medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-19-110-113medsovet-7171Research ArticleДЕРМАТОЛОГИЯDERMATOLOGYОсобенности псориаза у детейFeatures of psoriasis in childrenhttps://orcid.org/0000-0003-1876-0713КрасниковаВ. Н.KrasnikovaV. N.

 Красникова Виктория Николаевна, детский врач-дерматолог 

 127473, Россия, Москва, ул. Селезневская, д. 20 

Viktoriia N. Krasnikova, Pediatric Dermatologist

20, Seleznevskaya St., Moscow, 127473, Russia 

https://orcid.org/0000-0001-5669-4214ЧебышеваС. Н.ChebyshevaS. N.

Чебышева Светлана Николаевна, к.м.н., доцент, доцент кафедры детских болезней Клинического института детского здоровья имени Н.Ф. Филатова 

119435, Россия, Москва, ул. Большая Пироговская, д. 19 

Svetlana N. Chebysheva, Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Childhood Diseases, N.F. Filatov ClinicalInstitute of Children’s Health

19, Bolshaya Pirogovskaya St., Moscow, 119991, Russia 

svetamma@gmail.comhttps://orcid.org/0000-0003-2027-5987СаканияЛ. Р.SakaniyaL. R.

Сакания Луиза Руслановна, врач-дерматовенеролог, младший научный сотрудник; врач-дерматовенеролог, косметолог, трихолог 

 127473, Россия, Москва, ул. Селезневская, д. 20 

109029, Россия, Москва, ул. Средняя Калитниковская, д. 30

Luiza R. Sakaniya, Dermatovenereologist, Junior Researcher; Dermatologist, Cosmetologist, Trichologist

30, Srednyaya Kalitnikovskaya St., Moscow, 109029, Russia

20, Seleznevskaya St, Moscow, 127473, Russia 

https://orcid.org/0000-0002-6583-0318КорсунскаяИ. М.KorsunskayaI. M.

Корсунская Ирина Марковна, д.м.н., профессор, заведующая лабораторией 

109029, Россия, Москва, ул. Средняя Калитниковская, д. 30

Irina M. Korsunskaya, Dr. Sci. (Med.), Professor, Head of the Laboratory

30, Srednyaya Kalitnikovskaya St., Moscow, 109029, Russia 

marykor@bk.ruМосковский научно-практический центр дерматовенерологии и косметологииРоссияMoscow Scientific and Practical Center of Dermatovenereology and CosmetologyRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationМосковский научно-практический центр дерматовенерологии и косметологии; Центр теоретических проблем физико-химической фармакологии РАНРоссияCenter for Theoretical Problems of Physical and Chemical Pharmacology of Russian Academy of Sciences; Moscow Scientific and Practical Center of Dermatovenereology and CosmetologyRussian FederationЦентр теоретических проблем физико-химической фармакологии РАН;РоссияCenter for Theoretical Problems of Physical and Chemical Pharmacology of Russian Academy of SciencesRussian Federation202214112022019110113Copyright © Красникова В.Н., Чебышева С.Н., Сакания Л.Р., Корсунская И.М., 20222022Красникова В.Н., Чебышева С.Н., Сакания Л.Р., Корсунская И.М.Krasnikova V.N., Chebysheva S.N., Sakaniya L.R., Korsunskaya I.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7171

Распространенность псориаза в мире среди взрослого населения достигает порядка 3% и в 2 раза ниже в детской популяции. У детей, так же как и у взрослых, псориаз ассоциирован с рядом различных сопутствующих патологий: метаболическим синдромом, депрессией, тревогой, артритом и другими. Однако диагностика псориаза у детей и последующее лечение представляют собой достаточно сложную задачу. Клиническая картина у педиатрического пациента отличается от проявления заболевания у взрослого. Псориатические бляшки обычно более тонкие и с менее выраженным шелушением и нередко сопровождаются зудом, также для детей характерны необычные области локализации высыпаний, например, преаурикулярная или околопупочная области. Псориатические высыпания в области подгузника зачастую неверно диагностируют как пеленочный дерматит. Однако пеленочный псориаз является наиболее распространенным проявлением, наблюдаемым примерно в 45% случаев у детей в возрасте до 2 лет. У детей наличие псориаза связано с повышенным риском метаболического синдрома и его компонентов и с более высокими показателями гиперлипидемии, даже после контроля веса, в дополнение к наблюдаемому повышенному риску депрессии и тревоги и возможному повышенному риску артрита и болезни Крона. Клиническая картина детского псориаза разнообразна, и диагноз чаще всего ставится клинически. Симптом Ауспитца, феномен Кебнера и кольцо Воронова могут помочь в клинической диагностике. Терапия псориаза у детей во многом основана на тех же принципах, что и у взрослых. Однако лишь немногие из существующих вариантов лечения одобрены для использования у детей и подростков.

