van der Vleuten C J, van de Kerkhof P C
Department of Dermatology, University Hospital Nijmegen, The Netherlands.
Drugs. 2001;61(11):1593-8. doi: 10.2165/00003495-200161110-00006.
Scalp psoriasis is a frequent expression of the common skin disease psoriasis, and scaling and itching are the two major complaints. Topical treatments are the mainstay of the treatment of psoriasis of the scalp, with the vehicle as well as the active ingredient relevant to efficacy, tolerability and compliance. Vehicles can be shampoos, lotions, gels, foams, creams and more greasy ointments. Active ingredients are keratolytics, coal tar (liquor carbonis detergens), dithranol, corticosteroids and vitamin D3 analogues. Some effect has also been described from topical or systemic imidazole derivatives. Topical corticosteroids remain the mainstay in the treatment of scalp psoriasis. The effects are rapid, the formulations are patient friendly and the adverse effects seem limited, although no data are available to support safety during prolonged use (more than 4 weeks). Topical vitamin D3 analogues have been available for the treatment of psoriasis since 1992. In the lotion formulation in particular, vitamin D3 analogues are a patient friendly, tolerable and effective alternative to corticosteroids, although the effects are optimal after 8 weeks, in contrast to 2-3 weeks for topical corticosteroids. Facial irritation (often temporary) can also be a disadvantage of vitamin D3 analogues, although only a small proportion of patients stop treatment for this reason. All other treatment options for psoriasis, such as tazarotene, phototherapy and systemic treatment with methotrexate, acitretin and cyclosporin are often not indicated or not suitable for treatment of the scalp. In daily practice, to make a choice from the available therapeutic arsenal for psoriasis, each patient should be examined individually. Deteriorating factors have to be excluded. For scaling, keratolysis is the first step. Subsequently, active treatment can be chosen depending on the clinical picture. When the psoriatic lesions are mainly characterised by inflammation, anti-inflammatory drugs such as topical corticosteroids are indicated. When scaling is the more important clinical feature, vitamin D3 analogues are indicated. Generally, intermittently used topical corticosteroids alternating with vitamin D3 derivatives either combined or not with liquor carbonis detergens containing shampoo is the most suitable treatment for most patients. Because psoriasis capitis is a chronic disease, long term treatment should, in addition to medical advice, also provide patient support and motivation.
头皮银屑病是常见皮肤病银屑病的一种常见表现形式，脱屑和瘙痒是两大主要症状。局部治疗是头皮银屑病治疗的主要手段，载体以及活性成分与疗效、耐受性和依从性相关。载体可以是洗发水、洗剂、凝胶、泡沫、乳膏以及更油腻的软膏。活性成分有角质剥脱剂、煤焦油（煤焦油溶液）、地蒽酚、皮质类固醇和维生素D3类似物。局部或全身应用咪唑衍生物也有一定疗效。局部皮质类固醇仍然是头皮银屑病治疗的主要药物。其效果迅速，剂型对患者友好，不良反应似乎有限，尽管尚无数据支持长期使用（超过4周）时的安全性。自1992年以来，局部维生素D3类似物可用于治疗银屑病。特别是洗剂剂型，维生素D3类似物是皮质类固醇的一种对患者友好、耐受性好且有效的替代药物，尽管其效果在8周后最佳，而局部皮质类固醇在2 - 3周后效果最佳。面部刺激（通常是暂时的）也是维生素D3类似物的一个缺点，不过只有一小部分患者因此停止治疗。银屑病的所有其他治疗选择，如他扎罗汀、光疗以及甲氨蝶呤、阿维A和环孢素的全身治疗，通常不适用于头皮治疗或不适合用于头皮治疗。在日常实践中，要从现有的银屑病治疗药物中做出选择，每个患者都应进行个体检查。必须排除恶化因素。对于脱屑，角质溶解是第一步。随后，可根据临床表现选择积极治疗。当银屑病皮损主要以炎症为特征时，应使用局部皮质类固醇等抗炎药物。当脱屑是更重要的临床特征时，应使用维生素D3类似物。一般来说，对于大多数患者，间歇性交替使用局部皮质类固醇与维生素D3衍生物，联合或不联合含煤焦油溶液的洗发水是最合适的治疗方法。因为头皮银屑病是一种慢性病，除了医疗建议外，长期治疗还应给予患者支持和鼓励。
