Psoriasis is a chronic, non-infectious disease, dermatosis, which primarily affects the skin. The autoimmune nature of this disease is currently believed. Psoriasis usually causes patches of skin that are too dry, red, and raised. However, some people with psoriasis do not have visible skin lesions. The spots caused by psoriasis are called plaques. These spots are by nature sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes in the skin, as well as excessive formation of new small capillaries in the underlying skin layer.
What causes psoriasis?
The causes of psoriasis are not yet fully understood. At present, there are two main hypotheses regarding 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 disturbed, and there is proliferation and proliferation of these cells. At the same time, the problem of psoriasis is perceived by the 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 into the thickness of the skin and their excessive proliferation in the skin are considered secondary, as the body's response to multiplicationexcessive immature and pathologically altered "bad" 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 or do not have propertiesInsignificant system immunomodulators - retinoids (synthetic analogues of vitamin A), vitamin D, and in particular its active form, esters of fumaric acid.
The second hypothesis suggests that psoriasis is an immune, immunopathological, or autoimmune-mediated disease in which the proliferation and multiplication of skin cells and, most importantly, keratinocytes are secondary to various inflammatory factors produced by cells of the immune system. and / or to, and Autoimmune cells damage the skin causing a secondary regenerative reaction.
What happens to the skin and how to take care of it?
Impairment of the barrier function of the skin (in particular mechanical injuries or irritations, friction and pressure on the skin, abuse of soap and detergents, contact with solvents, household chemicals, solutions containing alcohol, the presence ofinfected foci on the skin or skin allergies, immunoglobulin deficiency, excessive skin dryness) also play a role in the development of psoriasis.
Infection of dry skin causes chronic dry (non-exuding) 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 the inflammation and increased proliferation of skin cells, and due to the fact that the infectious organism consumes moisture, which would otherwise serve to hydrate the skin. To avoid excessive dryness of the skin and reduce the symptoms of psoriasis, patients with psoriasis are not recommended to use washcloths and scrubs, especially harsh ones, as they not only damage the skin. leaving microscopic scratches, but they also scratch the stem. protective horny layer and sebum of the skin, which normally protect the skin from dryness and the penetration of germs. It is also recommended to use talcum powder or baby powder after washing or bathing to absorb excess moisture from the skin, which would otherwise "get" to the infectious agent. In addition, it is recommended to use products that moisturize and nourish the skin and lotions that improve the function 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 genes associated with the development of psoriasis or directly involved in its development are already known, but it is still 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 that the next child will get sick is 17%, and in the presence of psoriasis in one of the parents, the possibility of the disease in children increases. at 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 dermatosis, it is believed that it is not the psoriasis itself that is inherited, but a predispositionto the latter, which in some cases is carried out as a result of a complex interaction 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 rapidly lead to thickening of the skin at the sites of injury, its elevation above the surface of the skin. healthy skin and the formation of pale, gray or silvery features. stains that look like hardened wax or paraffin ("paraffin lakes"). Psoriatic plaques most often appear first on places subject to friction and pressure - the surfaces of the elbows and knees bend, on the buttocks. However, psoriatic plaques can occur and are located anywhere on the skin, including the scalp (scalp), the palmar surface of the hands, the plantar surface of the feet, and the external genitalia. Unlike eczema rashes, which often affect the inner surface of the knee and elbow joint flexors, psoriatic plaques are more often located on the outer surface of joint extensors.
What does it take to be diagnosed with psoriasis?
It is generally 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 to psoriasis. Nevertheless, with active and progressive psoriasis or its severe course, abnormalities in blood tests can be detected, confirming the presence of an active inflammatory, autoimmune and rheumatic process (increased titers of rheumatoid factor, proteins of the acute phase, leukocytosis, increased ESR, etc. ), as well as endocrine and biochemical disorders. Sometimes a skin biopsy is needed to rule out other skin conditions and histologically confirm the diagnosis of psoriasis.
How is psoriasis treated?
