Psoriasis is a chronic non-infectious disease, dermatosis, which mainly affects the skin. The autoimmune nature of this disease is currently being speculated. Psoriasis usually causes excessively dry, red, raised patches of skin. However, some psoriasis sufferers have no visible skin lesions. The spots caused by psoriasis are called plaques. These spots are by their nature sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages and keratinocytes of the skin, as well as excessive formation of new small capillaries in the underlying skin layer.
What are the causes of psoriasis?
The causes of psoriasis are currently not fully understood. At the moment, there are two main hypotheses about 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 interrupted and there is an overgrowth and proliferation of these cells. At the same time, the problem of psoriasis is seen by supporters of this hypothesis as a violation of the function of the epidermis and its keratinocytes.
The autoimmune aggression of T lymphocytes and macrophages against skin cells, their invasion into the thickness of the skin and excessive proliferation of the skin are seen as secondary, as the body's response to the excessive multiplication of "wrong" keratinocytes, immature, pathologically altered. This hypothesis is supported by the presence of a positive effect in the treatment of psoriasis with drugs that inhibit the multiplication of keratinocytes 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 multiplication of skin cells and, especially, keratinocytes are secondary to various inflammatory factors produced by the cells of the immune system and / or , and autoimmune cells damage the skin causing a secondary regenerative reaction.
What happens to the skin and how to cure it?
Altered barrier function of the skin (in particular, mechanical injury or irritation, friction and pressure on the skin, abuse of soap and detergents, contact with solvents, household chemicals, solutions containing alcohol, presence of infected foci on the skin or skin allergies, deficiency of immunoglobulins, excessive dry skin) also play a role in the development of psoriasis.
Dry skin infection 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 in dry skin, both due to inflammation and increased proliferation of skin cells, and due to the fact that the infectious organism consumes moisture, which would otherwise serve to hydrate the skin. To avoid excessive dryness of the skin and reduce psoriasis symptoms, psoriasis patients are not advised to use wipes and scrubs, especially hard ones, as they not only damage the skin, leaving microscopic scratches, but also scrape the upper protective stratum corneum and skin sebum, which normally protect the skin from dryness and the penetration of microbes. It is also advisable to use baby powder or baby powder after washing or bathing to absorb excess moisture from the skin, which would 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 soap, detergents. You should try to avoid skin contact with solvents, household chemicals.
Is psoriasis hereditary?
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 is not clear how these genes interact during the development of the disease. Most of the currently known genes 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, the probability that the next child will get sick is 17%, and in the presence of psoriasis in one of the parents, the possibility 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 establish 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 occurs as a result of a complex interplay of hereditary factors and adverse environmental influences.
What does psoriasis look like?
Excessive proliferation of keratinocytes (skin cells) in psoriatic plaques and skin infiltration with lymphocytes and macrophages rapidly leads to thickening of the skin at the lesion sites, its elevation above the surface of healthy skin and the formation of features pale, gray, or silvery spots that resemble hardened wax or paraffin ("lakes of paraffin"). Psoriatic plaques most often appear for the first time in places subject to friction and pressure: the surfaces of the elbow and knee bend, on the buttocks. However, psoriatic plaques can occur that are found anywhere on the skin, including the scalp (scalp), the palmar surface of the hands, the plantar surface of the feet, and the external genitalia. In contrast to eczema rashes, which often affect the inner surface of the flexor of the knee and elbow joints, psoriatic plaques are most often found on the outer surface of the joint extensor.
What does it take 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 greater the 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 in blood tests can be detected, confirming the presence of an inflammatory, autoimmune, active rheumatic process (increased titers of the 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 conditions and histologically confirm the diagnosis of psoriasis.
How is psoriasis treated?
It is worth starting to treat psoriasis for children as soon as possible and monitor the child so that he observes all the doctor's recommendations. The baby's immune system is very sensitive. With the right approach, it can cope with psoriasis, and if you let the disease take its course, the skin will be increasingly affected.
If the child has symptoms of the disease - plaques on the skin, itching, redness, peeling, it is necessary to immediately begin treatment, strictly follow all the recommendations of the doctor, and he will advise you to apply a special cream to the skin.
