Psoriasis is a chronic, non-communicable disease called dermatosis, which affects the skin. The autoimmune nature of the disease is currently hypothesized. Psoriasis usually causes too dry, red, prominent spots on the skin. However, some people with psoriasis do not have any visible skin changes. Spots caused by psoriasis are called plaques. These spots are by their nature sites of chronic inflammation and excessive proliferation of skin lymphocytes, macrophages, and keratinocytes, as well as excessive formation of new small capillaries in the underlying skin layer.
What causes psoriasis?
The causes of psoriasis are currently not fully understood. There are currently two main hypotheses about the nature of the process leading to the development of the disease.
The first hypothesis is that psoriasis is a primary skin disease in which the normal maturation and differentiation of skin cells is disrupted and these cells overgrow and multiply. However, proponents of this hypothesis see the problem of psoriasis as a violation of the function of the epidermis and its keratinocytes.
Autoimmune aggression of T lymphocytes and macrophages against skin cells, penetration into skin thickness, and excessive proliferation in the skin are considered secondary as the body's response to excessive proliferation of "bad", immature, pathologically altered keratinocytes. retinoids (synthetic analogues of vitamin A), vitamin D, and in particular its active form, fumaric acid esters.
The second hypothesis suggests that psoriasis is an immune-mediated, immunopathological or autoimmune disease in which the proliferation and proliferation of skin cells and especially keratinocytes is secondary to various inflammatory factors produced by immune cells and / or autoimmune cell damage in the skin. .
What happens to the skin and how do we care?
Impaired skin barrier function (especially 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 allergy, immunoglobulin deficiency, excessive dryness)play a role in the development of psoriasis.
Infection of dry skin causes dry (non-exudative) chronic inflammation, which in turn causes psoriasis-like symptoms such as itching and increased proliferation of skin cells. This in turn leads to a further increase in dry skin, both due to inflammation and increased proliferation of skin cells, and because the infectious organism consumes moisture, which would otherwise serve to hydrate the skin. To avoid excessive dehydration of the skin and to reduce the symptoms of psoriasis, the use of dishcloths and exfoliators is not recommended for people with psoriasis, as they not only damage the skin, leave microscopic scratches, but also scrape off the top. it protects the stratum corneum and sebum of the skin, which usually protects the skin from dehydration and the penetration of microbes. Even after washing or bathing, it is recommended to use rocking powder or baby powder to absorb excess moisture from the skin that would otherwise "get in" with the infectious agent. In addition, the use of skin moisturizing and nourishing products and body lotions to improve sebaceous gland function is recommended. It is not recommended to abuse soap or detergents. Try to avoid skin contact with solvents, household chemicals.
Is psoriasis inherited?
The hereditary component plays an important role in the development of psoriasis, and many genes associated with or directly involved in the development of psoriasis are already known, but it is still unclear how these genes interact during the development of the disease. Most of the genes currently 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 next child has a 17% chance of developing psoriasis, and if one parent has psoriasis, the chances of the disease increase to 25% in children (up to 60-70% with both parents).
Given that hereditary transmission of dermatosis cannot be established in most patients with psoriasis, it is believed that it is not the psoriasis itself that is inherited, but the tendency to do so as a result in some cases. complex interaction of hereditary factors and adverse environmental effects.
What Does Psoriasis Look Like?
Excessive proliferation of keratinocytes (skin cells) in the plaques of psoriasis, as well as infiltration of skin lymphocytes and macrophages, leads to rapid thickening of the skin, rising above the surface of healthy skin, and the development of a characteristic pale gray or silvery color. patches reminiscent of hardened wax or paraffin ("paraffin ponds"). (scalp), the palm of the hands, the soles of the feet, and the external genitals In contrast to eczema rashes, which often affect the internal flexor surface of the knee and elbow joints, psoriasis plaques are more likely to be located on the outer, extensor surface of the joints.
What is needed to diagnose psoriasis?
This is usually much more severe in children than in adults: in children, psoriasis often takes an atypical form, which can lead to diagnostic difficulties. And the earlier the diagnosis is made, the more opportunities there are to fight the disease.
There are no specific diagnostic procedures or blood tests for psoriasis. However, in the case of active, progressive psoriasis or its severe course, there are abnormalities in the blood tests that confirm the presence of an active inflammatory, autoimmune, rheumatic process (increased rheumatoid factor titer, acute phase proteins, leukocytosis, increased ESR, etc. ). ) and endocrine and biochemical disorders. Sometimes a skin biopsy is needed to rule out other skin conditions and to confirm the histology of the diagnosis of psoriasis.
How is psoriasis treated?
It is a good idea to start treating psoriasis in children as soon as possible and to monitor the child to follow all the advice given by the doctor. The baby's immune system is very sensitive. With the right approach, you can cope with psoriasis, and if you let the course of the disease go, the skin will become more and more affected.
