In children, psoriasis or scaly lichen is a chronic disease characterized by the formation of silver-white papules (bumps) on the skin of the child. The incidence of psoriasis among all dermatoses is about 8%. The disease occurs more frequently in different age groups of children, including infants and newborns, and more girls. The disease is characterized by some seasonality: in winter there are more cases of psoriasis than in summer.
The disease is not contagious, although a viral theory of its origin is still under consideration.
Causes of the disease
The normal maturation period of skin cells is 30 days. In psoriasis, it shrinks to 4-5 days, which is manifested by the formation of psoriatic plaques. Electron microscopy revealed that the same changes occur in the child's healthy skin, as in the affected areas. In addition, patients with psoriasis are found to have disorders of the nervous, endocrine, immune systems, metabolism (mainly enzymatic and fatty), and other changes in the body. This indicates 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 in twins, relatives of several generations, as well as biochemical studies of healthy family members. If one of the parents is ill, the child is 25% more likely to develop psoriasis, and if both parents are ill, 60-75%. At the same time, the type of inheritance remains uncertain and is recognized as multifactorial.
Environmental factors include seasonal changes, skin contact with clothing, the effects of stress on a child's psyche, and relationships with peers. Focusing the attention of the children on the team on a sick child, treating them like "black sheep", limiting contact with them for fear of infection - all these factors can lead to new flares, an increase in the area of skin damage. The child's psyche is especially sensitive during adolescence, which is associated with hormonal changes. Therefore, a large percentage of cases are diagnosed in adolescents.
The ratio of genetic and environmental factors that trigger the onset of psoriasis is 65% and 35%, respectively.
Infections trigger the mechanisms of an infectious-allergic reaction that can trigger the development of psoriasis. Thus, the disease can occur after influenza, pneumonia, pyelonephritis, hepatitis. Even the post-infectious form of the disease is different. It is characterized by abundant papular rash in the form of drops all over the body.
In some cases, the onset of psoriasis is accompanied by skin trauma.
Symptoms
Psoriasis is characterized by the appearance of red islets ("plaques") on the skin, with silver-white spots, the appearance of a rash that is easily stained and itchy. The appearance of cracks in the plaques may be accompanied by slight bleeding and is fraught with the addition of a secondary infection.
Externally, psoriatic skin rashes in children are the same as in adults, but there are some differences. Koebner's syndrome is very common in children with psoriasis - the appearance of rashes in areas affected by irritation or injury.
The course of childhood psoriasis is long, except for the tearful, 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 ring. Lymph nodes can grow and thicken, especially in severe psoriasis. In the stationary stage, the growth of rashes stops, the center of the plaques is flattened, desquamation is reduced. During the regression phase, the scattering elements melt, leaving a depigmented edge (Voronov ring). The rash leaves hyper or hypopigmented spots behind.
The localization of psoriatic eruptions may be different. Most often affected elbows, knees, hips, navel, scalp. One in three children with psoriasis is affected by nails (a so-called high symptom that shows small holes in the nail plates that look like a high hole). Plaques can often be found in the folds of the skin. Mucous membranes, especially the tongue, are also affected, and rashes can change location and shape ("geographic 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). The face is less affected, rashes appear 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 a violation of fat metabolism.
Forms of childhood psoriasis
- in the form of drops;
- plaque;
- pustules;
- erythrodermic;
- psoriasis in infants;
- psoriatic arthritis.
It is the most common formtears psoriasis. . . It manifests itself in the form of red bumps on the body and limbs after minor injuries, as well as after infections (otitis media, rhinopharyngitis, influenza, etc. ). Cytological examination of the larynx reveals streptococci. The tearful form of psoriasis is often confused with allergic reactions.
Plaque psoriasis is characterized by a red eruption with clear borders and a thick layer of white scales.
Pustular or pustular form of the disease is rare. The appearance of pustules can occur as a result of infection, vaccinations, use of certain medications, stress. Pustular psoriasis that occurs in newborns is called neonatal.
The skin of a child with erythrodermic psoriasis appears completely red; There may be plaque in some areas of the skin. Often skin manifestations are accompanied by an increase in body temperature and joint pain.
Pustular and erythrodermic psoriasis can take generalized forms with a severe course. They require hospital treatment to prevent death.
Infantile psoriasis is also known as uterine psoriasis. It is difficult to diagnose because most skin lesions occur in the hip area and can be mistaken for dermatosis due to skin irritation with urine and feces.
Psoriatic arthritis affects about 10% of children with psoriasis. Joints swell, muscles stiffen, pain in the toes, ankles, knees, wrists. Conjunctivitis is often combined.
Usually, the course of any form of the disease changes every three months. Symptoms often subside in the summer months due to sun exposure.
Treatment
It is best to hospitalize a child with psoriasis for the first time.
- Sensitizers (5% calcium gluconate solution or 10% calcium chloride solution inside, 10% calcium gluconate solution intramuscularly) and sedatives (motherwort tincture, valerian) are prescribed.
- Antihistamines and tranquilizers are compatible with severe itching.
- B vitamins are indicated for intramuscular injection for 10-20 injections: B6 (Pyridoxine), B12 (Cyanocobalamin), B2 (Riboflavin); inside: B15 (Pangamic acid), B9 (Folic acid), A (Retinol) and C (Ascorbic acid).
- Drugs with 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 blood transfusion, plasma and albumin administration.
- If treatment is ineffective, as well as in severe cases, the doctor may prescribe glucocorticoids in a course of 2-3 weeks, with a gradual reduction in dose and subsequent discontinuation of the drug. Dosage is selected individually. Cytostatics are not prescribed for children due to toxicity.
- Occlusive (sealed) dressings containing salicylic, sulfur-tar ointments are used to combat plaque on the palms and soles.
- In the inpatient and regressive stages of psoriasis, children are prescribed UFOs, sedative baths, herbal medicines. Sapropel extract has proven itself, used in the form of applications or baths.
Sources of infection with frequent colds accompanied by psoriasis need to be sanitized: treat decayed teeth, deworming, tonsillectomy and adenotomy if indicated. 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 should be prepared for long-term and regular treatment.
It is necessary to instill in the child a healthy lifestyle, to teach him to cope with stress, to respond calmly to the attacks of peers. The situation is especially difficult in children with facial skin. All family members should support the sick child, which will help him to avoid complexes and grow up as a socially adapted person.
Which doctor to consult
Psoriasis in children is treated by a dermatologist. If not only the skin but also the joints are affected, consult a rheumatologist with the development of conjunctivitis - an ophthalmologist. It is necessary to sanitize the foci of chronic infections by visiting a dentist, an infectious disease specialist, an ENT doctor. If you have difficulty in the differential diagnosis of psoriasis and allergic diseases, you should contact an allergist. A dietitian, physiotherapist and psychologist help in the treatment of the patient.