Psoriasis, also known as “white H” in Chinese traditional medicine, is formally known as psoriasis, but the official name is psoriasis, and the use of the word psoriasis to summarize the name of the disease is very unscientific, because psoriasis is not actually The term ringworm refers to a number of skin diseases caused by fungal infections, such as ringworm of the head, ringworm of the femur, ringworm of the body, ringworm of the hands and feet, ringworm of the fingernails, etc. The local dander of ringworm can often be found under the microscope as fungal hyphae or fungal spores, and treatment with antifungal drugs is often very effective. Psoriasis, on the other hand, is not caused by a fungal infection and is medically referred to as psoriasis. It has a complex pathogenesis and treatment with antifungal drugs is often ineffective. Therefore, don’t look to take antifungal medications on your own or use ringworm topicals indiscriminately to avoid wasting money and aggravating your condition. Since psoriasis lesions are covered with silvery-white scales, which are very characteristic, it is very appropriate for Western medicine to call it psoriasis. The use of the term psoriasis should also be advocated in a respectful attitude toward patients.
Pathogenesis
The causes of psoriasis are complex and the etiology is not yet clear. In recent years, most scholars believe that it is related to genetics, infection, metabolic disorders, immune dysfunction and endocrine disorders. It has become increasingly common, especially in developed cities. Psoriasis is not an infectious disease, but because of its skin problems, it often causes great physical and mental pain and economic burden to patients.
History and current situation
The ancient Greeks considered psoriasis a curse of the gods and forced psoriasis sufferers to ring bells to prevent being infected. Among known celebrities, Lin Biao, Stalin and Zeng Guofan suffered from this disease. Zeng Guofan suffered from severe psoriasis and had to have his maidservant scratch his itch every night before he could sleep, and was never cured. It was once thought to be related to the detergent they used to wash their hands, as housewives and catering workers were more common in the past. As the society at that time believed that psoriasis was contagious, in order to prevent customers from being infected by eating food containing dander by mistake, these employees would be fired from the restaurant. Nowadays, it is generally believed that the endocrine disorders of the patients are due to excessive stress in their lives, which affects the immune system of the body. Therefore, doctors sometimes prescribe vitamin B miscellaneous for patients to help relieve stress; some doctors believe that patients should do more aerobic exercise, so that the body’s natural regulatory mechanism through exercise and self-adjustment. In Hong Kong, many students and teachers have localized psoriasis, mainly on the palms of their hands, arms, legs or shoulders. In the United States, a pharmaceutical company has recently invented an injection that can control the course of the disease in severe patients and return their skin to smoothness. This injection was also introduced to Canada for clinical testing in 2006. However, this injection cannot cure psoriasis and the problem will return as soon as the injection is stopped.
According to the survey, the incidence of psoriasis accounts for 0.1% to 3% of the world’s population, and the incidence rate of yellow people is 0.1% to 0.3%. The incidence rate of the disease in the population is significantly higher for Caucasians than for yellow people, and the second highest for black people. By 1998, the number of psoriasis patients in China had reached more than 2.8 million. According to a survey conducted in the United States in recent years, its incidence rate is 2.6%, with as many as 6-7 million patients, far higher than that of China. Because the disease is stubborn and difficult to treat, it is still listed as an important research topic in the field of dermatology in the world today and is one of the key prevention and treatment diseases in dermatology worldwide. At the National Collaborative Conference on Psoriasis Prevention and Treatment held in recent years, the participating experts agreed that “the combination of traditional Chinese medicine and traditional Chinese and Western medicine is the direction of psoriasis prevention and treatment. Western medicine anti-cancer drugs and hormonal drugs have serious side effects and should be avoided as much as possible.
The lesions are characterized by red papules or plaques covered with multiple layers of silvery-white scales, with obvious seasonality, with most patients suffering from the disease in spring, aggravated in winter and relieved in summer. The total national prevalence rate is 0.72‰, with more men than women, more in the north than in the south, and higher in urban than in rural areas. The age of first occurrence is 20-39 years old for men and 15-39 years old for women. The incidence has been on the rise in the last decade. It is thought to be related to industrial pollution and working environment. The cause of psoriasis is not yet known but preliminary observations relate it to the following factors.
Genetic factors. It is believed that the disease is controlled by multiple genes and is also influenced by other external factors.
