Psoriasis is a chronic non-communicable disease, dermatosis, which mainly affects the skin. The autoimmune nature of this disease is now thought to be. Psoriasis usually causes extremely dry, red, puffy spots on the skin. However, some psoriasis patients do not have visible skin lesions. The spots caused by psoriasis are called plaques. These spots are by nature chronic inflammation and overproduction of skin lymphocytes, macrophages and keratinocytes, as well as the formation of new small capillaries in the lower layer of the skin.
What causes psoriasis?
The causes of psoriasis are not yet fully understood. Currently, there are two main hypotheses about the nature of the process that led to the development of this disease.
According to the first hypothesis, psoriasis is a primary skin disease in which the normal growth and differentiation of skin cells is disrupted, with excessive growth and proliferation of these cells. At the same time, the problem of psoriasis is seen by proponents of this hypothesis as a dysfunction of the epidermis and its keratinocytes.
Autoimmune aggression of T-lymphocytes and macrophages against skin cells, their invasion of skin thickness, and their proliferation in the skin are considered secondary as the body's response to the proliferation of "wrong" immature, pathologically altered keratinocytes. This hypothesis is confirmed by the positive effect of psoriasis in the treatment of psoriasis with drugs that inhibit the proliferation of keratinocytes and / or cause their accelerated maturation and differentiation, as well as drugs that do not or do not have significant systemic immunomodulatory properties. retinoids (synthetic analogues of vitamin A), vitamin D and especially its active form, esters of fumaric acid.
The second hypothesis suggests that psoriasis is an immune, immunopathological, or autoimmune disease in which the overgrowth and proliferation of skin cells and, above all, keratinocytes are caused by various inflammatory factors and / or secondary factors produced by the cells of the immune system. Autoimmune cell damage to the skin causing a secondary regenerative reaction.
What happens to the skin and how to care for it?
Impaired skin barrier function (especially mechanical injury or irritation, friction and pressure on the skin, abuse of soaps and detergents, solvents, household chemicals, contact with alcoholic solutions, presence of foci on the skin or skin, allergies, immunoglobulin deficiency, excessivealready dry skin) also plays a role in the development of psoriasis.
In dry skin, the infection causes dry (non-exudative) chronic inflammation, which in turn causes symptoms such as psoriasis, such as itching and proliferation of skin cells. This, in turn, leads to an increase in dry skin due to both inflammation and proliferation of skin cells, as well as the consumption of moisture by the infectious organism, which otherwise serves to moisturize the skin. To prevent excessive dryness of the skin and reduce the symptoms of psoriasis, patients with psoriasis are not recommended to use detergents and scrubs, especially hard ones, as they not only damage the skin, leave microscopic scratches, but also break the upper part. skin protection stratum corneum and sebum, normally protects the skin from drying out and the penetration of microbes. It is recommended to use talcum powder or baby powder after washing or pinching to absorb excess moisture from the skin, otherwise it will "get" the infectious agent. In addition, it is recommended to use products that moisturize and nourish the skin, lotions that improve the function of sebaceous glands. It is not recommended to abuse soap and detergents. You should try to avoid skin contact with solvents and household chemicals.
Is Psoriasis Inherited?
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 not yet clear how these genes interact during the development of the disease. Most of the genes known to be associated with psoriasis affect the immune system in one way or another.
It is estimated that if a healthy parent has a child with psoriasis, the next child has a 17% chance of getting sick, and if one parent has psoriasis, the child is 25% more likely to get the disease (with both parents having the disease - 60-70%).
Since it is not possible to determine the hereditary transmission of dermatosis in the majority of patients with psoriasis, it is believed that it is not the hereditary psoriasis itself, but in some cases, the resulting predisposition to it. complex interaction of hereditary factors and adverse effects of the environment.
What does psoriasis look like?
Excessive proliferation of keratinocytes (skin cells) and infiltration of the skin with lymphocytes and macrophages in psoriatic plaques rapidly causes thickening of the skin in damaged areas, rising above the surface of healthy skin and the formation of the characteristic pale, gray or silver color. hardened wax or paraffin-like stains ("lakes of paraffin"). Psoriatic plaques appear primarily on areas exposed to friction and pressure - on the surfaces of the elbows and knees, on the hips. 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 flexion surface of the knee and elbow joints, psoriatic plaques are more likely to be located on the outer, extensor surface of the joint.
What is needed to diagnose psoriasis?
This is usually more difficult in children than in adults: psoriasis in children often takes an atypical form, which can lead to diagnostic difficulties. And the sooner it is diagnosed, the more opportunities there are to fight the disease.
There are no specific diagnostic procedures or blood tests for psoriasis. However, abnormalities can be detected in blood tests confirming the presence of active, progressive psoriasis or its severe course, active inflammatory, autoimmune, rheumatic process (increased rheumatoid factor titers, acute phase proteins, leukocytosis, increased ESR, etc. ). ), as well as endocrine and biochemical disorders. Sometimes a skin biopsy is needed to rule out other skin diseases and to histologically confirm the diagnosis of psoriasis.
