What Is Psittacosis?

Psoriasis, commonly known as psoriasis, is a chronic inflammatory skin disease with a long course and a tendency to relapse, and some cases are almost unhealed for life. The onset of the disease is mainly young adults, which has a greater impact on the patient's physical health and mental status. The clinical manifestations are mainly erythema and scaly, which can occur on the whole body. The scalp and the extremities of the limbs are more common, and they are aggravated in winter.

Basic Information

nickname

Psoriasis

English name

psoriasis

Visiting department

dermatology

Multiple groups

Young people

Common causes

Unknown, related to heredity, infection, immunity, endocrine, etc.

Common symptoms

Mainly erythema, scaly

Contagious

no

Causes of psoriasis

Although many studies have been conducted on the etiology of this disease, it is still not clear. It is currently believed that the occurrence of this disease is not a single cause, and may involve multiple aspects.

Heredity

A considerable number of patients have a familial history, and some families have a significant genetic predisposition. It is generally believed that people with family history account for about 30%. The incidence varies widely among different races. Psoriasis is a multi-gene hereditary disease that interacts with multiple factors including genetic factors and environmental factors. The incidence of certain HLA antigens in patients with this disease is significantly increased. Psoriasis may overlap with other diseases (such as rheumatoid arthritis, atopic dermatitis, etc.).

2. infection

Many scholars have confirmed that streptococcal infection is related to the onset and duration of psoriasis from humoral immunity (anti-streptococcus group), cellular immunity (peripheral blood and skin lesion T cells), bacterial culture and treatment. In patients with psoriasis, S. aureus infection can aggravate skin lesions, which is related to the superantigen of S. aureus exotoxin. Although the occurrence of this disease is related to viral (such as HIV) and fungal (such as Malassezia) infections, the exact mechanism has not yet been confirmed.

3. Immune abnormalities

A large number of studies have proved that psoriasis is an immune-mediated inflammatory skin disease, and its pathogenesis is related to inflammatory cell infiltration and inflammatory factors.

4. Endocrine factors

In some women, skin lesions are reduced or even disappeared after pregnancy, and worsened after delivery.

5. Other

Neuropsychological factors have a certain relationship with the incidence of psoriasis. Alcohol, smoking, drugs, and stress can induce psoriasis.

Clinical manifestations of psoriasis

1. Psoriasis vulgaris

It is the most common type with multiple acute onsets. Typical manifestations are erythema with clear realm, different shapes and sizes, and inflammatory redness around. Slightly wetted and thickened. The surface is covered with multiple layers of silvery white scales. The scales are easy to scrape off, the translucent film is red and shiny after scraping, and small bleeding points (Auspitz sign) can be seen when the film is scratched. Skin lesions are common in the head, crotch, and lateral extremities. Some patients feel itching to varying degrees.

2. Pustular psoriasis

Rare, sub-pan hairstyle and palmar type. Generalized pustular psoriasis is a cluster of superficial, sterile pustules on the erythema, some of which can be fused into a pus lake. The disease can occur throughout the body. It is more common in the limb flexion and folds, 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 discomfort, and increased white blood cell counts. Most of them occur periodically, and psoriasis vulgaris skin lesions often occur during the remission period. Palmoplantar pustular lesions are confined to the hands and feet, occur symmetrically, are generally in good condition, stubborn, and recurrent

3. Erythrodermic psoriasis

Also known as psoriasis exfoliative dermatitis, it is a serious psoriasis. Often due to strong external stimulant drugs, long-term large-scale application of glucocorticoids, excessive reduction or sudden withdrawal. It manifests as diffuse flushing, swelling and desquamation of the skin throughout the body, accompanied by systemic symptoms such as fever, chills, discomfort, superficial lymphadenopathy, and increased white blood cell count.

4. Arthropathy psoriasis

Also known as psoriatic arthritis. Rheumatoid arthritis-like joint damage occurs concurrently in patients with psoriasis, which can involve joints of all sizes, but the interphalangeal joint disease of the terminal finger (toe) is the most characteristic. The affected joints are red and swollen and painful, and the skin around the joints is often red and swollen. Joint symptoms often increase or decrease simultaneously with skin symptoms. Blood rheumatoid factor is negative.

Diagnosis of psoriasis

According to the clinical manifestations of the disease, the characteristics of skin lesions, the location of the onset, seasonal diagnosis can be made.

Psoriasis Treatment

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

External medicine

For new small skin lesions, use external medicine as much as possible. The concentration of the drug should be from low to high. Which medicine to choose depends on the nature of the medicine and the specific condition of the patient.

(1) Vitamin D3 analogues This class of drugs includes calcipotriol, takasitol, etc., and has a better effect on plaque psoriasis. Calcipotriol creams, ointments, and lotions (for the head) are applied twice a day. They are usually effective within 8 weeks, and there is no dependence on long-term use. This medicine can be used in combination with glucocorticoids or UVB to improve efficacy. It should be used with caution in patients with bone diseases, calcium metabolism disorders and renal insufficiency, so as not to cause hypercalcemia.

