Psoriasis is a chronic non-infectious disease, dermatosis, which mainly affects the skin. The autoimmune nature of this disease is currently assumed. Psoriasis usually causes excessively dry, red, raised patches on the skin. However, some people with psoriasis do not have visible skin lesions. Stains caused by psoriasis are called plaques. These spots are by their nature 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 lower layer of the skin.
What causes psoriasis?
The causes of psoriasis are not yet fully understood. At the moment, there are 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 skin cells is impaired, and these cells overgrowth and proliferate. At the same time, supporters of this hypothesis saw the problem of psoriasis as a violation of the function of the epidermis and its keratinocytes.
Autoimmune aggression of T-lymphocytes and macrophages on skin cells, their invasion of skin thickness and excessive proliferation in the skin are considered secondary to the body's response to excessive proliferation of "wrong", immature, pathologically altered keratinocytes. drugs that inhibit keratinocyte proliferation and / or cause their accelerated maturation and differentiation, while not possessing or possess insignificant systemic immunomodulatory properties - retinoids (synthetic analogues of vitamin A), vitamin D, and especially its active form, fumaric acid esters.
The second hypothesis suggests that psoriasis is an immune-mediated, immunopathological or autoimmune disease in which excessive growth and proliferation of skin cells and primarily keratinocytes are secondary to various inflammatory factors produced by immune and / or cells, and autoimmune cells damage the skin causing secondaryregenerative reaction.
What happens to the skin and how to provide it with care?
Skin barrier dysfunction (especially mechanical injuries or irritations, friction and pressure on the skin, abuse of soap and detergents, contact with solvents, household chemicals, alcohol-containing solutions, presence of infected skin or allergy foci, lack of immunoglobulins, excessive dry skin) also play a role in the development of psoriasis.
Dry skin infection 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 due to the fact that the infectious organism consumes moisture, which would otherwise serve to moisturize the skin. To avoid excessive drying of the skin and reduce the symptoms of psoriasis, patients with psoriasis are not recommended to use cloths and peels, especially hard ones, because they not only damage the skin leaving microscopic scratches, but also scrape the upper skin. protective stratum corneum and sebum from the skin, which otherwise protect the skin from drying out and from microbial penetration. It is also recommended to use talcum powder or baby powder after washing or bathing in order to absorb excess moisture from the skin, which would otherwise "come" to the infectious agent. Additionally, it is recommended to use products that moisturize and nourish the skin, and lotions that improve the function of the sebaceous glands. Abuse of soap and detergent is not recommended. You should 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 remains unclear how these genes interact during disease development. Most of the currently known genes associated with psoriasis, in one way or another, affect the functioning of the immune system.
It is believed that if healthy parents have a child with psoriasis, then the probability that the next child will get 17%, and in the presence of psoriasis in one parent, the possibility of disease in children increases to 25% (with both parents - up to 60-70%).
Due to the fact that in most patients with psoriasis it is not possible to determine the hereditary transmission of dermatosis, it is considered that psoriasis itself is not inherited, but a predisposition for it, which in some cases is achieved as a result. complex interactions of hereditary factors and adverse environmental influences.
What does psoriasis look like?
Excessive proliferation of keratinocytes (skin cells) in psoriatic plaques and infiltration of the skin by lymphocytes and macrophages quickly leads to thickening of the skin at the site of the lesion, its rise above the surface of healthy skin and the formation of characteristic pale, gray or silvery spots reminiscent of hardened wax or paraffin. lakes "). Psoriatic plaques usually first appear in places that are subject to friction and pressure - on the surfaces of the elbows and knees, buttocks. However, psoriatic plaques can occur and are located anywhere on the skin, including the scalp (scalp), palmar surface of the hands, plantar surface of the feet and external genitalia Unlike eczema rashes, which often affect the inner flexor surface of the knee and elbow joints, psoriatic plaques are more common on the outer, extensor surface of the joints.
What is needed to diagnose psoriasis?
This is usually much more difficult 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 diagnostic procedures or blood tests specific for psoriasis. However, in active, progressive psoriasis or its severe course, abnormalities in blood tests can be detected that confirm the presence of active inflammatory, autoimmune, rheumatic process (increased titer of rheumatoid factor, acute phase protein, leukocytosis, increased ESR, etc. ), as well asendocrine and biochemical disorders. Sometimes a skin biopsy is necessary to rule out other skin conditions and histologically confirm the diagnosis of psoriasis.
How is psoriasis treated?
It is worth starting the treatment of psoriasis in children as early as possible and monitoring the child to follow all the advice of the doctor. The baby's immune system is very sensitive. With the right approach, you can deal with psoriasis, and if you let the disease go its course, the skin will be more and more affected.
