Psoriasis, commonly known as psoriasis, is a common recurrence-prone chronic inflammatory skin disease. In addition to causing skin diseases, it can also lead to a series of physical and mental diseases.

psoriatic skin Itching and other discomfort, poor appearance will cause emotional and psychological distress to patients, leading to depression, anxiety , avoid socialization, or even commit suicide. More than 30% of patients will have joint involvement, called psoriatic arthritis (PSA), which may further weaken and reduce their quality of life. In addition, psoriasis is an independent risk factor for cardiometabolic disease, obesity, and other chronic inflammatory diseases such as inflammatory bowel disease.

There is currently no information on the etiology and pathogenesis of psoriasis Completely clear, the study found that its incidence is related to genetic factors, infection with streptococcus, abnormal immune function, metabolic disorders and endocrine changes.

Diagnosis of Psoriasis

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1

Three characteristics of psoriatic skin lesions

The diagnosis of psoriasis is mainly through physical examination. For erythematosquamous skin lesions, according to the three characteristics of psoriatic skin lesions: Silver-white scales, red glossy film, spotting< /strong>, it can be easier to judge.

The initial skin lesions are often red envelopes or small brown-red Spotted or maculopapular rash, with dry silvery white and grayish white scales, the scales are easily scraped off at first, when scratched, the scales fly off one after another, revealing a reddish translucent shiny film. Small sieve-shaped hemorrhages, like dew droplets, appear.

After that, the rash gradually expanded and increased, and some rashes They merged with each other to form patches, with obvious infiltration at the bottom, clear edges, and inflammatory flushes around them, which were drip-shaped, coin-shaped, map-shaped, disc-shaped, and oyster-shell-shaped. It usually occurs in the hair, the extensor side of the elbow and knee joints, and the lower back and sacrococcygeal region, and is often neglected by patients.

2

Skin biopsy

Because some skin diseases are easily confused with psoriasis, it is necessary to obtain a small piece of skin tissue and rely on microscopy to confirm the diagnosis when the diagnosis is difficult.

Because the skin is on the surface of the body, the biopsy operation is relatively simple. Skin histopathological examination can be used as an important means of auxiliary diagnosis. However, if the pathological results do not meet the characteristics of psoriasis, the possibility of psoriasis cannot be ruled out clinically.

3

General characteristics of lesions in specific areas

Psoriasis in specific sites often lacks some of the typical features of psoriasis and is difficult to diagnose. Such as scalp psoriasis, which is characterized by large lesions covered with very thick scales, which are difficult to remove and show spotting bleeding; the scales on the palms and soles are sticky but not loose, Often with chapped; psoriasis in the skin folds of the armpits, groin, under the breasts, genitals, and buttocks, smooth and not scaly due to moist friction, often with maceration And chapped, erythema lesions with clear boundaries and so on.

4

Psoriatic features of some rash variants

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Such as seborrheic psoriasis, sometimes it may be psoriasis vulgaris combined with seborrheic dermatitis, and the rash is mostly distributed in the facial nasolabial folds, eyebrows, and scalp Seborrhea and other parts of the body, erythema covered with yellow greasy scales, and large erythema< /strong>.

Oyster shell psoriasis is seen in a minority of patientsThe skin lesions were eroded and exuded, and the infiltrated silver-white scales dried to form layers of brown coffee peels. Overlapping, similar to oyster shells;

verrucous shavings The disease is more common in brown verrucous plaques on the flexors of the limbs, persistent, pruritic, often There are typical psoriatic lesions on other parts of the body.

Types of psoriasis

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Plaque psoriasis

Plaques form on the scalp, elbows, knees, or lower back. For example, thick and raised skin patches, scabs (dry, thin, silvery-white coatings) covering some patches, skin patches of the same size, Smaller patches join together to form larger patches.

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Guttate Psoriasis

< p data-track="69">Sudden appearance of tiny bumps on the skin that are small and scaly and appear salmon-colored to Pink. Lumps tend to cover most of the trunk, legs, and arms. Sometimes, bumps also appear on the face, scalp, and ears.

3

Reverse Psoriasis

< p data-track="74">Smooth red skin looks rough, but has little rare silver coating< /span>, and sometimes pain in the skin. The most common parts are the elbows and scalp, of course, including the calf extension, waist and abdomen, back and so on.

