Wang Ting-Shun, Tsai Tsen-Fang
Department of Dermatology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, #7, Chung-Shan South Road, Taipei, Taiwan.
Am J Clin Dermatol. 2017 Feb;18(1):17-43. doi: 10.1007/s40257-016-0222-4.
Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it.
Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely.
Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature.
To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis.
More controlled studies are needed for an evidence-based approach to scalp psoriasis.
头皮银屑病通常是银屑病的初始表现，几乎80%的银屑病患者最终都会出现。
尽管已有多项系统评价和指南，但进行一次包含生物制剂和新型口服小分子药物使用方面最新进展的循证综述很有必要。
从PubMed最初检索到475项研究，从Embase检索到845项研究（截至2016年5月），排除非英文文献后，本综述纳入了27项临床试验、4篇报告其他临床试验汇总分析的论文、10项开放标签试验、1个病例系列和2篇病例报告。
据我们所知，专门针对头皮银屑病进行的随机对照试验很少。外用糖皮质激素疗效良好，通常被推荐为一线治疗药物。卡泊三醇倍他米松二丙酸酯耐受性良好，比其任何单一成分都更有效。在有毛发的部位，局部光疗优于全身光疗。甲氨蝶呤、环孢素、富马酸酯和阿维A是治疗银屑病的公认药物，但我们未发现专门评估这些药物治疗头皮银屑病的已发表随机对照试验。生物制剂和新型小分子药物对头皮银屑病显示出优异疗效，但这些治疗费用高昂，这意味着它们可能仅限于用于广泛的头皮银屑病。
需要更多对照研究，以便对头皮银屑病采取循证治疗方法。
