Psoriasis, or psoriasis in children, is a chronic disease that manifests itself by the formation of silvery-white papules (bumps) on the child's skin. The incidence of psoriasis among all dermatoses is about 8%. This disease occurs in groups of children of different ages, including infants and newborns, more often in girls. The disease is characterized by a certain seasonality: there are more cases of psoriasis in winter than in summer.
The disease is not contagious, although the virus theory of its origin is still being considered.
Causes of the disease
The normal maturation cycle of skin cells is 30 days. In psoriasis, it shrinks to 4-5 days, which is manifested in the formation of psoriasis plaques. Using the electron microscopy method, it was found that the same changes are present on the child's healthy skin as on the affected areas. In addition, in patients with psoriasis, there is a disruption of the functioning of the nervous system, endocrine system, immune system, metabolism (mainly enzymatic and fatty) and other changes in the body. This suggests that psoriasis is a systemic disease.
There are three main groups of causes of psoriasis:
- Inheritance;
- Wednesday;
- Infections.
Heredity is a leading factor in the development of psoriasis. This is confirmed by the study of dermatoses that occur in twins, in relatives in several generations, as well as biochemical studies on healthy family members. If one of the parents is sick, the probability that the child will get psoriasis is 25%, if both parents are sick, then 60-75%. At the same time, the type of inheritance remains unclear and is recognized as multifactorial.
Environmental factors include seasonal changes, the contact of clothing with the skin, the effects of stress on the child's psyche, relationships with peers. Draw the attention of children in a team to a sick child, treat them like a "black sheep", limit contacts for fear of infection - all these factors can provoke new exacerbations, an increase in skin lesions. A child's psyche is particularly vulnerable during puberty, which is due to hormonal changes. Hence, a large percentage of the detection of the disease falls on adolescents.
The ratio of genetic and environmental factors that trigger the occurrence of psoriasis is 65% and 35%.
Infections trigger infectious-allergic reaction mechanisms that can trigger the development of psoriasis. So, the disease can appear after the transferred flu, pneumonia, pyelonephritis, hepatitis. A distinction is also made between the post-infectious form of the disease. It is characterized by a strong papular rash in the form of drops all over the body.
In some cases, the onset of psoriasis is preceded by trauma to the skin.
Symptoms
Psoriasis is characterized by the appearance of a rash in the form of red islets ("plaques") with silvery-white spots that are slightly scaly and itchy. The appearance of cracks in the plaques can be accompanied by light bleeding and is fraught with additional infection.
Outwardly, psoriatic rashes in children are similar to those in adults, but there are some differences. For children with psoriasis, Koebner syndrome is very characteristic - the appearance of rashes in areas affected by irritation or injury.
The course of psoriasis in childhood is long, with the exception of a teardrop-shaped, more favorable form of the disease. There are three stages of the disease:
- progressive;
- stationary;
- regressive.
The progressive stage is characterized by the formation of small, itchy papules surrounded by a red border. Lymph nodes can enlarge and thicken, especially in severe psoriasis. At the stationary stage, rashes stop growing, the center of the plaques is flattened, and the peeling decreases. At the regression stage, the elements of the rash dissolve, leaving a depigmented margin (Voronov margin). The rash leaves hyper- or hypopigmented spots.
The localization of psoriatic eruptions can be different. The skin of the elbows, knees, buttocks, navel, and scalp is most commonly affected. One out of three children with psoriasis has affected nails (the so-called foxglove symptom, where tiny holes appear on the nail plates that resemble the fossa of a thimble). Plaques are often found in folds of skin. The mucous membranes, especially the tongue, are also affected and the rash can change its position and shape ("geographic tongue"). The skin of the palms of the hands and the surface of the soles of the feet is characterized by hyperkeratosis (thickening of the upper layer of the epidermis). The face is less affected, the rash appears on the forehead and cheeks and may spread to the ears.
During the analysis of blood, an increase in the total amount of protein and gamma globulin level, a decrease in the albumin-globulin coefficient and violations of lipid metabolism are noted.