4

pustular psoriasis

massive pustules, pustules with systemic symptoms such as fever, joint pain, white blood cells Increased neutrophils, etc. Additionally, brown spots (and sometimes scales) appear when the pus-filled bump dries out. The skin may experience extreme soreness or pain.

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erythrodermic psoriasis

This severe and life-threatening form of psoriasisrequires immediate medical attention. At the beginning, flushing appeared in the original psoriatic skin lesions, which quickly expanded into large areas, and finally showed diffuse flushing infiltration throughout the body. . Often accompanied by fever, chills, headache, general malaise and so on.

Psoriasis Area and Severity Index h1>

PASI (Psoriasis Area and Severity Index) is the Lesion severity (including erythema, infiltration, scaling) and lesion area were scored. The final score is calculated by a specific formula and is often used to assess the severity of psoriasis vulgaris. It is a internationally used scoring standard for the degree of psoriasis skin lesions.

Skin lesion area score: the whole body is divided into head and neck , upper limbs, trunk and lower limbs 4 parts. The percentages of the above sites in the body surface area were 10%, 20%, 30% and 40%, respectively. The 4 sites were scored for the area of ​​skin lesions, and the specific criteria were as follows.

Severity score of skin lesions: score according to the above 4 parts , and each site was scored according to the following 3 clinical features of skin lesions:

erythema: red or dark red inflammatory

infiltration: the tendency of skin lesions to spread and spread around, the boundary is blurred, and the pressure is substantial;< /span>

Dequamation: refers to the exfoliation of epidermal cells.

Legend: Lesion Area and Severity Score p>

Where, E=erythema, D=scaly, I=infiltration, A=skin The lesion area, h, u, t, and i represent the head, upper extremity, trunk, and lower extremity, respectively.

Legend: PASI Detailed Scoring Instructions

Treatment of psoriasis

Currently, the treatment of psoriasis mainly includes topical drugs Therapy, systemic therapy, physical therapy and other treatments.

1

Topical treatment

In the acute phase of psoriasis, it is best to use mild protectants and emollients, such as petrolatum, glycerin, mineral oil, etc.; Drugs with stronger effects can be used in the stable and regression phases. Tazarotene, moderate and potent glucocorticoids, and calcipotriol can be used as first-line drugs for topical therapy.

2

Physiotherapy

Optional ultraviolet light (UVA), photochemotherapy (PUVA) , Broad Spectrum UVB and Narrow Spectrum UVB Treatment.

3

Internal medication

Anti-infectives, such as penicillin, erythromycin, cephalosporins, etc.; methotrexate is an effective treatment for psoriasis.

Tretinoin, Cyclosporine, Glucocorticoids Hormones have a certain therapeutic effect on psoriasis.

4

Psychotherapy

According to the patient’s condition, various forms such as individual therapy, intensive therapy, family therapy and social therapy can be adopted, and biofeedback therapy, abdominal breathing training can also be used to improve The patient’s psychological state improves the patient’s self-regulation.

5

Biologics

Biologics are molecularly targeted drugs, which are the product of the combination of immunological theory and molecular biology techniques. They can target specific targets >Precise suppression has been widely used in immune-mediated diseases in recent years, such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, etc.

Currently, most studies suggest that tumor necrosis factor-α (tumornecrosis factor-α, TNF-α), interleukin-17 (interleukin-17, IL-17), interleukin-12 (interleukin-12, IL-12)/interleukin-23 (interleukin-23, IL-23) inhibitors, Cytokine-mediated signaling pathways such as IL-23 inhibitors play a significant role in the pathogenesis of psoriasis.

Note: Biologics for psoriasis that have been marketed in my country

Summary

Currently, there is no effective or radical cure for psoriasis. If someone proposes to you that there is an ancestral secret recipe in the family or how a certain medicine is magical, can completely cure psoriasis, never recur, solve the world’s problems, etc., please do not believe these advertisements lightly, and million Don’t go to the doctor indiscriminately, to avoid being deceived, so as not to cause economic losses, and more importantly, it may delay the best period of disease treatment.

[Important] This official account [Family Says] The information in the article is for reference only, the specific treatment Follow the doctor’s advice!