Psoriasis is a chronic non-infectious disease, dermatosis, which mainly affects the skin. The autoimmune nature of this disease is currently suspected. Psoriasis usually causes too dry, red, raised patches on the skin. However, some psoriasis sufferers do not have visible skin lesions. Spots caused by psoriasis are called plaques. These spots are by nature sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes on 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. 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 is disrupted and there is overgrowth and proliferation of these cells. At the same time, the problem of psoriasis is considered by supporters 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 skin thickness and excessive skin proliferation are considered secondary to the body's response to the overgrowth of "wrong", immature, pathologically altered keratinocytes. supports the presence of a positive effect in the treatment of psoriasis with drugs that inhibit the proliferation of keratinocytes and / or cause their accelerated maturation and differentiation and at the same time do not have or have minor systemic immunomodulatory properties - retinoids (synthetic analogues of vitamin A)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 overgrowth and proliferation of skin cells, and especially keratinocytes, are secondary to various inflammatory factors produced by immune cells and / or byskin, causing a secondary regenerative reaction.
What happens to the skin and how to provide it with care?
Impaired barrier function of the skin (in particular, mechanical injury or irritation, rubbing and pressure on the skin, misuse of soap and detergents, contact with solvents, household chemicals, alcohol-containing solutions, the presence of infected skin or skin allergies, deficiencyof immunoglobulins, excessive dry skin) also play a role in the development of psoriasis.
Infection in dry skin causes dry (non-exudative) chronic inflammation, which in turn causes psoriasis-like symptoms such as itching and increased proliferation of skin cells. This in turn leads to an additional increase in dry skin, both due to inflammation and increased proliferation of skin cells, and due to the fact that the infectious organism consumes moisture that would otherwise serve to moisturize the skin. To avoid excessive dryness of the skin and reduce the symptoms of psoriasis, it is not recommended that patients with psoriasis use towels 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 from the skin, which normally protect the skin from drying out and from the penetration of microbes. It is also recommended to use talc or baby powder after washing or bathing to absorb excess moisture from the skin that would otherwise "reach" the infectious agent. It is also recommended to use products that moisturize and nourish the skin and lotions, which improve the function of the sebaceous glands. Do not abuse the use of soap, detergents. You should try to avoid skin contact with solvents, household chemicals.
Is psoriasis inherited?
The hereditary component plays an important role in the development of psoriasis and many of the genes associated with or directly involved in the development of psoriasis 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 affect the functioning of the immune system in one way or another.
It is estimated that if healthy parents have a child with psoriasis, then the probability of the next child getting sick is 17%, and in the presence of psoriasis in one parent, the chance of disease in children increases to 25% (with 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 inherited psoriasis itself, but a predisposition to it, which in some cases is due to 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 with lymphocytes and macrophages quickly leads to thickening of the skin at the site of the lesion, its rise above the surface of healthy skin and the formation of characteristic pale, gray or silver spotsof hardened wax or paraffin ("paraffin ponds"). Psoriatic plaques most often appear first in places subjected to friction and pressure - the surfaces of the elbow and knee joints, on the buttocks. However, psoriatic plaques can appear andare located all over the skin, including the scalp, the palmar surface of the hands, the plantar surface of the legs and the external genitalia. Unlike eczema rashes, which often affect the inner flexor surface of the knee and elbow joints, psoriatic plaques are more commonlocated on the outer, extensor surface of the joints.
What is needed to diagnose 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 earlier the diagnosis is made, the more options there are to fight the disease.
There are no diagnostic procedures or blood tests specific for psoriasis. However, in active, progressive psoriasis or severe psoriasis, abnormalities in blood tests may be detected, confirming the presence of active inflammatory, autoimmune, rheumatic processes (increased titers of rheumatoid factor, acute phase proteins, leukocytosis, 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 worth starting the treatment of psoriasis for children as early as possible and monitor the child so that he follows all the advice of the doctor. The baby's immune system is very sensitive. With the right approach, it can deal with psoriasis, and if you let the disease develop, the skin will be more and more affected.
If the child has symptoms of the disease - skin plaques, itching, redness, scaling, you should immediately begin treatment, strictly follow all the recommendations of the doctor and he will advise you to apply a special cream on the skin.
