Psoriasis in children

This chronic papulosclerosis inflammatory skin disease, like psoriasis, develops at any age, and psoriasis in children can begin.

It is believed that this genetically determined dermatological pathology has an autoimmune or immuno-mediated nature. That is, it is not an infection, but a kind of dermatosis, and you can not get psoriasis. According to the ICD-10, psoriasis is classified in class XII (skin and subcutaneous tissue diseases) and has the code L40.0- L40.9.

[1], [2], [3]

Epidemiology

Psoriasis in children is much less common than in adults. In various international studies, estimates of the prevalence of this cutaneous pathology in children range from 0 to 2.1% or within 1% (in adults, from 0.9 to 8.5%).

According to the American National Psoriasis Foundation (NPF), about 10-15% of patients experienced psoriasis before the age of 10 years. As a rule, the disease begins in the period from 15 to 40 years (equally in both sexes).

As for the epidemiology of geography, the number of patients increases as the distance from the equator to the north.

In addition, as noted by the experts of the Association of Pediatric Psoriasis (USA), almost 48% of children with psoriasis are overweight all over the world, which may indicate a certain role of the violation of the general metabolism in the etiological factors of this disease.

Another study showed that vulgar plaque psoriasis accounts for more than 62% of cases, for drop-shaped psoriasis - 26%, for pustular psoriasis - 10%, for psoriasis erythrodermic - no more than 5%. In this case, rashes on the scalp are 57-65% of patients, nail plate damage - every third.

[4], [5], [6], [7], [8], [9],

Causes of the psoriasis in the child

To date, researchers have not identified the exact causes of psoriasis in children and adults, but the etiology of this disease is associated with a combination of immune, genetic, psychogenic and environmental prerequisites.

There are certain hereditary risk factors for the development of psoriasis in a child. According to the International Federation of Psoriasis Associations (IFPA), about 2-4% of the world's population has some form of psoriasis, but infants and young children are not diagnosed with this disease infrequently. According to some estimates, in a third of adult patients, the manifestation of pathology began approximately in 16-20 years. And dermatologists state that if one of the parents has psoriasis, that there is a 10-15% chance that the child will develop this disease. And when psoriasis in both parents, this risk increases to 50-70%. It is noted that if psoriasis develops in children in the presence of healthy parents, then there is a 20% chance that the brother or sister may develop psoriasis (the principle of alternation of generations with the family inclination to diseases works).

In both adults and children, factors such as psychological stress, depression, physical overstrain, the use of certain drugs, and abrupt changes in climatic conditions (especially cold dry weather) can be a trigger for this chronic illness.

Often, psoriasis can manifest itself after streptococcal infection (pharyngitis, tonsillitis, otitis), and this type is known as teardrop-shaped psoriasis in children.

In addition, the features of psoriasis in children consist in the fact that psoriatic spots (plaques) appear on the area of the injured skin (in place of cuts, scratches, abrasions, irritations, etc.). In dermatology, this phenomenon is called the isomorphic provoking reaction or the Kebner phenomenon.

[10], [11], [12]

Pathogenesis

The pathogenesis of psoriasis lies in the accelerated proliferation of keratinocytes - the formation of new cells in the basal and suprabasal layers of the epidermis. Constant natural renewal of keratinocytes and their migration into the stratum corneum are necessary for the regeneration of the skin, but when the rate of this process increases by 6-8 times, "overproduction" of new skin cells occurs, and then they accumulate in the stratum corneum, which is manifested by characteristic thickened spots on the Skin and their intensified desquamation (desquamation).

Now, few doubt that all this is an autoimmune reaction caused by an inflammatory cascade in the dermis involving dendritic cells, mononuclear phagocytes, intra-epidermal macrophages and T-lymphocytes. Immune cells that perceive skin cells as an antigen move from the dermis to the epidermis and secrete inflammatory cytokines-interleukins and tumor necrosis factor-alpha. In response, abnormal proliferation of keratinocytes and an additional synthesis of keratin begins - to replace damaged cells and isolate them from surrounding tissues.

In the pathogenesis of psoriasis, specialists also follow a clear violation of the tissue structure and synthesis of keratogialin - a protein of the granular layer of the epidermis, which provides a normal process of keratinization.

Also connects the causes of psoriasis in children and adults with the genetic aberration of almost 20 loci (PSORS) on different chromosomes responsible for the differentiation of leukocyte T cells, interleukins and their receptors.

[13], [14],

Symptoms of the psoriasis in the child

The main symptoms of psoriasis in children do not differ from the signs of this pathology in adults and depend on its variety.

Species or clinical variants of psoriasis that can be diagnosed in childhood: teardrop, plaque, inverse (inverse), pustular, psoriatic erythroderma (or erythrodermal psoriasis), psoriatic arthritis.

