Psoriasis is a chronic, non-contagious disease, dermatosis, that primarily affects the skin. The autoimmunity of this disease is currently believed. Psoriasis usually causes excessively dry, red, raised patches of skin. However, some psoriasis patients do not have any visible skin lesions. The spots caused by psoriasis are called plaques. These spots are inherently sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin, as well as excessive formation of new small capillaries in the underlying skin layer.
What causes psoriasis?
The causes of psoriasis are not yet fully understood. There are currently two main hypotheses about the nature of the process that leads to the development of this disease.
According to the first hypothesis, psoriasis is a primary skin disease in which the normal maturation and differentiation of the skin cells is disturbed and these cells overgrow and multiply. At the same time, the problem of psoriasis is seen by the supporters of this hypothesis as a violation of the function of the epidermis and its keratinocytes.
Autoimmune aggression of T lymphocytes and macrophages against skin cells, their penetration into the skin thickness and excessive proliferation in the skin are seen as secondary to the body's reaction to the excessive proliferation of "false", immature, pathologically altered keratinocytes. This hypothesis is supported bysupports the presence of a positive effect in the treatment of psoriasis with drugs that inhibit the multiplication of keratinocytes and / or cause their accelerated maturation and differentiation, and at the same time have no or insignificant systemic immunomodulatory properties - retinoids (synthetic analogues of vitamin A), vitamin Dand especially its active form, fumaric acid ester.
The second hypothesis suggests that psoriasis is an immune-mediated, immunopathological, or autoimmune disease in which the overgrowth and proliferation of skin cells, and especially keratinocytes, is secondary to various inflammatory factors produced by cells of the immune system and / or to, and autoimmune cell damage to the skin, the onesecondary regenerative response.
What happens to the skin and how do you care for it?
Impairment of the skin's barrier function (in particular, mechanical damage or irritation, friction and pressure on the skin, abuse of soap and detergents, contact with solvents, household chemicals, alcoholic solutions, presence of infected foci on the skin or skin allergies, deficiency of immunoglobulins, excessive drynessSkin) also play a role in the development of psoriasis.
Infection in dry skin leads to dry (non-exudative) chronic inflammation, which in turn leads to psoriasis-like symptoms such as itching and increased skin cell proliferation. This in turn leads to a further increase in dry skin, both due to inflammation and increased proliferation of skin cells, as well as due to the fact that the infectious organism absorbs moisture that would otherwise serve to moisturize the skin. To avoid excessive dryness of the skin and reduce the symptoms of psoriasis, the use of washcloths and scrubs, especially tough ones, is not recommended for patients with psoriasis, as these not only damage the skin and leave microscopic scratches, but that tooThe upper material scrapes the protective horny layer and sebum from the skin, which normally protect the skin from drying out and the penetration of microbes. It is also advisable to use talcum powder or baby powder after washing or bathing to absorb excess moisture from the skin that would otherwise "get" to the infectious agent. In addition, it is recommended to use products that moisturize and nourish the skin, as well as lotions that improve the functioning of the sebum glands. It is not recommended to abuse soap and detergents. You should try to avoid skin contact with solvents and household chemicals.
Is psoriasis inherited?
The hereditary component plays an important role in the development of psoriasis, and many of the genes that are linked to or directly involved in the development of psoriasis are already known, but it remains unclear how these genes develop during the development of the psoriasisDisease interact. Most of the genes currently known to be associated with psoriasis affect the functioning of the immune system in one way or another.
It is believed that if healthy parents have a child with psoriasis, the likelihood of the next child getting sick is 17%, and if one of the parents has psoriasis, the likelihood of the disease in children increases to 25% (withthe disease of both parents - up to 60-70%).
Due to the fact that in most patients with psoriasis the hereditary transmission of the dermatosis cannot be determined, it is assumed that it is not the psoriasis itself that is inherited, but a predisposition to it, which in some cases is realized by a complex interplay of hereditary factors andadverse environmental influences.
What does psoriasis look like?
Excessive proliferation of keratinocytes (skin cells) in psoriatic plaques and infiltration of the skin with lymphocytes and macrophages quickly leads to thickening of the skin at the lesion sites, their elevation above the surface of healthy skin and the formation of characteristic pale, gray or silvery spotsthat resemble hardened wax or paraffin ("paraffin lakes"). Psoriatic plaques most often appear first in areas exposed to friction and pressure - the surfaces of the elbows and squats, on the buttocks. However, psoriatic plaques can appear anywhere on theSkin, including the scalp (scalp), the palm of the hands, the soles of the feet, and the external genitals. Unlike eczema rashes, which often affect the inner flexor surface of the knee and elbow joints, psoriatic plaques are more often on the outer one, stretching surface of the joints.
What does it take to diagnose psoriasis?
This is usually much more difficult in children than in adults: In children, psoriasis often takes on an atypical form, which can lead to diagnostic difficulties. And the earlier the diagnosis is made, the more opportunities to fight the disease.
There are no diagnostic procedures or blood tests that are specific to psoriasis. Nevertheless, with active, progressive psoriasis or its severe course, abnormalities can be detected in blood tests that confirm the presence of an active inflammatory, autoimmune, rheumatic process (increased titers of rheumatoid factor, acute phase proteins, leukocytosis, increased ESR, etc. ), as well as endocrineand biochemical diseases. Sometimes a skin biopsy is needed to rule out other skin conditions and to histologically confirm the diagnosis of psoriasis.
How is psoriasis treated?
