Psoriasis or scaly lichen in children is a chronic disease that manifests itself by the formation of silvery-white papules (bumps) on the skin of the child. The incidence of psoriasis among all dermatoses is about 8%. This disease occurs among groups of children of different ages, including newborns and infants, more often in girls. The disease is characterized by a certain seasonality: in winter there are more cases of psoriasis than in summer.
The disease is not contagious, although a viral theory of its origin is still being considered.
Causes of disease
The normal cycle of skin cell maturation is 30 days. In psoriasis, it is reduced to 4-5 days, which is manifested by the formation of psoriatic plaques. Electron microscopy revealed that the same changes were present on the child's healthy skin as in the affected areas. In addition, patients with psoriasis are found to have disorders of the nervous, 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 studies of dermatosis that occur in twins, relatives in several generations, as well as biochemical studies of healthy family members. If one of the parents is ill, the probability that the child will get psoriasis is 25%, if both are ill, then 60-75%. At the same time, the type of inheritance remains unclear and is recognized as multifactorial.
Environmental factors include seasonal changes, contact of clothing with the skin, the impact of stress on the child's psyche, relationships with peers. Focusing the children on the team on a sick child, treating them like "black sheep", limiting contact for fear of infection - all these factors can cause new exacerbations, increase the area of skin lesions. The child's psyche is especially sensitive at puberty, which is due to hormonal changes. Therefore, a large percentage of disease detection falls on adolescents.
The ratio of genetic and environmental factors that provoke the development of psoriasis is 65% and 35%.
Infections trigger infectious-allergic response mechanisms that can cause the development of psoriasis. Thus, the disease can occur after the transmitted flu, pneumonia, pyelonephritis, hepatitis. There is even a post-infectious form of the disease. It is characterized by abundant papular rash in the form of drops all over the body.
In some cases, psoriasis is preceded by skin trauma.
Symptoms
Psoriasis is characterized by the appearance on the skin of a rash in the form of islets ("plaques") of red color with silvery-white spots that easily peel and itch. The appearance of cracks on plaques may be accompanied by mild bleeding and filled with secondary infection.
Externally, psoriatic skin rash in children is similar to that in adults, but there are some differences. Children with psoriasis are very characterized by Koebner's syndrome - the appearance of a rash in areas affected by irritation or injury.
The course of childhood psoriasis is long, with the exception of the droplet, 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 become enlarged and thickened, especially in severe psoriasis. In the stationary phase, the growth of the rash stops, the center of the plaques flattens, and the desquamation decreases. In the regression phase, the elements of the rash dissolve, leaving a depigmented edge (Voronov's edge). The rash leaves behind hyper- or hypopigmented spots.
The location of psoriatic eruptions may be different. The most commonly affected skin is the elbows, knees, buttocks, navel, scalp. Every third child with psoriasis has affected nails (the so-called thimble symptom, in which small holes appear on the nail plates that resemble the pit of the thimble). Plaques can often be found in skin folds. Mucous membranes are also affected, especially the tongue, and the rash may change its location and shape ("geographical language"). The skin of the palms and plantar surface of the foot is characterized by hyperkeratosis (thickening of the upper epidermis). on the forehead and cheeks, and may extend to the ears.
The analysis of the blood reveals an increase in the amount of total protein and gamma globulin levels, a decrease in the albumin-globulin coefficient and a violation of fat metabolism.
Forms of childhood psoriasis
- in the form of a drop;
- plaque;
- pustular;
- erythrodermic;
- infant psoriasis;
- psoriatic arthritis.
The most common form istear-shaped psoriasis. . . It manifests itself in the form of red bumps on the body and limbs, which occur after minor injuries, as well as after infections (otitis media, rhinopharyngitis, influenza, etc. ). Cytological examination reveals streptococci in the throat swab. The tear-shaped form of psoriasis is often confused with allergic reactions.
Plaque psoriasis is characterized by red eruptions with clear borders and a thick layer of white scales.
Pustular, or pustular, form of the disease is rare. The appearance of pustules can be triggered by infection, vaccination, use of certain medications, stress. Pustular psoriasis that occurs in newborns is called neonatal.
In erythrodermic psoriasis, the child's skin looks completely red; some areas of the skin may have plaque. Often, skin manifestations are accompanied by an increase in body temperature and joint pain.
Pustular and erythrodermic psoriasis may have generalized forms with severe course. They need hospital treatment to avoid death.
Infant psoriasis is also known as diaper psoriasis. It is difficult to diagnose because skin lesions most commonly occur in the buttocks area and can be mistaken for dermatosis due to skin irritation with urine and feces.
Psoriatic arthritis affects about 10% of children with psoriasis. The joints swell, the muscles become stiff, there are pains in the toes, ankles, knees, ankles. Conjunctivitis is often associated.
Usually the course of any form of the disease changes every three months. In summer, due to sun exposure, symptoms often subside.
Treatment
It is best to hospitalize a child with psoriasis for the first time.
- Desensitizing agents (5% calcium gluconate solution or 10% calcium chloride solution inside, 10% calcium gluconate solution intramuscularly) and sedatives (lemon balm tincture, valerian) are prescribed.
- Antihistamines and sedatives are suitable for severe itching.
- 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).
- Drugs that have a pyrogenic (raising temperature) property are used to activate the body's defenses. They normalize vascular permeability and reduce the rate of epidermal cell division.
- Weekly blood transfusions, introduction of plasma and albumin are shown.
- If treatment is ineffective, as in severe cases of the disease, the doctor may prescribe glucocorticoids for 2-3 weeks, with a gradual reduction in dose and subsequent discontinuation of the drug. Dosage is chosen individually. Cytostatics are not prescribed to children due to their toxicity.
- Occlusive (sealed) dressings with salicylic, sulfur-tar ointments are used to suppress plaque on the palms and soles.
- In the stationary and regressive stage of psoriasis, children are prescribed UFOs, sedative baths, herbal medicines. Sapropel extract has been shown to be used in the form of applications or baths.
With frequent colds that accompany psoriasis, it is necessary to repair the sources of infection: cure carious teeth, perform deworming, if indicated, perform tonsillectomy 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 be prepared for long-term and regular treatment.
The child should be instilled with a healthy lifestyle, taught to cope with stress, calmly reacts to peer attacks. The situation is especially difficult for children whose facial skin is affected. All family members should support a sick child, which will help him avoid complexes and grow up as a socially adjusted person.
Which doctor to go to
Psoriasis in children is treated by a dermatologist. If not only the skin is affected, but also the joints, a consultation with a rheumatologist is indicated, with the development of conjunctivitis - an ophthalmologist. It is necessary to repair the foci of chronic infection by visiting a dentist, infectologist, ENT doctor. If there are difficulties in the differential diagnosis of psoriasis and allergic diseases, consult an allergist. A nutritionist, physiotherapist and psychologist help treat the patient.