Psoriasis or scaly lichen in children is a chronic disease that manifests itself with the formation of silvery-white papules (bumps) on the skin of the child. The incidence of psoriasis among all dermatoses is about 8%. This disease occurs in 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 being considered.
Causes of the disease
The normal cycle of skin cell maturation is 30 days. In psoriasis it shrinks up to 4-5 days, which manifests itself with the formation of psoriatic plaques. The method of electron microscopy revealed that the healthy skin of the child has the same changes as in the affected areas. In addition, patients with psoriasis are found to have dysfunction of the nervous, endocrine, immune system, metabolism (mainly enzymatic and fatty) and other changes in the body. This suggests that psoriasis is a systemic disease.
There are three main groups of causes of psoriasis:
- heredity;
- Wednesday;
- infections.
Heredity is a leading factor in the development of psoriasis. This is confirmed by the study of dermatosis, which occurs in twins, relatives in several generations, as well as biochemical studies of healthy family members. If one of the parents is ill, the probability of the child getting psoriasis is 25%, if both are sick, then 60-75%. At the same time, the type of inheritance remains unclear and is recognized as multifactorial.
Environmental factors include seasonal changes, contact of clothing with the skin, the impact of stress on the child's psyche, relationships with peers. Focusing children's attention in a team on a sick child, treating them like a "black sheep", limiting contact for fear of infection - all these factors can provoke new exacerbations, increase the area of skin lesions. The child's psyche is especially vulnerable during puberty due to hormonal changes. Therefore, a large percentage of the detection of the disease falls on adolescents.
The ratio of genetic and environmental factors that provoke the appearance of psoriasis is 65% and 35%.
Infections trigger mechanisms of infectious-allergic response that can cause the development of psoriasis. So the disease can occur after transmission of influenza, pneumonia, pyelonephritis, hepatitis. Even the post-infectious form of the disease differs. It is characterized by an abundant papular rash in the form of drops all over the body.
In some cases, the appearance of psoriasis is preceded by skin trauma.
Symptoms
Psoriasis is characterized by the appearance on the skin of a rash in the form of islets ("plaques") with a red color with silvery-white spots that easily peel and itch. The appearance of cracks in the plaques may be accompanied by slight bleeding and is accompanied by the addition of secondary infection.
Externally, psoriatic skin rashes in children are similar to those in adults, but there are some differences. For children with psoriasis, Koebner's syndrome is very common - the appearance of rashes in areas affected by irritation or injury.
The course of childhood psoriasis is long, except for the drop-shaped, more favorable 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 edge. Lymph nodes can become enlarged and thickened, especially in severe psoriasis. In the stationary stage, the growth of the rash stops, the center of the plaques flattens out and the desquamation decreases. In the regression stage, the elements of the rash dissolve, leaving behind a depigmented edge (Voronov's edge). The rash leaves behind hyper- or hypopigmented spots.
The location of psoriatic eruptions may be different. The skin of the elbows, knees, buttocks, navel, scalp is most often affected. Every third child with psoriasis has affected nails (the so-called thimble symptom, in which small holes appear on the nail plates, resembling the foxglove fossa). Plaques can often be found in the folds of the skin. The mucous membranes are also affected, especially the tongue, and the rash can change its location and shape ("geographical language"). The skin of the palms and the plantar surface of the foot is characterized by hyperkeratosis (thickening of the upper layer of the epidermis). likely to be affected, the rash appears on the forehead and cheeks and can spread to the ears.
Blood tests show an increase in total protein and gamma globulin levels, a decrease in albumin-globulin ratio and disorders of fat metabolism.
Forms of childhood psoriasis
- drop-shaped;
- crying;
- pustular;
- erythrodermic;
- psoriasis in infants;
- psoriatic arthritis.
The most common form isdrip psoriasis. . . It manifests itself in the form of red bumps on the body and limbs, which appear after minor injuries, as well as after infections (otitis media, rhinopharyngitis, influenza, etc. ). In a swab from the throat, cytological examination reveals streptococci. The drip form of psoriasis is often confused with allergic reactions.
Plaque psoriasis is characterized by red eruptions with clear borders and a thick layer of white scales.
Pustular or pustular form of the disease is rare. The appearance of pustules can be caused by infection, vaccinations, use of certain drugs, stress. Pustular psoriasis, which occurs in newborns, is called neonatal.
In erythrodermic psoriasis, the child's skin appears completely red; some areas of the skin may have plaque. Often skin manifestations are accompanied by fever and joint pain.
Pustular and erythrodermic psoriasis can have generalized forms with severe course. They need hospital treatment to avoid death.
Infant psoriasis is also known as diaper psoriasis. It is difficult to diagnose because skin lesions occur most often in the buttocks and can be mistaken for dermatosis due to skin irritation with urine and feces.
Psoriatic arthritis affects about 10% of children with psoriasis. The joints swell, the muscles become stiff, there is pain in the toes, ankles, knees, wrists. Conjunctivitis is often associated.
Usually the course of each form of the disease changes every three months. In summer, due to sun exposure, the symptoms often subside.
Treatment
It is best to hospitalize a child with psoriasis for the first time.
- Desensitizers (5% calcium gluconate solution or 10% calcium chloride solution inside, 10% calcium gluconate solution intramuscularly) and sedatives (mother tincture, valerian) are prescribed.
- Antihistamines and tranquilizers are suitable for severe itching.
- B vitamins are indicated intramuscularly for 10-20 injections: B6 (pyridoxine), B12 (cyanocobalamin), B2 (riboflavin); inside: B15 (pangamic acid), B9 (folic acid), A (retinol) and C (ascorbic acid).
- Drugs that have pyrogenic (temperature-raising) properties are used to activate the body's defenses. They normalize vascular permeability and reduce the rate of division of epidermal cells.
- Weekly transfusions, plasma and albumin administration indicated.
- If treatment is ineffective, as in severe cases of the disease, the doctor may prescribe glucocorticoids for a course of 2-3 weeks, with a gradual reduction in dose and subsequent discontinuation of the drug. The dosage is chosen individually. Cytostatics are not prescribed to children due to their toxicity.
- Occlusive (sealed) dressings with salicylic, sulfur-tar ointments are used to combat plaque on the palms and soles of the feet.
- In the stationary and regressive stages of psoriasis, children are prescribed UFOs, sedative baths, herbal medicines. Sapropel extract has been proven to be used in the form of applications or baths.
In case of frequent colds accompanying psoriasis, it is necessary to rehabilitate the sources of infection: to cure carious teeth, to perform deworming, if shown, 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 must cultivate a healthy lifestyle, teach him to cope with stress, calmly respond to peer attacks. The situation is especially difficult for children whose facial skin is affected. All family members should support a sick child, which will help him avoid complexes and grow as a socially adapted person.
Which doctor to go to
Psoriasis in children is treated by a dermatologist. If not only the skin but also the joints are affected, a consultation with a rheumatologist is indicated, with the development of conjunctivitis - an ophthalmologist. It is necessary to rehabilitate outbreaks of chronic infection by visiting a dentist, infectious disease specialist, 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 help in the treatment of the patient.