Infectious factors. It is thought to be due to viral infection, although eosinophilic inclusion bodies have been found in the nuclei of epidermal spinal cells, but so far viral cultures have been unsuccessful. Streptococcal infection may be an important predisposing factor for the disease, as acute punctate psoriasis is often preceded by acute tonsillitis or upper respiratory tract infection.
Metabolic disorders. Increased serum lipids, cholesterol, globulin, sugar, uric acid and potassium, and decreased folate levels have been reported, but no firm conclusions have been made. Increased polyamines and arachidonic acid in the skin lesions have also been reported.
Immune dysfunction. Some patients have low cellular immunity; some have increased serum IgG, IgA and IgE; some have anti-IgG antibodies in the serum; some have measured anti-keratin autoantibodies in the epidermal stratum corneum by immunofluorescence technique.
Mental factors. Trauma and emotional stress and overexertion can trigger the disease or aggravate it.
Others. Most patients have relapses and exacerbations in winter, with remission or natural regression in summer, but seasonal regularity disappears in long-standing patients. Some women patients also have exacerbations around menstruation, and the rash subsides during pregnancy and recurs after delivery. Chloroquine, lithium carbonate and β-adrenergic blocking drugs can aggravate the disease.
Symptoms
The rash starts as a pinhead or green bean sized red dot rash, which gradually expands, and some of the dots are separated from each other to form patches. The surface is covered with dry silvery scales, and when the scales are gently scraped away, small patches of blood are visible, which are characteristic of the disease.
Clinically, most patients show the rash as aggravated in winter and spring and naturally reduced in summer and autumn. This is due to the cold and dry climate in winter and spring, the constriction of epidermal blood vessels, the poor blood supply to the skin, and the loss of nourishment to the skin. In the case of individual immune dysfunction, the temptation that can lead to the disease is the lack of resistance and thus cause the disease.
The disease is an erythema, papules and other skin lesions of unknown etiology and pathogenesis. Scaly, chronic inflammatory relapsing skin disease. It is believed that genetic, immune, metabolic disorders, infections, trauma and psychological factors are the causative factors for the development of this disease. The disease can affect both men and women, but more young adults and more men than women. The most common sites are scalp, extensor side of the limbs. The second most common site is the scalp, the extremities, the trunk, and the whole body.
Clinical lesion characteristics: common lesions start as red papules or macules, gradually increasing or fusing into plaques, which are covered with multiple layers of silvery white dry scales, scales easily scraped off, revealing a red shiny layer of film at the base, called the film phenomenon. If the film is scraped off, it is sieved and bleeding, called punctate bleeding phenomenon, which is the clinical specific symptom of the disease. The lesions can be in various forms during the development, such as dotted, coin-shaped, map-shaped, ring-shaped, oyster shell-shaped, etc.. It may be accompanied by pruritus and other self-conscious symptoms.
Pustular lesions are characterized by the rapid appearance of corn-sized sterile pustules on the erythematous plaques, which are scattered or fused into pus lakes and form ulcers and pustules after rupture, and may be accompanied by systemic symptoms such as high fever and arthralgias.
Arthritic lesions have the same characteristics as the common type or pustular type. However, it is accompanied by painful swelling of large and small joints all over the body, and in severe cases, it may cause joint ankylosis or deformity.
Erythrodermic lesions are characterized by flushing and swelling of the skin, covered with a large number of scales, which are constantly shed, while the normal skin is surrounded by the lesions like an island in the ocean. There may be burning pain at the lesions, accompanied by chills and fever, headache, arthralgia and other systemic symptoms. Clinical treatment can be internal methotrexate, etretinate, etc., and external therapy can be GOECKERMA triple therapy, etc.
This disease is considered as “dry ringworm” in Chinese medicine, such as “Treatise on the Origin of Diseases”. According to Chinese medicine, this disease is mostly caused by the loss of harmony between blood and Ying, internal depletion, wind and dryness, and loss of skin nourishment.
The treatment of psoriasis vulgaris is unique in Chinese medicine, with side effects. The curative effect is stable. Generally, the clinical treatment is divided into two types: blood-heat type and blood-deficiency and wind-dry type. If it belongs to blood-heat type, the treatment should be to clear heat and cool blood, activate blood circulation and remove blood stasis; if it belongs to blood-deficiency and wind-dry type, the treatment should be to nourish blood and activate blood, dispel wind and moisten dryness. In the former case, Rhizoma Dihuang Tang or Cool Blood Dihuang Tang is used as an addition and subtraction, while in the latter case, Siwu Tang combined with Feng Wan San is used as an addition and subtraction.
