Scheinfeld Noah S, Mikhail Maryann
Department of Dermatology, St. Lukes Roosevelt Hospital, New York, NY 10025, USA.
Skinmed. 2004 Jul-Aug;3(4):225-7.
A 40-year-old Hispanic man presented for treatment of dermatitis on his elbows and knees that had been evident for 5 years (Figure 1). He also had scaling plaques on his scalp. He had not been treated previously. He did not have any other medical problems and did not complain of arthritis. A clinical diagnosis was made of psoriasis and he was prescribed clobetasol propionate ointment with salicylic acid 6% in petrolatum that should be applied in the evening to his elbows and knees and calcipotriene ointment with clobetasol that should be applied in the morning. For his scalp, he was prescribed betamethasone valerate foam 0.12% to be applied directly to the scalp once a day and told to use a tar shampoo contain-ing 4% neutar solubilized coal tar extract (1.0% coal tar) three times a week. He followed this regimen for 2 weeks and the plaques became much less keratotic. He continued his scalp regimen. He then started using calcipotriene ointment and clobetasol propionate ointment together twice a day. Three weeks later the plaques were much flatter and less erythematous. The patient was instructed to apply clobetasol propionate to the affected areas twice a day on Saturday and Sunday and calcipotriene twice a day Monday through Friday. At this point, his scalp was almost clear and the patient was told touse the foam as necessary and to continue the shampoo.
一名40岁的西班牙裔男子因肘部和膝盖的皮炎前来治疗，这种皮炎已经出现5年了（图1）。他的头皮上也有鳞屑性斑块。他之前未接受过治疗。他没有任何其他健康问题，也没有关节炎症状。临床诊断为银屑病，给他开了丙酸氯倍他索软膏，其中含有6%水杨酸的凡士林，应在晚上涂抹于肘部和膝盖，还有卡泊三醇软膏和氯倍他索，应在早上涂抹。对于他的头皮，给他开了0.12%的戊酸倍他米松泡沫剂，每天直接涂抹于头皮一次，并告知他每周使用三次含有4%中焦油溶解煤焦油提取物（1.0%煤焦油）的焦油洗发水。他遵循这个治疗方案两周后，斑块的角化程度明显减轻。他继续进行头皮治疗方案。然后他开始每天两次同时使用卡泊三醇软膏和丙酸氯倍他索软膏。三周后，斑块变得更加扁平，红斑也减少了。患者被告知在周六和周日每天两次在受影响区域涂抹丙酸氯倍他索，周一至周五每天两次涂抹卡泊三醇。此时，他的头皮几乎已经痊愈，患者被告知必要时使用泡沫剂，并继续使用洗发水。