Forms of psoriasis in childhood
- teardrop-shaped;
- Plaque;
- pustular;
- erythrodermic;
- Infant psoriasis;
- Psoriatic arthritis.
The most common form isTear psoriasis. . . It manifests itself in the form of red bumps on the body and limbs that occur after minor injuries and infections (otitis media, rhinopharyngitis, flu, etc. ). A cytological examination reveals streptococci in a throat swab. The teardrop shape of psoriasis is often mistaken for allergic reactions.
Plaque psoriasis is characterized by red eruptions with clear borders and a thick layer of white scales.
The pustular or pustular form of the disease is rare. The appearance of pustules can be triggered by infections, vaccinations, taking certain medications, stress. Pustular psoriasis that occurs in newborns is called newborns.
With erythrodermic psoriasis, the child's skin looks completely red; plaque may appear on some areas of the skin. Skin symptoms are often associated with an increase in body temperature and joint pain.
Pustular and erythrodermic psoriasis can take on generalized forms with a severe course. You need hospital treatment to avoid death.
Psoriasis in infants is also known as diaper psoriasis. Diagnosis is difficult because skin lesions are most common in the buttocks area and can be mistaken for dermatosis due to irritation of the skin with urine and feces.
Psoriatic arthritis affects around 10% of children with psoriasis. The joints swell, the muscles become stiff, there is pain in the toes, ankles, knees, wrists. Conjunctivitis is often associated with it.
Usually the course of any form of the disease changes every three months. In the summer, the symptoms often subside due to the sun exposure.
treatment
It is best to hospitalize a child with psoriasis for the first time.
- Desensitizers are prescribed (5% calcium gluconate solution or 10% calcium chloride solution inside, 10% calcium gluconate solution intramuscularly) and sedatives (feverfew tincture, valerian).
- If the itching is severe, antihistamines and sedatives are appropriate.
- B vitamins are shown intramuscularly for 10-20 injections: B6 (pyridoxine), B12 (cyanocobalamin), B2 (riboflavin); inside: B15 (pangamic acid), B9 (folic acid), A (retinol) and C (ascorbic acid).
- To activate the body's own defenses, drugs are used that have a pyrogenic (temperature-increasing) property. They normalize vascular permeability and reduce the speed of epidermal cell division.
- Shown weekly blood transfusions, the introduction of plasma and albumin.
- If treatment is ineffective, as well as in severe cases of the disease, the doctor may prescribe glucocorticoids over the course of 2-3 weeks, gradually reducing the dose and then withdrawing the drug. The dosage is chosen individually. Cytostatics are not prescribed to children because of their toxicity.
- To combat plaque on the palms of the hands and soles of the feet, occlusive (sealed) dressings with salicylic-sulfur-tar ointments are used.
- In the stationary and regressive stages of psoriasis, children are prescribed UFO, calming baths, herbal medicine. Sapropel extract, which is used in the form of applications or baths, has proven itself.
With frequent colds that accompany psoriasis, it is necessary to disinfect the sources of infection: to heal carious teeth, if necessary, to perform deworming, to perform tonsillectomy and adenotomy. A desirable step in the treatment of psoriasis is spa treatment.
It must be remembered that psoriasis is a chronic disease characterized by periods of exacerbation and remission, and one should be prepared for long-term and regular treatment.
The child needs to instill a healthy lifestyle, teach him to deal with stress, calmly react to attacks from his peers. The situation is particularly difficult with children whose facial skin is affected. All family members should support a sick child who will help them avoid complexes and grow up as a socially adjusted person.
Which doctor should you contact?
Psoriasis in children is treated by a dermatologist. If not only the skin, but also the joints are affected, a consultation with a rheumatologist with the development of conjunctivitis is indicated - an ophthalmologist. It is necessary to disinfect chronic foci of infection by visiting a dentist, an infectious disease specialist or an ENT doctor. If you have difficulty in differential diagnosis of psoriasis and allergic diseases, you should contact an allergist. A nutritionist, physiotherapist and psychologist support the patient's treatment.