It is worthwhile to start treating psoriasis in children as soon as possible and to monitor the child so that he follows all the doctor's advice. The baby's immune system is very sensitive. With the right approach, she can cope with psoriasis, and if you let the disease run its course, the skin will be affected more and more.
If the child has symptoms of the disease - patches on the skin, itching, redness, peeling, you should immediately begin treatment, strictly follow all the recommendations of the doctor, and he will advise you to apply a special cream to the skin.
In an evolving stage and with common forms of the disease, it is better to hospitalize the child. Prescribe desensitizers and sedatives, inside 5% calcium gluconate solution or 10% calcium chloride solution in teaspoons, dessert or tablespoons 3 times a day. Apply a 10% solution of calcium gluconate intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 injections per course. In case of severe itching, antihistamines are needed orally in short courses, for 7 to 10 days. In older children at an advanced stage, with restlessness, poor sleep, small doses of hypnotics and small tranquilizers sometimes give 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 cycle of treatment. Vitamin B12 is particularly indicated for common exuding forms of psoriasis - 30 to 100 mcg 2 times per week intramuscularly in combination with folic and ascorbic acids for 172 to 2 months. Vitamin A is administered at the rate of 10, 000 to 30, 000 ME 1 time per day for 1 to 2 months. Patients with the summer form of psoriasis, especially with severe itching, are given nicotinic acid inside. In the event of psoriatic erythroderma, it is recommended: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in double dose), potassium orotate. Vitamin D2 should be used with some 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. 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 erythrodermal) forms of psoriasis, sometimes it is not possible to achieve a positive effect from these funds. Then glucocorticoids are prescribed orally at the rate of 0. 5-1 mg per 1 kg of body weight per day for 2-3 weeks, followed by a gradual decrease in the dose of the drug until it is canceled. Due to their toxicity, cytostatic drugs are not recommended for children of all ages. In 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 ointments (1 to 2%), sulfur tar (2 to 3%); 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. For children with a predominantly scalp lesion, recently used phosphodiesterase inhibitors as lubricants or occlusive dressings with ointments may be recommended.
It is necessary to underline the importance of the purification of the focal infection (diseases of the respiratory tracts, ENT organs, helminthic invasions, etc. ). Tonsillectomy and adenotomy for children with psoriasis can be done after the age of 3. In 90% of cases, such surgical interventions have a beneficial effect on the course of the process, and in 10% of patients, especially with generalized exudative psoriasis, exacerbations continue. The follow-up examination after 7-10 years showed that 2/3 of patients after tonsillectomy had no relapses of the disease, but even the remaining 1/3 of children with exacerbations of the rash were rare andprolonged remissions; 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 generalized, with a severe course.
Is Psoriasis a Lifetime Diagnosis?
If you start with timely and correct treatment, then no. The development of psoriasis in a child does not at all mean that in adulthood he will also suffer from this disease. Of course, psoriasis is a chronic disease, it is almost impossible to get over it 100%. But the period of calm can be maximized. Childhood psoriasis is treated like an adult, switching from one type of treatment to another every three months.
The child should be psychologically prepared in advance for the fact that there are flaws on his body. Unlike adults, in children psoriasis often affects not the body, but the face (30% of cases). Rashes may appear on the forehead, cheeks, and eyelids. Psychologically, it is quite difficult to bear. In addition, in a third of children with childhood 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 for a child's state of mind. Parents shouldn't leave him alone with a problem. All activity should be encouraged: sports, games. However, it is worth remembering the precautions. For example, the skin in some areas of the body may be stretched (for example, when riding a bicycle for a long time). And it can cause psoriasis. Despite the apparently unsightly skin condition, the child can go swimming! 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 still unclear. Some psoriasis affects the face, some have limbs, some have joints! Why marriage occurs in the cells of our bodies is not clear. In oncology, psoriasis cannot be treated with pills. Interesting developments are underway in our country at the moment. They try to treat children with ointments made from natural raw materials. The forecast is favorable, but the ointment has not yet entered production. In the meantime, my advice to parents is not to trust charlatans and pseudo healers, and if there are signs of psoriasis in a child, contact a professional - a pediatric dermatologist.