Kim Whan B, Jerome Dana, Yeung Jensen
Dermatology resident at the University of Ottawa in Ontario.
Head of the Division of Rheumatology at the University of Toronto in Ontario.
Can Fam Physician. 2017 Apr;63(4):278-285.
To provide primary care clinicians with an up-to-date and practical overview of the diagnosis and management of psoriasis.
PubMed, MEDLINE, EMBASE, and Cochrane databases were searched for relevant meta-analyses, randomized controlled trials, systematic reviews, and observational studies about the diagnosis and management of psoriasis.
Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint involvement. Beyond the physical dimensions of disease, psoriasis has an extensive emotional and psychosocial effect on patients, affecting social functioning and interpersonal relationships. As a disease of systemic inflammation, psoriasis is associated with multiple comorbidities, including cardiovascular disease and malignancy. The diagnosis is primarily clinical and a skin biopsy is seldom required. Depending on the severity of disease, appropriate treatment can be initiated. For mild to moderate disease, first-line treatment involves topical therapies including corticosteroids, vitamin D3 analogues, and combination products. These topical treatments are efficacious and can be safely initiated and prescribed by primary care physicians. Patients with more severe and refractory symptoms might require further evaluation by a dermatologist for systemic therapy.
Many patients with psoriasis seek initial evaluation and treatment from their primary care providers. Recognition of psoriasis, as well as its associated medical and psychiatric comorbidities, would facilitate timely diagnosis and appropriate management with effective and safe topical therapies and other medical and psychological interventions, as needed. More severe and refractory cases might warrant referral to a dermatologist for further evaluation and possible systemic therapy.
为基层医疗临床医生提供关于银屑病诊断与管理的最新实用概述。
检索了PubMed、MEDLINE、EMBASE和Cochrane数据库，以查找有关银屑病诊断与管理的相关荟萃分析、随机对照试验、系统评价和观察性研究。
银屑病是一种慢性多系统炎症性疾病，主要累及皮肤和关节。除了疾病的身体层面，银屑病对患者有广泛的情绪和心理社会影响，影响社会功能和人际关系。作为一种系统性炎症性疾病，银屑病与多种合并症相关，包括心血管疾病和恶性肿瘤。诊断主要依靠临床，很少需要进行皮肤活检。根据疾病的严重程度，可以开始适当的治疗。对于轻度至中度疾病，一线治疗包括局部治疗，如皮质类固醇、维生素D3类似物和联合制剂。这些局部治疗有效，基层医疗医生可以安全地开始并开具处方。症状更严重且难治的患者可能需要皮肤科医生进行进一步评估以进行系统治疗。
许多银屑病患者最初会寻求基层医疗服务提供者的评估和治疗。认识银屑病及其相关的医学和精神合并症，将有助于及时诊断，并根据需要通过有效且安全的局部治疗以及其他医学和心理干预措施进行适当管理。更严重且难治的病例可能需要转诊至皮肤科医生处进行进一步评估及可能的系统治疗。