If the child has symptoms of the disease - plaques on the skin, itching, redness, peeling, you must immediately begin treatment, strictly follow all the recommendations of the doctor, and he will advise you to apply a special cream on the skin.
In the progressive stage and with the usual forms of the disease, it is best to hospitalize the child. Prescribe desensitizing and sedatives, within 5% solution of calcium gluconate or 10% solution of calcium chloride in teaspoons, dessert or tablespoons 3 times a day. Apply 10% solution of calcium gluconate intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 injections per course. In severe itching, antihistamines are needed orally in short courses, 7-10 days. In older children in a progressive stage, anxious state, poor sleep, sometimes a good effect give small doses of hypnotics and small sedatives.
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 common 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 given in a dose of 10, 000 - 30, 000 IU once a day for 1-2 months. Patients with summer psoriasis, especially with severe itching, are shown nicotinic acid inside. In psoriatic erythroderma, it is recommended: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in a double dose), potassium orotate. Vitamin D2 should be used with caution in all forms of psoriasis.
In order to stimulate protective and adaptive mechanisms, pyrogenic drugs are prescribed that normalize vascular permeability and inhibit the mitotic activity of the epidermis. Good therapeutic effect is given by transfusions of blood, plasma, weekly, several times, depending on the obtained result. In children with persistent (exudative and erythrodermic) forms of psoriasis, it is sometimes not possible to achieve a positive effect from these drugs. Glucocorticoids are then prescribed orally at a dose of 0. 5-1 mg per 1 kg of body weight daily for 2-3 weeks, followed by a gradual reduction in the dose of the drug until canceled. Due to their toxicity, cytostatics are not recommended for children of all ages. 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 of psoriasis.
Salicylic (1-2%), sulfur-tar (2-3%) fats; glucocorticoid ointments. These ointments quickly give a direct effect in the form of occlusive dressings in the localization of psoriatic plaques on the palms and soles. Recently used phosphodiesterase inhibitors in the form of lubricants or occlusive ointment dressings may be recommended for children with a dominant scalp lesion.
It is necessary to emphasize the importance of remediation of focal infection (diseases of the respiratory tract, ENT organs, helminthic invasion, etc. ). Tonsillectomy and adenoma in children with psoriasis can be performed after 3 years. In 90% of cases, these surgical interventions have a favorable effect on the course of the process, and in 10% of patients, especially in widespread exudative psoriasis, exacerbations continue. A follow-up examination after 7-10 years showed that 2/3 of the patients did not relapse after tonsillectomy, but even the remaining 1/3 of children with rash exacerbations were scarce and remissions were prolonged; exacerbations of dermatosis were more common in unoperated children with psoriasis and chronic tonsillitis.
Our long-term observations of children show that in most cases relapses of psoriasis occur less frequently with age, are less pronounced and there is a clear tendency for common forms of dermatosis to become limited. However, in some patients the process remains generalized, with a difficult course.
Is psoriasis a lifelong diagnosis?
If you start timely and proper treatment, then no. The development of psoriasis in a child does not mean that he will suffer from this disease as an adult. Of course, psoriasis is a chronic disease, it is almost impossible to cure 100% of it. But the period of silence can be maximized. Pediatric psoriasis is treated as an adult, changing from one type of treatment to another every three months.
The child should be mentally prepared in advance for the fact that there are defects in his body. Unlike adults, in children psoriasis often does not affect the body, but the face (30% of cases). The rash can appear on the forehead, cheeks and eyelids. Psychologically, it is quite difficult to endure. Also, one third of children with childhood psoriasis have nails affected. This makes it quite difficult to hide the disease.
In addition to physically unpleasant sensations, psoriasis can be a difficult test for a child's mental state. Parents should not leave him alone with the problem. Every activity should be encouraged: sports, games. However, it is worth remembering the precautions. For example, the skin on certain parts of the body may be stretched (for example, when riding a bicycle for a long time). And that can cause psoriasis. Despite the ugly appearance of the skin, a child can swim! And if there are chemicals in the water, remove them
Why is there still no complete cure for psoriasis?
This disease is rightly called mysterious. The essence of this disease is still unclear. Some psoriasis affects the face, others have limbs, some joints! Why marriage occurs in the cells of our body is not clear. Like oncology, psoriasis cannot be treated with pills. Interesting events are taking place in our country now. They try to treat children with fats from natural raw materials. The prognosis is favorable, but the fat has not yet entered production. In the meantime, my advice to parents is not to trust charlatans and pseudo healers, and in case of signs of psoriasis in a child, consult a professional - pediatric dermatologist.