Psoriasis or scaly lichen is a chronic disease in children that results in 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 some seasonality: there is more psoriasis in winter than in summer.
The disease is not contagious, although a viral theory of its origin is still under consideration.
Causes of the disease
The normal maturation cycle of skin cells is 30 days. In psoriasis, it shrinks for 4-5 days, which manifests itself in the formation of psoriasis plaques. Electron microscopy found that the child had healthy skin with the same changes as in the affected areas. In addition, patients with psoriasis develop disorders of the nervous system, endocrine, 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:
- heredity;
- Wednesday;
- infections.
Heredity is a leading factor in the development of psoriasis. This is confirmed by the study of dermatosis that occurs in generations in twins and relatives, as well as the biochemical study of healthy family members. If one parent is ill, the probability that a child will get psoriasis is 25%, if they are both ill, it is 60-75%. However, the type of inheritance remains unclear and is recognized as multifactorial.
Environmental factors include seasonal changes, skin contact with clothing, the effect of stress on a child’s psyche, and relationships with peers. Focusing the attention of the children on the team on a sick child, treating them as "black lambs", restricting relationships for fear of infection - all of these factors can lead to further exacerbations, an increase in the area of skin lesions. The child’s psyche is particularly vulnerable during puberty due to hormonal changes. Therefore, a large percentage of the disease is detected in adolescents.
The rates of genetic and environmental factors that cause psoriasis are 65% and 35%, respectively.
Infections trigger infectious-allergic response mechanisms that can lead to the development of psoriasis. So the disease can occur after the transmitted flu, pneumonia, pyelonephritis, hepatitis. Even the post-infection form of the disease is distinguished. It is characterized by abundant papular rashes throughout the body in the form of drops.
In some cases, the appearance of psoriasis is preceded by skin damage.
Symptoms
Psoriasis is characterized by the appearance of rashes on the skin in the form of red islets ("plaques") with silvery-white patches that are easily peeling and itchy. The appearance of plaque rupture may be accompanied by mild bleeding and is accompanied by the addition of a secondary infection.
Externally, psoriatic rash in children is similar to that in adults, but there are differences. Children with psoriasis are very prone to developing Koebner syndrome rashes in areas affected by irritation or injury.
The course of childhood psoriasis is long, except for the teardrop-shaped, more favorable form of the disease. The disease has three stages:
- advanced;
- stationary;
- decreasing.
The progressive stage is characterized by the formation of tiny, itchy papules surrounded by a red rim. Lymph nodes can become enlarged and thickened, especially in severe psoriasis. In the stationary stage, the growth of rashes stops, the middle of the plaques flattens out, and peeling decreases. In the regression phase, the elements of the rash dissolve, leaving a depigmented rim (Voronov rim). The rash leaves hyper- or hypopigmented spots.
The localization of psoriatic outbreaks may be different. The skin of the elbow, knee, buttocks, navel, and scalp are most commonly affected. Every third child with psoriasis has their fingernails affected (a so-called thymic symptom in which small holes appear on the nail plates that resemble the thimble). Plaques are often found in the folds of the skin. The mucous membranes, especially the tongue, are also affected, and the location and shape of the rash may change ("geographical language"). The skin of the palm and the plantar surface of the foot are characterized by hyperkeratosis (thickening of the upper layer of the epidermis). The face is less likely to have rashes on the forehead and faces and may spread to the ears.
Blood analysis shows an increase in total protein and gamma globulin levels, a decrease in the albumin-globulin coefficient, and a violation of fat metabolism.
Forms of childhood psoriasis
- drop-shaped;
- patch;
- pustular;
- erythrodermic;
- psoriasis in infants;
- psoriatic arthritis.
The most common form istears in psoriasis. . . It manifests as red bumps on the body and limbs after minor injuries and infections (otitis media, pharyngitis, flu, etc. ). In the throat smear, cytological examination reveals streptococci. The teardrop-shaped form of psoriasis is often confused with allergic reactions.
Plaque psoriasis is characterized by red eruptions with clear boundaries and a thick layer of white scales.
The pustular or pustular form of the disease is rare. The appearance of pustules can be caused by infection, vaccinations, taking certain medications, and stress. Pustular psoriasis in newborns is called newborn.
With erythrodermic psoriasis, a child’s skin appears completely red; there may be plaque on some parts of the skin. Manifestations of the skin are often accompanied by an increase in body temperature and joint pain.
Pustular and erythrodermic psoriasis can take on severe, generalized forms. They require hospital treatment to avoid death.
Infant psoriasis also known as diaper psoriasis. It is difficult to diagnose because skin lesions are most common in the buttocks and can be confused with dermatosis due to skin irritation in the urine and feces.
Psoriatic arthritis affects about 10% of children with psoriasis. The joints become swollen, the muscles stiffen, there are pain in the toes, ankles, knees, wrists. Conjunctivitis is often associated.
Usually, the course of any form of the disease changes every three months. In summer, exposure to sunlight often relieves symptoms.
Treatment
It is best to place a child in a hospital with psoriasis first.
- Desensitizers (5% calcium gluconate solution or 10% calcium chloride solution within, 10% calcium gluconate solution intramuscularly) and sedatives (motherwort tincture, valerian) are prescribed.
- In case of severe itching, antihistamines and sedatives are appropriate.
- Vitamins B are administered intramuscularly for 10 to 20 injections: B6 (pyridoxine), B12 (cyanocobalamin), B2 (riboflavin); within: B15 (pangamic acid), B9 (folic acid), A (retinol) and C (ascorbic acid).
- Medicines that have pyrogenic (temperature-raising) properties are used to activate the body's defenses. They normalize the permeability of blood vessels and reduce the rate of epidermal cell division.
- Displayed weekly blood transfusion, plasma and albumin introduction.
- If treatment is ineffective and the disease is severe, your doctor may prescribe glucocorticoids within 2-3 weeks, gradually reducing the dose and then stopping the medicine. The dose is selected individually. Cytostatics are not prescribed to children because of their toxicity.
- Occlusive (closed) dressings with salicylic, sulfur-tar ointments are used to combat plaque on the palms and soles.
- In the inpatient and regressive stages of psoriasis, children are prescribed UFOs, a sedative bath, and herbal medicine. Sapropel extract is used in the form of applications or baths.
In case of frequent colds of psoriasis, it is necessary to disinfect the sources of the infection: treatment of decaying teeth, if necessary, deworming, tonsillitis and adenotomy. A desirable step in the treatment of psoriasis is spa treatment.
It should be borne in mind that psoriasis is a chronic disease characterized by periods of exacerbation and remission and should be prepared for long-term and regular treatment.
The child should adopt a healthy lifestyle, be taught to deal with stress, and respond calmly to peer attacks. The situation is especially difficult for children whose facial skin is affected. All family members need to support the sick child, which helps them avoid complexities and grow up as a socially adaptive person.
Which doctor to go to
Psoriasis in children is treated by a dermatologist. If it affects not only the skin but also the joints, the development of conjunctivitis requires consultation with a rheumatologist - an ophthalmologist. Disinfection of chronic infection foci is necessary by visiting a dentist, infectious specialist, otolaryngologist. If you have difficulty in the differential diagnosis of psoriasis and allergic diseases, consult an allergist. A nutritionist, physiotherapist and psychologist will help treat the patient.