The prevalence of psoriasis reaches about 3% of the global adult population and is twice as lower in the paediatric population. In children, as well as in adults, psoriasis is associated with several different concomitant pathologies: metabolic syndrome, depression, anxiety, arthritis, etc. However, the diagnosis of psoriasis in children and subsequent treatment is quite a difficult task. The clinical presentation in a pediatric patient differs from the symptoms of the disease in an adult. Psoriatic patches are usually thinner and with less severe desquamation, which is often accompanied by itching, and children are also characterized with unusual regions of rash localization, such as the periaucular or umbilical region. Psoriatic diaper rash is often misdiagnosed as diaper dermatitis. However, diaper psoriasis is the most common manifestation, seen in about 45% of cases in children under two years of age. In children, the presence of psoriasis is associated with an increased risk of metabolic syndrome and its components, and with higher rates of hyperlipidemia, even after weight management, in addition to an observed increased risk of depression and anxiety and a possible increased risk of arthritis and Crohn’s disease. The clinical presentation of pediatric psoriasis is diverse, and the diagnosis is most often made clinically. Auspitz’s sign, Koebner’s phenomenon, and Voronov’s ring might be of some help in clinical diagnosis. The treatment of psoriasis in children is based primarily on the same principles as in adults. However, few of the existing treatment options are approved for use in children and adolescents.

