Leung Alexander Kc, Barankin Benjamin, Lam Joseph M, Leong Kin Fon
Department of Pediatrics, The University of Calgary, Calgary, Alberta, Canada.
The Alberta Children's Hospital, Calgary, Alberta, Canada.
Drugs Context. 2023 Oct 23;12. doi: 10.7573/dic.2023-8-2. eCollection 2023.
Guttate psoriasis is common and affects 0.5-2% of individuals in the paediatric age group. This review aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis and proper management of guttate psoriasis.
A search was conducted in July 2023 in PubMed Clinical Queries using the key term "guttate psoriasis". The search strategy included all observational studies, clinical trials and reviews published within the past 10 years. The information retrieved from the search was used in the compilation of the present article.
Guttate psoriasis typically presents with an abrupt onset of numerous, small, scattered, tear-drop-shaped, scaly, erythematous, pruritic papules and plaques. Sites of predilection include the trunk and proximal extremities. There may be a history of preceding streptococcal infection. Koebner phenomenon is characteristic. Guttate psoriasis may spontaneously remit within 3-4 months with no residual scarring, may intermittently recur and, in 40-50% of cases, may persist and progress to chronic plaque psoriasis. Given the possibility for spontaneous remission within several months, active treatment may not be necessary except for cosmetic purposes or because of pruritus. On the other hand, given the high rates of persistence of guttate psoriasis and progression to chronic plaque psoriasis, some authors suggest active treatment of this condition.
Various treatment options are available for guttate psoriasis. Triggering and exacerbating factors should be avoided if possible. Topical corticosteroids alone or in combination with other topical agents (e.g. tazarotene and vitamin D analogues) are the most rapid and efficient treatment for guttate psoriasis and are therefore the first-line treatment for mild cases. Other topical therapies include vitamin D analogues, calcineurin inhibitors, anthralin, coal tar and tazarotene. Ultraviolet phototherapy is the first-line therapy for moderate-to-severe guttate psoriasis, as it is more practical than topical therapy when treating widespread or numerous small lesions. Systemic immunosuppressive and immunomodulatory therapies (e.g. methotrexate, cyclosporine, retinoids, fumaric acid esters and biologics) may be considered for patients with moderate-to-severe guttate psoriasis who fail to respond to phototherapy and topical therapies.
点滴状银屑病很常见，在儿童年龄组中影响0.5%-2%的个体。本综述旨在使医生熟悉点滴状银屑病的临床表现、评估、诊断和恰当管理。
2023年7月在PubMed临床查询中使用关键词“点滴状银屑病”进行检索。检索策略包括过去10年内发表的所有观察性研究、临床试验和综述。从检索中获取的信息用于撰写本文。
点滴状银屑病通常表现为突然出现大量、小的、散在的、泪滴状、鳞屑性、红斑性、瘙痒性丘疹和斑块。好发部位包括躯干和四肢近端。可能有前驱链球菌感染史。同形反应具有特征性。点滴状银屑病可能在3-4个月内自发缓解，不留瘢痕，可能会间歇性复发，并且在40%-50%的病例中，可能会持续并进展为慢性斑块状银屑病。鉴于在几个月内有自发缓解的可能性，除了出于美容目的或因瘙痒外，可能无需积极治疗。另一方面，鉴于点滴状银屑病持续存在并进展为慢性斑块状银屑病的比例较高，一些作者建议对这种情况进行积极治疗。
点滴状银屑病有多种治疗选择。应尽可能避免诱发和加重因素。单独使用外用糖皮质激素或与其他外用药物（如他扎罗汀和维生素D类似物）联合使用是治疗点滴状银屑病最快速有效的方法，因此是轻度病例的一线治疗方法。其他外用疗法包括维生素D类似物、钙调神经磷酸酶抑制剂、蒽林、煤焦油和他扎罗汀。紫外线光疗是中度至重度点滴状银屑病的一线治疗方法，因为在治疗广泛或众多小皮损时，它比外用疗法更实用。对于中度至重度点滴状银屑病且对光疗和外用疗法无反应的患者，可考虑使用全身免疫抑制和免疫调节疗法（如甲氨蝶呤、环孢素、维甲酸、富马酸酯和生物制剂）。
