CLINICAL AND IMMUNOLOGICAL FEATURES OF PSORIASIS IN CHILDREN

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 122 CLINICAL AND IMMUNOLOGICAL FEATURES OF PSORIASIS IN CHILDREN A.A. Valiev Tashkent State Medical University https://doi.org/10.5281/zenodo.17783996 Abstract. The given article is devoted to the clinical and immunological analysis of psoriasis in the pediatric population. The study included 60 children aged 5 to 16 years. The study group consisted of 40 children with a confirmed diagnosis of psoriasis and 20 children who formed the control group. Only patients with clinically confirmed psoriasis and without severe comorbidities were included in the study. Keywords: psoriasis, children, immunology, cytokines, IL-17, IL-23, immune status. Introduction and Relevance. The number of children suffering from psoriasis increases every year worldwide. In recent years, there has been a rise in incidence and an increase in the frequency of new cases of psoriasis among children; its prevalence in economically developed countries ranges from 2–8%. According to the World Health Organization (WHO), “…over the next thirty years, the number of children with psoriasis continues to grow steadily, and in various countries around the world, from 0.09% to 11.4% of children suffer from this dermatosis” ¹. The rising incidence of psoriasis especially among the pediatric population its recurrent course, and the increasing number of new cases in children highlight the need to improve pathogenetic treatment methods through the study of the clinical and immunogenetic characteristics of the disease...». The increase in the incidence of psoriasis especially among the pediatric population its recurrent course, as well as the growing number of new cases among children, necessitate the improvement of pathogenetic treatment methods through the study of the clinical and immunogenetic characteristics of the disease. A number of scientific studies are being conducted worldwide aimed at examining the clinical and immunogenetic features of psoriasis and improving treatment approaches. As a result of scientific research conducted in this area, the role of certain polymorphic variants of the TNF-α gene and cytokines in the development of psoriasis in children has been established. Since the presence of polymorphic variants of the TNF-α gene in patients with psoriasis increases the risk of developing the disease and leads to immuno-cytokine alterations, special attention is given to studying the impact of these TNF-α gene variants on the development of psoriasis, the cytokine levels influencing the course of the disease, and the development of an effective algorithm for pathogenetic treatment [1,2,4,5,6]. The observed increase in psoriasis prevalence especially among children along with its recurrent nature and the rising number of new cases in this age group, indicates an urgent need to improve pathogenetic treatment approaches. This requires a more detailed investigation of the clinical and immunological manifestations of the disease [3,7,14,15]. Psoriasis in children differs from that in adults, being characterized by a more severe course, frequent immune system disturbances, and negative impacts on mental and emotional well-being [3,7,8,13]. In Uzbekistan, an increase in childhood psoriasis cases has been noted, which can be explained both by better detection and by adverse environmental influences. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 123 The pathogenesis of psoriasis is driven by immunological disorders, including the activation of T-helper cells (Th1, Th17, Th22) and excessive production of cytokines (IL-17, IL23, TNF-α). This leads to chronic inflammation of the skin and accelerated proliferation of epidermal cells (keratinocytes). Studying the clinical and immunological characteristics of psoriasis in children is essential for timely diagnosis, assessment of disease severity, and the selection of optimal treatment targeting specific pathogenic mechanisms. The aim of the study was to conduct a clinical and immunological assessment of children suffering from psoriasis, to compare immune status indicators and cytokine levels with those of a control group, and to identify possible immunological predictors of disease severity. Clinical and laboratory research methods were used, including the determination of IL-6, IL-17, IL-23, TNF-α levels, and CD4+ and CD8+ lymphocytes. Literature Review. Researchers from CIS countries have conducted a number of studies confirming that immune system disorders play a key role in the development of psoriasis (Khayrutdinov V.R., 2012; Evdokimov E.Yu. et