psychosocial impact on children affected by the psoriasis at the ... 48(41.4%) children and stationary phase with joined plaque-type papular rashes covered.
Open Access Research Journal, www.pieb.cz ISSN: 1804-1884 (Print)
Medical and Health Science Journal, MHS Volume 3,2010, pp. 25-28
CHILDREN PSORIASIS AND PSYCHOSOCIAL FACTORS Psoriasis is common inflammatory skin disease. A total 156 children with different clinical form of psoriasis were included in study. The age of examined patients was from 7 to 14 years, middle age is 9.3±0.6. The manifestation of disease was marked 5.4±0.4 years. The aim of this paper is to research the psychosocial impact on children affected by the psoriasis at the manifestation and recurrent stage of the disease. The psychosocial surrounding of the child significantly changes the duration of the disease. Keywords:
Childhood psoriasis, psychosocial trigger factors.
UDC:
616.5-001/-002: 616.517-053.3/5
KAHRAMON KHAITOV
Department of Dermatovenereology, Tashkent Pediatric Medical Institute, Uzbekistan
Introduction
Psoriasis is a common chronic inflammatory skin disease associated with significant morbidity, including impairment in quality of life, encompassing functional, psychological, and social dimensions (Griffits and Barker, 2007). Psoriasis vulgaris is a disease with an incidence of 1.5% to 2% in Western industrialized countries (Nevitt and Hutchinson, 1996). Studying psoriasis etiology and pathogenesis is given great attention since it affects the choice of correct treatment strategy (Smith and Barker, 2006). There are many theories explaining causes and mechanisms of the development of these dermatoses. The predominant point of view is that psoriasis is a systemic disease of organism of multifactorial nature with participation of genetic and environmental factors (Langley et al., 2005). The most important causes triggering psoriasis include neuro-psychological trauma, stress, long exertion (Farber et al., 1986). Stress can play a trigger role in breakdown of adaptive organism’s system, leading to psoriasis development. Due to nervous-psychic genesis of psoriasis stress situations initiate the cascade of biochemical and immunological reactions leading to psoriatic focus (Jankovic et al., I987). Stress situations for children take place in families, schools, in relationships with parents, contemporaries. The start and exacerbation of dermatoses depend on many psychosocial risk factors at child’s age (Nyfors and Lomholt, 1975). The aim of the research was to study the significance of psychosocial risk factors in formation of psoriasis in children. Materials and methods
156 children with psoriasis at the age from 7 to 14 years were examined in dermatological department of Tashkent Pediatric Medical Institute from 2006 to 2008. The manifestation of disease was marked at 5.4±0.4 years in average. The duration of psoriasis varied from 2 weeks to 11 years. In all examined patients the cutaneous pathological process was of prevalent character, with predominant localization of papular rash on hair part of head, extensor surfaces of hands and legs. Progressive stage of psoriasis with particular small papular rash with hyperaemic inflammatory rim on the periphery was observed in 48(41.4%) children and stationary phase with joined plaque-type papular rashes covered with dirty grey small lamellar squamules - in 68(58.6%) patients. Genetic predisposition was observed in 74 (63.8%) patients, presence of disease was 32(27.6%) in father, in mother it was 11(9.5%), 21(18.1%) was in sibs, 51(43.9%) was in siblings. © 2010 Prague Development Center
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Medical and Health Science Journal / MHSJ / ISSN: 1804-1884 (Print)
Questionnaires for children and parents, considering a variety of relationships of patients in families and schools, were used as the main research methods to identify the effect of surrounding psychosocial risk factors. Results of study
Among psychosocial factors leading to the initiation and recurrence there were often noted unsatisfactory accommodation conditions in family (30.1%), problematic relationships with parents (37.8%), conflicts with mother and father (28.2%), conflicts and quarrels between parents in family (43.4%), unsatisfactory relations with their coevals, pathology in education (Table1). In some cases, the causes of stresses and emotional disturbances were problematic situations, occurring at school: problems with teachers, change of school, negative attitude and unwillingness to attend school because of the complications with classmates, dissatisfaction and concern about educational progress. To a lesser extent there were identified quarrels and conflicts with siblings (13.4%), feelings about the divorce of parents and the inferiority of the family (10,9%), concern about parents’ or relatives’ disease (17.9%). The revealed psychosocial factors aggravated psoriasis clinic and were the causes of persistence of disease symptoms to treatment. TABLE 1. PSYCHOSOCIAL RISK FACTORS IN CHILDREN WITH PSORIASIS Risk factors
Number of patients n - 156 absol. %
Unsatisfactory accommodation Problems in interaction with parents Educational pathology Conflicts with mother and father Conflicts in family with brothers and sisters Conflicts between parents Conflicts with coevals Problems with teachers at school Incomplete family Worries about illness of parents Death of close relatives Residency change Change of school Negative attitude to school because of problems with coevals Negative attitude to education Educational progress trouble
47 59 57 44 21 68 59 42 17 28 14 21 33 67
30.1 37.8 36.5 28.2 13.4 43.5 37.8 26.9 10.9 17.9 8.9 13.4 21.1 42.9
61 75
39.1 48.1
