Psoriasis is a chronic non-infectious disease, dermatosis, which mainly affects the skin. The autoimmune nature of this disease is currently assumed. Psoriasis usually causes extremely dry, red and raised spots on the skin. However, some psoriasis patients do not have any noticeable skin lesions. The spots caused by psoriasis are called plaques. These spots are by nature places of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin, as well as excessive formation of small new capillaries in the lower layer of the skin.
What causes psoriasis?
The causes of psoriasis are currently not fully understood. There are currently two main hypotheses regarding the nature of the process leading 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 an increase and proliferation of these cells. At the same time, the problem of psoriasis is seen by the proponents of this hypothesis as a violation of the function of the epidermis and its keratinocytes.
The autoimmune aggressiveness of T lymphocytes and macrophages against skin cells, their invasion into the thickness of the skin, and their excessive proliferation in the skin are seen as secondary, in response to the body's excessive proliferation of "wrong", immature, pathologically altered keratinocytes. This hypothesis is supported by the presence of a positive effect in the treatment of psoriasis with drugs that inhibit keratinocyte proliferation and / or cause their accelerated maturation and differentiation and, at the same time, do not possess or possess insignificant systemic immunomodulatory properties - retinoids (synthetic analogues of vitamin A), vitamin 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 the overgrowth and proliferation of skin cells and, above all, keratinocytes are secondary to various inflammatory factors produced by cells of the immune systemand / or, and autoimmune cells damage the skin causing a secondary regenerative reaction.
What happens to the skin and how to take care of it?
Impaired skin barrier function (in particular, mechanical injury or irritation, skin friction and pressure, soap and detergent abuse, contact with solvents, household chemicals, alcohol-based solutions, the presence of infected foci on the skin or skin allergies, lack of immunoglobulins, excess dry skin) also play a role in the development of psoriasis.
Infection in dry skin causes chronic dry (non-exudative) inflammation, which in turn causes psoriasis-like symptoms such as itching and increased proliferation of skin cells. This in turn leads to a further increase of dry skin, both due to inflammation and increased proliferation of skin cells, as well as the fact that the infectious organism consumes moisture, which otherwise would serve to hydrate the skin. skin. To avoid excessive drying of the skin and to reduce the symptoms of psoriasis, it is not recommended that psoriasis patients use washing and cleansing cloths, especially hard ones, as they not only damage the skin, leaving microscopic scratches, but also scratches. the upper part. protective layer corneum and sebum from the skin, which normally protect the skin from drying out and the penetration of microbes. It is also recommended to use talcum powder or baby powder after washing or bathing to absorb excess moisture from the skin, which would otherwise "reach" the infectious agent. Furthermore, it is recommended to use products that moisturize and nourish the skin, as well as creams that improve the function of sebaceous glands. It is not recommended to abuse 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 the development of psoriasis or directly involved in its development are already known, but it remains unclear how these genes interact during the development of the disease. Most of the genes currently known to be associated with psoriasis, in one way or another, affect the functioning of the immune system.
It is believed that if healthy parents have a child with psoriasis, then the probability that the other child will get sick is 17%, and in the presence of psoriasis in one parent, the chance of the disease in children increases to 25% (with the disease of both parents -up to 60-70%).
Due to the fact that in most patients with psoriasis it is not possible to determine the hereditary transmission of dermatosis, it is believed that it is not the psoriasis itself that is inherited, but a predisposition to it, which in some cases is realized as a result. of a complex interaction of hereditary factors and adverse environmental impacts.
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 sites of the lesion, its rising above the surface of healthy skin and the formation of a characteristic pale color, gray or silver. stains resembling wax or hardened paraffin ("paraffin lakes"). Psoriatic plaques most often appear first in places that are subject to friction and pressure - the surfaces of the elbow and knee bends, in the buttocks. However, psoriatic plaques can appear and are found everywhere on the skin, including the 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 flexor surface of the knee and elbow joints, psoriatic plaques are more often located on the outer, extensor surface of the joints.
What is needed to be diagnosed with 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 opportunities to fight the disease.
There are no specific diagnostic procedures or blood tests for psoriasis. However, with active, progressive psoriasis or its severe course, abnormalities can be detected in blood tests, confirming the presence of an active inflammatory process, autoimmune, rheumatic (increased titers of rheumatoid factor, 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?