Clinical manifestations of psoriasis
According to the clinical manifestations and pathological features of psoriasis, there are generally six types.
1, common psoriasis: the rash generally occurs on the scalp, trunk, extensor side of the limbs, is the appearance of red papules on the skin, gradually expanding and fusing into patches or plaques, the surface has thick silvery white phosphorous, irregular shape, some have a map or island-like appearance, some lesions are smaller, more, full of stars appearance, scales layer by layer off, gently scrape off the dander can see a thin layer of red film, scrape off the red film can See small bleeding spots, some people called blood dew, medical also called sieve bleeding, which is the clinical characteristics of common psoriasis.
2, erythrodermic psoriasis: is more serious, less common, this type refers to about 70% of the whole body skin is diffuse red, dark red infiltrative lesions, the surface has a lot of furfur-like flakes, sometimes in the axilla, thigh root and umbilicus due to swelling and epidermal exfoliation and exudation, oropharynx and nose and conjunctiva can be congested red, patients often have fever chills, headache and general discomfort and other symptoms.
3, pustular psoriasis: divided into generalized and limited. The pustular psoriasis is mostly acute, and the pustules can spread all over the body within a few days to a few weeks, with dense pinpoint-sized potential small pustules first, which soon fuse into pus lakes, often accompanied by high fever, joint swelling and pain, and general discomfort, with an increase in white blood cells seen in routine blood tests. Restricted pustular psoriasis is more common in palm and toe pustular psoriasis. There are symmetrical erythematous patches on the palms of both hands and toes, and pinhead-sized to chestnut-sized to small pustules appear on the erythematous patches: they dry up on their own after about 1-2 weeks, and new pustules appear after desquamation, which stretches repeatedly and has a stubborn course.
4, arthritic psoriasis: rare, can occur at any age, can occur in large and small joints at the same time, but commonly wrist, finger and toe small joints, spinal joints can also occur. The diseased joints have redness, swelling, pain, severe joint cavities with fluid, swollen skin near the joints with restricted activity, and joint stiffness over time, and in severe cases the joints are seen to be destroyed on X-ray, with fast blood sedimentation, often with fever and other systemic symptoms, but rheumatoid agglutination factor is negative, arthritic psoriasis, skin damage is mostly accompanied by thick oyster shell-like lesions, or there may be only the erythematous and silvery skin of common psoriasis Damage.
5.Pustular pustulosis of the palm: including pustular psoriasis of the palm and pustular bacterial rash.
6.Continuous acrodermatitis: characterized by aseptic pustules, so it is also considered to be the same disease as pustular psoriasis. It is also considered to be a subtype of pustular psoriasis, but there are also different opinions that it should be an independent disease. It occurs in middle-aged people and is mostly caused by trauma.
Hazards
Although psoriasis does not directly affect life, it has a direct impact on physical health and physical and mental well-being.
The main cause of psoriasis disease, reactive oxygen species, is a harmful product of muscle metabolism that infiltrates the interstitial matrix of blood cells, leading to pollution of the internal environment of the muscle and changes in the pure quality of blood. Blood heat, blood dryness, blood stasis, and excessive accumulation of stagnation and obstruction lead to the development of plague and poison in the skin. The disease is recurrent over the years, and the course of the disease is prolonged for a long time, consuming the blood and hurting the essence, causing the skin to lose its nourishment, dryness and itching, and hurting the mind and losing sleep, and destroying the body.
Psoriasis is mostly triggered by mental factors, due to overwork, family disputes, death of relatives, economic problems, etc. to make patients overstressed and depressed, which can cause a series of psychological reactions, leading to endocrine disorders, immune function decline, thus promoting the occurrence and development of psoriasis.
Therefore, in case of irresistible natural or man-made disasters, patients should try to control their emotions, try to keep their mood calm, ensure sufficient sleep, and take sedatives in appropriate amounts when necessary.
Precautions
Psoriasis patients should actively cooperate with doctors in addition to treatment in daily life to pay attention to.
1. 3 major taboos: avoid alcohol, seafood, and spices. The most important thing to remember is that you have to be careful about what you eat.
