Clinical symptoms of psoriasis

4. Endocrine factors

Some female patients have reduced or even lost skin lesions after pregnancy and increased after delivery.

5. Other

The neurological factors are related to the onset of psoriasis. Drinking, smoking, drugs and mental stress may induce psoriasis.

Three �� clinical manifestations

Psoriasis vulgaris

For the most common type, multiple acute onset. Typical manifestations are erythema with clear boundaries and different shapes and sizes, surrounded by inflammatory redness. Slightly infiltrated and thickened. The surface is covered with multiple layers of silvery white scales. The scales are easy to scrape off, and the translucent film is reddish after being scraped, and the small bleeding point (Auspitz sign) is visible on the film. Skin lesions occur on the head, ankles and limbs. Some patients consciously have varying degrees of itching.

2. Pustular psoriasis

Less common, divided into general hair style and palmar type. Generalized pustular psoriasis is a cluster of superficial aseptic pustules on the erythema, some of which can be fused into a pus. The whole body can be ill. It is more common in the flexion and wrinkles of the extremities, and the oral mucosa can be affected at the same time. Acute onset or sudden exacerbation is often accompanied by systemic symptoms such as chills, fever, joint pain, general malaise, and increased white blood cell count. Frequent episodes of psoriatic lesions often occur during remission. The psoriasis lesions are limited to the hands and feet, symmetry occurs, the general condition is good, the condition is stubborn, recurrent

3. erythrodermic psoriasis

Also known as psoriatic exfoliative dermatitis, it is a serious psoriasis. Often due to topical irritant drugs, long-term use of glucocorticoids, excessive reduction or sudden withdrawal. It is characterized by diffuse flushing, swelling and scaling of the skin, accompanied by systemic symptoms such as fever, chills and discomfort. Superficial lymph nodes and white blood cell counts increase.

4. Arthritic psoriasis

Also known as psoriatic arthritis. Psoriasis patients with rheumatoid arthritis-like joint damage can affect the whole body size joints, but the most characteristic of the interphalangeal joint lesions. The affected joints are red and swollen, and the skin around the joints is often red and swollen. Joint symptoms often worsen or reduce with skin symptoms. Blood rheumatoid factor negative.

Four :inspections

Pathological examination

Skin biopsy of psoriasis patients can be used to determine the type of skin lesions in patients with psoriasis that are suitable for topical treatment. Histopathological examination of lesions in patients with atypical clinical manifestations is helpful in confirming the diagnosis.

2. Visceral function check

Examination of the visceral function of patients with psoriasis facilitates the development of a treatment plan based on the patient's physical condition. B-ultrasound helps to understand changes in the shape of organs such as liver and kidney; problems with the heart can be reflected by electrocardiogram and echocardiography.

3. Targeted inspection

Liver function should be checked for patients suspected of having liver damage or when drugs affecting liver function should be used, and regular review should be conducted; in addition to urine tests, kidney function and blood acid and alkali and electrolyte levels should be checked.

4. Routine laboratory inspection

Blood routines include hemoglobin content and red blood cells, white blood cells, and platelet counts; urine routines include pH, urine sugar, protein, various cells, etc.; stool routines include traits, cell counts, occult blood, and the like. Patient examination items are subject to need.

5. X-ray inspection

Arthritic psoriasis requires X-ray examination (perspective, filming, etc.) to determine the location, type, degree of joint damage, and response and outcome after treatment. Chest fluoroscopy is also routinely performed to see if there is an infection with a combined respiratory tract.

Five :diagnosis

According to the clinical manifestations of the disease, the characteristics of skin lesions, predilection sites, seasonal diagnosis.

Six treatment

There is no specific treatment for this disease, but it is not an incurable disease. Proper symptomatic treatment can control symptoms. Because this disease is a chronic recurrent disease, many patients need long-term treatment, and various treatments have certain adverse reactions. There are mainly combination therapy, alternation therapy, sequential and intermittent therapy.

External medicine

For new lesions with small area, use external medicine as much as possible. The concentration of the drug should be from low to high. Which medicine to use should be combined with the nature of the drug itself and the specific condition of the patient.

(1) Vitamin D3 analogues This class of drugs, including calcipotriol, tacalcitol, etc., is effective for plaque psoriasis. Calcipotriol cream, ointment and lotion (for the head) are applied twice daily for a period of time, which is usually effective within 8 weeks, and does not depend on long-term use. This drug is used in combination with glucocorticoids or UVB to improve efficacy. Patients with bone disease, calcium metabolism disorders and renal insufficiency should be used with caution to avoid causing hypercalcemia.

(2) Glucocorticoids Glucocorticoids for external use are still the current treatments for psoriasis. Strong hormones should be used in the head and palmar, and the weak hormones should be applied to the face and the rubbing part. Ointments and creams are commonly used in general areas. A solution (propylene glycol) and a gel are required for the head. Local encapsulation therapy can significantly increase the intensity of the action.