According to dermatologists, spotted or teardrop-shaped psoriasis in children is revealed more often than other species. And its first signs appear on the skin of the limbs, head and torso suddenly - in the form of small red nodules that begin to peel and can cause itching.

The second most common in childhood or adolescence is plaque (normal) psoriasis. In these cases, the initial stage of psoriasis in children is manifested by the formation on the elbows and knees of dry, slightly reddish spots (plaques) appearing above the surface, rapidly covered with a layer of whitish-silvery scales. See - Symptoms of psoriasis

Plaques increase, a layer of scales (consisting of dead skin cells) become thicker; All over the body and on the scalp, new spots appear, often located symmetrically. They can itch, scaly "crust" on them can crack and cause a slight soreness; The skin beneath it is covered with protruding microscopic droplets of blood. Nail plates fade and crumble, there may be a partial exfoliation of the nail plates (onycholysis).

In some classifications seborrheic form of the disease and psoriasis of the nails are separately isolated, although psoriasis in the child on the head, like psoriasis of the nails in children, is only local symptoms of plaque variety of the disease.

There are inverse psoriasis, in which plaques appear not on the extensor part of the elbows and knee joints, but on smooth areas and in the folds of the skin. It is this type that manifests itself as psoriasis in children under one year, it can also be defined as diaper. This form is very often confused with the usual or exfoliative dermatitis, pemphigus of newborns or diaper rash, since psoriasis is an extremely rare disease among infants, especially if it is not in the family anamnesis. Rashes in the diaper area has the form of red shiny spots, clearly delimited from healthy skin.

To extremely rare manifestations in childhood, clinical forms include:

• erythrodermic psoriasis (psoriatic erythroderma) - a burn reminiscent of severe redness, covering most or all of the body; generalized hyperemia may be accompanied by intense itching, tactile tenderness of the skin, fever;
• pustular psoriasis - rash in the form of vesicles with purulent exudate, exudative rash, which rapidly increases and merges into solid spots (often blisters appear on soles and palms). With this form, the symptoms of psoriasis in children may include subfebrile temperature, loss of appetite, muscle weakness;
• arthropathic psoriasis or psoriatic arthritis - swelling of the joints, their stiffness, pain (often on the background of plaque rashes, but possibly even before the appearance of skin symptoms).

Stages

There are different stages of the immunoinflammatory process in psoriasis: progressive, stationary and regressive. All of them successively replace each other.

For the acute progressive stage, the appearance of new rashes is characteristic, and those that are already present, increase and flake. And the plaques have clear boundaries in the form of a red border, and in the middle of them - the epicenter of desquamation.

The cessation of the formation of new plaques, as well as the increase in the size of the old ones, are the symptoms by which the stationary stage is determined. In addition, the plaques become slightly bluish, and their entire surface is scratched intensively.

At the regressing stage, the plaque becomes flat, the scales gradually disappear, the spots turn pale, and in their place remain whitish traces of the type of leukoderma.

[15], [16]

Complications and consequences

The consequences and complications of psoriasis are related to the fact that this disease is chronic, with periods of exacerbation and remission. Therefore, parents should know that there is a risk of development in children of severe forms, in particular, psoriatic arthritis.

In addition, experts warn of a relatively high probability of occurrence of other metabolic diseases of an autoimmune nature, in particular, gluten enteropathy or celiac disease (gluten intolerance) and granulomatous enteritis (Crohn's disease).

Also, psoriasis can lead to the development of a metabolic syndrome, including increased blood pressure, insulin levels (type II diabetes) and cholesterol.

Complications of psoriatic arthritis, affecting any joints and surrounding connective tissues, can cause swelling of the fingers and toes, known as dactylitis. Possible inflammatory defeat of the joints of the hip, knees, spine (spondylitis) and sacroiliac joints (sacroiliitis).

Psoriasis in children and adults often negatively affects the quality of life, causing the formation of low self-esteem, frequent depression and the desire to avoid the society of others.

[17], [18],

Diagnostics of the psoriasis in the child

Dermatologists assert that the diagnosis of psoriasis in children does not present difficulties: it is enough to conduct a physical examination of the baby's skin, scalp and nails. Clinical signs are the basis of the definition of this disease.

Also, the doctor should ask the parents what the child was sick, they themselves are all next of kin.

Instrumental diagnostics is carried out with the help of a dermatoscope, increasing fragments of rashes and fixing it on the monitor screen and in the form of a scanned image.

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Differential diagnosis

If necessary, a skin sample (biopsy) can be taken to examine it under a microscope. This allows the dermatologist to clarify the situation, since only differential diagnostics makes it possible to distinguish psoriasis from other dermatological pathologies with partially similar symptoms: ichthyosis, xerosis of skin, red flat, pink or ringworm, seborrheic dermatitis or keratosis, contact or atopic dermatitis, etc.

