Psoriasis, or squamous lichen, in babies is a chronic disease that occurs with the formation of silvery-white papules (bumps) on the baby's skin. The incidence of psoriasis among all dermatoses is about 8%. This disease occurs between 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 studied.
Causes of the disease
The normal skin cell maturation cycle is 30 days. In psoriasis, it is reduced to 4-5 days, which is manifested by the formation of psoriatic plaques. It was discovered with the electron microscopy method that the same changes are present in the baby's healthy skin as in the affected areas. Also, in patients with psoriasis, a disruption in the functioning of the nervous, endocrine, immune, metabolism (mainly enzymatic and fat) and other changes in the body is revealed. This suggests that psoriasis is a systemic disease.
There are three main groups of causes of psoriasis:
- inheritance;
- Wednesday;
- infections.
Heredity is an important factor in the development of psoriasis. This is confirmed by the study of dermatosis that occurs in twins, in relatives of several generations, as well as by biochemical studies of healthy family members. If one of the parents is sick, the probability of the child suffering from psoriasis is 25%, if both are sick, 60-75%. At the same time, the type of inheritance remains unclear and is recognized as multifactorial.
Environmental factors include seasonal changes, contact of clothing with the skin, the impact of stress on the child's psyche, relationships with peers. By focusing the attention of the children in a team on a sick child, treating them like a "black sheep", limiting contact for fear of being infected: all these factors can provoke new exacerbations, an increase in the area of skin lesions. A child's psyche is particularly vulnerable during puberty due to hormonal changes. Therefore, a large percentage of the detection of the disease falls on adolescents.
The relationship between genetic and environmental factors that provoke the onset of psoriasis is 65% and 35%.
Infections trigger allergic-infectious response mechanisms that can trigger the development of psoriasis. So, the disease can occur after the transferred flu, pneumonia, pyelonephritis, hepatitis. The post-infectious form of the disease is also distinguished. It is characterized by an abundant papular rash in the form of drops 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 red islets ("plaques") with silvery-white patches that are easily flaky and itchy. The appearance of cracks in the plaques can be accompanied by light bleeding and is fraught with the addition of a secondary infection.
Outwardly, psoriatic rashes in children are similar to those in adults, but there are some differences. For children with psoriasis, Koebner's syndrome is very characteristic - the appearance of rashes in the areas affected by irritation or lesions.
The course of childhood psoriasis is long, with the exception of a more favorable form of the tear-shaped disease. 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 border. Lymph nodes can swell and thicken, especially in severe psoriasis. In the stationary phase, the growth of the rashes stops, the center of the plaques flattens and peeling decreases. In the regression phase, the elements of the rash dissolve, leaving a depigmented border (Voronov's rim). The rash leaves hyper or hypopigmented spots.
The localization of psoriatic rashes can be different. Most often, the skin on the elbows, knees, buttocks, navel, scalp is affected. One in three children with psoriasis has affected nails (the so-called thimble symptom, in which small holes appear on the nail plates, similar to the pit of a thimble). Plaques are often found in the folds of the skin. Mucous membranes, particularly the tongue, are also affected and the rash may change position and shape ("geographic tongue"). The skin on the palms and 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, the rash appears on the forehead and cheeks, and can spread to the ears.
In the blood test, an increase in the amount of total protein and the level of gamma globulin, a decrease in the albumin-globulin coefficient and violations of fat metabolism are detected.
Forms of infant psoriasis
- drop-shaped;
- plate;
- pustular;
- erythrodermic;
- psoriasis of newborns;
- psoriatic arthritis.
The most common form isdrip psoriasis. . . 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, nasopharyngitis, flu, etc. ). In a throat swab, a cytological examination reveals streptococci. The teardrop-shaped form of psoriasis is often confused with allergic reactions.
Plaque psoriasis is characterized by red rashes 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 triggered by infections, vaccinations, the use of certain drugs, stress. Pustular psoriasis that occurs in newborns is called neonatal.
With erythrodermal psoriasis, the baby's skin appears completely red; some areas of the skin may have plaque. Skin manifestations are often accompanied by an increase in body temperature and joint pain.
Pustular and erythrodermal psoriasis can take generalized forms with a severe course. They require hospital treatment to avoid death.
Infant psoriasis is also known as diaper psoriasis. It is difficult to diagnose because skin lesions most often occur in the buttock area and can be mistaken for dermatosis due to irritation of the skin with urine and feces.
Psoriatic arthritis affects approximately 10% of children with psoriasis. The joints swell, the muscles stiffen, pains occur in the toes, ankles, knees, wrist joints. Conjunctivitis is often associated.
Usually, the course of any form of the disease changes every three months. In summer, due to sun exposure, symptoms often subside.
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-of-pearl tincture, valerian) are prescribed.
- With severe itching, antihistamines and tranquilizers are appropriate.
- Vitamins of group B 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 pyrogenic properties (increase the temperature) are used. They normalize vascular permeability and reduce the epidermal cell division rate.
- Show weekly blood transfusions, the introduction of plasma and albumin.
- If the treatment is ineffective, as well as in severe cases of the disease, the doctor may prescribe glucocorticoids over the course of 2-3 weeks, with a gradual decrease in the dose and subsequent discontinuation of the drug. The dosage is selected individually. Cytostatics are not prescribed for children due to their toxicity.
- To combat plaque on the palms and soles of the feet, occlusive (sealed) dressings with salicylic and sulfur-tar ointments are used.
- In the stationary and regressive stages of psoriasis, children are prescribed UFOs, sedative baths, herbal medicine. Sapropel extract has proven itself well, which is used in the form of applications or baths.
With frequent colds accompanying psoriasis, it is necessary to sanitize the sources of infection: treat decayed teeth, carry out deworming, if indicated, perform tonsillectomy and adenotomy. A desirable step in the treatment of psoriasis is the spa treatment.
It should be remembered that psoriasis is a chronic disease characterized by periods of exacerbation and remission, and be prepared for regular and long-term treatment.
The child needs to instill a healthy lifestyle, teach him to cope with stress, calmly respond to attacks from peers. 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 is affected, but also the joints, a consultation with a rheumatologist is indicated, with the development of conjunctivitis - an ophthalmologist. It is necessary to disinfect foci of chronic infection by visiting a dentist, an infectious disease specialist, an ENT doctor. If there are difficulties in the differential diagnosis of psoriasis and allergic diseases, it is necessary to contact an allergist. A nutritionist, physiotherapist and psychologist assist in the treatment of the patient.