There is an itch that can keep you up at night, and not only that, it’s recurring – it’s psoriasis!
Psoriasis, commonly known as “psoriasis”, is one of the most common skin diseases. It is an immune-mediated, chronic, relapsing, inflammatory, systemic disease that is triggered by a combination of genetics and the environment.
Psoriasis picture
The typical manifestation of psoriasis is a red papule or plaque covered with multiple layers of silvery white scales, etc., which may be accompanied by intense itching, pins and needles and pain, limited or widely distributed, and non-infectious, with the elbows, knees, scalp, hands and feet being the most common.
So far, the pathogenesis of psoriasis is not yet clear, and a large number of studies at home and abroad have found that it may be related to genetic factors, environmental factors, autoimmune factors, psycho-neurological factors and infectious factors.
According to authoritative statistics, the global prevalence of psoriasis is about 2%, and its epidemiological characteristics vary according to age, gender and geographical area, and the prevalence of psoriasis varies from region to region, with higher prevalence in high latitudes and white races, and relatively lower in East Asian countries. The prevalence of psoriasis in China is about 0.47%, with more than 6.5 million patients, and about 30% of psoriasis patients have developed moderate to severe disease.
In addition, according to the research data in recent years, with the acceleration of modernization, people’s lifestyle and environmental changes, the incidence of psoriasis is gradually increasing, which has a trend of “underage”, many children suffer from it!
According to the clinical performance, psoriasis is mainly divided into four types, including common, pustular, erythrodermic and arthritic psoriasis.
1.Unusual psoriasis
Psoriasis vulgaris is the most common type of psoriasis and also the most common type of psoriasis in children, which can be divided into plaque psoriasis and drip psoriasis according to clinical performance.
Psoriasis vulgaris
(1) Plaque-like psoriasis: It is mainly manifested as red papules and plaques with widespread or restricted distribution, covered with silvery-white scales, and accompanied by itching and peeling, mainly distributed on the trunk, limbs, scalp and other parts. This type accounts for about 70% of psoriasis in children. Compared with adults, the erythematous plaques covered with white scales are smaller and thinner, with less obvious infiltration, and often occur on the face and flexors of the body. The scalp is usually the first site of psoriasis in children, and girls are more likely to develop it.
Reverse psoriasis is more common in children than adults, appearing as moist, slightly greasy scaly red patches or plaques in folds and some flexural areas; and diaper area psoriasis is a special type of childhood psoriasis, commonly seen in infants and children <2 years old, and differs from diaper dermatitis manifestations in that diaper area psoriasis is characterized by well-defined, bright red, slightly elevated plaques, often with maceration, and the groin area is often involved.
(2) Pitting psoriasis: it often develops after acute upper respiratory tract infection, and its clinical manifestation is a well-defined red papule or macule with a diameter of 2~5 mm, covered with a little scale, most commonly on the trunk and limbs, accompanied by different degrees of itching. Pitting psoriasis has a tendency to fade on its own, while some continue to develop into plaque psoriasis. This type is more common in children and in the progressive stage of psoriasis, and is often associated with streptococcal infection of the respiratory tract.
2.Pustular psoriasis
Pustular psoriasis is relatively rare and can be divided into two types: generalized and limited.
(1) generalized pustular psoriasis: it is mostly of acute onset and quickly spreads all over the body, accompanied by high fever, general discomfort and increased white blood cells. The damage is dense pinhead to corn-sized, yellowish or yellow-white shallow sterile pustules on the basis of erythema, often densely distributed, with the flexural folds of the extremities being the most common, and easily fused to form pus lakes. The pustules dry, crust, and desquamate, but they often recur periodically and have a stubborn course.
(2) Limited pustular psoriasis: mainly palmoplantar pustular psoriasis, also known as palmoplantar pustulosis and limited continuous limb dermatitis. Occurred in the palm, fish, metatarsal and heel lateral edge of the erythematous flaking area of the cluster, small deep in the sexual pustules, after absorption to leave brown spots.
3.Erythrodermic psoriasis
Erythrodermic psoriasis is the most serious type of psoriasis, and its treatment time is also longer, and even affects the life of patients. The main manifestation is the flushing, swelling and flaking of the skin of the whole body, the area of the skin lesion is greater than 70% of the whole body surface area, accompanied by fever and a lot of flaking. At this time, the flakes appear as fine as bran, and even yellow and brown flakes.
In some patients, the epidermis will peel and exude due to swelling in the armpits, thighs and umbilicus, and the oropharynx, nose and conjunctiva of the eyes may be congested and red.
4.Arthritic psoriasis
Psoriasis arthritis (PsA) is also known as arthritis of the joints. Most of the PsA occurs after psoriasis, while some of the arthritis occurs at the same time as psoriasis or before psoriasis. The main symptoms are erythematous scaling of the skin, swelling and pain in the small asymmetrical joints of the palms of the hands and feet, and gradually the joints become enlarged, with restricted movement and even irreversible reactions at the end.
Psoriasis of the joints
PsA can start at any age in children, with peaks at 2 to 3 years of age (early onset) and 10 to 12 years of age (late onset), with a predominantly inflammatory arthritic clinical presentation.
References
[1] Shi Yuling. Interpretation of the Chinese psoriasis diagnosis and treatment guidelines (2018 edition) [J]. Journal of Tongji University (Medical Edition),2019,40(03):265-267.
[2]Huang D,Chen Kun. Advances in epidemiological investigations related to psoriasis[J]. Diagnostic theory and practice,2021,20(01):48-52.