Psoriasis or scaly lichen in children is a chronic disease that manifests itself with the formation of white silver papules (bumps) on the skin of the child. The incidence of psoriasis among all dermatoses is about 8%. This disease occurs among groups of children of different ages, including infants and newborns, most 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 debated.
Causes of the disease
The normal maturation cycle for skin cells is 30 days. In psoriasis it decreases in 4-5 days, which is manifested by the formation of psoriatic plaques. With the method of electron microscopy it was found that in the healthy skin of the child are the same changes as in the affected areas. In addition, in patients with psoriasis, a disruption in the functioning of the nervous system, endocrine, immune, metabolism (mainly enzymatic and fatty) and other changes in the body are detected. This suggests that psoriasis is a systemic disease.
There are three main groups of causes of psoriasis:
- inheritance;
- Wednesday;
- infections.
Heredity is a major factor in the development of psoriasis. This is confirmed by the study of dermatosis that appears in twins, relatives in several generations, as well as biochemical studies of healthy family members. If one of the parents is ill, the probability that the child gets psoriasis is 25%, if both are ill, then 60-75%. At the same time, the type of inheritance remains unclear and is known as multifactorial.
Environmental factors include seasonal changes, clothing contact with the skin, the impact on the child's psyche from stress, relationships with peers. Focusing children's attention on a team on a sick child, treating them like a "black sheep", limiting contact for fear of infection - all of these factors can provoke new exacerbations, an increase in the area of lesionsof the skin. A child's psyche is particularly vulnerable during puberty, which is due to hormonal changes. Therefore, a large percentage of disease detection falls on adolescents.
The ratio of genetic and environmental factors that provoke the occurrence of psoriasis is 65% and 35%.
Infections trigger infectious-allergic reaction mechanisms that may promote the development of psoriasis. So the disease can occur after transferred flu, pneumonia, pyelonephritis, hepatitis. The postinfectious form of the disease is also distinguished. It is characterized by a large papular rash in the form of spots all over the body.
In some cases, the onset of psoriasis is preceded by skin trauma.
Symptoms
Psoriasis is characterized by the appearance on the skin of a rash in the form of islands ("plaques") of red color with silvery white spots that easily melt and itch. The appearance of cracks in the plaques can be accompanied by slight bleeding and is fraught with the addition of a secondary infection.
Externally, psoriatic skin rashes in children are similar to those in adults, but there are some differences. For children with psoriasis, Koebner syndrome is very characteristic - the appearance of rashes in the areas affected by irritation or injury.
The course of psoriasis in childhood is long, except for a more favorable form of the disease in the form of tears. 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 phase, the growth of redness stops, the center of the plaque flattens and the desquamation decreases. In the regression phase, the redness elements dissolve, leaving behind a depigmented edge (Voronov edge). The rash leaves behind hyper- or hypopigmenting spots.
The localization of psoriatic outbreaks may be different. Most often the skin of the elbows, knees, buttocks, navel, scalp is affected. Every third child with psoriasis has affected nails (the so-called finger symptom, in which small holes appear in the nail plates, resembling the fossa of a sheath). Tiles can often be found on skin folds. The mucous membranes, especially the tongue, are also affected, and the rash may 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). The face is less likely to be affected, redness appears on the forehead and cheeks and can spread to the ears.
The blood test reveals an increase in the amount of total protein and the level of gamma globulins, a decrease in the albumin-globulin coefficient and a violation of fat metabolism.
Forms of childhood psoriasis
- in the form of falling;
- tile;
- pustular;
- erythrodermic;
- psoriasis in infants;
- psoriatic arthritis.
The most common form ispsoriasis with tear drops. . . It appears in the form of red lumps on the body and limbs, which appear after minor injuries, as well as after infections (otitis media, rhinopharynx, flu, etc. ). On a throat swab, a cytological examination reveals streptococci. The tear-shaped form of psoriasis is often confused with allergic reactions.
Plaque psoriasis is characterized by red outbreaks with clear borders and a thick layer of white scales.
The pustular or pustular form of the disease is rare. The appearance of pustules can be caused by infection, vaccines, use of certain medications, stress. Pustular psoriasis that occurs in newborns is called neonatal.
With erythrodermic psoriasis, the baby’s skin appears completely red; some areas of the skin may have plaques. 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 seek hospital treatment to avoid death.
Infant psoriasis is also known as diaper psoriasis. It is difficult to diagnose because skin lesions occur more often in the buttock area and can be confused with 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, pain appears in the toes, ankles, knees, ankles. Conjunctivitis is often accompanied.
Usually, the course of each form of the disease changes every three months. In summer, due to sun exposure, the symptoms often disappear.
Treatment
It is best to hospitalize a child with psoriasis for the first time.
- Desensitizing agents (5% calcium gluconate solution or 10% calcium chloride solution inside, 10% calcium gluconate solution intramuscularly) and sedatives (mother tincture, valerian) are prescribed.
- With severe itching, antihistamines and sedatives are appropriate.
- B vitamins are shown intramuscularly for 10-20 injections: B6 (Pyridoxine), B12 (Cyanocobalamin), B2 (Riboflavin); inside: B15 (pangamic acid), B9 (folic acid), A (retinol) and C (ascorbic acid).
- To activate the body's defenses, drugs that have a pyrogenic property (temperature rise) are used. They normalize vascular permeability and reduce the rate of epidermal cell division.
- Weekly blood transfusions, plasma and albumin intake are indicated.
- If treatment is ineffective, as well as in severe cases of the disease, the doctor may prescribe glucocorticoids in a course of 2-3 weeks, with a gradual reduction of the dose and subsequent discontinuation of the drug. The dose is selected individually. Cytostatics are not prescribed for children because of their toxicity.
- To combat plaque on the palms and soles, occlusive (closed) dressings with salicylic, sulfur-tar ointments are used.
- In the stationary and regressive stages of psoriasis, children are prescribed UFOs, sedatives, herbal remedies. Sapropel extract has proven itself, which is used in the form of applications or baths.
With the frequent colds that accompany psoriasis, it is necessary to sanitize the sources of infection: to cure tooth decay, to perform deworming, if indicated, to perform tonsillectomy and adenotomy. A desirable step in treating psoriasis is spa treatment.
It should be remembered that psoriasis is a chronic disease characterized by periods of deterioration and remission and prepare for long-term and regular treatment.
The child must establish a healthy lifestyle, teach it to cope with stress, respond calmly to peer attacks. The situation is especially difficult with 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 contact
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 disinfect the foci of chronic infection by visiting the 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 treat the patient.