From the very beginning of his life a man is involved in social interaction, which results in forming his identity. Socialization is the process and the product of assimilation and subsequent active reproduction by a person of his individual social experience. Family, preschool institutions, school are important stages of persons’ socialization. A person may develop in different conditions: hypoprotection is lack of trusteeship and control, interest to work and life of a child; dominating hyperprotection is an extreme control and little trusteeship which suppresses sense of responsibility and duty, restricts development of self-reliance; promoting hyperprotection is lack of control and non-critical attitude to behavioral disorder; training in “disease’s cult” when sickness gives a child exclusive rights and puts him in the center of family’s attention; emotional rejection when a child feels as a burden; condition of severe relationships - breakdowns, rage and cruelty; condition of excessive emotional responsibility - a child carries adult problems and excessive expectations; contradictory education - incompatible educational approaches of different family members. Among the examined children with psoriasis in families different conditions of person’s formation were marked: hypoprotection (21.7%), promoting and dominating hyperprotection (30.7%), training in “disease’s cult” (10.2%), conditions of © 2010 Prague Development Center
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Medical and Health Science Journal / MHSJ / ISSN: 1804-1884 (Print)
excessive emotional responsibility (19.8%), contradictory education (8.9%) (Table 2). Negative influence of these family environment settings often lead to development of inner conflict situation in sick children, contributing to recurring and progression of psoriatic process. TABLE 2. CONDITIONS OF PERSONALITY DEVELOPMENT OF CHILDREN, SUFFERING FROM PSORIASIS Variants of development Hypoprotection Dominating hyperprotection Promoting hyperprotection Training in “disease’s cult” Emotional rejection Condition of severe interaction Condition of excessive emotional responsibility Contradictory education
absol.(n – 156) 34 21 27 16 7 6 31 14
% 21.7 13.4 17.3 10.2 4.5 3.8 19.8 8.9
Relationship with parents is important for the development of children; parents by their attitude, behavior, presence or absence of attention to child’s problems affect the formation of self-reliance, confidence, and independence of the individual. The following types of behavior of parents in the family can be distinguished: Model of behavior I (Authoritative parental control). Parents treat their children tenderly, with warmth and understanding, friendly, they often talk with them, children are under control, demand a conscious behavior. While listening their children and respecting their independence they did not come from their desire, adhere to reasonable rules, directly and clearly explain their own requirements. Model of behavior II (Forceful parental control). Parents rely more on strictness and punishment, treat children with less warmth, sympathy and understanding, they rarely interact with them. Parents strictly control their children, easily use their power, do not allow children to express their opinion. Such education leads to the development of insecure, distrustful and closed children. Model of behavior III (Condescending parental attitude). Parents are not demanding, condescending, non-organized, they are poorly adjusted to life. They do not encourage children; very rarely make comments, do not pay attention to the development of the child’s independence and confidence. As a result, children grow up unsure of themselves, closed and mistrustful. Forceful model of behavior was dominated in 50.6% of surveyed families with children suffering from psoriasis; this model led to the development of conflict situations between children and parents (Table 3). Disease recurrence was marked up to 5-6 times a year in such children; and the disease was characterized by widespread and persistent clinical course. Condescending model of behavior was observed not often (20%); in such families the carelessness from parents to the problems of sick children led to the development of complications, atypical forms of the disease. Favorable prognostic situation existed in families with authoritative parental control, as timely treatment of doctor, necessary attention to the problems of the child, monitoring his condition in post-clinical period conditioned a long-term remission of psoriasis. TABLE 3. BEHAVIORAL INTERACTION OF PARENTS IN FAMILIES WITH CHILDREN SUFFERING FROM PSORIASIS
Models of behavior Authoritative parental control Forceful parental control Condescending
© 2010 Prague Development Center
absol. 46 79 31
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% 29.4 50.6 20
Medical and Health Science Journal / MHSJ / ISSN: 1804-1884 (Print)
Conclusion
Thus, psoriasis is a complex pathology of skin and trigger mechanisms leading to the beginning or exacerbations of the disease plays important role in the development of the disease. Various damaging situations occurring in families, schools, during communication with coevals, in relations between parents and children, parents’ behavior patterns have significant influence on patients. These psychosocial factors influence clinical symptoms, course, and duration of psoriasis in children. Identification and exclusion of these factors have a positive impact on the dynamics of the disease, increase the effectiveness of therapy of dermatosis. References Farber, E., Nickoloff, B., Recht, B. et al., 1986. “Stress, symmetry and psoriasis: Possible role of neuropeptides,” Journal American Academy of Dermatology, Vol.14, pp.305-11. Griffits, C., Barker, J., 2007. “Pathogenesis and clinical features of psoriasis,” Lancet, Vol.370, pp.263-71. Jankovic, B., Markovic, B., Spector, N., 1987. “Neuroendocrine correlates of neuroimmunomodulation,” Annals of the New York Academy of Science, Vol.496, pp.103-107. Langley, R., Krueger, G., Griffiths, C., 2005. “Psoriasis: Epidemiology, clinical features and quality of life,” Annals of the Rheumatic Diseases, Vol.64(Suppl.2), pp.18-23. Nevitt, G., Hutchinson, P., 1996. “Psoriasis in the community: Prevalence, severity and patients’ beliefs and attitudes towards the disease,” British Journal of Dermatology, Vol.135, pp.533-37. Nyfors, A., Lomholt, K., 1975. “Psoriasis in children. A short review of 245 cases,” British Journal of Dermatology, Vol.72, pp.437-42. Smith, C., Barker, J., 2006. “Management of psoriasis,” British Medical Journal, Vol.333, pp.380-84.
© 2010 Prague Development Center
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