At a progressive stage and with common forms of the disease, it is better to hospitalize the child. Prescribe desensitizers and sedatives, inside a 5% calcium gluconate solution or 10% calcium chloride solution in teaspoons, desserts or spoons 3 times a day. Apply a 10% solution of calcium gluconate intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 injections per cycle. With severe itching, antihistamines by mouth are needed in short courses, for 7-10 days. In older children in the progressive phase, with a state of agitation, poor sleep, small doses of hypnotics and small tranquilizers sometimes give a good effect.
Apply vitamins: ascorbic acid 0. 05-0. 1 g 3 times a day; pyridoxine - 2. 5-5% solution, 1 ml every other day, 15-20 injections per course of treatment. Vitamin B12 is particularly suitable for the 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 administered at 10, 000 - 30, 000 ME 1 time per day for 1-2 months. Patients with the summer form of psoriasis, especially with severe itching, are shown nicotinic acid inside. In case of psoriatic erythroderma we recommend: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in double dosage), potassium orotate. Vitamin D2 should be used with some caution in all forms of psoriasis.
In order to stimulate protective and adaptive mechanisms, pyrogenic drugs are prescribed that normalize vascular permeability and inhibit the mitotic activity of the epidermis. A good therapeutic effect is given by transfusions of blood, plasma, weekly, several times, depending on the result obtained. In children with persistent (exudative and erythrodermal) forms of psoriasis, it is sometimes not possible to achieve a positive effect from these funds. Then, glucocorticoids are prescribed orally at 0. 5-1 mg per 1 kg of body weight per day for 2-3 weeks, followed by a gradual decrease in the dose of the drug until it is canceled. Due to their toxicity, cytostatic drugs are not recommended for children of all ages. In the stationary and regressive stages of the disease, 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 ointments (1-2%), sulfur-tar (2-3%); glucocorticoid ointments. These ointments quickly give a direct effect in the form of occlusive dressings in the localization of psoriatic plaques on the palms and soles of the feet. For children with a predominant lesion of 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 infection (diseases of the respiratory tract, ENT organs, helminthic invasions, etc. ). Tonsilectomy and adenotomy for children with psoriasis can be done after 3 years of age. 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, exacerbations continue. Follow-up examination after 7-10 years showed that 2/3 of patients after tonsillectomy had no recurrence of the disease, but the remaining 1/3 of children with rash exacerbations were also poor and remissions were prolonged. ; flare-ups of dermatosis were more frequent in unoperated children with psoriasis and chronic tonsillitis.
Our long-term observations on children indicate that in most cases, relapses of psoriasis with age occur less frequently, are less pronounced, and a tendency to transition from common to limited forms of dermatosis is clearly visible. However, in some patients, the process remains generalized, with a severe course.
Is psoriasis a diagnosis for life?
If you start timely and correct treatment, then no. The development of psoriasis in a child does not at all mean that, as an adult, he too will suffer from this ailment. Of course, psoriasis is a chronic disease, it is almost impossible to cure it 100%. But the quiet period can be maximized. Children's psoriasis is treated like an adult, switching from one type of treatment to the other every three months.
The child should be psychologically prepared in advance for the fact that there are defects on his body. Unlike adults, in children, psoriasis often affects not the body, but the face (30% of cases). Rashes may appear on the forehead, cheeks and eyelids. Psychologically, it is quite difficult to bear. In addition, in one third of children with childhood psoriasis, the nails are affected. Therefore, it is rather difficult to hide the disease.
In addition to the physically unpleasant sensations, psoriasis can be a severe test for a child's mood. Parents shouldn't leave him alone with a problem. Any activity should be encouraged: sports, games. However, it is worth remembering the precautions. For example, the skin of some areas of the body can be stretched (for example, when cycling for a long time). And this can cause psoriasis. Despite the seemingly unsightly skin condition, the baby can swim! And if there are chemicals in the water, remove
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, some have limbs, some have joints! Why marriage takes place in the cells of our body is unclear. As an oncology, psoriasis cannot be treated with pills. Interesting developments are underway in our country right now. They try to treat children with ointments based on natural raw materials. Forecasts are favorable, but the ointment has not yet entered production. In the meantime, my advice to parents is not to trust quacks and pseudo healers, and in case of signs of psoriasis in a child, contact a professional - a pediatric dermatologist.