Psoriasis is a chronic, non-communicable, dermatological disease that primarily affects the skin. The autoimmune nature of this disease is currently being assumed. Psoriasis often 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 essentially sites of chronic inflammation and excessive proliferation of lymphocytes, macrophages, and keratinocytes of the skin, as well as over-formation of new small capillaries in the lateral skin layer. below.
What causes psoriasis?
The cause of psoriasis is still not fully understood. At present, there are two main hypotheses regarding 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 disrupted, and there is an overgrowth and proliferation of skin cells. this cell. At the same time, the problem of psoriasis is considered by proponents of this hypothesis to be a violation of the function of the epidermis and its keratinocytes.
Autoimmune infiltration of T lymphocytes and macrophages against skin cells, their infiltration into the dermal thickness, and dermal overgrowth are considered secondary, as the response oforganism to excessive multiplication of "wrong", immature, pathologically altered keratinocytes. This hypothesis is supported by the presence of a positive effect in the treatment of psoriasis with drugs that inhibit keratinocyte proliferation and/or induce their rapid maturation and differentiation. , which also possess no or negligible systemic immunomodulatory properties - retinoids (synthetic analogues of vitamin A), vitamin D, and especially its active form, fumaric acid esters.
The second hypothesis holds that psoriasis is an immunologic, immunological, or autoimmune disease in which the overgrowth and multiplication of skin cells and, above all, keratinocytes aresecondary to various inflammatory factors produced by cells of the immune system and/or, and autoimmune cells that damage the skin causing a secondary regenerative response.
What happens to the skin and how to take care of it?
Impaired skin barrier function (in particular, mechanical trauma or irritation, friction and pressure on the skin, overuse of soaps and detergents, exposure to solvents, household chemicals, solutions)alcohol content, the presence of foci of infection on the skin or skin allergies, immunoglobulin deficiency, excessive dryness of the skin) also play a role in the development of psoriasis.
Infections in dry skin cause chronic dry (non-exudative) inflammation, which in turn causes psoriasis-like symptoms such as itching and increased skin cell proliferation. This leads to further increase in skin dryness, both due to inflammation and proliferation of skin cells, and to the fact that the infectious organism consumes moisture, which in turn serves to moisturize the skin. skin. To avoid excessive dryness of the skin and reduce symptoms of psoriasis, psoriasis patients should not use scrubs and scrubs, especially harsh fabrics, as they not only damage the skin, Leaves small scratches that can also scratch the top. The stratum corneum and sebum protect the skin, usually protecting it from drying out and from bacterial invasion. Baby powder or baby powder should also be used after washing your face or bathing to absorb excess moisture from the skin, otherwise it will "come into contact" with an infectious agent. In addition, it is recommended to use products that moisturize and nourish the skin, creams that improve the function of the sebaceous glands. Do not use soap or detergents. You should try to avoid exposing your skin to solvents and household chemicals.
Is psoriasis hereditary?
The genetic component plays an important role in the development of psoriasis, and many genes involved in the development of psoriasis or directly related to its development are known, butIt is unclear how these genes interact during disease development. Most of the genes currently known to be involved in psoriasis, in one way or another, influence the functioning of the immune system.
It is believed that if a healthy parent has a child with psoriasis, there is a 17% chance that the next child will develop the disease, and if a parent has psoriasis in one of the parents, the chance of the child developing the disease is 17%. increased to 25% (with disease of both parents - up to 60-70%).
Due to the fact that in most patients with psoriasis, it is not possible to form hereditary dermatophytosis, it is believed that psoriasis itself is not hereditary, but a predisposition to it, the result is in some cases. complex interplay of genetic factors and adverse environmental influences.
What does psoriasis look like?
Excessive proliferation of keratinocytes (skin cells) in psoriatic plaques and rapid infiltration of lymphocytes and macrophages into the skin leads to thickening of the skin at the site of injury, elevation ofit on the surface of healthy skin and forms the characteristic pale, gray or silver color. waxy or hardened paraffin-like spots ("paraffin lakes"). Psoriasis patches often first appear in places of friction and pressure - the surfaces of the elbows and knees, on the buttocks. However, psoriasis patches can occur and are located anywhere on the skin, including the scalp (scalp), palmar surfaces, foot surfaces, and external genitalia. In contrast to eczematous rashes, which typically affect the inner flexor surfaces of the knee and elbow joints, psoriatic plaques are often located on the outer, extended surface of the joint.
What does it take to be diagnosed with psoriasis?
This is often much more difficult in children than in adults: in children, psoriasis often has an atypical form, which can lead to difficulty in diagnosis. And the earlier the diagnosis, the better the chance of fighting off the disease.
There is no specific diagnostic procedure or blood test for psoriasis. However, with active, progressive or severe psoriasis, blood test abnormalities can be detected, confirming the presence of inflammatory, autoimmune, rheumatic processes. active (increased rheumatoid factor titer, acute phase protein, leukocytosis, elevated ESR, etc. ), as well as endocrine and biochemical disturbances. Sometimes a skin biopsy is needed to rule out other skin conditions and for histological confirmation to diagnose psoriasis.
How is psoriasis treated?
