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Choroby reumatyczne u dzieci. Jak objawiają się na skórze?

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Choroby reumatyczne, choć zwykle kojarzone z występowaniem u osób starszych, pojawiają się także wśród dzieci. Niektóre choroby reumatyczne manifestują się na skórze. Należą do nich m.in. toczeń rumieniowaty, twardzina czy młodzieńcze zapalenie skórno-mięśniowe.

Choroby reumatyczne o podłożu zapalnym mogą występować u dzieci nawet w bardzo wczesnym okresie życia. Niepokojącymi objawami są m.in. bóle i obrzęki stawów, bóle kręgosłupa, mięśni, a także osłabienie, gorączka, wysypka, wypadanie włosów czy afty w jamie ustnej. Niektóre choroby reumatyczne charakteryzują się również rozległymi zmianami skórnymi.

Toczeń rumieniowaty układowy u dzieci

Toczeń rumieniowaty układowy jest przewlekłą chorobą autoimmunologiczną. Może zajmować wiele narządów i tkanek, w szczególności stawy, skórę, serce, płuca, układ nerwowy i nerki. U dzieci schorzenie najczęściej rozpoczyna się w wieku od 11. do 15. roku życia zarówno u dziewcząt, jak i chłopców.

Toczeń rumieniowaty objawia się charakterystycznym rumieniem twarzy w kształcie motyla. Rumień ma formę lekko wypukłego zaczerwienienia skóry. Obejmuje policzki, grzbiet nosa, czasem czoło, okolice oczu, szyję i dekolt. Objaw ten występuje znacznie częściej u dzieci niż u dorosłych i nie powoduje bliznowacenia. Toczeń rumieniowaty układowy manifestuje się również liszajem krążkowym i pokrzywką, jednak te objawy rzadziej dotyczą małych pacjentów. U pacjentów z toczniem rumieniowatym występuje również nadwrażliwość na światło słoneczne.

Toczeń rumieniowaty u noworodków

W wyniku biernego przeniesienia przeciwciał z krwioobiegu matki do płodu w czasie ciąży u noworodków może pojawić się toczeń rumieniowaty noworodkowy. Objawia się charakterystycznymi zmianami skórnymi, mogącymi pojawiać się tuż po urodzeniu lub w ciągu pierwszych tygodni życia. Manifestacje skórne zwykle związane są z ekspozycją na działanie promieni słonecznych.

Objawy skórne obejmują rumień na twarzy w okolicach oczodołów, owłosionej skóry głowy oraz szyi. Rzadziej manifestują się na tułowiu bądź kończynach. Mają gładką powierzchnię z delikatnym złuszczeniem. Zmiany mogą również przybierać postać wykwitów podobnych do pokrzywki. Mogą się złuszczać, ulegać wrzodzeniu i tworzyć strupy. W toczniu rumieniowatym u noworodków pojawiają się również uogólnione ogniska rumieniowo-obrzękowe, obrączkowe lub policykliczne, a także zmiany pęcherzowe (zwłaszcza na podeszwach stóp). Objawy często ustępują w ciągu 5 do 7 miesięcy po narodzinach dziecka. Manifestacje skórne mogą być nietypowe, często mylone są z atopowym lub łojotokowym zapaleniem skóry.

Twardzina ograniczona i uogólniona

Twardzina u dzieci występuje w dwóch postaciach: ograniczonej i uogólnionej (znacznie rzadziej).

Twardzina ograniczona częściej pojawia się u dziewczynek niż u chłopców. Pierwsze jej objawy mogą manifestować się już w 1. roku życia. Zmiany skórne najczęściej przybierają postać wykwitów skórnych o woskowatym lub porcelanowym zabarwieniu, które są wyraźnie odgraniczone od zdrowej skóry. Twardzina ograniczona podzielona została na kilka odmian:

  • twardzina ograniczona linijna – najczęściej występująca u dzieci odmiana. Zmiany skórne dotyczą głównie kończyn i są asymetryczne.
  • twardzina ograniczona tzw. cięta szablą – objawia się na skórze twarzy i owłosionej skórze głowy. Przebiega linijnie.
  • twardzina ograniczona plackowata – manifestuje się licznymi stwardniałymi ogniskami o woskowożółtym zabarwieniu, w aktywnej fazie choroby ogniska otoczone są sinofioletową linią.

Twardzina uogólniona znacznie rzadziej dotyka dzieci. Objawy mają postać stwardniałych zmian na twarzy, szyi, tułowiu i kończynach. Na opuszkach palców mogą pojawiać się trudno gojące się owrzodzenia. Twarz pacjentów w tej postaci twardziny jest amimiczna. Dochodzi również do wyraźnego zaniku czerwieni wargowej oraz czerwieni skrzydełek nosa.

Młodzieńcze zapalenie skórno-mięśniowe

Ta choroba reumatyczna objawia się najczęściej w obrębie małych naczyń krwionośnych zlokalizowanych w skórze i mięśniach. Na młodzieńcze zapalenie skórno-mięśniowe częściej chorują dziewczynki niż chłopcy. Pierwsze objawy manifestują się w 3.-10. roku życia.

Objawy obejmują heliotropowy rumień powiek (w kształcie okularów) i okolicy nosa, który charakteryzuje się lekko fioletowym zabarwieniem. Zmiana może również dotyczyć fałdów nosowo-wargowych oraz brody i układać się w kształt motyla. U najmłodszych pacjentów występuje także rozległy rumień okolicy stawów rąk, stóp i łokci. Zmianom może towarzyszyć rogowacenie i złuszczanie się naskórka.

W przebiegu młodzieńczego zapalenia skórno-mięśniowego często dochodzi również do obrzęku okolicy płytki paznokciowej, a w okolicach szyi i dekoltu manifestują się wrażliwe na działanie promieni słonecznych zmiany skórne. Chorobie towarzyszyć mogą również grudki Gottrona – sinawe grudki z przerostem naskórka, które zlokalizowane są po wyprostnej stronie stawów łokciowych, kolanowych i skokowych, niekiedy nadgarstków. Innymi objawami choroby są również owrzodzenia i nadżerki w okolicach pachwin, pod pachami i w kącikach oczu – zmiany te są jednak częściej spotykane u dorosłych pacjentów. W obrębie wałów paznokciowych mogą pojawiać się rumienie z obrzękiem, wybroczynami, teleangiektazjami czy owrzodzenia troficzne.

Źródła:

dermatologia-praktyczna.pl

mp.pl

K. Lun Hon, A. K.C. Leung, Toczeń rumieniowaty noworodków, Dermatologia po Dyplomie 2013;4(1), str. 32-40

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