The effect of glucocorticoids on skin lesions is temporary. The initial effect is significant, and sudden withdrawal often results in a "rebound" phenomenon. Intermittent therapy should be used for those who need long-term medication, that is, once every 2 to 3 days. Combined with other drugs (such as vitamin D3 analogues, vitamin A acids, etc.), it is conducive to consolidating the efficacy and reducing adverse reactions.

(3) Yulin is often used for chronic plaque psoriasis. Can be formulated into ointments, pastes and paraffin. The commonly used concentration is 0.05% to 1.0%, starting from a low concentration and gradually increasing according to the patient's tolerance. Do not use on the face and between the parts, pay attention to protect normal skin. Skin lesions usually begin to subside after 2 to 3 weeks.

(4) Vitamin A acid gel and cream (0.05% to 0.1%) 1 or 2 times a day is effective for psoriasis. Due to slower onset, it is generally not used as a first-line drug alone. It can be combined with glucocorticoids such as clobetasol propionate. After the control of skin lesions, tazarotene is continued and glucocorticoids are gradually stopped. Pregnant women, lactating and recent births require women to be banned.

(5) Tars Commonly used tars include coal tar, turpentine oil, retort oil and black soybean oil, etc., and are formulated into a 5% concentration ointment for external use. Coal tar is more effective for chronic stable psoriasis, scalp psoriasis and palmoplant psoriasis. It is contraindicated in pregnant women, pustular and erythrodermic psoriasis. There are now some colorless, odorless coal tar formulations that are nearly as effective as crude products. Soluble coal tar can be used for bathing, and coal tar shampoo is used for shampooing. Coal tar tincture is used for sputum application and is effective for the treatment of head psoriasis.

(6) Other external drugs such as immunosuppressive agents such as tacrolimus, pimecrolimus for external treatment, and package for the treatment of intractable localized psoriasis. 0.03% camptothecin ointment, 5% salicylic acid ointment, etc.

2. Internal medication

(1) Methotrexate (MTX) is a folate reductase inhibitor that prevents DNA synthesis during epidermal cell proliferation and inhibits mitosis in the nucleus. MTX can inhibit the proliferation of activated lymphocytes in vivo and attenuate the function of CD8 cells and inhibit the chemotaxis of neutrophils. MTX is a standard drug for the treatment of psoriasis, but long-term use can cause extensive fibrosis and liver in the liver. Hardening, so pay attention when applying. MTX is suitable for erythrodermic and articular diseases. Pustular, generalized psoriasis and other conventional treatments are less effective. Avoid using liver and kidney dysfunction, pregnancy or breastfeeding, decreased white blood cell count, active infectious diseases, alcoholism, immunodeficiency and other serious diseases.

(2) Vitamin A acid retinoic acid drugs can regulate epidermal proliferation and differentiation, immune function, etc., for generalized pustular psoriasis, erythrodermic psoriasis, severe plaque psoriasis , alone or in combination with other therapies, have a satisfactory effect. Commonly used drugs are acitretin, avid A and other vitamin A acid drugs, the main side effect is teratogenicity. Studies have shown that stopping the administration of acitretin for 2 years is still measured in the urine, and some Avi A It can be converted into acitretin. Therefore, contraceptive measures should be taken within 2 years after stopping the treatment of women of childbearing age: lip, eye, nasal mucosa dry, diffuse desquamation and hair loss during medication. Increased blood lipids may occur when taken for a long time. Liver damage, etc., but can be recovered after stopping the drug.

(3) Glucocorticoids This class of drugs should not be used in routine systems for psoriasis because the effect is not significant, and the symptoms are worse than the original after stopping the drug, and may even induce acute pustular psoriasis or erythroderma. Psoriasis. However, because glucocorticoids have an "anti-inflammatory" effect, erythropoiesis, arthritic and generalized pustular psoriasis can be used in cases where other therapies (such as MTX) are ineffective or contraindicated. Use with caution.

(4) Immunotherapy and biologic therapy The cyclosporin A, tacrolimus, and mycophenolate mofetil are currently used in severe psoriasis. Some new biological agents, such as the cytokine blocker etanercept, are new advances in the treatment of psoriasis, but they are expensive and have adverse effects, and clinical applications require further observation.

(5) The occurrence and recurrence of psoriasis in antibiotics are related to bacterial, fungal, viral and other micro-infections, especially acute psoriasis psoriasis often accompanied by acute tonsillitis or upper respiratory tract infection. In these cases, penicillin and cephalosporin may be applied. The treatment of bacteriocins has a good effect. Certain antibiotics also have immunomodulatory effects such as erythromycin. In some patients, Malassezia is multiplied in the area of ​​sebum spillage, and it can be treated with ketoconazole lotion.

3. Physical therapy

UV, photochemotherapy (PUMA), broad-spectrum UVB (BB-UVB) therapy, narrow-band UVB (NB-UVB) therapy, spa treatment.

4. Chinese medicine treatment

It can be applied to Chinese herbal medicines and compound Chinese medicines such as Qinglan Pills, Tripterygium wilfordii, and Compound Danshen Tablets.