Assessing the severity of psoriasis can help in deciding on the most appropriate treatment. The degree of severity of psoriasis is determined by determining the surface area of the body affected by rashes: mild degree - less than 3% of the body surface; moderate degree - from 3 to 10%; severe degree - more than 10%.

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Treatment of the psoriasis in the child

To cure psoriasis, that is completely to get rid of it, it is impossible. As in adults, the treatment of psoriasis in children is aimed at reducing the manifestations of the disease. Most children have an easy degree, at which there is enough local therapy.

Moisturizing the skin plays a role in the normalization of hyperproliferation, and also has an anti-inflammatory effect by saturating the cells of the epidermis with lipids. Therefore, children of younger age are advised to treat affected areas of the skin with mineral oils or petroleum jelly.

Doctors prescribe medicines for external use, including corticosteroids - ointments Hydrocortisone, Betasalik (Betamethasone, Betaderm A, Diprosalik), Flucinar (Sinaphlan), Lorinden, etc., which are used only during exacerbations and contribute to reducing itching, inflammation and the size of the rashes.

For example, ointment Betasalik (betamethasone + salicylic acid) should be applied no more than twice a day, lightly rubbing into the affected area. The duration of the application of ointments with corticosteroids is determined by the attending physician, since among the side effects of the preparations of this group burning, allergic irritation, dryness and atrophy of the skin are noted. Lotion Betasalik is used to lubricate the skin on the head.

Exclusively with plaque psoriasis and only children after 12 years, ointments such as Calcitriol, Daivobet, Forcal, Xamiol, containing a synthetic analogue of the active metabolite of vitamin D, can be prescribed. However, the manufacturers of the Psorkutan ointment (with the same active substance) indicated that the appointment to patients under 18 years of age can tolerate in case of inefficiency of other means and for a short time; and for Duivonex ointment with calcitriol the age limit was reduced to 6 years of age. Side effects of calcitriol: dermatitis, eczema, angioedema, hypercalcemia, exacerbation of psoriasis, etc.

External agents with bitumen dithranol (Chignoderm, Ditrastik, Antralin) in pediatric dermatology are contraindicated because this substance has carcinogenic properties.

It is recommended to use absorbable ointments in the stationary and regressing stages of plaque psoriasis: 5% tar, 3% sulfur-tar, naphthalene, 2% salicylic. More information - Non - hormonal ointments from psoriasis

Vitamins A, C, B1, B6, B9, B12, B15, PP, taken by courses for 28-30 days with interruptions are called to improve the skin condition.

Also it is possible to carry out physiotherapeutic treatment: UV-therapy (sun baths for 30 minutes a day); narrow-band PUVA therapy (children over 10 years old); in the stage of remission - sea bathing, mud treatment (from 3 to 14 years in a day, for 10 minutes).

Alternative treatment

When rashes on the scalp, alternative treatment involves washing the head with a decoction of St. John's wort (two tablespoons of herb per liter of water). And if, and psoriasis in children under one year, you need to bathe the baby in a decoction of three-part (3 parts), chamomile pharmacy (1 part) and horsetail field (1 part).

It is recommended to lubricate the plaques with such a means: to dry lime branches, to remove the bark (to be 100-150 g), to burn the bark from the metal container and to obtain the semi-liquid resinous substance to lubricate the affected areas (morning and evening).

After this means is over, take a break for 6-7 days and prepare a homemade ointment according to the following recipe. 150 g of fresh cranberries wipe through a sieve, squeeze and the resulting juice boil for 10 minutes. In a thickened juice put a tablespoon of homemade pork lard or melted butter, drip 5 drops of fish oil, stir until homogeneous, pour into a jar with a lid (keep the product in the refrigerator), lubricate the rash at the initial stage of psoriasis in children.

From a mixture of Vaseline and alcohol extract of the sequence (1: 1), a good ointment is obtained for the acute stage of ordinary psoriasis. More information in the article - Treatment of psoriasis in the home

Treatment with herbs in the form of their broths for ingestion to children is not recommended, so it is better to make baths. Ingredients: sage grass (1 part), plantain leaves large (2 parts), tri-colored violet grass (1 part), nettle grass (1 part). The broth is prepared from 1.5 liters of water, filtered and added to the bath. The same broth can rinse your head after washing, when psoriasis in the child on the head. And in the shampoo for washing your head advise to add 10 drops of tea tree oil or juniper essential oil.

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Prevention

Obviously, the prevention of psoriasis in children, given the etiology of the disease, is hardly possible. But to order the baby's nutrition with a similar diagnosis can be, as developed a diet for psoriasis

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