al., 2021). It has been established that certain types of T-cells (Tc17) in psoriatic skin lesions secrete the cytokines IL-17, IL-21, and IL-22. In addition, a high level of TNF-α contributes to the development of the disease by stimulating the production of other inflammatory substances such as IL-1, IL-6, IL-8, as well as activating the NF-κB signaling pathway and cell adhesion molecules (ICAM-1, R-selectin, E-selectin) (Sobolev V.V. et al., 2022). Studies by Uzbek scientists emphasize the role of immune disturbances in the development of psoriasis. Changes in Tand B-lymphocyte subpopulations in children with psoriasis have been shown to be significant (Khaïtov K.N. et al., 2010). Clinical manifestations of moderate and severe psoriasis have also been examined (Melikova Kh.D., Tashkenbaeva U.A. et al., 2023). In patients with various forms of psoriasis, reduced levels of interleukin-2 (IL-2) were noted (Rakhmatov A.B. et al., 2020). Furthermore, a correlation was found between high psoriasis activity (PASI index) and elevated levels of pro-inflammatory cytokines such as IL-1β, IL-8, IL-17, and TNF-α, indicating their association with disease severity (Kh.D.Abdullaev et al., 2020). Modern scientific studies clearly demonstrate that cytokines IL-17 and IL-23 play a key role in the development of psoriasis (Lowes et al., 2014; Blauvelt et al., 2017). The central link in the inflammatory process is the activation of Th17 cells. Interestingly, this T-cell activation is more pronounced in children than in adults (Kleyn et al., 2019). In addition, research has shown that psoriasis may be triggered by genetic predisposition (e.g., HLA-Cw6 and IL-23R gene variants) as well as external factors such as stress and infections (e.g., streptococcal pharyngitis) [9,10,11,12]. Despite limited data in pediatric immunology, scientific evidence strongly indicates significant dysregulation of T-cell immunity in children with psoriasis (Smith J.A. et al., 2020). Along with this, statistics from Uzbekistan show an increasing number of pediatric psoriasis cases, highlighting the need to develop local diagnostic strategies (Abdullaev et al., 2021). Materials and Methods of the Study. For investigating the characteristics of psoriasis in children, 60 participants aged 5 to 16 years were selected. Of these, 40 children had a confirmed diagnosis of psoriasis and met the inclusion criteria (absence of severe comorbid somatic diseases). The control group consisted of 20 children without psoriasis. Exclusion criteria included the presence of autoimmune or oncological diseases, as well as long-term use of immunomodulatory drugs. SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 11 NOVEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 124 The study involved an assessment of the clinical presentation, immune status, and cytokine concentrations (IL-6, IL-17, IL-23, TNF-α) using the ELISA method. The number of CD4+ and CD8+ lymphocytes was determined by flow cytometry. For data analysis, methods of descriptive and inferential statistics were applied, including Student’s t-test and correlation analysis. Results. The results of the study are presented in Table 1. Table 1. Group | IL-6 (pg/mL) IL-17 (pg/mL) IL-23 (pg/mL) TNF-α (pg/mL) Children with psoriasis 15.4 ± 2.1 38.7 ± 4.2 42.3 ± 5.1 30.2 ± 3.4 Control 5.2 ± 1.1 12.4 ± 2.1 14.6 ± 2.2 10.3 ± 1.8 Children with psoriasis showed a significant increase in IL-6, IL-17, IL-23, and TNF-α levels compared to the control group. Additionally, a decrease in the CD4/CD8 ratio was observed, indicating an imbalance in the T-cell component of the immune system. Discussion. The results obtained demonstrate a significant elevation of pro-inflammatory cytokines in children with psoriasis. This is consistent with the findings of foreign authors (Lowes M.A. et al., 2014; Blauvelt A. et al., 2017), confirming the central role of Th17-axis cytokines in the pathogenesis of psoriasis. Comparison with the literature indicates that the immunological patterns in children are similar to those in adults; however, in the pediatric population, these indicators are more pronounced [1,2,16]. The practical significance lies in the possibility of using IL-17 and IL23 as biomarkers for predicting disease severity and selecting therapy. Furthermore, the study opens prospects for the use of targeted biological therapy in pediatric dermatology. Conclusion. Thus, children with psoriasis exhibit significant immune system disturbances characterized by elevated concentrations of pro-inflammatory cytokines such as IL-6, IL-17, IL-23, and TNF-α. 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