Objective — to аssess the impact of dermatosis on the quality of life of children with psoriasis. Materials and methods. Psoriasis severity indices (BSA, PASI, PGA) and dermatological life quality indices (DLQI, CDLQI) in children with psoriasis aged 4 to 17 years depending on the clinical and epidemiological features of dermatosis were determined. A correlation analysis of the presence of a relationship between the obtained indicators was carried out. Results and discussion. In 73.81 % of children, the BSA index was higher than 10, which provided an average BSA of 25.85 (8.78—38.38). The calculated PASI index at the beginning of treatment averaged 9.3 (3.6—18.9). 53.06 % of children had PASI < 10. The PASI index at the first diagnosis was almost 1.5 times lower than in relapses (p = 0.043). The average PGA index was 3 (2—3), namely, 32.99 % of children had PGA 1—2, 43.20 % had PGA 3 and 23.81 % of children had PGA 4. In the group of children aged 4—7 years, there was the smallest number of participants with the PGA index 4 (7.69 %), while in the group aged 16/17—17 years, this number was the largest (41.49 %) (p = 0.039). The calculated DLQI in children with psoriasis was 5 [3—9]. The average DLQI indicator in the group of girls was statistically higher than in the group of boys (p = 0.016). Statistically significant differences were identified between DLQI in the age groups, where the highest impact on quality of life was found for the children aged 16—17 years (p < 0.001) and depended on the clinical form of psoriasis: in scalp psoriasis, the impact on quality of life was moderate, and in inverse psoriasis, it was insignificant (p = 0.021). It was found that in moderatesevere/severe psoriasis, the impact on the quality of life in children increased and was assessed as moderate, while in mild psoriasis, the impact was assessed as minor (p < 0.05). Conclusions. The course of psoriasis in children can be assessed as moderate and severe, but in the first episodes of psoriasis in droplet and inverse forms, the course is mostly mild. The intensity of skin manifestations increases with age, especially in case of the disease recurrences in the plaque form. On the whole in children, psoriasis has an ambiguous impact on the quality of life: in boys, the impact of the disease is minor; in girls, it is moderate. Damage to the visible skin areas caused by psoriasis, an increase in the area affected by the pathological process and an increase in the intensity of skin manifestations with age leads to a more negative impact on the quality of life of a child.
Features of clinical course of psoriasis in children depending on haplotypes of the VDR gene and vitamin D level Objective. To compare epidemiological and clinical features of psoriasis in children depending on the studied haplotypes of the VDR gene and vitamin D level. Materials and methods. We examined 56 children with psoriasis, 23 boys and 33 girls aged 4-17, the mean age-12.30±0.45 years. Psoriasis was determined based on clinical findings and generally accepted diagnostic criteria. The severity and extent of body surface involvement were assessed on PASI, PGA, BSA indices. The buccal epithelium, taken from children, served as the material for genotyping. Polymorphic variants of the VDR gene were detected using the polymerase chain reaction technique and the following restriction fragment length polymorphism analysis. The values were calculated using the STATISTICA software package. Results. Five haplotypes of the VDR gene: TTCC, TTAC, TCAA, TCAС, CCAA were detected in children with psoriasis on the back of the study. Boys outnumbered in TTCC group, while girls in others. The age of disease onset in CCAA group was the youngest (5.6±1.69 years) while disease duration was among the longest (6.00±0.67 years). The TCAA haplotype indicated the shortest duration of psoriatic exacerbation (4.2±1.11 weeks), which gradually decreases over the years, and the considerable correlation (r=-0.56) with disease duration takes place. The lowest PGA index was in case of the TCAC haplotype (2.70±0.19), the highest-the TTAC (3.50±0.34) and TTCC (3.31±0.22) haplotypes. PASI and BSA indices were the highest in the presence of the CCAA haplotype. Average serum values of vitamin D in children with psoriasis were insufficient except for CCAA group-being optimal and the highest (32.17±4.22 ng/ml). Considerable, large and extremely large correlations between vitamin D serum levels in children with psoriasis and disease duration in the presence of TTCC, TTAC and TCAA haplotypes, between disease intensity and extent of body surface involvement in case of CCAA, TCAA and TCAC haplotypes were detected. Conclusions. Genotyping recognized 5 haplotypes-TTCC, TTAC, TCAA, TCAC, CCAA-that predetermine epidemiological and clinical features of psoriasis. It was concluded that in children with the TCAA haplotype, a younger age at the time of disease onset results in more durable exacerbation with age. In case of CCAA and TTAC haplotypes conversely, psoriatic exacerbation is shorter with age. A decrease in the level of serum vitamin D in children having TTCC, TTAC and TCAA haplotypes leads to an increase of exacerbation duration, while in the presence of TCAA, TCAC, CCAA haplotypes-an increase in the severity of psoriasis.
The objective. To study and analyze the differences in prevalence of ApaI (A/C) and TaqI (T/C) polymorphic variants of the VDR gene in children with psoriasis depending on gender. Materials and methods. We examined 56 children with psoriasis aged 4–17. Psoriasis was determined based on clinical findings and generally accepted diagnostic criteria. The buccal epithelium, taken from children, served as the material for genotyping. ApaI and TaqI polymorphisms of the VDR gene were detected using the polymerase chain reaction (PCR) technique and the following restriction fragment length polymorphism (RFLP) analysis. The values were calculated using the STATISTICA software package. Results and discussion. When studying polymorphic variants of the VDR gene, AC (48.21%) and TC (47.37%) heterozygotes were identified to prevail by ApaI (A/C) and TaqI (T/C) allele frequency in the group of children with psoriasis. In the group of boys with psoriasis the number of AA homozygotes (8.70%) by ApaI was apparently less than in the group of healthy ones (58.33%), TT homozygous variants (56.52%) prevailed by TaqI polymorphic variant, while in the group of healthy boys – TC heterozygotes (44.00%). Based on the research results the increasing frequency of the ApaI C allele (0.56) and significant frequency of the TaqI T allele (0.68), which prevails due to the distinctions between groups of boys with psoriasis and healthy ones, were registered in the group of children with psoriasis. Five haplotype combinations, in the loci studied, were detected in children, and TTCC haplotype (32.14%) as well as TCAC (35.71%) prevailed, while CCAA haplotype (8.93%) was least in number. Conclusion. Statistically significant differences by the frequency of ApaI (A/C) and TaqI (T/C) polymorphic variants were detected between groups of children with psoriasis and healthy children. While grouping haplotype frequencies by two polymorphic variants of the VDR gene, a statistically significant difference was detected between groups of children with psoriasis and healthy ones, which takes place due to a statistically significant difference in the frequencies of TTAA and TTCC haplotypes between groups. The risk of psoriasis was reported to be the highest in children with TTCC haplotype.
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