Intertriginous psoriasis is an infrequent type of psoriatic lesion of the skin, characterized by atypical localization of the pathological process in large folds of the skin, atypical primary elements, practically devoid of peeling. It is clinically manifested by the formation of edematous hyperemic spots of bright pink color, papules with elements of wetness, which transform into erosions with the epithelium peeling off along the perimeter. A feature of intertriginous psoriasis is its tendency to spontaneous degeneration into severe complicated forms. The diagnosis is confirmed histologically. Complex treatment (medication – general and local, phototherapy, detoxification).
General information
Intertriginous psoriasis is a chronic dermatosis of unclear etiology affecting the folds of the skin. The disease is a form of psoriasis, which more often affects children, the elderly and patients with endocrine disorders. The disease has no racial, gender characteristics, is devoid of endemicity, but it is more common among the peoples of the Far North. It is believed that about 100 million people of the world’s population suffer from psoriasis. According to various authors, the prevalence of psoriasis in various countries ranges from 0.1% to 3% (in the USA, 1% of the population is ill).
Intertriginous psoriasis is a disease of the young. In 75% of cases, it debuts at the age of 30 and refers to psoriasis of the first type, in 25% – at the age of 55 and refers to psoriasis of the second type. According to the distribution by groups, there are two peaks of morbidity: in women – 16-55 years, in men – 28-55 years. Dermatologists note a low incidence of intertriginous psoriasis in countries where fish and seafood are included in the diet in large quantities, which indirectly confirms the interest of metabolic processes in the development of the disease.
Causes
In modern dermatology, intertriginous psoriasis is considered to be a dermatosis with a heterogeneous etiology. Recent scientific developments have shown that the main gene involved in the mutation that determines the hereditary predisposition to intertriginous psoriasis is the PSOR1 gene, which also affects the genetic determination of lipid and carbohydrate metabolism disorders. This is indirectly confirmed by the clinic of the disease: mainly young patients suffer from this form of psoriasis, in the elderly, the development of pathology is associated with an age-related change in the hormonal background, leading to a violation of lipid and carbohydrate metabolism. Also, the disease can be traced in patients with inherited diabetes mellitus.
Immunological instability in the genesis of the disease is associated with dysregulation of immunocompetent cells with hyperproduction of cytokines that provoke spontaneous development of generalized inflammation, which is also confirmed by the clinical picture. Finally, focal infection in the conditions of localization of the primary focus in the folds of the skin due to the lack of air, ventilation, sunlight, constant injury, irritation with deodorants becomes a factor complicating the primary elements.
Symptoms
The primary element is an atypical papule, devoid of scales, smooth, shiny, slightly rising above the surface of the skin, scarlet or burgundy with clear borders. Papules tend to merge, forming large foci of geographical outlines, erode with the formation of a “frill” from the cells of the remaining epidermis around the perimeter, begin to get wet. A secondary infection joins, including a fungal infection, itching, scratching of the crust, soreness, a feeling of heat in the lesion. Nearby lymph nodes react to inflammation.
The elements (foci) are located in the folds of the skin: behind the ears, in the armpits, under the mammary glands, between the fingers and toes, in the groin, the interstitial region, the folds of the genitals. Such localization significantly violates the quality of life of the patient. The development of the disease is considered especially unfavorable when it suddenly transforms into erythroderma. Generalization of the process has given rise to some dermatologists to consider intertriginous psoriasis as systemic dermatosis. Others call intertriginous psoriasis reverse, inverse, oppositional, that is, not obeying the general laws of the course and treatment of pathology. The severity of the course of the disease and resistance to therapy is explained by the inaccessibility of the primary focus, and its spontaneous generalization is due to the weakening of general and local immunity.
Diagnosis and treatment
Clinical manifestations are atypical, there is no clinical triad (it is possible to preserve the symptom of terminal film and bleeding by the type of “dew drops”). The diagnosis is made on the basis of histological examination data (hyperkeratosis, infiltration in the upper layers of the skin). In unclear cases, immunological testing is carried out, including the search for tissue compatibility antigens and rheumatoid factor. Differentiate intertriginous psoriasis with candidiasis, epidermophytosis, rubromycosis.
Therapy of intertriginous psoriasis is complex. First of all, this form of the disease is a reason to turn to an endocrinologist. You also need to consult a dermatologist. General therapy includes calcium and magnesium salts intravenously every other day (course – 15 injections), antihistamines, sedatives, lipotropic drugs in combination with belladonna, vitamins (groups B, C, A, E, P), coenzymes (adenosine monophosphate). When a secondary infection is attached, antibiotics are used in combination with antiviral agents. In severe forms, cytostatics and immunosuppressants are used. Hemodialysis, hemosorption, hemofiltration, plasmapheresis are connected.
Uncomplicated forms of psoriasis respond well to external therapy. Salicylic ointments, Unna cream are used. Corticosteroid ointments are effective according to an individual program under the supervision of a doctor. They have antiseptic, anti-allergic, anti-inflammatory effect, relieve itching. UVI, PUVA therapy of psoriasis is indicated. Patients with intertriginous psoriasis should carefully choose deodorants (antiperspirants), since they can provoke the appearance of new rashes. The prognosis is relatively favorable, during the period of exacerbation, the quality of life is significantly impaired.