Psoriasis is a chronic non-infectious disease, dermatosis, which mainly affects the skin. The autoimmune nature of this disease is currently assumed. Psoriasis often causes excessively dry red patches on the skin. However, some patients with psoriasis do not have visible skin lesions. Patches caused by psoriasis are called plaques. These patches are, by nature, sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages, and skin keratinocytes, as well as excessive formation of new small capillaries in the underlying skin layer.
What causes psoriasis?
The causes of psoriasis are still not fully understood. There are currently 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 are interrupted, with excessive growth and proliferation of these cells. At the same time, the psoriasis problem is seen by proponents of this hypothesis as a violation of the function of the epidermis and its keratinocytes.
The autoimmune aggression of T lymphocytes and macrophages against skin cells, their invasion of the skin thickness and excessive proliferation in the skin are seen as secondary, as the body's response to the excessive multiplication of "wrong", immature, pathologically altered keratinocytes. This hypothesis is supported by the presence of a positive effect in the treatment of psoriasis with drugs that inhibit the multiplication of keratinocytes and / or cause their accelerated maturation and differentiation and, at the same time, do not have or have insignificant systemic immunomodulatory properties - 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 overgrowth and multiplication of skin cells and, above all, keratinocytes are secondary to various inflammatory factors produced by cells of the immune system and/or to , and autoimmune skin cell damage causing a secondary regenerative reaction.
What happens to the skin and how to take care of it?
Impaired skin barrier function (in particular, mechanical injury or irritation, friction and pressure on the skin, abuse of soap and detergents, contact with solvents, household chemicals, solutions containing alcohol, the presence of infected foci on the skin or skin allergies, immunoglobulin deficiency, excessively dry skin) also play a role in the development of psoriasis.
Dry skin infection causes chronic dry (non-exudative) inflammation, which in turn causes psoriasis-like symptoms such as itching and increased skin cell proliferation. 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 that would otherwise serve to moisturize the skin. To prevent excessive dryness of the skin and reduce the symptoms of psoriasis, it is not recommended for patients with psoriasis to use cloths and scrubs, especially hard ones, as they not only damage the skin, leaving microscopic scratches, but also scrape the top. protective horny layer and sebum of the skin, which normally protect the skin from dryness and penetration of microbes. It is also recommended to use baby powder or baby powder after washing or bathing to absorb excess moisture from the skin, which would otherwise "reach" the infectious agent. In addition, it is recommended to use products that moisturize and nourish the skin, and lotions that improve the functioning of the sebaceous glands. It is not recommended to abuse soap, detergents. You should try to avoid skin contact with solvents, household chemicals.
Is psoriasis hereditary?
The hereditary component plays an important role in the development of psoriasis, and many of the genes associated with the development of psoriasis or directly involved in its development are already known, but it remains unclear how these genes interact during the development of the disease. 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, the probability of the next child getting sick is 17% and, in the presence of psoriasis in one of the parents, the possibility of the disease in children increases to 25% (with the disease of both parents - up to 60-70%).
Due to the fact that in most patients with psoriasis it is not possible to establish the hereditary transmission of the dermatosis, it is believed that it is not the psoriasis itself that is inherited, but a predisposition to it, which in some cases occurs as a result of a complex interplay 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 with lymphocytes and macrophages quickly lead to thickening of the skin at the lesion sites, its elevation above the surface of healthy skin and the formation of pale, gray or pale patches. Features silvery patches that resemble hardened wax or paraffin ("paraffin lacquers"). Psoriatic plaques most often appear in places subject to friction and pressure - the surfaces of the elbow and knee crease, in the buttocks. However, psoriatic plaques can occur and are located anywhere on the skin, including the scalp (scalp), the palm surface of the hands, the plantar surface of the feet, and the external genitalia. In contrast to eczema rashes, which often affect the inner flexor surface of the knee and elbow joints, psoriatic plaques are more often located on the outer extensor surface of the joints.
What does it take to be diagnosed with 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 sooner the diagnosis is made, the more opportunities to fight the disease.
There are no specific diagnostic procedures or blood tests for psoriasis. However, with active progressive psoriasis or its severe course, abnormalities in blood tests can be detected, confirming the presence of an active inflammatory, autoimmune, rheumatic process (increased titers of rheumatoid factor, acute phase proteins, leukocytosis, increased ESR, etc. ), as well as endocrine and biochemical disturbances. Sometimes a skin biopsy is needed to rule out other skin conditions and histologically confirm the diagnosis of psoriasis.
How is psoriasis treated?
It's worth starting to treat childhood psoriasis as early as possible and watching your child follow all the doctor's advice. The baby's immune system is very sensitive. With the right approach, she can deal with the psoriasis, and if you let the disease run its course, the skin will become more and more affected.
If the child shows symptoms of the disease - plaques on the skin, itching, redness, scaling, treatment must be started immediately, strictly following all the doctor's recommendations, who will advise you to apply a special cream to the skin.