детский псориаздиагностикапсориатические бляшкивульгарный псориазпеленочный псориазладонно-подошвенный псориазпсориаз ногтейpediatric psoriasisdiagnosticspsoriatic patchespsoriasis vulgarisdiaper psoriasispalmoplantar psoriasisnail psoriasisReferencesNestle F.O., Kaplan D.H., Barker J. Psoriasis. N Engl J Med. 2009;(361):496–509. https://doi.org/10.1056/NEJMra0804595.Nestle F.O., Kaplan D.H., Barker J. Psoriasis. N Engl J Med. 2009;(361):496–509. https://doi.org/10.1056/NEJMra0804595.Arakawa A., Siewert K., Stohr J., Besgen P., Kim S.M., Ruhl G. et al. Melanocyte antigen triggers autoimmunity in human psoriasis. J Exp Med. 2015;212(13):2203–2212. https://doi.org/10.1084/jem.20151093.Arakawa A., Siewert K., Stohr J., Besgen P., Kim S.M., Ruhl G. et al. Melanocyte antigen triggers autoimmunity in human psoriasis. J Exp Med. 2015;212(13):2203–2212. https://doi.org/10.1084/jem.20151093.Christophers E. Psoriasis-epidemiology and clinical spectrum. Clin Exp Dermatol. 2001;26(4):314–320. https://doi.org/10.1046/j.1365-2230.2001.00832.x.Christophers E. Psoriasis-epidemiology and clinical spectrum. Clin Exp Dermatol. 2001;26(4):314–320. https://doi.org/10.1046/j.1365-2230.2001.00832.x.Michalek I.M., Loring B., John S.M. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017;31(2):205–212. https://doi.org/10.1111/jdv.13854.Michalek I.M., Loring B., John S.M. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017;31(2):205–212. https://doi.org/10.1111/jdv.13854.Augustin M., Glaeske G., Radtke M.A., Christophers E., Reich K., Schäfer I. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol. 2010;162(3):633–636. https://doi.org/10.1111/j.1365-2133.2009.09593.x.Augustin M., Glaeske G., Radtke M.A., Christophers E., Reich K., Schäfer I. Epidemiology and comorbidity of psoriasis in children. Br J Dermatol. 2010;162(3):633–636. https://doi.org/10.1111/j.1365-2133.2009.09593.x.Parisi R., Symmons D.P., Griffiths C.E., Ashcroft D.M. Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–385. https://doi.org/10.1038/jid.2012.339.Parisi R., Symmons D.P., Griffiths C.E., Ashcroft D.M. Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–385. https://doi.org/10.1038/jid.2012.339.Harder E., Andersen A.M., Kamper-Jorgensen M., Skov L. No increased risk of fetal death or prolonged time to pregnancy in women with psoriasis. J Invest Dermatol. 2014;134(6):1747–1749. https://doi.org/10.1038/jid.2014.35.Harder E., Andersen A.M., Kamper-Jorgensen M., Skov L. No increased risk of fetal death or prolonged time to pregnancy in women with psoriasis. J Invest Dermatol. 2014;134(6):1747–1749. https://doi.org/10.1038/jid.2014.35.Lonnberg A.S., Skov L., Skytthe A., Kyvik K.O., Pedersen O.B., Thomsen S.F. Heritability of psoriasis in a large twin sample. Br J Dermatol. 2013;169(2):412–416. https://doi.org/10.1111/bjd.12375.Lonnberg A.S., Skov L., Skytthe A., Kyvik K.O., Pedersen O.B., Thomsen S.F. Heritability of psoriasis in a large twin sample. Br J Dermatol. 2013;169(2):412–416. https://doi.org/10.1111/bjd.12375.Matusiewicz D., Koerber A., Schadendorf D., Wasem J., Neumann A. Childhood psoriasis – an analysis of German health insurance data. Pediatr Dermatol. 2014;31(1):8–13. https://doi.org/10.1111/pde.12205.Matusiewicz D., Koerber A., Schadendorf D., Wasem J., Neumann A. Childhood psoriasis – an analysis of German health insurance data. Pediatr Dermatol. 2014;31(1):8–13. https://doi.org/10.1111/pde.12205.Raychaudhuri S.P., Gross J. A comparative study of pediatric onset psoriasis with adult onset psoriasis. Pediatr Dermatol. 2000;17(3):174–178. https://doi.org/10.1046/j.1525-1470.2000.01746.x.Raychaudhuri S.P., Gross J. A comparative study of pediatric onset psoriasis with adult onset psoriasis. Pediatr Dermatol. 2000;17(3):174–178. https://doi.org/10.1046/j.1525-1470.2000.01746.x.Henseler T., Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450–456. https://doi.org/10.1016/S0190-9622(85)70188-0.Henseler T., Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985;13(3):450–456. https://doi.org/10.1016/S0190-9622(85)70188-0.Romiti R., Maragno L., Arnone M., Takahashi M.D. Psoriasis in childhood and adolescence. An Bras Dermatol. 2009;84(1):9–20. https://doi.org/10.1590/S0365-05962009000100002.Romiti R., Maragno L., Arnone M., Takahashi M.D. Psoriasis in childhood and adolescence. An Bras Dermatol. 2009;84(1):9–20. https://doi.org/10.1590/S0365-05962009000100002.Benoit S., Hamm H. Childhood psoriasis. Clin Dermatol. 2007;25(6):555–562. https://doi.org/10.1016/j.clindermatol.2007.08.009.Benoit S., Hamm H. Childhood psoriasis. Clin Dermatol. 2007;25(6):555–562. https://doi.org/10.1016/j.clindermatol.2007.08.009.Morris A., Rogers M., Fischer G., Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol. 2001;18(3):188–198. https://doi.org/10.1046/j.1525-1470.2001.018003188.x.Morris A., Rogers M., Fischer G., Williams K. Childhood psoriasis: a clinical review of 1262 cases. Pediatr Dermatol. 