Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Br J Dermatol. 2019 Aug;181(2):332-337. doi: 10.1111/bjd.17689. Epub 2019 May 7.
Traditionally, psoriasis in certain body sites such as the scalp, nails, palms, soles and intertriginous areas has been acknowledged as difficult to treat.
To investigate the body location of treatment-resistant psoriasis in patients treated with biologic agents in real-world clinical practice, and to study the association between localization and quality of life.
This was an observational, noninterventional, study. We investigated the skin and/or nail location of treatment-resistant psoriasis in patients with moderate-to-severe psoriasis treated for > 6 months with biologic agents. A partial or good response to treatment was defined as having a Psoriasis Area and Severity Index (PASI) score ≥ 1 and ≤ 5. Experienced PASI assessors used a uniform data collection form in which the body area was divided into 26 regions and 20 nails.
We included 146 patients with chronic plaque-type psoriasis (109 men, 74·7%, mean ± SD age 49·8 ± 13·7 years), with a median PASI score of 2·4 (interquartile range 1·2-3·2). The median PASI reduction from treatment initiation was 86·1% (interquartile range 78·1-91·3). The most common site of recalcitrant psoriasis was the anterior lower leg [49·3%; 95% confidence interval (CI) 41·2-57·4]. Further common sites of recalcitrant psoriasis were the posterior lower leg (24·7%; 95% CI 17·7-31·6), elbow (35·6%; 95% CI 27·8-43·4) and the scalp (19·2%; 95% CI 12·8-25·6%). No association between Dermatology Life Quality Index and specific areas of recalcitrant psoriasis were observed.
In real-world clinical practice, the most common sites of recalcitrant psoriasis in patients treated with biologic agents are the anterior lower leg, posterior lower leg and elbows. Recalcitrant psoriasis in no specific area caused a greater impact on quality of life than any other area.
传统上，头皮、指甲、手掌、足底和皱褶部位等特定部位的银屑病被认为难以治疗。
在真实临床实践中，调查接受生物制剂治疗的患者中治疗抵抗性银屑病的身体部位，并研究定位与生活质量之间的关系。
这是一项观察性、非干预性研究。我们调查了接受生物制剂治疗 6 个月以上的中重度银屑病患者中治疗抵抗性银屑病的皮肤和/或指甲部位。部分或良好的治疗反应定义为银屑病面积和严重程度指数（PASI）评分≥1 且≤5。经验丰富的 PASI 评估员使用统一的数据收集表，将身体区域分为 26 个区域和 20 个指甲。
我们纳入了 146 例慢性斑块型银屑病患者（109 例男性，74.7%，平均年龄 49.8±13.7 岁），中位 PASI 评分为 2.4（四分位距 1.2-3.2）。从治疗开始时的 PASI 中位数降低了 86.1%（四分位距 78.1-91.3）。最常见的难治性银屑病部位是前小腿[49.3%；95%置信区间（CI）41.2-57.4]。难治性银屑病的其他常见部位包括小腿后[24.7%；95%CI 17.7-31.6]、肘部[35.6%；95%CI 27.8-43.4]和头皮[19.2%；95%CI 12.8-25.6]。未观察到皮肤病生活质量指数与特定难治性银屑病部位之间存在关联。
在真实临床实践中，接受生物制剂治疗的患者中最常见的难治性银屑病部位是前小腿、小腿后和肘部。与其他任何部位相比，无特定部位的难治性银屑病对生活质量的影响更大。
