van de Kerkhof P C
Department of Dermatology, University Hospital Nijmegen, the Netherlands.
Clin Exp Dermatol. 2001 Jun;26(4):356-61. doi: 10.1046/j.1365-2230.2001.00829.x.
Long-term management of psoriasis requires an individualized approach. Some treatments such as calcipotriol, methotrexate and acitretin may be used as maintenance treatment for many months. However, most anti-psoriasis treatments should be prescribed for restricted periods of time. Rotational treatment is a practical approach to reduce the cumulative toxicity of anti-psoriasis treatments. The selection of a treatment is based on the clinical presentation of psoriasis and whether contraindications might exist. Combination treatment is another approach, which is used by the majority of patients. Useful combinations are calcipotriol-acitretin, calcipotriol-cyclosporin, calcipotriol-PUVA, calcipotriol-topical corticosteroids, dithranol-UVB, dithranol-tar, coaltar-UVB, acitretin-UVB and acitretin-PUVA. Combinations which are contraindicated are coaltar-PUVA, UVB-cyclosporin, PUVA-cyclosporin and methotrexate-acitretin. Combined use of UVB-methotrexate, UVB-PUVA; PUVA-methotrexate; methotrexate-cyclosporin and cyclosporin-acitretin require careful monitoring and might be helpful in patients with severe and recalcitrant psoriasis. Depending on the individual presentation of psoriasis, previous anti-psoriatic treatments and side-effects, treatment adjustments are made.
银屑病的长期管理需要个体化方法。一些治疗方法，如卡泊三醇、甲氨蝶呤和阿维A，可作为维持治疗使用数月。然而，大多数抗银屑病治疗应在限定的时间段内开具处方。轮换治疗是一种降低抗银屑病治疗累积毒性的实用方法。治疗的选择基于银屑病的临床表现以及是否可能存在禁忌证。联合治疗是另一种方法，大多数患者会采用。有效的联合方案有卡泊三醇 - 阿维A、卡泊三醇 - 环孢素、卡泊三醇 - 光化学疗法（PUVA）、卡泊三醇 - 外用糖皮质激素、地蒽酚 - 紫外线B（UVB）、地蒽酚 - 焦油、煤焦油 - UVB、阿维A - UVB和阿维A - PUVA。禁忌的联合方案有煤焦油 - PUVA、UVB - 环孢素、PUVA - 环孢素以及甲氨蝶呤 - 阿维A。UVB与甲氨蝶呤、UVB与PUVA、PUVA与甲氨蝶呤、甲氨蝶呤与环孢素以及环孢素与阿维A的联合使用需要仔细监测，可能对重度和顽固性银屑病患者有帮助。根据银屑病的个体表现、既往抗银屑病治疗情况及副作用，进行治疗调整。
