Psoriasis is a chronic non -communicable disease, dermatosis, which mainly affects the skin. The autoimmune nature of the disease is assumed at this time. Psoriasis usually causes patches of skin that are too dry, red and raised. However, some people with psoriasis do not have any visible skin lesions. The spots caused by psoriasis are called plaques. These spots are the site of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin, as well as the formation of excessive new small capillaries in the skin layer beneath it.
What causes psoriasis?
The cause of psoriasis is currently not fully understood. Currently, there are two main hypotheses about the nature of the processes 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 excessive growth and proliferation of these cells. At the same time, the problem of psoriasis is seen by proponents of this hypothesis as a violation of the function of the epidermis and its keratinocytes.
Autoimmune invasion of T-lymphocytes and macrophages against skin cells, their invasion into skin thickness and excessive proliferation on the skin is seen as secondary, as the body’s response to excessive multiplication of "wrong", immature, pathologically altered keratinocytes. This hypothesis is supported by the presence of positive effects in the treatment of psoriasis with drugs that inhibit the multiplication of keratinocytes and / or cause accelerated maturation and differentiation and, at the same time, do not possess or possess insignificant systemic immunomodulatory properties - retinoids (synthetic analogs of vitaminsA), 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 excessive growth and multiplication of skin cells and, above all, keratinocytes are secondary to various inflammatory factors produced by immune system cells and / or to, and skin autoimmune cell damage causes a secondary regenerative response.
What happens to the skin and how to provide it with care?
Impaired skin barrier function (in particular, mechanical injury or irritation, friction and pressure on the skin, abuse of soaps and detergents, contact with solvents, household chemicals, alcohol -containing solutions, presence of infected foci on the skin or allergic skin, immunoglobulin deficiency, excessive dry skin) also plays a role in the development of psoriasis.
Infections on dry skin cause chronic dry (non-exudative) inflammation, which in turn causes psoriasis-like symptoms such as itching and increased skin cell proliferation. This in turn leads to a further increase in dry skin, both due to inflammation and increased proliferation of skin cells, and due to the fact that infectious organisms use moisture, which in turn will serve to moisturize the skin. To prevent excessive skin dryness and reduce the symptoms of psoriasis, psoriasis patients are not recommended to use wipes and scrubs, especially hard ones, because they not only damage the skin, leaving microscopic scratches, but also scrape the top. protector of the stratum corneum and sebum from the skin, which usually protects the skin from dryness and from microbial penetration. It is also recommended to use talcum powder or baby powder after washing or bathing to absorb excess moisture from the skin, which will otherwise "get" to the infectious agent. In addition, it is recommended to use products that moisturize and nourish the skin, and lotions that improve the function of the sebaceous glands. It is not recommended to abuse soaps, detergents. You should try to avoid skin contact with solvents, household chemicals.
Is psoriasis inherited?
Hereditary components play 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 still unclear how these genes interact during disease progression. Most of the genes now known to be associated with psoriasis, in one way or another, affect immune system function.
It is believed that if a healthy parent has a child with psoriasis, then the probability of the next child falling ill is 17%, and with the presence of psoriasis in one of the parents, the probability of the disease in the child increases to 25% (with the disease of the second parent -up to 60-70%).
Due to the fact that in most patients with psoriasis it is not possible to establish hereditary dermatosis transmission, it is believed that it is not psoriasis itself that is inherited, but a predisposition to it, which in some cases is realized as a result. complex interactions of hereditary factors and adverse environmental influences.
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 site of the lesion, its height above the surface of healthy skin and the formation of pale, gray or silvery features. spots resembling wax or hardened paraffin ("paraffin lakes"). Psoriatic plaques most often first appear in places subject to friction and pressure - the surface of the elbows and bent knees, on the buttocks. However, psoriatic plaques can occur and are located anywhere on the skin, including the scalp (scalp), the surface of the palms, the plantar surface of the feet, and the external genitalia. In contrast to eczema rashes, which often affect the inner flexor surfaces of the knee and elbow joints, psoriatic plaques are more often located on the outer surface, the extensor joints.
What does it take to be diagnosed with psoriasis?
This is usually more difficult in children than in adults: in children, psoriasis often takes an atypical form, which can lead to diagnostic difficulties. And the earlier a diagnosis is made, the more chances there are to fight the disease.
There are no specific diagnostic procedures or blood tests for psoriasis. However, with active, progressive psoriasis or its severe disease, abnormalities in blood tests can be detected, confirming the presence of active inflammatory, autoimmune, rheumatic processes (increased titer of rheumatoid factors, acute phase protein, leukocytosis, increased ESR, etc. ), as well as endocrine and biochemical disorders. Sometimes a skin biopsy is needed to rule out other skin conditions and histologically confirm the diagnosis of psoriasis.
How is psoriasis treated?
It is worth starting to treat psoriasis for a child as early as possible and monitor the child so that he or she adheres to all the doctor’s advice. The baby's immune system is very sensitive. With the right approach, he can overcome psoriasis, and if you let the disease linger, the skin will be increasingly affected.