If your child has symptoms of the disease - plaques on the skin, itching, redness, peeling, treatment should be started immediately, all recommendations of your doctor should be strictly followed and you will be advised to apply a special cream on your skin.
In the progressive stage and in common forms of the disease, it is best to place the child in hospital. Prescribe desensitizers and sedatives, within 5% calcium gluconate solution or 10% calcium chloride solution in a teaspoon, dessert or tablespoon three times a day. Apply 10% calcium gluconate solution intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 injections per course. In case of severe itching, antihistamines are needed orally, in short courses, for 7-10 days. In older, excited children in the progressive stage, poor sleep, small doses of sleeping pills, and small sedatives sometimes have a good effect.
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 treatment. Vitamin B12 is especially recommended for common exudative forms of psoriasis - 30-100 mcg twice a week in combination with folic acid and ascorbic acid for 172-2 months. Vitamin A is given at a dose of 10, 000 to 30, 000 IU once a day for 1-2 months. Nicotinic acid is shown in patients with summer forms of psoriasis, especially severe itching. For psoriatic erythroderma, it is recommended: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in a suppository (double dose), potassium orotate. Vitamin D2 should be used with caution in all forms of psoriasis.
To stimulate protective and adaptive mechanisms, pyrogenic drugs are prescribed that normalize vascular permeability and inhibit epidermal mitotic activity. Transfusion of blood and plasma gives a good therapeutic effect, several times a week, depending on the result obtained. In children with persistent (exudative and erythrodermic) forms of psoriasis, a positive effect from these funds can sometimes not be achieved. Glucocorticoids are then prescribed orally at 0, 5-1 mg / kg body weight / day for 2-3 weeks, followed by gradual dose reduction until withdrawal. Cytostatic drugs are not recommended for all ages due to their toxicity. In the stationary and regressive stages of the disease, more active therapy is prescribed - UFO, general baths at 35-37 ° C for 10-15 minutes, after 1 day.
External treatment of psoriasis.
salicylic acid (1-2%), sulfur tar (2-3%) ointments; glucocorticoid ointments. These ointments quickly have a direct effect on the localization of psoriatic plaques on the palms and soles in the form of occlusive dressings. Recently used phosphodiesterase inhibitors, ointments or occlusive dressings may be recommended for children with predominant scalp lesions.
The importance of disinfecting focal infections (respiratory diseases, otolaryngology, helminthic invasions, etc. ) should be emphasized. Tonsil and adenotomy in children with psoriasis can be performed after 3 years of age. In 90% of cases, these surgical interventions have a beneficial effect on the course of the process, and in 10% of patients, especially those with extensive exudative psoriasis, exacerbations continue. A follow-up study after 7 to 10 years showed that 2/3 of the patients did not have a relapse after tonsillectomy, but even the remaining 1/3 of the children with worsening rash had little remission and prolonged remission. ; exacerbation of dermatosis was more common in children with unoperated psoriasis and chronic tonsillitis.
Our long-term observations in children show that in most cases, the relapse of psoriasis with advancing age is less frequent, less pronounced, and there is a clear tendency for common forms of dermatosis to become limited. However, in some patients the process remains general, with a severe course.
Is psoriasis a lifelong diagnosis?
If you start treatment on time and correctly, you will not. The development of psoriasis in a child does not mean at all that he will suffer from the disease as an adult. Of course, psoriasis is a chronic disease, it is almost impossible to recover 100% from it. But the quiet period can be maximized. Psoriasis in children is treated like an adult, switching from one type of treatment to another every three months.
The child must be pre-psychologically prepared for the presence of defects in his or her body. Unlike adults, psoriasis in children often affects the face rather than the body (30% of cases). Rash may appear on the forehead, face and eyelids. Psychologically, it’s pretty hard to bear. In addition, nails are affected in one-third of children with childhood psoriasis. Therefore, it is quite difficult to hide the disease.
In addition to feeling physically uncomfortable, psoriasis can be a severe test of a child's state of mind. Parents cannot leave you alone with your problem. All activities should be encouraged: sports, games. However, it is worth remembering the precautions. For example, the skin may stretch in certain areas of the body (such as when cycling for a long time). And this can provoke psoriasis. Despite the ugly skin condition, the child can swim! And if there are chemicals in the water, remove it
Why is there still no complete cure for psoriasis?
This disease is called mysterious for a reason. The essence of this disease is still unclear. Some psoriasis affects the face, others have limbs, others joints! It is not clear why marriage takes place in the cells of our body. As an oncology, psoriasis cannot be treated with pills. Interesting developments are taking place in Hungary now. Children are tried to be treated with ointments made from natural ingredients. Forecasts are favorable, but the ointment has not yet been produced. In the meantime, I advise parents not to trust charlatans and pseudo-healers, and if they notice any signs of psoriasis in a child, consult a specialist - a pediatric dermatologist.