(2) Glucocorticoid Topical glucocorticoid is still a commonly used therapy for psoriasis. Strong hormones should be used on the head and palms, and weak hormones should be used on the face and between the rubbing areas. Ointments and creams are commonly used in general areas. A solution (propylene glycol) and a gel should be used on the head. Local packet therapy can significantly increase the intensity of the effect.

The effect of glucocorticoids on skin lesions is temporary. The initial effect is significant, and sudden withdrawal often results in a "bounce" phenomenon. Those who need long-term medication should use intermittent therapy, that is, once every 2 to 3 days. Combined with other drugs (such as vitamin D3 analogs, retinoids, etc.), it is beneficial to consolidate the efficacy and reduce adverse reactions.

(3) Anthracene forest is often used for chronic plaque psoriasis. Can be formulated into ointments, pastes and paraffins. 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 rubbing area, take care to protect normal skin. Skin lesions usually begin to resolve after 2 to 3 weeks.

(4) Vitamin A gels and creams (0.05% to 0.1%) have a good effect on psoriasis when applied once or twice a day. Due to slower onset, it is generally not used alone as a first-line drug. It can be used in combination with glucocorticoids such as clobetasol propionate, and tazarotene should be continued after skin lesion control, and glucocorticoids should be gradually stopped. Pregnant women, breastfeeding and recent fertility requirements women are prohibited.

(5) Tars Commonly used tars include coal tar, pine oil, bran oil, and black bean oil, etc., formulated as an ointment with a concentration of 5% for external use. Coal tar is effective for chronic stable psoriasis, scalp psoriasis, and palmar plantar psoriasis. Prohibited in pregnant women, pustular and erythrodermic psoriasis. There are now some colorless, odorless coal tar preparations, which are close to crude products. Soluble coal tar is used for bathing, and coal tar shampoo is used for shampooing. Coal tar tincture is used for tinting and is effective for treating psoriasis of the head.

(6) Other topical drugs such as immunosuppressive agents, such as tacrolimus, pimecrolimus, topical treatment, and packets for refractory localized psoriasis. 0.03% camptothecin ointment, 5% salicylic acid ointment, etc.

2. Internal use

(1) Methotrexate (MTX) is a folate reductase inhibitor that prevents DNA synthesis during epidermal cell proliferation and inhibits nucleus mitosis. MTX can inhibit the proliferation of activated lymphocytes in the body, weaken the function of CD8 cells, and inhibit the chemotaxis of neutrophils. MTX is the standard medication for systematic treatment of psoriasis, but long-term medication can cause extensive liver fibrosis and liver Hardened, so pay attention when applying. MTX is suitable for erythrodermic and joint diseases. Pustular type, generalized psoriasis and other conventional treatments with poor results. Avoid use in patients with liver and kidney dysfunction, pregnancy or breastfeeding, decreased white blood cell count, active infectious diseases, alcoholism, immune deficiency and other serious diseases.

(2) Retinoids Retinoids can regulate epidermal proliferation and differentiation and immune function, and are used for generalized pustular psoriasis, erythrodermic psoriasis, and severe plaque psoriasis , Take it alone or in combination with other therapies, have a satisfactory effect. Commonly used drugs are Avi A ester, Avi A and other retin A acid drugs. The main side effect is teratogenicity. Studies have proven that Avi A ester is still measured in urine for 2 years after discontinuation of Avi A ester, and some Avi A It can be converted to Avenamate. Therefore, contraceptive measures should be taken within 2 years after the drug is discontinued in women of childbearing age: lip, eye, and nasal mucous membranes dry during the administration of the drug, and the skin is diffusely desquamated and hair is lost. Elevated blood lipids can 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 routinely for psoriasis, because the effect is not great, and the symptoms are worse than the original after stopping the drug, and can even induce acute pustular psoriasis or erythroderma Psoriasis. However, because glucocorticoids have an "anti-inflammatory" effect, they can be used for erythrodermic, arthritic, and generalized pustular psoriasis when other treatments (such as MTX) are ineffective or contraindicated Use with caution.

(4) Immunotherapy and biologic therapy Immunosuppressive agents such as cyclosporine A, tacrolimus, and mycophenolate mofetil have good curative effects in severe psoriasis. The application of some new biological agents, such as the cytokine blocker etanercept, is a new development in the treatment of psoriasis, but it is expensive and has adverse reactions, and its clinical application needs further observation.

(5) The occurrence and recurrence of some antibiotics psoriasis are related to microbe infections such as bacteria, fungi, and viruses, especially acute drip psoriasis is often accompanied by acute tonsillitis or upper respiratory tract infection. Penicillin and cephalosporin can be used in these cases Bacteriocin treatment, good effect. Certain antibiotics also have immunomodulatory effects, such as erythromycin. In some patients, Malassezia multiply in the sebum overflow site, which can be treated with ketoconazole lotion.

3. physical therapy

Applicable to ultraviolet, photochemical therapy (PUMA), broad-spectrum medium-wave ultraviolet (BB-UVB) therapy, narrow-spectrum medium-wave ultraviolet (NB-UVB) therapy, hydrotherapy

4. Chinese medicine and traditional Chinese medicine treatment

Chinese herbal medicine and compound Qingdai pills, tripterygium wilfordii, compound salvia miltiorrhiza tablets can be applied.