How is psoriasis treated?
For children, it is worth treating psoriasis as early as possible and watching the child to follow all the doctor's recommendations. The baby's immune system is very sensitive. With the right approach, it can cope with psoriasis, and if you allow the disease to progress, the skin will become more and more affected.
If the child has symptoms of the disease - skin plaques, itching, redness, peeling, it is necessary to immediately begin treatment, strictly follow all the recommendations of the doctor, and he recommends applying a special cream to the skin.
It is best to hospitalize a child with a progressive stage and general forms of the disease. Prescribe desensitizing and sedative drugs in 5% calcium gluconate solution or 10% calcium chloride solution in a teaspoon, dessert or tablespoon 3 times a day. Intramuscular 10% solution of calcium gluconate, 3-5-8 ml per day (depending on age), 10-15 injections per course. With severe itching, antihistamines are needed in short courses by mouth, for 7-10 days. Anxiety, poor sleep, small doses of hypnotics and small tranquilizers are sometimes effective in older children in the advanced stage.
Apply vitamins: 0, 05-0, 1 g of ascorbic acid 3 times a day; pyridoxine - 2, 5-5% solution, 1 ml per day, 15-20 injections per course of treatment. Vitamin B12 is especially indicated for common exudative forms of psoriasis - 30-100 mcg 2 times a week intramuscularly 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. Nicotinic acid is indicated in patients with a summer form of psoriasis, especially severe itching. Recommended for psoriatic erythroderma: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (double dose), potassium orotate. Vitamin D2 should be used with some caution in all forms of psoriasis.
To stimulate the protective and adaptive mechanisms, pyrogenic drugs that normalize vascular permeability and inhibit the mitotic activity of the epidermis are prescribed. A good therapeutic effect is given by blood, plasma transfusion several times a week, depending on the result obtained. In children with persistent (exudative and erythrodermic) forms of psoriasis, it is sometimes not possible to obtain a positive effect from these drugs. Glucocorticoids are then administered orally at a dose of 0. 5-1 mg per 1 kg body weight per day for 2-3 weeks, then the dose is gradually reduced until the dose is eliminated. Due to its toxicity, cytostatic drugs are not recommended for children of all ages. In the 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 for psoriasis.
salicylic (1-2%), sulfur-tar (2-3%) ointments; glucocorticoid ointments. These ointments have a direct effect in the form of occlusive dressings on the localization of psoriatic plaques on the palms and soles of the feet. Recently used phosphodiesterase inhibitors in the form of occlusive dressings with lubricating oils or ointments may be recommended for children with a predominant scalp lesion.
It is necessary to emphasize the importance of sanitation of focal infections (diseases of the respiratory tract, ENT organs, helminthic invasions, etc. ). For children with psoriasis, tonsilectomy and adenotomy can be performed after the age of 3. In 90% of cases, these surgeries have a beneficial effect on the course of the process, and exacerbation continues in 10% of patients, especially in widespread exudative psoriasis. Re-examination after 7-10 years showed that 2/3 of patients after tonsillectomy had no recurrence of the disease, but even in the remaining 1/3 of children with rash exacerbations were less and remissions were prolonged; Exacerbation of dermatosis is more common in non-surgical children with psoriasis and chronic tonsillitis.
Long-term observations in children show that in most cases, recurrences of psoriasis occur less frequently with age, are less noticeable, and the tendency for the general forms of dermatosis to become more limited is obvious. However, in some patients the process remains generalized to a severe course.
Is Psoriasis a Lifetime Diagnosis?
If you start treatment on time and correctly, then not. The development of psoriasis in a child does not mean that he will suffer from this disease as an adult. Of course, psoriasis is a chronic disease, from which it is almost impossible to cure 100%. But the quiet period can be maximized. Psoriasis in children is treated as an adult, changing from one type of treatment to another every three months.
The child must be psychologically prepared in advance for the presence of defects in the body. Unlike adults, psoriasis in children often affects the face, not the body (30% of cases). Rash may appear on the forehead, cheeks and eyelids. It is very difficult to tolerate it psychologically. Also, one-third of children with childhood psoriasis are affected by nails. Therefore, it is very difficult to hide the disease.
In addition to the physical discomfort, psoriasis can be a serious test for a child's mental state. Parents should not leave him alone with the problem. Any activity should be encouraged: sports, games. However, precautionary measures are worth remembering. For example, the skin may stretch in certain areas of the body (for example, when riding a bicycle for a long time). And it can cause psoriasis. Despite the seemingly useless skin condition, the child can go swimming! 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, some have limbs, some have joints! It is not clear why marriage takes place in the cells of our body. As an oncologist, psoriasis cannot be treated with pills. At present, interesting events are taking place in our country. They try to treat children with ointments made 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 pseudohealers, and if the child shows signs of psoriasis, contact a specialist - a pediatric dermatologist.