Psoriasis, or squamous lichen, in children is a chronic disease that presents with the formation of silvery-white papules (bulges) on the child's skin. The incidence of psoriasis among all dermatoses is around 8%. This disease occurs in groups of children of different ages, including babies and newborns, most often in girls. The disease is characterized by some seasonality: in winter there are more cases of psoriasis than in summer.
The disease is not contagious, although the viral theory of its origin is still being considered.
disease causes
The normal maturation cycle of skin cells is 30 days. In psoriasis, it decreases to 4-5 days, which is manifested by the formation of psoriatic plaques. It was verified by the electron microscopy method that the same alterations are present in the child's healthy skin and in the affected areas. Furthermore, in patients with psoriasis, a disturbance in the functioning of the nervous, endocrine, immune, metabolism (mainly enzymatic and fatty) systems and other changes in the body is revealed. This suggests that psoriasis is a systemic disease.
There are three main groups of causes of psoriasis:
- heredity;
- Wednesday;
- infections.
Heredity is an important factor in the development of psoriasis. This is confirmed by the study of dermatosis that occurs in twins, in relatives of several generations, as well as biochemical studies of healthy family members. If one of the parents is sick, the probability that the child will get psoriasis is 25%; if both are sick, it is 60-75%. At the same time, the type of inheritance remains unclear and is recognized as multifactorial.
Environmental factors include seasonal changes, clothing-to-skin contact, impact of stress on the child's psyche, relationships with peers. Focusing the attention of children in a team on a sick child, treating him like a "black sheep", limiting contacts for fear of becoming infected - all these factors can provoke new exacerbations, an increase in the area of skin lesions. A child's psyche is especially vulnerable during puberty, which is due to hormonal changes. Therefore, most of the detection of the disease falls on teenagers.
The proportion of genetic and environmental factors that cause the onset of psoriasis is 65% and 35%.
Infections trigger infectious allergic response mechanisms that can trigger the development of psoriasis. Thus, the disease can occur after transferred flu, pneumonia, pyelonephritis, hepatitis. Even the post-infectious form of the disease is differentiated. It is characterized by a profuse teardrop-shaped papular eruption all over the body.
In some cases, the onset of psoriasis is preceded by skin trauma.
Symptoms
Psoriasis is characterized by the appearance on the skin of a rash in the form of red islets ("plaques") with silvery-white patches that easily peel and itchy. The appearance of cracks in the plaques may be accompanied by slight bleeding and is fraught with the addition of a secondary infection.
Externally, psoriatic rashes in children are similar to those in adults, but there are some differences. For children with psoriasis, Koebner syndrome is very characteristic - the appearance of rashes in areas affected by irritation or injury.
The course of childhood psoriasis is long, with the exception of the most favorable tear-shaped 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 enlarge and thicken, especially in severe psoriasis. In the stationary stage, the growth of the eruptions stops, the center of the plates flattens out and the scaling diminishes. In the regression stage, the elements of the eruption dissolve, leaving behind a depigmented edge (Voronov's edge). The rash leaves hyperpigmented or hypopigmented patches.
The location of psoriatic eruptions may be different. Most of the time, the skin on the elbows, knees, buttocks, navel and scalp is affected. Every third child with psoriasis has affected nails (the so-called thimble symptom, in which small holes appear in the nail plates, resembling the fossa of a thimble). Plaques can often be found in the folds of the skin. Mucous membranes, especially the tongue, are also affected, and the rash may change location and shape ("geographic language"). The skin on the palms of the hands and the plantar surface of the foot is characterized by hyperkeratosis (thickening of the upper layer of the epidermis). The face is less likely to be affected, the rash appears on the forehead and cheeks, and may spread to the ears.
In blood analysis, an increase in the amount of total protein and in the level of gamma globulins, a decrease in the albumin-globulin ratio and violations of fat metabolism are detected.
Forms of childhood psoriasis
- in the form of a drop;
- board;
- pustular;
- erythrodermic;
- baby psoriasis;
- psoriatic arthritis.
The most common way istear psoriasis. . . It manifests itself in the form of red swellings on the body and limbs, which occur both after minor injuries and after infections (otitis media, rhinopharyngitis, flu, etc. ). On a throat smear, a cytological examination reveals streptococci. Tear-shaped psoriasis is often confused with allergic reactions.
Plaque psoriasis is characterized by red eruptions with clear borders and a thick layer of white scales.
The 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 is completely red; some areas of the skin may have plaque. Skin manifestations are often accompanied by an increase in body temperature and joint pain.
Pustular and erythrodermic psoriasis can take on generalized forms with a severe course. They require hospital treatment to prevent death.
Infantile psoriasis is also known as diaper psoriasis. It is difficult to diagnose because skin lesions most often occur in the buttocks area and can be mistaken for dermatosis due to irritation of the skin with urine and feces.
Psoriatic arthritis affects about 10% of children with psoriasis. Joints swell, muscles stiffen, toes, ankles, knees, and wrists ache. Conjunctivitis is often associated.
Typically, the course of any form of the disease changes every three months. In summer, due to sun exposure, symptoms tend to decrease.
Treatment
It is best to hospitalize a child with psoriasis for the first time.
- Desensitizing agents are prescribed (5% calcium gluconate solution or 10% calcium chloride solution inside, 10% calcium gluconate solution intramuscularly) and sedatives (mothergrass tincture, valerian).
- With intense itching, antihistamines and tranquilizers are appropriate.
- 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).
- To activate the body's defenses, drugs that have a pyrogenic property (increase in temperature) are used. They normalize vascular permeability and reduce the rate of epidermal cell division.
- Shown weekly blood transfusions, introduction of plasma and albumin.
- If treatment is ineffective, as in severe cases of the disease, the physician may prescribe glucocorticoids over a course of 2 to 3 weeks, with a gradual dose reduction and subsequent discontinuation of the drug. Dosage is selected individually. Cytostatics are not prescribed for children because of their toxicity.
- To combat bacterial plaque on the palms of the hands and soles of the feet, occlusive (sealed) dressings with salicylic and sulfurous tar ointments are used.
- In the stationary and regressive stages of psoriasis, children are prescribed UFOs, sedative baths and herbal medicines. Sapropel extract has proven its effectiveness, being used in the form of applications or baths.
With the frequent colds that accompany psoriasis, it is necessary to sanitize the sources of infection: to cure decayed teeth, perform deworming, if indicated, perform tonsillectomy and adenotomy. A desirable step in treating psoriasis is spa treatment.
It should be remembered that psoriasis is a chronic disease characterized by periods of exacerbation and remission, and it should be prepared for regular and long-term treatment.
The child needs to instill a healthy lifestyle, teach him to deal with stress, respond calmly to peer attacks. The situation is especially difficult with children whose facial skin is affected. All family members should support the sick child, which will help them avoid complexes and grow into a socially adapted person.
which doctor to contact
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 - the ophthalmologist. It is necessary to sanitize outbreaks of chronic infection by visiting a dentist, specialist in infectious diseases, or an otolaryngologist. If there are difficulties in the differential diagnosis of psoriasis and allergic diseases, an allergist should be contacted. Nutritionist, physiotherapist and psychologist assist in the patient's treatment.