Psoriasis is a non-infectious chronic disease, dermatosis, that mainly affects the skin. The autoimmune nature of this disease is currently assumed. Psoriasis usually causes too dry, red, and raised patches on the skin. However, some psoriasis patients do not have 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 Causes Psoriasis?
The causes of psoriasis are not yet fully understood. At the moment, there are two main hypotheses about the nature of the process that leads 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 disturbed, and there is excessive growth and proliferation of these cells. At the same time, supporters of this hypothesis see the problem of psoriasis 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 in the skin are considered secondary, as the body's response to the excessive multiplication of "wrong" keratinocytes, immature and 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 maturation and accelerated differentiation and, at the same time, do not possess or possess negligible systemic immunomodulatory properties - retinoids (synthetic analogs 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, above all, keratinocytes are secondary to various inflammatory factors produced by the cells of the immune system. and / or for, 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, friction and pressure on the skin, abuse of soap and detergents, contact with solvents, household chemicals, alcohol-containing solutions, presence of infected foci in the skin or skin). allergies, immunoglobulin deficiency, excessive 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 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 the symptoms of psoriasis, it is not recommended that psoriasis patients use cloths and scrubs, especially harsh ones, as they not only damage the skin, leaving microscopic scratches, but also scrape the upper part. The protective horny layer and sebum of the skin, which normally protect the skin from dryness and the penetration of microbes. It is also recommended to use talcum or baby powder after washing or bathing to absorb excess moisture from the skin, which would otherwise "get" at the infectious agent. Additionally, it is recommended to use products that hydrate 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?
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, then the probability that the next 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 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 is carried out 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 infiltration of the skin with lymphocytes and macrophages rapidly leads to thickening of the skin at the sites of injury, their elevation above the surface of healthy skin and the formation of pale, gray or silvery features. stains that resemble hardened wax or paraffin ("paraffin lakes"). Psoriatic plaques most often appear in places subject to friction and pressure: the surfaces of the elbows and knee flexions, on the buttocks. However, psoriatic plaques can appear 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. Unlike eczema rashes, which often affect the inner flexor surface of the knee and elbow joints, psoriatic plaques are more frequently localized on the extensor outer surface of the joints.
What does it take to be diagnosed with psoriasis?
This is often much more difficult in children than in adults: in children, psoriasis often takes on an atypical form, which can lead to diagnostic difficulties. And the earlier a diagnosis is made, the more opportunities you have to fight the disease.
There are no specific diagnostic procedures or blood tests for psoriasis. However, with active, progressive psoriasis or its severe course, alterations can be detected in blood tests, confirming the presence of an active inflammatory, autoimmune, rheumatic process (increased titers of rheumatoid factor, acute phase proteins, leukocytosis , increased ESR, etc. ), as well as endocrine and biochemical disorders. Sometimes a skin biopsy is necessary 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 to follow all the advice of the doctor. The baby's immune system is very sensitive. With the right approach, she can cope with psoriasis, and if she lets the disease run its course, her skin will be more and more affected.
If the child has symptoms of the disease: plaques on the skin, itching, redness, peeling, she should immediately start treatment, strictly follow all the recommendations of the doctor, and he will recommend that you apply a special cream to the skin.
In a progressive stage and with common forms of the disease, it is best to hospitalize the child. Prescribe desensitizers and sedatives, within a 5% calcium gluconate solution or 10% calcium chloride solution in teaspoons, dessert or tablespoons 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, oral antihistamines are needed in short courses, for 7-10 days. In older children in a progressive stage, with a state of agitation, lack of 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 especially indicated for common exudative forms of psoriasis: 30-100 mcg twice a week intramuscularly in combination with folic and ascorbic acids for 172-2 months. Vitamin A is administered at the rate of 10, 000 - 30, 000 ME 1 time per day for 1-2 months. In patients with summer psoriasis, especially with severe itching, nicotinic acid is shown inside. With psoriatic erythroderma, it is advisable: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in double doses), potassium orotate. Vitamin D2 should be used with some caution in all forms of psoriasis.
To stimulate protective and adaptive mechanisms, pyrogenic drugs are prescribed that normalize vascular permeability and inhibit 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 erythrodermic) forms of psoriasis, it is sometimes not possible to get 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 of psoriasis.
Salicylic ointments (1-2%), sulfur tar (2-3%); glucocorticoid ointments. These ointments quickly give 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 a predominant scalp injury, recently used phosphodiesterase inhibitors may be recommended as lubricants or occlusive dressings with ointments.
It is necessary to emphasize the importance of sanitation of focal infection (diseases of the respiratory tract, ENT organs, helminthic invasions, etc. ). Tonsillectomy and adenotomy for children with psoriasis can be done after age 3. In 90% of cases, these surgical interventions have a beneficial effect on the course of the process, and in 10% of patients, especially with generalized exudative psoriasis, exacerbations continue. The follow-up examination after 7-10 years showed that 2/3 of the patients after tonsillectomy had no relapses of the disease, but even the remaining 1/3 of the children with exacerbations of the rash were scarce and remissions were lengthened; in non-operated children with psoriasis and chronic tonsillitis, exacerbations of dermatosis were more frequent.
Our long-term observations of children indicate that, in most cases, relapses of psoriasis with age occur less frequently, are less pronounced, and a trend toward transition from common forms of dermatosis to forms is clearly visible. limited. However, in some patients, the process remains widespread, with a severe course.
Is psoriasis a lifelong diagnosis?
If you start timely and correct treatment, then no. The development of psoriasis in a child does not mean at all that, in adulthood, he will also suffer from this ailment. Of course, psoriasis is a chronic disease, it is almost impossible to recover 100%. But the quiet period can be maximized. Childhood psoriasis is treated like an adult, switching from one type of treatment to another every three months.
The child must be psychologically prepared in advance for the fact that there are defects in her body. Unlike adults, in children, psoriasis does not usually affect 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 a third of children with childhood psoriasis, the nails are affected. Therefore, it is quite difficult to hide the disease.
In addition to the physically unpleasant sensations, psoriasis can be a severe test for a child's mental state. 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 in certain areas of the body can be stretched (for example, when riding a bike for a long time). And this can lead to psoriasis. Despite the seemingly unpleasant skin condition, the child can go swimming! 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 not yet clear. Some psoriasis affects the face, some have extremities, some have joints! It is not clear why marriage occurs in the cells of our body. As an oncology, psoriasis cannot be treated with pills. Interesting developments are taking place in our country now. They try to treat children with ointments made from natural raw materials. The forecasts are favorable, but the ointment has not yet entered production. In the meantime, 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.