It is worth starting psoriasis treatment for children as soon as possible and monitoring the child so that he follows all the doctor's advice. The baby's immune system is very sensitive. With the right approach, it can withstand psoriasis and if you let the disease take its course, the skin will be affected more and more.
If the child has symptoms of the disease - plaques on the skin, itching, redness, peeling, 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 with common forms of the disease, it is good for the child to be hospitalized. Describe desensitizers and sedatives, within 5% calcium gluconate solution or 10% calcium chloride solution in teaspoon, dessert or tablespoon 3 times daily. Apply a 10% solution of calcium gluconate intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 injections per course. With severe itching, antihistamines are needed orally in short courses, for 7-10 days. In older children in the progressive stage, with restless state, poor sleep, small doses of hypnotics and small sedatives sometimes give a good effect.
Apply vitamins: ascorbic acid 0, 05-0, 1 g 3 times a day; pyridoxine - solution 2, 5-5%, 1 ml every other 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 in combination with folic and ascorbic acid for 172-2 months. Vitamin A is given in 10 000 - 30, 000 ME once a day for 1-2 months. Patients with the summer form of psoriasis, especially with severe itching, show nicotinic acid inside. With psoriatic erythroderma is advised: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in double dose), potassium orthoses. Vitamin D2 should be used with caution in all forms of psoriasis.
To stimulate defense and adaptation mechanisms, pyrogenic drugs are prescribed that normalize vascular permeability and inhibit the mitotic activity of the epidermis. A good therapeutic effect is given by blood transfusions, plasma, 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 funds. Subsequently, glucocorticoids are prescribed orally at 0, 5-1 mg per 1 kg body weight per day for 2-3 weeks, followed by a gradual reduction of the drug dose until canceled. Due to their toxicity, cytostatic drugs are not recommended for children of all ages. In the stationary and regressive stages of the disease, a 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 ointment (1-2%), sulfur-tar (2-3%); glucocorticoid ointments. These ointments quickly give a direct effect in the form of occlusive dressings on the localization of psoriatic plaques on the palms and soles. For children with a predominant scalp lesion, recently used phosphodiesterase inhibitors in the form of lubricants or occlusive ointment dressings may be recommended.
It is necessary to emphasize the importance of hygiene of focal infection (diseases of the respiratory tract, ENT organs, helminthic invasions, etc. ). Tonsilectomy and adenotomy for children with psoriasis can be performed after the age of 3 years. In 90% of cases, these surgical interventions have a beneficial effect on the course of the process and in 10% of patients, especially with diffuse exudative psoriasis, the irritations persist. Subsequent examination after 7-10 years showed that 2/3 of the patients after tonsillectomy had no relapses of the disease, but also the remaining 1/3 of the children with rash irritations were few and the remissions prolonged; in children who did not have surgery for psoriasis and chronic tonsillitis, exacerbations of dermatosis were more common.
Our long-term observations of children show that in most cases, relapses of psoriasis with age occur less frequently, are less pronounced, and a tendency toward the transition from common forms of dermatosis to limited ones is clearly evident. However, in some patients, the process remains generalized, with a severe progression.
Is psoriasis a diagnosis for life?
If you start treatment on time and correctly, then no. The development of psoriasis in a child does not mean at all that, as an adult, he will also suffer from this disease. Of course, psoriasis is a chronic disease, it is almost impossible to cure it 100%. But the quiet period can be maximized. Childhood psoriasis 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 fact that there are flaws 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, in one third of children with childhood psoriasis the nails are affected. Therefore, it is quite difficult to hide the disease.
In addition to feeling physically uncomfortable, psoriasis can be a serious test for a child's mood. Parents should not leave it to just one problem. Every activity should be encouraged: sports, games. However, it is worth remembering the precautions. For example, skin in certain areas of the body may stretch (for example, when cycling for a long time). And it can provoke psoriasis. Despite the ugly external condition of the skin, the baby 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 essence of this disease is still unclear. Some psoriasis affect the face, others have limbs, some have joints! Why marriage occurs in the cells of our body is not clear. Like oncology, psoriasis cannot be treated with pills. Interesting developments are already taking place in our country. They try to treat children with ointments made from natural raw materials. Predictions are favorable, but the ointment has not yet entered production. Meanwhile, my advice to parents is not to trust charlatans and pseudo-healers, and in case of signs of psoriasis in a child, contact a professional - a pediatric dermatologist.