2, hemolytic streptococcal infection is a predisposing factor for this disease, as far as possible to avoid the occurrence of colds, tonsillitis, pharyngitis. Once it happens, you should actively treat the symptoms to avoid aggravating psoriasis. Tonsillectomy is recommended if the disease is often triggered or aggravated by suppuration of the tonsils. For this article tonsil removal should be done with caution.
3.Eliminate mental tension factors, avoid excessive fatigue, and pay attention to rest.
4.Living conditions should be dry, ventilated and easy to bathe.
5.In daily medication, antimalarials and beta-blockers can induce or aggravate the condition.
6.Endocrine changes and pregnancy can trigger the disease and make it worse.
7, eat more vitamin-rich foods, such as fresh fruits and vegetables.
8.When cleaning the affected area, the action should be lightly rubbed and do not forcibly peel off the skin flakes to avoid local infection, such as redness, swelling, heat and pain, which will affect the treatment and prolong the course of the disease.
9, after the clinical temporary healing of psoriasis, its immune function, microcirculation, metabolism is still not completely restored to normal, generally need 2-3 months to recover. Therefore, after the clinical healing, that is, after the appearance of the lesions have completely receded, you should continue to take 2-3 courses of drugs for consolidation, so that the virus is cleared more thoroughly to avoid relapse.
Daily life dietary care and beneficial food therapy
According to the dialectical analysis of Chinese medicine, psoriasis has the symptoms of “blood dryness, blood heat, and blood deficiency”, while from the perspective of Western medicine, it is due to the excessive proliferation of keratinocytes and various biochemical metabolism disorders.
Therefore, any food that has the effect of nourishing, cooling and activating blood or inhibiting cellular DNA synthesis and improving microcirculation is good for psoriasis, such as fruit drinks like umeboshi and grapefruit, which have the effect of clearing heat, cooling blood, quenching thirst and generating fluid, and are not only rich in vitamins and trace elements, but can also reduce blood lipids and blood viscosity. It is an effective fruit to prevent and control psoriasis in summer.
Common knowledge
1. There is no special prevention method or sure cure for this disease;
2, the disease is not contagious, even in patients with severe disease;
3, treatment at the same time must relieve the patient’s mind concerns, avoid possible triggers, avoid stimulating food, avoid stimulating therapy, prohibit scratching and hot water washing;
4.Appropriate treatment of psoriasis can lead to a recent clinical cure, but most patients may relapse;
5, generally no visceral damage, good prognosis;
6, because of the need to fast certain foods, patients need to adjust to increase other foods to prevent malnutrition.
7, psoriasis treatment has a great relationship with mood, maintaining a good mood is the key.
Psychological treatment plan for psoriasis patients
First, establish a friendly doctor-patient relationship. Doctors should sympathize with patients, establish a friendly relationship with them, pay attention to communication, encourage patients to speak freely, fully express their inner feelings and actively ask questions.
Second, individual psychotherapy. Explain to patients in detail about psoriasis, such as the current epidemiological situation, pathogenic factors, pathogenesis, the impact of the disease on the organism, the purpose and status of treatment, the problems and precautions in the current treatment, so that patients can correctly understand the occurrence of the disease. To build up confidence in overcoming the disease, change the wrong viewpoint, give up the idea of demanding a radical cure, and not to seek medical treatment indiscriminately. Make it clear to patients and family members that the disease is not contagious and does not require isolation from relatives.
Third, group treatment. Try to let patients communicate with each other and communicate with each other, so as to eliminate the feeling of isolation. Encourage patients to actively participate in cultural, sports and social activities to shorten the distance between them and others and to improve their psychological tolerance to the disease and other difficulties.
Treatment modalities known today
It is important to highlight that there is no cure for psoriasis and that all treatments carry strong side effects. Many patients deteriorate from drug stimulation rather than from the disease itself. Any advertisement claiming to be able to cure psoriasis is extremely irresponsible, and many of them will cause serious harm to the patient’s body and psyche. The so-called cure today is only a temporary clinical cure, but the throw will recur, and the length of the recurrence cycle varies according to individual differences.
The five known treatment methods today are western medicine, Chinese medicine, diet, bathing, and prescriptions. It is necessary to add that the deterioration of many psoriasis patients is caused by western medicine, hormone medicine and cytotoxic drugs, while Chinese medicine tonics for psoriasis still have certain effects because Chinese medicine treatment is an overall regulation of the patient’s body, and there are many clinical psoriasis patients who do not relapse after taking Chinese medicine cure for many years, and some who heal themselves without treatment. These, are accessible to the folk.