2001;18(3):188–198. https://doi.org/10.1046/j.1525-1470.2001.018003188.x.Lysell J. Psoriasis in childhood and adolescence. Lakartidningen. 2017;114:EUWA. Available at: https://lakartidningen.se/wp-content/uploads/EditorialFiles/WA/%5BEUWA%5D/EUWA.pdf.Lysell J. Psoriasis in childhood and adolescence. Lakartidningen. 2017;114:EUWA. Available at: https://lakartidningen.se/wp-content/uploads/EditorialFiles/WA/%5BEUWA%5D/EUWA.pdf.Fan X., Xiao F.L., Yang S., Liu J.B., Yan K.L., Liang Y.H. et al. Childhood psoriasis: A study of 277 patients from China. J Eur Acad Dermatol Venereol. 2007;21(6):762–765. https://doi.org/10.1111/j.1468-3083.2007.02014.xFan X., Xiao F.L., Yang S., Liu J.B., Yan K.L., Liang Y.H. et al. Childhood psoriasis: A study of 277 patients from China. J Eur Acad Dermatol Venereol. 2007;21(6):762–765. https://doi.org/10.1111/j.1468-3083.2007.02014.xKumar B., Jain R., Sandhu K., Kaur I., Handa S. Epidemiology of childhood psoriasis: A study of 419 patients from northern India. Int J Dermatol. 2004;43(9):654–658. https://doi.org/10.1111/j.1365-4632.2004.02182.x.Kumar B., Jain R., Sandhu K., Kaur I., Handa S. Epidemiology of childhood psoriasis: A study of 419 patients from northern India. Int J Dermatol. 2004;43(9):654–658. https://doi.org/10.1111/j.1365-4632.2004.02182.x.Ko H.C., Jwa S.W., Song M., Kim M.B., Kwon K.S. Clinical course of guttate psoriasis: Long-term follow-up study. J Dermatol. 2010;37(10):894–899. https://doi.org/10.1111/j.1346-8138.2010.00871.x.Ko H.C., Jwa S.W., Song M., Kim M.B., Kwon K.S. Clinical course of guttate psoriasis: Long-term follow-up study. J Dermatol. 2010;37(10):894–899. https://doi.org/10.1111/j.1346-8138.2010.00871.x.Popadic S., Nikolic M. Pustular psoriasis in childhood and adolescence: A 20-year single-center experience. Pediatr Dermatol. 2014;31(5):575–579. https://doi.org/10.1111/pde.12296.Popadic S., Nikolic M. Pustular psoriasis in childhood and adolescence: A 20-year single-center experience. Pediatr Dermatol. 2014;31(5):575–579. https://doi.org/10.1111/pde.12296.Liao P.B., Rubinson R., Howard R., Sanchez G., Frieden I.J. Annular pustular psoriasis-most common form of pustular psoriasis in children: Report of three cases and review of the literature. Pediatr Dermatol. 2002;19(1):19–25. https://doi.org/10.1046/j.1525-1470.2002.00026.x.Liao P.B., Rubinson R., Howard R., Sanchez G., Frieden I.J. Annular pustular psoriasis-most common form of pustular psoriasis in children: Report of three cases and review of the literature. Pediatr Dermatol. 2002;19(1):19–25. https://doi.org/10.1046/j.1525-1470.2002.00026.x.Piraccini B.M., Triantafyllopoulou I., Prevezas C., Starace M., Neri I., Patrizi A. et al. Nail psoriasis in children: Common or uncommon. Results from a 10-year double-center study? Skin Appendage Disord. 2015;(1):43–48. https://doi.org/10.1159/000377709.Piraccini B.M., Triantafyllopoulou I., Prevezas C., Starace M., Neri I., Patrizi A. et al. Nail psoriasis in children: Common or uncommon. Results from a 10-year double-center study? Skin Appendage Disord. 2015;(1):43–48. https://doi.org/10.1159/000377709.Pourchot D., Bodemer C., Phan A., Bursztejn A.C., Hadj-Rabia S., Boralevi F. et al. Nail psoriasis: A systematic evaluation in 313 children with psoriasis. Pediatr Dermatol. 2017;34(1):58–63. https://doi.org/10.1111/pde.13028.Pourchot D., Bodemer C., Phan A., Bursztejn A.C., Hadj-Rabia S., Boralevi F. et al. Nail psoriasis: A systematic evaluation in 313 children with psoriasis. Pediatr Dermatol. 2017;34(1):58–63. https://doi.org/10.1111/pde.13028.Zisman D., Gladman D.D., Stoll M.L., Strand V., Lavi I., Hsu J.J. et al. The juvenile psoriatic arthritis cohort in the CARRA registry: Clinical characteristics, classification, and outcomes. J Rheumatol. 2017;44(3):342–351. https://doi.org/10.3899/jrheum.160717.Zisman D., Gladman D.D., Stoll M.L., Strand V., Lavi I., Hsu J.J. et al. The juvenile psoriatic arthritis cohort in the CARRA registry: Clinical characteristics, classification, and outcomes. J Rheumatol. 2017;44(3):342–351. https://doi.org/10.3899/jrheum.160717.Lara-Corrales I., Xi N., Pope E. Childhood psoriasis treatment: evidence published over the last 5 years. Rev Recent Clin Trials. 2011;6(1):36–43. https://doi.org/10.2174/157488711793980174.Lara-Corrales I., Xi N., Pope E. Childhood psoriasis treatment: evidence published over the last 5 years. Rev Recent Clin Trials. 2011;6(1):36–43. https://doi.org/10.2174/157488711793980174.Sticherling M., Augustin M., Boehncke W.H., Christophers E., Domm S., Gollnick H. et al. Therapy of psoriasis in childhood and adolescence – a German expert con- sensus. J Dtsch Dermatol Ges. 2011;9(10):815–823. https://doi.org/10.1111/j.1610-0387.2011.07668.x.Sticherling M., Augustin M., Boehncke W.H., Christophers E., Domm S., Gollnick H. et al. Therapy of psoriasis in childhood and adolescence – a German expert con- sensus. J Dtsch Dermatol Ges. 2011;9(10):815–823. https://doi.org/10.1111/j.1610-0387.2011.07668.x.

The authors declare that there are no conflicts of interest present.