In a progressive stage and in common forms of the disease, it is best to hospitalize the child. Prescribe desensitizing and sedatives, inside a 5% solution of calcium gluconate or 10% solution of calcium chloride in teaspoons, dessert or tablespoons 3 times a day. Apply 10% solution of calcium gluconate intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 injections per course. In severe itching, oral antihistamines are needed in short courses of 7-10 days. In older children in a progressive stage, with an agitated state, poor sleep, sometimes small doses of sleeping pills and small tranquilizers 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 course of treatment. Vitamin B12 is especially indicated in common exudative forms of psoriasis - 30-100 mcg 2 times a week intramuscularly in combination with folic and ascorbic acids for 172-2 months. Vitamin A is given 10, 000 - 30, 000 ME once a day for 1-2 months. In patients with summer psoriasis, especially with severe itching, nicotinic acid is indicated inside. In psoriatic erythroderma it is recommended: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in a double dose), potassium orotate. Vitamin D2 should be used with caution in all forms of psoriasis.
In order to stimulate the protective and adaptive mechanisms, pyrogenic drugs are prescribed, which normalize vascular permeability and inhibit the mitotic activity of the epidermis. Good therapeutic effect is given by blood transfusions, 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 get a positive effect from these drugs. Glucocorticoids are then prescribed orally at 0. 5-1 mg per 1 kg of body weight per day for 2-3 weeks, followed by a gradual reduction in the dose of the drug until discontinued. Due to their toxicity, cytostatics are not recommended for children of all ages. In the stationary and regressive stages of the disease, more active therapy is prescribed - UFOs, shared baths at a temperature of 35-37 ° C for 10-15 minutes, after 1 day.
External treatment of psoriasis.
Salicylic (1-2%), sulfur-tar (2-3%) ointments; 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. Recently used phosphodiesterase inhibitors in the form of lubricants or occlusive ointment dressings may be recommended for children with a predominant scalp lesion.
It is necessary to emphasize the importance of remediation of focal infection (diseases of the respiratory tract, ENT organs, helminthic 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 process, and in 10% of patients, especially with widespread exudative psoriasis, exacerbations continue. The follow-up examination after 7-10 years showed that 2/3 of the patients after tonsillectomy did not have recurrences of the disease, but even the remaining 1/3 of the children with exacerbation of the rash are scarce and remissions are prolonged; in unoperated children with psoriasis and chronic tonsillitis, dermatosis exacerbations are more common.
Our long-term observations of children show that in most cases recurrences of psoriasis with age occur less frequently, less pronounced and there is a clear trend towards the transition of common forms of dermatosis to limited. In some patients, however, the process remains generalized, with a severe course.
Is psoriasis a lifelong diagnosis?
If you start timely and proper treatment, then no. The development of psoriasis in a child does not mean that as an adult he will also suffer from this disease. Of course, psoriasis is a chronic disease, it is almost impossible to cure 100%. But the period of rest can be maximized. Pediatric psoriasis is treated as an adult, switching from one treatment to another every three months.
The child must be psychologically prepared in advance for the fact that there are defects in his body. Unlike adults, in children psoriasis often affects not the body but the face (30% of cases). Rash can appear on the forehead, cheeks and eyelids. Psychologically it is quite difficult to endure. Also, one-third of children with childhood psoriasis have their nails affected. Therefore, it is quite difficult to hide the disease.
In addition to physical discomfort, psoriasis can be a severe ordeal for a child's mental state. Parents should not leave him alone with a problem. Every activity should be encouraged: sports, games. However, it is worth remembering the precautions. For example, the skin of certain areas of the body can be stretched (for example, when riding a bike for a long time). And this can provoke psoriasis. Despite the ugly condition of the skin, the child can swim! And if there are chemicals in the water, remove them
Why is there still no complete cure for psoriasis?
This disease is called mysterious for a reason. The nature of this disease is still unclear. Some psoriasis affects the face, others have limbs, some have joints! Why marriage occurs in the cells of our body is not clear. As an oncologist, psoriasis cannot be treated with pills. At the moment, interesting developments are being developed in our country. They try to treat children with ointments from natural raw materials. The prognosis 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 in case of signs of psoriasis in a child to consult a professional - pediatric dermatologist.