobed hemorrhagic finger (toe) nail-like depression pustules
A lesion is more common in psoriasis, and its incidence is 10% to 50%. The common manifestations are as follows:
1. A depression point: the most common, can invade 1 to all nails, nails are more susceptible, the depressions are small and shallow, generally not more than 1mm, irregularly scattered, occasionally arranged in a line, the separation distance is equal, it It is caused by a change in the methyl-like psoriasis that forms the shallow deck. When the proximal nail fold is doubled, the keratotic keratinous layer of the keratosis is detached to form a typical depression.
2. A stripping: starting from the distal margin, but not more than 1/2 of the nail, the separated deck is grayish yellow, which is due to the massive accumulation of blood glycoprotein, the latter common nail epidermis and nail When the bed has inflammation.
3. Thickening under the armor: Psoriasis damage in the nail epithelium and distal nail bed, resulting in hyperkeratosis.
4. The deck is tarnished, whitened, thickened, uneven, or even cracked and peeled off.
5. Splinter hemorrhages are also common in psoriasis. The incidence of abnormal psoriasis is higher and the changes are more serious, especially in continuous acral dermatitis in pustular psoriasis. Why?
Examine
Psoriasis check
Clinical skin examination: the depressions are small and shallow, generally no more than 1mm, irregularly scattered, occasionally arranged in a line, and the separation distance is equal. It is caused by a change in the methylation of a shallow deck that forms a psoriasis.
Abnormal performance of skin live cell examination:
1. The skin protrusions are neatly extended and the lower part is thickened.
2. Dermal nipple prolongation and edema.
3. The particle layer disappears.
4. The keratinization is incomplete.
5. MUNRO micro abscess.
Other examinations: blood routine, secretion bacteriological examination.
Diagnosis
Psoriasis diagnosis and identification
diagnosis
Diagnosis is based on clinical manifestations and examinations.
Differential diagnosis
(1) Psoriasis: the erythema border is clear, the basal infiltration is obvious, and it is patchy. The surface covered with scales is thick and dry, and it is silvery white. After the scales are scraped off, a bright translucent film can be seen, and then the film can be seen. Bleeding. This is the key to the identification of psoriasis and other erythematous scaly diseases.
(2) Seborrheic dermatitis: The edge of the erythema is not very sharp, the base is infiltrated lightly, the scales are few and thin, and it is pale yellow and greasy. There is no film phenomenon and punctiform bleeding after scraping.
(3) pityriasis rosea: occurs in the trunk and the proximal extremities. It is a large oval patch with its long axis arranged along the ribs and skin lines. The scales are small and thin. Most patients can heal themselves after a few weeks and are less likely to relapse after regression. There is usually a mother spot in the onset of the disease, which gradually increases in the future.