If a child has symptoms of the disease-plaque on the skin, itching, redness, peeling, you should immediately begin treatment, strictly following all the recommendations of the doctor, and he will advise you to use a special cream on the skin.
In the progressive stage and with common forms of the disease, it is best to be admitted to a pediatric hospital. Set desensitizing and sedative, in a solution of 5% calcium gluconate or a solution of 10% calcium chloride in a teaspoon, dessert or spoon 3 times a day. Apply 10% calcium gluconate solution intramuscularly, 3-5-8 ml (depending on age) daily, 10-15 injections per course. With severe itching, antihistamines are needed by mouth in a short course, for 7-10 days. In older children in the progressive stage, with restlessness, lack of sleep, small doses of hypnotics and small sedatives sometimes have a good effect.
Apply vitamins: ascorbic acid 0. 05-0. 1 g 3 times a day; pyridoxine-a solution of 2. 5-5%, 1 ml per day, 15-20 injections per course of treatment. Vitamin B12 is indicated mainly for psoriasis of the common exudative form-30-100 mcg 2 times a week intramuscularly in combination with folic and ascorbic acids for 172-2 months. Vitamin A is given at 10, 000 - 30, 000 ME 1 time a day for 1-2 months. Patients with summer form psoriasis, especially with severe itching, are shown nicotinic acid in it. With psoriatic erythroderma, it is recommended: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in double doses), potassium orotate. Vitamin D2 should be used with caution in all forms of psoriasis.
To stimulate protective and adaptive mechanisms, pyrogenic drugs are prescribed that normalize vascular permeability and inhibit epidermal mitotic activity. Good therapeutic effect is given by transfusions of blood, plasma, weekly, several times, depending on the results obtained. In children with persistent forms of psoriasis (exudative and erythrodermic), it is sometimes impossible to obtain a positive effect from these funds. Then, glucocorticoids are prescribed orally at 0. 5-1 mg per 1 kg of body weight daily for 2-3 weeks, followed by a gradual decrease in the dose of the drug until it is canceled. Due to its 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 bath at a temperature of 35-37 ° C for 10-15 minutes, after 1 day.
External treatment for psoriasis.
Salicylic (1-2%), sulfur-tar ointment (2-3%); glucocorticoid ointment. This ointment quickly has a direct effect in the form of occlusive bandages in the localization of psoriatic plaques on the palms and soles of the feet. For children with primary lesions on the scalp, recently used phosphodiesterase inhibitors in the form of lubricants or occlusive dressings with ointments may be recommended.
It is necessary to emphasize the importance of sanitation of focal infections (diseases of the respiratory tract, ENT organs, helminthic invasion, etc. ). Tonsillectomy and adenotomy for children with psoriasis can be performed after the age of 3 years. In 90% of cases, this surgical intervention has a beneficial effect on the course of the process, and in 10% of patients, especially with widespread exudative psoriasis, exacerbations persist. Follow-up examination after 7–10 years showed that 2/3 of patients after tonsillectomy did not experience recurrence of the disease, but the remaining 1/3 of children with rash exacerbation were few and remission was prolonged; in nonoperative children with psoriasis and chronic tonsillitis, exacerbation of dermatosis is more frequent.
Our long-term observations of children show that in most cases, recurrence of psoriasis with age occurs less frequently, is less pronounced and a tendency toward the transition of normal to limited forms of dermatosis is clearly visible. However, in some patients, the process remains general, with a severe course.
Is psoriasis a lifelong diagnosis?
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 or she will also suffer from the disease. Of course, psoriasis is a chronic disease, it is almost impossible to recover from it 100%. But a quiet period can be maximized. Pediatric psoriasis is treated like an adult, switching from one type of treatment to another every three months.
The child should be psychologically prepared in advance for the fact that there is a weakness in his body. Unlike adults, in children, psoriasis often does not affect the body, but the face (30% of cases). The rash can appear on the forehead, on the cheeks, and on the eyelids. Psychologically, it’s a bit hard to bear. Also, in one-third of children with childhood psoriasis, nails are affected. Therefore, it is quite difficult to hide the disease.
In addition to unpleasant physical sensations, psoriasis can be a severe test for a child’s state of mind. Parents should not leave him alone with problems. Any activity should be encouraged: sports, games. However, it is advisable to keep in mind the precautions. For example, the skin on certain parts of the body can be stretched (for example, when cycling for long periods of time). And this can trigger psoriasis. Despite the unattractive external skin condition, the child can swim! And if there are chemicals in the water, remove them
Why is there still no cure for psoriasis completely?
The disease is called a mystery for some reason. The essence of the disease is still unclear. Some psoriasis affects the face, others have limbs, some have joints! Why marriage takes place in the cells of our body is not clear. As an oncologist, psoriasis cannot be treated with pills. Interesting developments are taking place in our country right now. They try to treat children with ointments made from natural raw materials. The prognosis is good, but the ointment has not yet entered production. In the meantime, my advice to parents is not to trust scammers and pseudo healers, and if there are signs of psoriasis in children, contact a professional-a pediatric dermatologist.