van de Kerkhof P C, de Hoop D, de Korte J, Kuipers M V
Department of Dermatology, University Hospital Nijmegen, The Netherlands.
Dermatology. 1998;197(4):326-34. doi: 10.1159/000018026.
The scalp is a well-known predilection site for psoriasis. Many patients indicate that scalp psoriasis is both psychologically and socially distressing.
The aim of the present investigation is to provide epidemiological data on the various manifestations of scalp psoriasis, as well as on its therapeutic management.
A questionnaire, targeted on scalp psoriasis, was mailed to patient subscribers of a Dutch journal on psoriasis. In total 1,023 forms were returned and evaluated.
Remarkably, a relatively high occurrence of facial psoriasis (25%) and nail psoriasis (40%) was recorded. The dynamics of scalp psoriasis were rather similar to psoriasis at other sites with respect to the total duration of the disease and exacerbations/remissions. In 57% of the patients, psoriasis was psychologically and socially distressing, at least occasionally. Itch and scaling proved to be the leading symptoms, in terms of frequency of occurrence as well as in terms of distress. Therefore, these parameters should be regarded as primary efficacy criteria in the treatment of scalp psoriasis. On average, most patients were seen by the dermatologist 5 times a year. The majority of prescriptions (76%) was given by the dermatologist. The application of topical corticosteroids was by far the most frequent treatment modality. To our surprise, calcipotriol was used by 28% of patients. At the time of investigation calcipotriol was only available as ointment. Tar shampoos were used by 51% of the patients, although the clinical efficacy of such a shampoo has never been demonstrated in a controlled study. A remarkable observation was the lack of instruction on the duration of treatment and the frequency of applications. In fact, 72% of the patients used topical treatments, including topical corticosteroids, for more than 8 weeks, and 42% of the patients used an intermittent schedule of a few applications per week.
Based on the present survey, the following profile for an optimal treatment of scalp psoriasis can be constructed: (1) effective applications a few times per week; (2) either a lotion or an emulsion, and (3) safety for long-term use.
头皮是银屑病众所周知的好发部位。许多患者表示头皮银屑病在心理和社交方面都令人苦恼。
本研究的目的是提供关于头皮银屑病各种表现及其治疗管理的流行病学数据。
针对头皮银屑病的问卷被邮寄给一家荷兰银屑病杂志的患者订阅者。总共回收并评估了1023份问卷。
值得注意的是，面部银屑病（25%）和指甲银屑病（40%）的发生率相对较高。头皮银屑病在疾病总持续时间以及加重/缓解方面的动态变化与其他部位的银屑病相当相似。在57%的患者中，银屑病至少偶尔在心理和社交方面令人苦恼。瘙痒和脱屑在发生频率以及困扰程度方面均被证明是主要症状。因此，这些参数应被视为头皮银屑病治疗的主要疗效标准。平均而言，大多数患者每年看皮肤科医生5次。大多数处方（76%）由皮肤科医生开具。外用糖皮质激素的应用是迄今为止最常用的治疗方式。令我们惊讶的是，28%的患者使用了卡泊三醇。在调查时，卡泊三醇仅以软膏形式提供。51%的患者使用了焦油洗发水，尽管这种洗发水的临床疗效从未在对照研究中得到证实。一个显著的观察结果是缺乏关于治疗持续时间和应用频率的指导。事实上，72%的患者使用包括外用糖皮质激素在内的外用治疗超过8周，42%的患者采用每周几次的间歇用药方案。
基于本次调查，可以构建如下头皮银屑病最佳治疗方案：（1）每周有效应用几次；（2）洗剂或乳剂；（3）长期使用安全。
