Noiles Kristin, Vender Ronald
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
J Drugs Dermatol. 2008 Dec;7(12):1165-7.
Psoriasis of the skin is in itself a disturbing disorder both physically and psychologically. However, most often the scaly plaques can be hidden by clothing. When psoriasis involves the face it can be more disabling and can decrease the patient's quality of life. Facial psoriasis is difficult to treat and is associated with severe cutaneous disease. Patients who have a long duration of psoriasis or early age of onset are more likely to suffer from facial involvement. Facial psoriasis may also be associated with pruritus, psoriatic arthritis, and with a family history of psoriasis.
The authors report a case of a female patient with psoriasis with severe cutaneous disease and extensive facial involvement successfully treated with adalimumab. This 50-year-old Caucasian female had a history of cutaneous psoriasis since 1990 and psoriatic arthritis since 2005. The patient had associated pruritus and a family history (maternal). Systematic treatment with mycophenolate mofetil and acitretin proved unsuccessful. The patient also lost efficacy after months of ultraviolet light B and topical psoralen plus ultraviolet light A phototherapy.
In 2007, the patient was screened and initiated therapy with a monoclonal humanized tumor necrosis factor alpha inhibitor, adalimumab. She had severe facial and body involvement with a body surface area of 25%, a Psoriasis Area and Severity Index of 20.4 (PASI), and a head and neck psoriasis area and severity index (HNPASI) of 3.6. Photographic documentation was carried out with improvement noted as soon as 4 weeks with continuing significant response thereafter. No adverse effects were noted. The patient's quality of life also improved.
Although severe facial psoriasis is rare and associated with only the most extensive and severe psoriatic cases, it is likely the most psychologically disturbing and cosmetically disrupting to the patient because it cannot easily be covered or concealed. The authors hope this case can illustrate an excellent therapeutic option for these patients.
Although facial psoriasis is difficult to treat, with newer systemic therapy now available in the form of biologics, patients now have a hope for this disease, especially devastating when associated with severe and extensive cutaneous involvement. The case gives promise in a serial photo-documented fashion of the success that can be achieved.
皮肤银屑病本身就是一种在身体和心理上都令人困扰的疾病。然而，大多数情况下鳞屑斑块可以被衣物遮盖。当银屑病累及面部时，它可能更具致残性，并会降低患者的生活质量。面部银屑病难以治疗，且与严重的皮肤疾病相关。银屑病病程长或发病年龄早的患者更易出现面部受累。面部银屑病还可能与瘙痒、银屑病关节炎以及银屑病家族史有关。
作者报告一例患有严重皮肤疾病且面部广泛受累的女性银屑病患者，使用阿达木单抗成功治疗的病例。这位50岁的白种女性自1990年起患有皮肤银屑病，自2005年起患有银屑病关节炎。患者伴有瘙痒且有家族史（母亲一方）。使用霉酚酸酯和阿维A进行系统治疗未成功。患者在接受数月的窄谱中波紫外线（UVB）及外用补骨脂素加紫外线A（PUVA）光疗后也失去了疗效。
2007年，该患者接受筛查并开始使用单克隆人源化肿瘤坏死因子α抑制剂阿达木单抗进行治疗。她面部和身体严重受累，体表面积为25%，银屑病面积和严重程度指数（PASI）为20.4，头颈部银屑病面积和严重程度指数（HNPASI）为3.6。进行了照片记录，4周时即观察到改善，此后持续有显著反应。未观察到不良反应。患者的生活质量也得到了改善。
尽管严重的面部银屑病很少见，且仅与最广泛、最严重的银屑病病例相关，但它可能对患者在心理上造成最大的困扰，在外观上造成最大的破坏，因为它不容易被遮盖。作者希望这个病例能够为这些患者说明一种很好的治疗选择。
尽管面部银屑病难以治疗，但随着现在有了以生物制剂形式出现的更新的全身治疗方法，患者现在对这种疾病有了希望，尤其是当它与严重和广泛的皮肤受累相关时更是具有毁灭性。该病例以系列照片记录的方式展示了可以取得的成功。
