银屑病:当前观点,重点在于治疗
Psoriasis: current perspectives with an emphasis on treatment.
作者信息
Linden K G, Weinstein G D
机构信息
Department of Dermatology, University of California, Irvine 92697, USA.
出版信息
Am J Med. 1999 Dec;107(6):595-605. doi: 10.1016/s0002-9343(99)00284-3.
An individualized treatment regimen is necessary for each patient with psoriasis because of the diverse nature of the disease. The manifestation of psoriasis, the severity and extent of the lesions, and the medical history and lifestyle of the patient are important factors that determine the selection of treatment, but in general therapies with the fewest side effects are preferred. First-line topical treatments are corticosteroids, calcipotriene, and tazarotene. If topical treatments are unsuccessful, phototherapy with ultraviolet B or photochemotherapy with psoralens plus ultraviolet A (PUVA) are the next choices. If psoriasis fails to respond to an adequate trial of topical therapy or phototherapy, systemic therapies including methotrexate, acitretin, or cyclosporin should be initiated. Because the regimens involved in systemic and phototherapy are complex and require frequent dose adjustments and specialized equipment, the patient should be referred to a dermatologist when topical therapy is not effective.
由于银屑病具有多样性,因此为每位银屑病患者制定个性化治疗方案很有必要。银屑病的表现、皮损的严重程度和范围,以及患者的病史和生活方式都是决定治疗选择的重要因素,但一般而言,副作用最少的疗法是首选。一线外用治疗药物有皮质类固醇、卡泊三烯和他扎罗汀。如果外用治疗无效,接下来可选择紫外线B光疗或补骨脂素加紫外线A光化学疗法(PUVA)。如果银屑病对充分的外用治疗或光疗试验无反应,则应开始使用包括甲氨蝶呤、阿维A或环孢素在内的全身治疗。由于全身治疗和光疗方案复杂,需要频繁调整剂量并使用专门设备,因此当外用治疗无效时,应将患者转诊给皮肤科医生。