Psoriasis, or scaly lichen, in children is a chronic condition that manifests as silvery-white papules (bumps) on the child's skin. The incidence of psoriasis among all skin conditions is approximately 8%. This disease occurs among groups of children of different ages, including infants and newborns, 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 the viral theory of its origin is still under study.
Causes of the disease
The normal maturation cycle of skin cells is 30 days. In psoriasis, it reduces to 4-5 days, which is manifested by the formation of psoriatic plaques. It was found by the method of electron microscopy that the same changes are present in the healthy skin of the child as in the affected areas. In addition, in patients with psoriasis, a disruption in the functioning of the nervous, endocrine, immune systems, metabolism (mainly enzymatic and fatty) and other changes in the body are revealed. This suggests that psoriasis is a systemic disease.
There are three main groups of causes of psoriasis:
- heredity;
- Wednesday;
- infections.
Heredity is a major factor in the development of psoriasis. This is confirmed by the study of dermatosis that occurs in twins, in parents of several generations, as well as by biochemical studies of healthy family members. If one of the parents is sick, the probability of the child contracting psoriasis is 25%, if both are sick, then 60-75%. At the same time, the type of transmission remains uncertain and is recognized as multifactorial.
Environmental factors include seasonal changes, skin contact of clothing, impact on the child's psyche of stress, peer relationships. Focusing the attention of the children of a team on a sick child, treating him like a "black sheep", limiting contact for fear of being infected - all these factors can cause further exacerbations, an increase in the surface of the lesionscutaneous. A child's psyche is especially vulnerable during puberty, which is due to hormonal changes. Therefore, a large percentage of the detection of the disease falls on adolescents.
The ratio of genetic and environmental factors causing the onset of psoriasis is 65% and 35%.
Infections trigger infectious allergic response mechanisms that can trigger the development of psoriasis. So, the disease can occur after the transferred flu, pneumonia, pyelonephritis, hepatitis. Even the post-infectious form of the disease is distinguished. It is characterized by a profuse papular rash in the form of drops all over the body.
In some cases, the onset of psoriasis is preceded by skin trauma.
Symptoms
Psoriasis is characterized by the appearance of a rash on the skin in the form of red islets ("patches") with silvery-white patches that flake and itch easily. The appearance of cracks in the plaques may be accompanied by slight bleeding and is fraught with the addition of secondary infection.
Externally, psoriatic rashes in children are similar to those in adults, but there are some differences. For children with psoriasis, Koebner's syndrome is very characteristic - the appearance of rashes in the areas affected by irritation or injury.
The course of childhood psoriasis is long, except for a more favorable teardrop-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. At the stationary stage, the growth of rashes stops, the center of the plaques flattens out, and the scaling decreases. At the stage of regression, the elements of the rash dissolve, leaving behind a depigmented edge (Voronov's edge). The rash leaves hyper or hypopigmented spots.
The location of psoriatic rashes may be different. Most often, the skin of the elbows, knees, buttocks, navel, scalp is affected. One in three children with psoriasis have affected fingernails (a so-called thimble symptom, in which small holes appear on the nail plates, resembling the pit of a thimble). The plaques can often be found in the folds of the skin. The mucous membranes, especially the tongue, are also affected and the rash may change location and shape ("geographic tongue"). The skin of the palms 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 the analysis of blood, an increase in the amount of total protein and the level of gamma globulins, a decrease in the albumin-globulin coefficient and violations of fat metabolism are detected.
Forms of childhood psoriasis
- teardrop-shaped;
- plate;
- pustular;
- erythrodermic;
- infant psoriasis;
- psoriatic arthritis.
The most common form isteardrop psoriasis. . . It manifests as red bumps on the body and limbs, which occur after minor injuries, as well as after infections (otitis media, nasopharyngitis, flu, etc. ). In a throat swab, a cytological examination reveals streptococci. The teardrop-shaped form of psoriasis is often mistaken for allergic reactions.
Plaque psoriasis is characterized by red rashes with clear boundaries 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, vaccinations, the use of certain drugs, stress. Pustular psoriasis that occurs in newborns is called neonatal.
With erythrodermic psoriasis, the child's skin is 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 can take generalized forms with severe course. They require hospital treatment to avoid death.
Infant psoriasis is also known as diaper psoriasis. It is difficult to diagnose because skin lesions most often occur in the buttock area and can be mistaken for dermatosis due to irritation of the skin with urine and stool.
Psoriatic arthritis affects about 10% of children with psoriasis. Joints swell, muscles stiffen, pain occurs in toes, ankles, knees, wrist joints. Conjunctivitis is often associated.
Usually the course of any form of illness changes every three months. In summer, due to sun exposure, symptoms often go away.
Processing
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 (tincture of motherwort, valerian).
- In case of severe itching, antihistamines and tranquilizers are appropriate.
- B vitamins are presented intramuscularly for 10 to 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 are used that have a pyrogenic property (which raises the temperature). They normalize vascular permeability and reduce the rate of epidermal cell division.
- Shown weekly blood transfusions, the introduction of plasma and albumin.
- If the treatment is ineffective, as well as in severe cases of the disease, the doctor may prescribe glucocorticoids in 2-3 weeks, with a gradual decrease in the dose and subsequent discontinuation of the drug. The dosage is chosen individually. Cytostatics are not prescribed for children due to their toxicity.
- To combat plaque on the palms and soles of the feet, occlusive dressings (seals) with salicylic and sulfurous ointments are used.
- In the stationary and regressive stages of psoriasis, children are prescribed UFOs, sedative baths, medicinal plants. The proven sapropel extract, which is used in the form of applications or baths.
With frequent colds accompanying psoriasis, it is necessary to disinfect sources of infection: to cure decayed teeth, to perform deworming, if indicated, to perform tonsillectomy and adenotomy. A desirable step in the treatment of psoriasis is spa treatment.
It should be remembered 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 instill a healthy lifestyle, teach him to cope with stress, calmly respond to attacks from peers. The situation is particularly difficult with children whose facial skin is affected. All members of the family should support a sick child, which will help them avoid complexes and become 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 - an ophthalmologist. It is necessary to disinfect foci of chronic infection by consulting a dentist, a specialist in infectious diseases, an ENT doctor. If there are difficulties in the differential diagnosis of psoriasis and allergic diseases, you should contact an allergist. A nutritionist, physiotherapist and psychologist assist the patient in the treatment.