At a progressive stage and with common forms of the disease, it is better to hospitalize the child. Prescribe desensitizers and sedatives, in a 5% calcium gluconate solution or 10% calcium chloride solution in teaspoons, dessert or tablespoons 3 times a day. Apply a 10% calcium gluconate solution intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 injections per course. With intense itching, antihistamines are needed orally in short courses, for 7 to 10 days. In older children at a progressive stage, with an agitated state, poor sleep, small doses of hypnotics and small tranquilizers 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 course of treatment. Vitamin B12 is especially indicated for common exudative forms of psoriasis - 30-100 mcg twice a week intramuscularly in combination with folic and ascorbic acids for 172-2 months. Vitamin A is administered in 10, 000 - 30, 000 EM 1 time a day for 1-2 months. Patients with the summer form of psoriasis, especially those with severe itching, have nicotinic acid inside. In psoriatic erythroderma, it is advisable: intramuscular riboflavin mononucleotide, oral vitamin B15 or in suppositories (double dose), potassium orotate. Vitamin D2 must be used with some caution in all forms of psoriasis.
To stimulate the mechanisms of protection and adaptation, pyrogenic drugs that normalize vascular permeability and inhibit the mitotic activity of the epidermis are prescribed. A good therapeutic effect is given by transfusions of blood, plasma, weekly, several times, depending on the result obtained. In children with persistent (exudative and erythrodermic) forms of psoriasis, it is sometimes not possible to obtain a positive effect from these funds. Then, glucocorticoids are prescribed orally at 0. 5-1 mg per 1 kg of body weight per day for 2-3 weeks, followed by a gradual decrease in the drug dose until it is cancelled. Due to their toxicity, cytostatic drugs are not recommended for children of all ages. In the stationary and regressive stages of the disease, a more active therapy is prescribed - UFO, general baths at a temperature of 35-37 °C for 10-15 minutes, after 1 day.
External treatment for psoriasis.
Salicylic (1-2%), sulfur tar ointments (2-3%); glucocorticoid ointments. These ointments quickly have a direct effect in the form of occlusive dressings on the location of psoriatic plaques on the palms of the hands and soles of the feet. For children with a predominant scalp lesion, recently used phosphodiesterase inhibitors in the form of lubricants or occlusive dressings with ointments may be recommended.
It is necessary to emphasize the importance of sanitation of focal infections (diseases of the respiratory tract, otorhinolaryngological organs, helminth invasions, etc. ). Tonsillectomy 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 procedure, and in 10% of patients, especially with generalized exudative psoriasis, exacerbations continue. Follow-up examination after 7 to 10 years showed that 2/3 of patients after tonsillectomy had no relapses of the disease, but even the remaining 1/3 of children with rash flares were sparse and remissions prolonged; in unoperated children with psoriasis and chronic tonsillitis, dermatosis exacerbations were more frequent.
Our long-term observations of children indicate that, in most cases, relapses of psoriasis with age occur less frequently, are less pronounced, and a tendency to transition from common forms of dermatosis to limited forms is clearly visible. However, in some patients, the process remains widespread, with a severe course.
Is psoriasis a lifetime diagnosis?
If you start timely and correct treatment, no. The development of psoriasis in a child does not in any way mean that, as an adult, he will also suffer from this disease. Of course, psoriasis is a chronic disease, it is almost impossible to recover from it 100%. But the quiet period can be maximized. Childhood psoriasis is treated as an adult, switching from one type of treatment to another every three months.
The child must be psychologically prepared in advance for the fact that there are flaws in his body. Unlike adults, in children, psoriasis usually affects not the body but the face (30% of cases). Rashes can appear on the forehead, cheeks and eyelids. Psychologically it is very difficult to bear. Also, in one third of children with infantile psoriasis, the nails are affected. Therefore, it is quite difficult to hide the disease.
In addition to the physically unpleasant sensations, psoriasis can be a severe test of a child's state of mind. Parents shouldn't leave you alone with a problem. Any activity should be encouraged: sports, games. However, it is worth remembering the care. For example, the skin on certain areas of the body can be stretched (for example, when riding a bicycle for a long time). And that can trigger psoriasis. Despite the strangely unpleasant skin condition, the child can swim! And if there are chemicals in the water, remove
Why is there still no complete cure for psoriasis?
This disease is called mysterious for a reason. The essence of this disease is not yet clear. Some psoriasis affects the face, some have limbs, some have joints! Why marriage takes place in the cells of our bodies is not clear. Like oncology, psoriasis cannot be treated with pills. Interesting developments are underway in our country right now. They try to treat children with ointments made from natural raw materials. Forecasts are favorable, but the ointment has not yet entered into production. In the meantime, my advice to parents is not to trust quacks and pseudo-healers, and in case of signs of psoriasis in a child, contact a professional - a pediatric dermatologist.