Psoriasis is a chronic recurrent inflammatory skin disease. For special areas, such as psoriasis on the head and face, nail psoriasis, psoriasis in the axillae and inframammary folds, individualized treatment and care are needed so as to help to shorten the course of the disease, reduce symptoms and prevent recurrence.
Next, we will talk about the treatment and care of special psoriasis respectively.
I. What is the treatment of special psoriasis?
1.Treatment of head psoriasis
Scalp psoriasis is characterized by clear borders, erythema covered with thicker scales, scales mixed with sebum and dust in grayish yellow, silvery white after peeling, bundles of hair at the lesions, but normal hair, hair loss is occasionally seen in the affected lesions.
At present, the clinical treatment is mostly carried out by phototherapy, topical hormones, immunosuppressants and vitamin D3 derivatives.
For example, topical glucocorticoids of medium to strong potency are used, or in combination with vitamin D3 derivatives such as carbofuran; UVB light therapy combs can also be used to irradiate the scalp.
Usually, after the above methods, a better therapeutic effect can be achieved, but if it is ineffective, systemic treatment, such as Aveline, methotrexate, cyclosporine, etc., should be considered.
2.Treatment of facial psoriasis
Facial psoriasis is diagnosed as facial psoriasis if it meets the clinical diagnostic criteria of psoriasis and the lesions involve any one or more parts of the forehead, eyebrows, eyelids, nose, perioral area, cheeks, ear drums and periauricular area of the face.
Short-term treatment with weak hormone or immunosuppressant tacrolimus ointment can be used with an efficiency of 97.4%. Note that the first application of tacrolimus ointment on the face may cause a burning sensation on the face, which can be relieved by applying cold compresses or washing the face with water, and the burning pain basically disappears by the third day.
It can also be treated with oral retinoic acid, topical tacrolimus cream and combined with narrow-spectrum medium-wave ultraviolet radiation (NB-UVB), with an efficiency of 83.67%.
If only 308nm excimer laser is used to treat facial psoriasis, the efficiency reaches 85.7%, but there will be pigmentation, itching, pain, blisters and other adverse reactions.
3.Treatment of flexural or fold psoriasis
Also known as reverse psoriasis, it is a special type of psoriasis that can involve the axillae, inframammary folds, groin, vulva, buttocks and other folds, with inflammatory erythematous lesions with obvious boundaries and few or no scales.
It is often treated with weak hormones, immunosuppressive agents and vitamin D3 derivatives. Avi A capsule, vitamin E capsule and compound glycyrrhizin tablets are usually given orally, and Eloson and Capotriol are used topically, and patients can effectively improve their symptoms.
4.Treatment of nail psoriasis
For patients who only have nail damage without skin involvement, topical topical drug treatment is generally chosen.
For example, super-powerful glucocorticoids such as clobetasol propionate are commonly used as local encapsulation therapy.
For nail bed lesions, such as nail stripping, the nail plate is first cut or sealed with a highly concentrated urea ointment for about a week to soften the nail plate and make it fall off, and then topical glucocorticoids or vitamin D3 analogs are applied topically.
In addition, intra-dermal injection of drugs is also a common method for treating nail psoriasis. At present, small doses of tretinoin are mainly used, often chosen to be injected at the proximal nail crease, which can improve nail damage caused by nail matrix involvement, such as nail plate anomalies, nail dimples and nail ridge protrusions.
In addition, systemic therapy may be a good option when there is more severe skin or joint damage or when there is resistance to radiation therapy, for example.
However, the efficacy of medications is difficult to judge due to the lack of uniform criteria for judging the efficacy of nail psoriasis. The available drugs include cyclosporine, retinoids, methotrexate, hydroxyurea and biological agents.
Second, the care of special psoriasis, both skin and psychological should be paid attention to
1.Psychological care
Psoriasis on the head, face, nail and flexor side and other special parts of the body are more likely to lead to anxiety, and having a good mood plays an important role in disease control and prevention of psoriasis recurrence.
For patients with recurring psoriasis, we should help them analyze the causes of the disease and reduce their psychological burden, so as to reduce their symptoms and even cure them and facilitate their recovery.
In addition, patients’ family members should care more about the patients and comfort them, which also helps them recover from the disease.
2.Skin care
Scalp psoriasis and folds of psoriasis can be properly bathed, which can accelerate the flaking of scales, keep the skin clean and play a role in inhibiting the growth of bacteria.
Pay attention to improving the dry skin condition after bathing, and use post-bath lotion or emollient after bathing to avoid aggravating the condition due to dry skin.
The water temperature should be controlled at 37℃~39℃, the cleaning time should not be too long, 20~30 minutes is appropriate, and avoid using alkaline soap with strong grease removing ability.
If the patient’s skin is dry and itchy, he or she should apply topical compound chloramphenicol application or emollient to the affected area to reduce the itchiness.
When topical medication is used with common psoriasis, those with hypertrophic lesions should use emollients appropriately for exfoliation to enhance drug penetration and improve therapeutic effect.
When using drugs with exfoliating effect for nail psoriasis, glycerin should be applied appropriately to protect the skin around the nail.
Pustular psoriasis should be exposed as much as possible or clothes should be as loose and breathable as possible.
In addition, patients should be reminded to trim their nails diligently to avoid skin infections and allograft reactions caused by scratching.
References
[1] Wang Ying. Research progress in the treatment and care of psoriasis in special areas [J]. Medical Information,2015(19):334-335.
[2]Wu Jianbing,Cui Pangen,Zhang Caiping. Advances in the treatment of psoriasis of the face, flexural areas of the trunk and nail[J]. Journal of Clinical Dermatology,2009,38(01):60-62.
[3]Chinese psoriasis treatment guidelines (2018 complete version)[J]. Chinese Journal of Dermatology,2019(10):667-710.