Maul Julia-Tatjana, Anzengruber Florian, Conrad Curdin, Cozzio Antonio, Häusermann Peter, Jalili Ahmad, Kolios Antonios G A, Laffitte Emmanuel, Lapointe Anne-Karine, Mainetti Carlo, Schlapbach Christoph, Trüeb Ralph, Yawalkar Nikhil, Dippel Michaela, Navarini Alexander A
Department of Dermatology and Venereology, University Hospital of Zurich (USZ), Zurich, Switzerland,
Department of Dermatology and Venereology, University Hospital of Zurich (USZ), Zurich, Switzerland.
Dermatology. 2021;237(2):166-178. doi: 10.1159/000512930. Epub 2021 Jan 6.
Topical treatment is crucial for the successful management of plaque psoriasis. Topicals are used either as a stand-alone therapy for mild psoriasis or else in combination with UV or systemic treatment for moderate-to-severe disease. For the choice of a suitable topical treatment, the formulation matters and not just the active substances. This expert opinion paper was developed via a non-structured consensus process by Swiss dermatologists in hospitals and private practices to illustrate the current treatment options to general practitioners and dermatologists in Switzerland. Defining treatment goals together with the patient is crucial and increases treatment adherence. Patients' personal preferences and pre-existing experiences should be considered and their satisfaction with treatment and outcome regularly assessed. During the induction phase of "classical" mild-to-moderate psoriasis, the fixed combination of topical calcipotriol (Cal) 50 μg/g and betamethasone dipropionate (BD) 0.5 mg/g once daily is frequently used for 4-8 weeks. During the maintenance phase, a twice weekly (proactive) management has proved to reduce the risk of relapse. Of the fixed combinations, Cal/BD aerosol foam is the most effective formulation. However, the individual choice of formulation should be based on a patient's preference and the location of the psoriatic plaques. Tailored recommendations are given for the topical management of specific areas (scalp, facial, intertriginous/genital, or palmoplantar lesions), certain symptoms (hyperkeratotic or hyperinflammatory forms) as well as during pregnancy or a period of breastfeeding. As concomitant basic therapy, several emollients are recommended. If topical treatment alone does not appear to be sufficient, the regimen should be escalated according to the Swiss S1-guideline for the systemic treatment of psoriasis.
局部治疗对于斑块状银屑病的成功管理至关重要。局部用药既可以作为轻度银屑病的单一疗法，也可以与紫外线或全身治疗联合用于中重度疾病。对于选择合适的局部治疗方法，制剂很重要，而不仅仅是活性物质。这篇专家意见论文是由瑞士医院和私人诊所的皮肤科医生通过非结构化共识过程编写的，旨在向瑞士的全科医生和皮肤科医生说明当前的治疗选择。与患者共同确定治疗目标至关重要，并能提高治疗依从性。应考虑患者的个人偏好和既往经验，并定期评估他们对治疗和结果的满意度。在“经典”轻度至中度银屑病的诱导期，通常每天一次使用50μg/g的局部用卡泊三醇（Cal）和0.5mg/g的倍他米松二丙酸酯（BD）固定组合，持续4-8周。在维持期，每周两次（主动）管理已被证明可降低复发风险。在固定组合中，Cal/BD气雾剂泡沫是最有效的制剂。然而，制剂的个体选择应基于患者的偏好和银屑病斑块的位置。针对特定部位（头皮、面部、间擦疹/生殖器或掌跖部病变）、某些症状（角化过度或炎症过度形式）以及妊娠或哺乳期的局部管理给出了量身定制的建议。作为伴随的基础治疗，推荐使用几种润肤剂。如果单独的局部治疗似乎不够充分，应根据瑞士银屑病全身治疗S1指南逐步升级治疗方案。
