During the fall and winter seasons, it’s time for psoriasis to set in again. Psoriasis, commonly known as psoriasis, is a chronic dermatitis with a long course and a tendency to recur. In general, psoriasis is not a major health concern, but because the rash often spreads all over the body and is accompanied by itching, it causes psychological stress to patients and affects their social life and quality of life.
Although many studies have been conducted on the causes and pathogenesis of psoriasis, they are not yet well understood. It is currently believed that the occurrence of the disease is not a single cause, but may involve genetics, infection, metabolic disorders, immune abnormalities and other aspects.
Clinically, psoriasis is divided into four types, of which eh common type common psoriasis is the most common.
1.Unusual psoriasis
Typical manifestation is a well-defined, erythematous plaque of varying shapes and sizes, slightly infiltrated and thickened. The erythematous surface is covered with silvery white laminar scales. The scales are easy to scrape off, and bleeding is common on the base surface after scraping. The lesions are usually found on the head, sacral region and extensor surfaces of the limbs. Self-perceived itching. The lesions of pitting psoriasis are corn to bean-sized papules with scales on top, often widely distributed.
2.Pustular psoriasis is divided into generalized and limited
Their common feature is the appearance of clusters of superficial sterile pustules on the erythema, and the oral mucosa can be involved at the same time. Acute onset or sudden exacerbation is often accompanied by systemic symptoms such as chills, fever, joint pain, general malaise and leukocytosis. In the remission phase, common psoriatic lesions often appear. Limited pustular psoriasis includes “psoriasis with pustules”, limited Hallopeau’s continuous acrodermatitis, cyclopustular psoriasis and palmoplantar pustulosis.
3.Erythrodermic psoriasis
It manifests as diffuse flushing, swelling and flaking of the skin all over the body, accompanied by systemic symptoms such as fever, chills and malaise, enlarged superficial lymph nodes and increased white blood cell count.
4.Arthritic psoriasis, also known as psoriatic arthritis
Patients with psoriasis also have rheumatoid arthritis-like joint damage, which can involve large and small joints throughout the body, but interphalangeal joint lesions are the most characteristic. Blood rheumatoid factor is negative.
Treatment of psoriasis
There is no specific treatment for this disease. Appropriate symptomatic treatment can control the symptoms, but the problem of recurrence is difficult to solve. The treatment of common psoriasis is mainly as follows.
1.Topical medication
Topical drugs play a rather important role in the treatment of this disease. New lesions of small size, as far as possible, use the method of applying medicine. The principle is to start with a mild drug without irritation, and then gradually change to a stronger role, as appropriate. The concentration of the drug should also be low to high. The specific choice of a drug, in addition to the nature of the drug itself to consider, to a large extent depends on the experience of the physician and the specific conditions of the hospital. Topical drugs are often used according to the condition of the tar preparations, corticosteroids, anthralin, tazarotene, carbofuran, tacrolimus, pimecrolimus, ciclopirox, capsaicin, Sigma and other drugs.
2.Internal medicine often includes herbal treatment
There are different advocates for the identification and typing of herbal medicine for psoriasis. At present, there is also no fixed group formula in clinical treatment. However, traditional Chinese medicine does have certain efficacy in some cases, and the efficacy is better when it is properly combined with other therapies.
(1) Progressive phase: The treatment is to clear heat, detoxify and cool the blood, with the following formula: raw acacia flower, white foxglove root, chicken blood vine, genistein, bitter ginseng, panax notoginseng, angelica, red peony, earth poria, tannin, yellow lily, big blue leaf, raw gypsum.
(2) Quiescent stage: to nourish blood and moisten the skin as the treatment, the formula is used: asparagus, maitake, dahurian, salvia, raw earth, beehive, shouwu, yellow essence, helianthus bark, chicken blood vine.
There are often Chinese patent medicines such as silver elimination granules, compound Qing Dai pill, Yu Jin Yin Qi tablets, silver dandruff spirit, silver dandruff capsule, etc., but all of them are chosen according to the evidence.
3.Ultraviolet radiation and photochemotherapy
Most of the psoriasis patients’ skin lesions aggravate or recur in winter, and irradiation of ultraviolet light has significant effect on such cases. Usually, medium-wave ultraviolet ray (UVB) is used, and long-wave ultraviolet ray (UVA) is also available. With proper control, there are no adverse effects. Excessive exposure can cause UV damage (sunburn) and in some cases can even develop into generalized erythrodermatitis and exfoliative dermatitis. Summer-type patients (exacerbated or relapsed in summer) should avoid this method.
PUVA therapy includes oral (or topical topical application) of photosensitizing substances, such as 8-methoxypsoralen (8-MOP) or trimethoxypsoralen, in combination with exposure to long-wave ultraviolet light (UVA), using the interaction of chemical substances and light exposure to achieve therapeutic purposes.
4.Goeckerman therapy
The traditional method is to apply 2-5% crude coal tar ointment externally, 3 times/d (or by other methods to ensure that the drug can be retained on the skin surface), wipe off after 24h, and bathe, followed by UVB irradiation (UVB sub-erythema amount). Crude coal tar is black and smelly, which is not easily accepted by patients, so coal tar solution or colorless and odorless tar derivative gel can be used instead.
5.Ingram therapy
Formal Ingram therapy (24h therapy) is to irradiate ultraviolet light after the coal tar bath, followed by topical application of 0.2 to 0.5% anthralin paste (Lassar paste). Anthralin paste is also available in low concentrations (0.01-0.10%).
Other modified Ingram therapies, including.
① Topical application of 1 to 3% anthralin ointment, kept for 5 to 20 min; immediate washing with water, followed by ultraviolet (UVB) radiation.
②Topical application of anthralin plus PUVA therapy.
③Topical application of anthralin, plus vincristine therapy.
6.Local injection therapy
Local injection of glucocorticoids is suitable for the treatment of small facial lesions, particularly stubborn individual lesions and nail psoriasis. For example, trimethoprim suspension or prednisolone suspension is appropriately diluted with saline or procaine and injected into the skin lesions locally. For nail damage to be injected into the nail epithelium, the syringe needle should be as small as possible, preferably with a needleless syringe.
7.Medicated bath therapy
This therapy is a commonly used method in psoriasis treatment. Commonly used methods include wheatstone mineral powder bath, sulfur bath, bran bath, tar bath, mineral bath, seawater bath, and herbal bath to stimulate the skin, improve blood flow, and eliminate inflammatory infiltrates. The therapeutic effects of medicinal baths on psoriasis are specifically manifested in the following areas.
①Cleaning effect, clean skin is significantly more resistant to various microbial infections, in addition, clean skin can improve the therapeutic effect. Before the drug package and light treatment, thoroughly clean skin can increase the absorption of drugs and the effect of light therapy.
②Thermal effect Different water temperature can be chosen according to the different conditions of patients. 36-37℃ water bath has good sedative, anti-itch and soothing effects, 38-40℃ can improve skin peripheral circulation and promote metabolism.
The therapeutic mechanism is to play its role through skin absorption, penetration, entering blood circulation, direct elimination of endotoxin accumulated in the skin due to metabolism, excretion, etc., so that the damaged tissues can restore normal functions and effectively treat all types of psoriasis, which is easily accepted by patients.