Sukarovska Biljana Gorgievska, Lipozencić Jasna, Vrzogić Pero
Klinika za kozne i spolne bolesti, Klinicti bolnicki centar Zagreb i Medicinski fakultet Sveucilista u Zagrebu, Zagreb.
Acta Med Croatica. 2007 Sep;61(4):375-81.
Psoriasis is a chronic, recurrent, genetically determined, inflammatory dermatosis that affects the skin, scalp and joints. Psoriasis is caused by various triggers (infections, drugs, physical and emotional factors). It ranges in severity from mild to severe, and patients with moderate to severe disease suffer significant deterioration in the quality of life. Clinical types of psoriasis are psoriasis guttata, nummular psoriasis, plaque, generalized and erythrodermic psoriasis. Skin changes affect intertriginous regions (inverse psoriasis), and there also are special forms of pustular psoriasis and arthropathic psoriasis. The goals of psoriasis treatment are to gain initial and rapid control of the disease; to decrease plaque lesions and percentage of body surface area involved, to achieve long-term remission; and to minimize adverse events. Topical treatment for mild psoriasis includes topical corticosteroids, calcipotriene, tazarotene, topical tars, anthralin and keratolytics, and immunomodulators (pimecrolimus, tacrolimus). The treatment of moderate to severe psoriasis includes systemic therapies such as methotrexate, acitretin, cyclosporine, hydroxurea and biologicals. Topical treatment can be effective using combination, rotational or sequential regimens for patients with more severe disease. The aim of successful treatment of psoriasis is fast control of the disease and regression of lesions in a short period, prolonged remission and minimal adverse reaction. Local therapy with various topicals is administered for mild and localized forms of the disease, with or without phototherapy (UVB). Topical corticosteroids are used in a variety of formulations, with a potential ranging from superpotent to least potent (class 1-7), which decrease symptoms in tne first two weeks of treatment with improvement in subsequent weeks; D3 vitamin analog (effective in 6-8 weeks), retinoids (effective in 1-2 weeks), tars (2-4 weeks), anthralin (2-4 weeks), and keratolytics (most effective in combination with corticosteroids. Topical corticosteroids have been the first choice in the treatment of and inflammatory dermatoses since 1952 to the present. Corticosteroids are effective as monotherapy or in combination for sequential or rotational treatment. They are effective in short time, simple for use and inexpensive. Psoriasis is a chronic skin disease that requires long-term therapy. For patients with mild to moderate form, intermittent corticosteroid therapy is the most effective treatment. Every-other-day or weekend-only application may be effective in chronic stage. Calcipotriene and tazarotene are more effective in combination with corticosteroids in the initial weeks of therapy. Tar preparations, anthralin and keratolytics may be used with ultraviolet light and corticosteroids. Topical immunomodulators are effective on the face and intertriginous psoriatic lesions.
银屑病是一种慢性、复发性、由基因决定的炎症性皮肤病，可累及皮肤、头皮和关节。银屑病由多种诱因（感染、药物、物理和情绪因素）引起。其严重程度从轻度到重度不等，中重度患者的生活质量会显著下降。银屑病的临床类型有点滴状银屑病、钱币状银屑病、斑块状、泛发性和红皮病型银屑病。皮肤病变可累及褶皱部位（反向银屑病），还有脓疱型银屑病和关节病型银屑病等特殊形式。银屑病治疗的目标是初步快速控制病情；减少斑块损害和受累体表面积百分比，实现长期缓解；并将不良事件降至最低。轻度银屑病的局部治疗包括外用糖皮质激素、卡泊三醇、他扎罗汀、煤焦油、蒽林和角质剥脱剂，以及免疫调节剂（吡美莫司、他克莫司）。中重度银屑病的治疗包括甲氨蝶呤、阿维A、环孢素、羟基脲等系统疗法和生物制剂。对于病情较重的患者，采用联合、交替或序贯方案进行局部治疗可能有效。成功治疗银屑病的目标是快速控制病情，短期内皮损消退，缓解期延长且不良反应最小。对于轻度和局限性银屑病，可采用各种局部药物进行局部治疗，可联合或不联合光疗（紫外线B）。外用糖皮质激素有多种剂型，效力从超强效到最弱效（1 - 7级）不等，在治疗的前两周可减轻症状，随后几周症状改善；维生素D3类似物（6 - 8周起效）、维甲酸类（1 - 2周起效）、煤焦油（2 - 周起效）、蒽林（2 - 4周起效），角质剥脱剂（与糖皮质激素联合使用最有效）。自1952年至今，外用糖皮质激素一直是治疗炎症性皮肤病的首选药物。糖皮质激素作为单一疗法或联合用于序贯或交替治疗均有效。它们起效快、使用简便且价格低廉。银屑病是一种需要长期治疗的慢性皮肤病。对于轻至中度银屑病患者，间歇性糖皮质激素治疗是最有效的治疗方法。在慢性期，隔日或仅在周末用药可能有效。在治疗的最初几周，卡泊三醇和他扎罗汀与糖皮质激素联合使用更有效。煤焦油制剂、蒽林和角质剥脱剂可与紫外线和糖皮质激素联合使用。外用免疫调节剂对面部和褶皱部位的银屑病皮损有效。