It is necessary to start the treatment of psoriasis in a child as soon as possible and monitor the child so that he adheres to all the doctor's advice. The baby's immune system is very sensitive. With the right approach, she can cure psoriasis, but if left to progress, the skin will be affected more and more.
If the child has symptoms of the disease - patches on the skin, itching, redness, peeling of the skin, you need to start treatment immediately, strictly following all the recommendations of the doctor and the doctor will adviseYou apply a special cream to your skin.
In the advanced stage and with common forms of the disease, it is best to send the child to the hospital. Prescribe a desensitization and sedative, in 5% calcium gluconate solution or 10% calcium chloride solution in teaspoon, dessert or tablespoon 3 times a day. Apply 10% calcium gluconate solution intramuscularly, 3-5-8 ml (depending on age) every other day, 10-15 times each time. For severe itching, oral antihistamines should be used for a short period of time, for 7-10 days. In older children in the advanced stage, there is agitation, poor sleep, sometimes small doses of sleeping pills, small sedatives give good effect.
Topical vitamin: 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 the common forms of exudative psoriasis - 30-100 mcg intramuscularly 2 times a week in combination with folic acid and ascorbic acid for 172-2 months. Vitamin A is given in doses of 10, 000 - 30, 000 ME 1 time per day for 1-2 months. Patients with summer psoriasis, especially with intense itching, have nicotinic acid inside. For psoriatic erythema, it is recommended to use: riboflavin mononucleotide intramuscularly, vitamin B15 orally or in suppositories (in a double dose), potassium orotate. Vitamin D2 should be used with caution in all forms of psoriasis.
To stimulate protective and adaptive mechanisms, pyrogenic drugs are prescribed to normalize vascular permeability and inhibit the mitotic activity of the epidermis. A good therapeutic effect is given by transfusion of blood, plasma, weekly, several times, depending on the results obtained. In children with persistent forms of psoriasis (exudative and erythrocytosis), it is sometimes not possible to get a positive effect from these forms of psoriasis. Thereafter, glucocorticoids are prescribed orally at a dosage of 0. 5-1 mg per 1 kg of body weight per day for 2-3 weeks, followed by a gradual reduction in the dose of the drug until it is eliminated. . Because of their toxicity, cytostatics are not recommended for children of any age. In the sedentary and regressive stages of the disease, a more aggressive therapy is prescribed - UFO, joint bath at a temperature of 35-37 ° C for 10-15 minutes, after 1 day.
External treatment for psoriasis.
Salicylic ointment (1-2%), sulfur-tar (2-3%); glucocorticoid ointment. These ointments quickly provide a direct effect in the form of a topical bandage on the psoriatic plaques on the palms and soles. For children with predominantly scalp lesions, the use of recently used phosphodiesterase inhibitors as lubricants or dressings with ointments may be recommended.
It is important to emphasize the importance of cleaning the foci of infection (respiratory diseases, ENT organs, invasive helminths, etc. ). Tonsillectomy and adnexectomy for children with psoriasis can be performed after the child is 3 years old. In 90% of cases, these surgical interventions have a beneficial effect on the course, and in 10% of patients, especially with extensive exudative psoriasis, exacerbations continue. Re-examination after 7-10 years shows that 2/3 of patients after tonsillectomy do not have recurrence of the disease, even the remaining 1/3 of children have mild and prolonged rash; In non-surgical children with psoriasis and chronic tonsillitis, exacerbations of dermatosis are more frequent.
Our long-term observations of children indicate that in most cases, age-related relapsing psoriasis occurs less frequently, is less pronounced, and tends to shift fromcommon form of dermatosis to limited disease forms. In some patients, however, the process remains general, with a severe course.
Is psoriasis a diagnosis for life?
If you start treatment promptly and properly, then no. The development of psoriasis in a child does not at all mean that as an adult he will also get the disease. Of course, psoriasis is a chronic disease, which is almost impossible to cure 100%. But quiet time can be maximized. Psoriasis in children is treated like adults, changing from one type of treatment to another every three months.
Children should prepare mentally in advance for having defects in their body. Unlike adults, in children, psoriasis usually does not affect the body but affects the face (30% of cases). The rash may appear on the forehead, on the cheeks, and on the eyelids. Psychologically, quite hard to bear. In addition, in one-third of children with childhood psoriasis, the nails are affected. Therefore, hiding the disease is quite difficult.
In addition to physical discomfort, psoriasis can be a serious test of a child's mental state. Parents should not leave him alone with a problem. Any activity should be encouraged: sports, games. However, it is worth keeping in mind these precautions. For example, the skin on certain areas of the body can become stretched (for example, when cycling for long periods of time). And this can cause psoriasis. Despite the unsightly skin condition, kids can go swimming! And if there are chemicals in the water, remove them
Why is there still no cure for psoriasis?
This disease is called mysterious for a reason. The nature of this disease is still unclear. Some psoriasis affects the face, others have limbs, some have joints! Why marriage occurs in the cells of our bodies is still unclear. As a cancer, psoriasis cannot be treated with pills. Interesting developments are underway in our country today. They try to treat children with ointments made from natural ingredients. The forecasts are favorable, but the ointment has not yet entered production. In the meantime, my advice to parents is not to rely too much on fake healers and healers, and in case your child shows signs of psoriasis, contact a specialist - a skin doctor. willow child.