It is worth starting treatment for psoriasis in children as early as possible and monitoring the child so that he or she follows all the advice of the doctor. The baby's immune system is very sensitive. With the right approach, psoriasis can be coped with, and as you let the disease take its course, the skin becomes more and more affected.
If the child has symptoms of the disease - plaques on the skin, itching, redness, peeling, you need to immediately start treatment, strictly follow all the recommendations of the doctor, and he will advise you to apply a special cream to the skin.
At its progressive stage and with common forms of the disease, it is best to take the child to the hospital. Prescribe desensitizers and sedatives, in 5% calcium gluconate solution or 10% calcium chloride solution in teaspoons, desserts or tablespoons 3 times a day. Every other day, apply a 10% solution of calcium gluconate intramuscularly 3-5-8 ml (depending on age), 10-15 injections per course. With severe itching, antihistamines are needed orally in short courses for 7-10 days. Older children in a progressive state of agitation, poor sleep, small doses of hypnotics and small sedatives sometimes work well.
Apply vitamins: ascorbic acid 0, 05-0, 1 g 3 times a day; Pyridoxine - 2. 5-5% solution, 1 ml every other day, 15-20 injections per course of treatment. Vitamin B12 is especially indicated for frequent exudative forms of psoriasis - 30-100 mcg 2 times a week intramuscularly in combination with folic and ascorbic acid for 172-2 months. Vitamin A is administered with 10, 000 - 30, 000 ME once a day for 1-2 months. Patients with the summer form of psoriasis, especially those with severe itching, are shown nicotinic acid inside. In psoriatic erythroderma, the following are recommended: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in double dosage), potassium orotate. Vitamin D2 should be used with some caution in all forms of psoriasis.
To stimulate protective and adaptive mechanisms, pyrogenic drugs are prescribed, which normalize vascular permeability and inhibit the mitotic activity of the epidermis. A good therapeutic effect is achieved by weekly, multiple transfusions of blood, plasma, depending on the result achieved. In children with persistent (exudative and erythrodermic) forms of psoriasis, sometimes it is not possible to achieve a positive effect with these agents. Then glucocorticoids are prescribed orally at 0. 5-1 mg per 1 kg of body weight per day for 2-3 weeks, followed by a gradual decrease in the dose of the drug until it is discontinued. Because of their toxicity, cytotoxic drugs are not recommended for children of any age. In the stationary and regressive stages of the disease, more active therapy is prescribed - UFO, general baths at a temperature of 35-37 ° C for 10-15 minutes after 1 day.
External treatment for psoriasis.
Salicylic acid (1-2%), sulfur tar (2-3%) ointments; Glucocorticoid ointments. These ointments quickly show a direct effect in the form of occlusive dressings in the localization of psoriatic plaques on the palms of the hands and soles of the feet. In children with a predominant scalp lesion, the recently used phosphodiesterase inhibitors in the form of lubricants or occlusive dressings with ointments can be recommended.
It is necessary to emphasize the importance of remedying focal infections (diseases of the respiratory tract, ENT organs, helminth invasions, etc. ). Tonsilectomy and adenotomy in children with psoriasis can be performed after the age of 3 years. In 90% of cases, these surgical interventions have a beneficial effect on the course of the process, and exacerbations occur in 10% of patients, especially with extensive exudative psoriasis. Follow-up examinations at 7-10 years showed that 2/3 of the patients after tonsillectomy had no relapses of the disease, but even the remaining 1/3 of the children with exacerbations of the rash were sparse and the remissions prolonged; exacerbations of dermatosis were more common in children with psoriasis and chronic tonsillitis who had not undergone surgery.
Our long-term observations on children show that in most cases relapses of psoriasis occur less often with increasing age, are less pronounced and a tendency to transition from common forms of dermatosis to more restricted forms is clearly discernible. However, in some patients, the process remains generalized with a severe course.
Is Psoriasis a Diagnosis for Life?
If you start treatment on time and correctly, then no. The development of psoriasis in a child does not in any way mean that they will also have the disease as an adult. Of course, psoriasis is a chronic disease that is almost impossible to 100% recover from. But the resting phase can be maximized. Psoriasis in children is treated like an adult, switching from one type of treatment to the other every three months.
The child should be psychologically prepared in advance for the fact that his body has defects. In children, unlike adults, psoriasis often affects the face rather than the body (30% of cases). Rashes can appear on the forehead, cheeks, and eyelids. It's pretty hard to take psychologically. A third of children with childhood psoriasis also have the nails affected. Therefore, it is quite difficult to hide the disease.
In addition to physically uncomfortable sensations, psoriasis can be a difficult test of a child's mood. Parents shouldn't leave him alone with a problem. Every activity should be encouraged: sports, games. However, it is worth remembering the precautions. For example, the skin can be stretched in certain parts of the body (for example during long periods of cycling). And this can cause psoriasis. Despite the unsightly skin condition, the child can go swimming! And if there are chemicals in the water, remove it
Why is psoriasis still not fully curable?
This disease is called mysterious for a reason. The nature of this disease is not yet clear. Some psoriasis affects the face, some have limbs, some have joints! Why marriage takes place in the cells of our body is not clear. As an oncology, psoriasis cannot be treated with tablets. Interesting developments are currently underway in our country. They try to treat children with ointments made from natural raw materials. The prognosis is favorable, but the ointment has not yet gone into production. In the meantime, I advise parents, charlatans and pseudo-healers not to trust and, if there are signs of psoriasis in a child, contact a specialist - a pediatric dermatologist.