Psoriasis, or scaly lichen, in children is a chronic disease indicated by the formation of silvery white papules (bumps) on the skin of children. The incidence of psoriasis among all dermatoses is about 8%. The disease occurs in groups of children of different ages, including infants and newborns, more often in girls. The disease is characterized by several seasons: in winter there are more cases of psoriasis than in summer.
The disease is not contagious, although the original viral theory is still under consideration.
The cause of the disease
The normal maturation cycle for skin cells is 30 days. In psoriasis, it shrinks to 4-5 days, which is indicated by the formation of psoriatic plaques. It was found by electron microscope method that the same changes were present in the healthy skin of children as in the affected area. In addition, in psoriasis patients, disorders in nervous function, endocrine, immune system, metabolism (especially enzymatic and fatty) and other changes in the body are revealed. This suggests that psoriasis is a systemic disease.
There are three main groups of causes of psoriasis:
Heredity is a major factor in the development of psoriasis. This is confirmed by studies of dermatosis occurring in twins, in siblings in several generations, as well as biochemical studies of healthy family members. If one parent is sick, the probability of the child getting psoriasis is 25%, if both are sick, then 60-75%. At the same time, the type of inheritance is still unclear and is recognized as multi -factor.
Environmental factors include seasonal changes, contact of clothing with skin, effects on children's psychological stress, relationships with peers. Focusing the attention of children in a team on sick children, treating them like "scapegoats", limiting contact for fear of being infected-all these factors can trigger new severity, an increase in the area of skin lesions. The psyche of a child is particularly vulnerable during puberty, which is caused by hormonal changes. Thus, a large percentage of the detection of the disease falls on adolescents.
The ratio of genetic and environmental factors that trigger the onset of psoriasis is 65% and 35%, respectively.
The infection triggers an infectious allergic reaction mechanism that can trigger the development of psoriasis. So, the disease can occur after transmitted influenza, pneumonia, pyelonephritis, hepatitis. Even post -infectious forms of the disease are distinguished. It is characterized by an abundant papular rash in the form of droplets all over the body.
In some cases, the onset of psoriasis is preceded by skin trauma.
Psoriasis is characterized by the appearance of a rash on the skin in the form of small islands ("plaques") of red color with silvery white patches that easily peel off and itch. The appearance of cracks on the plaque may be accompanied by slight bleeding and fraught with the addition of secondary infections.
Externally, psoriatic skin rashes in children are similar to adults, but there are some differences. For children with psoriasis, Koebner syndrome is very characteristic - the appearance of a rash in the area affected by irritation or injury.
The course of childhood psoriasis is long, except for the form of tear drops, a better form of the disease. There are three stages of the disease:
The progressive stage is characterized by the formation of small itchy papules surrounded by red rims. Lymph nodes may enlarge and thicken, especially in severe psoriasis. At the stationary stage, rash growth stops, the middle part of the plaque becomes flat, and desquamation decreases. In the regression stage, the elements of the rash dissolve, leaving a depigmented rim (Voronov rim). The rash leaves hyper or hypopigmented spots.
The localization of psoriatic eruptions can vary. Often, the skin of the elbows, knees, back, navel, scalp are affected. Every third child with psoriasis has an affected nail (a symptom called a thimble, in which small holes appear on the nail plate, resembling a thimble fossa). Plaques can often be found in the folds of the skin. The mucous membranes, especially the tongue, are also affected, and the rash can change its location and shape ("geographical tongue"). The skin of the palms and plantar surfaces of the feet is characterized by hyperkeratosis (thickening of the upper layer of the epidermis). The face is less likely to be affected, a rash appears on the forehead and cheeks, and may spread to the ears.
In blood analysis, an increase in the amount of protein and the level of gamma globulin, a decrease in the coefficient of albumin-globulin, and a violation of fat metabolism were detected.
Forms of childhood psoriasis
- drop -shaped;
- infant psoriasis;
- psoriatic arthritis.
The most common form ispsoriasis teardrops. . . It manifests itself in the form of red bumps on the body and limbs, which occur after minor injuries, as well as after infections (otitis media, rhinopharyngitis, influenza, etc. ). In a throat swab, cytological examination revealed streptococcus. The teardrop -shaped form of psoriasis is often confused with an allergic reaction.
Plaque psoriasis is characterized by red eruptions with clear borders and a thick layer of white scales.
The pustular form, or pustular, of the disease is rare. The appearance of pustules can be triggered by infection, vaccination, use of certain medications, stress. Pustular psoriasis that occurs in newborns is called neonatal.
With erythrodermic psoriasis, a child’s skin appears completely red; some areas of the skin may have plaque. Often, skin manifestations are accompanied by an increase in body temperature and joint pain.
Pustular and erythrodermic psoriasis can take a general form with a severe course. They need hospital treatment to prevent death.
Infant psoriasis is also known as diaper psoriasis. It is difficult to diagnose because skin lesions most often occur in the back 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 become rigid, pain occurs in the toes, ankles, knees, wrist joints. Conjunctivitis is often associated.
Usually, the course of any form of illness changes every three months. In summer, due to sun exposure, symptoms often subside.
It is better to hospitalize a child with psoriasis for the first time.
- Desensitizing agents are prescribed (5% solution of calcium gluconate or 10% solution of calcium chloride inside, 10% solution of calcium gluconate intramuscularly) and sedatives (colored motherwort, valerian).
- With severe itching, antihistamines and sedatives are appropriate.
- Vitamin B is indicated intramuscularly for 10-20 injections: B6 (Pyridoxine), B12 (Cyanocobalamin), B2 (Riboflavin); in: B15 (Pangamik acid), B9 (folic acid), A (Retinol) and C (ascorbic acid).
- To activate the body's defenses, drugs are used that have pyrogenic properties (increase the temperature). They normalize vascular permeability and reduce the rate of epidermal cell division.
- Shown weekly blood transfusions, introduction of plasma and albumin.
- If treatment is ineffective, as well as in cases of severe illness, the doctor may prescribe glucocorticoids in a course of 2-3 weeks, with a gradual decrease in dose and subsequent discontinuation of the drug. The dose is selected individually. Cytostatics are not prescribed for children due to their toxicity.
- To combat plaque on the palms and soles of the feet, an occlusive (closed) bandage with salicylic, sulfur-tar ointment is used.
- In the stationary and regressive stages of psoriasis, children are prescribed UFOs, sedative baths, herbal remedies. Sapropel extract has proven itself, which is used in the form of applications or baths.
With the flu that often accompanies psoriasis, it is necessary to clean the source of infection: to cure dental caries, to carry out deworming, if indicated, to perform tonsillectomy and adenotomy. The proper step in the treatment of psoriasis is spa treatment.
Keep in mind that psoriasis is a chronic disease characterized by periods of exacerbation and remission, and is ready for long -term and regular treatment.
The child needs to adopt a healthy lifestyle, teach him to cope with stress, calmly respond to peer attacks. This condition is more difficult with children whose facial skin is affected. All family members should support the sick child, which will help him or her avoid complexes and grow up as a socially adaptable person.
Which doctor to contact
Psoriasis in children is treated by a dermatologist. If not only the skin is affected, but also the joints, consultation with a rheumatologist is indicated, with the development of conjunctivitis - an ophthalmologist. It is necessary to clear the focus of chronic infection by visiting a 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 assist in the treatment of the patient.