Radiation Therapy, Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, Queensland, Australia.
Royal Marsden Hospital, London, UK.
J Med Radiat Sci. 2021 Sep;68(3):326-331. doi: 10.1002/jmrs.467. Epub 2021 Apr 1.
Psoriasis is an inflammatory autoimmune disease of the skin and nails, causing debilitating pain and having an adverse effect on the patients' life. Typical treatment regimens involve topical and systemic therapies in combination with phototherapy. However, patients with extensive, chronic disease may encounter treatment resistance, with limited or no success of these therapies. Radiation therapy (RT) has been shown to be an effective treatment for benign skin lesions; however, recommended dose, fractionation and long-term follow-up is not well established within the literature making clinical implementation challenging. Furthermore, RT may induce the Koebner Phenomenon, exacerbating the disease. This case study presents a patient with chronic hyperkeratotic palmoplantar psoriasis who was offered RT as a last resort. A total dose of 6Gy was delivered using photons and superficial energies. Significant reduction in extent of disease was seen as a result, with the patient no longer wheelchair-bound and able to mobilise with minimal discomfort. This case is a single example of RT as a successful treatment for chronic palmoplantar psoriasis; however, a larger sample size and clinical trial is needed to ascertain dose and fractionation for optimal long-term control. Implementation of such treatments within departments invites clinicians to further develop RT practices and provide much needed relief to a new cohort of patients with non-malignant conditions.
银屑病是一种皮肤和指甲的炎症性自身免疫性疾病，导致严重的疼痛，并对患者的生活产生不利影响。典型的治疗方案包括局部和全身治疗以及光疗。然而，患有广泛、慢性疾病的患者可能会遇到治疗抵抗，这些治疗的效果有限或没有效果。放射治疗（RT）已被证明是治疗良性皮肤病变的有效方法；然而，在文献中，推荐剂量、分割和长期随访尚未得到很好的确定，这使得临床实施具有挑战性。此外，RT 可能会引发 Koebner 现象，使病情恶化。本病例研究介绍了一位患有慢性角化过度型手掌足底银屑病的患者，他被作为最后手段提供 RT 治疗。使用光子和浅层能量给予总剂量 6Gy。结果，疾病的严重程度显著减轻，患者不再需要坐轮椅，能够以最小的不适移动。这是 RT 治疗慢性手掌足底银屑病成功的一个例子；然而，需要更大的样本量和临床试验来确定最佳长期控制的剂量和分割。在科室中实施这些治疗方法邀请临床医生进一步发展 RT 实践，并为新的非恶性疾病患者提供急需的缓解。
