Psoriasis is a clinically common chronic inflammatory skin disease, known as “Bai R” and “pineal ringworm” in Chinese medicine. The disease mostly occurs in young and middle-aged people, with a slow course and even lifelong extension, which has a great impact on the physical health and mental health of patients. The cause of psoriasis is unknown and the pathogenesis is complex. The disease is difficult to treat, cannot be cured and is prone to recurrent attacks.
I. Diagnostic criteria
According to the relevant contents of professional works such as Clinical Dermatology and Yang Guoliang Dermatology. The main points are as follows.
1. clinical manifestation characteristics, including the characteristics of each type of lesion, the preferred site, the relationship with the seasons, etc.
2. Diagnosis with skin histopathology when necessary.
Clinical typing
According to the clinical characteristics, there are four types: common type, pustular type, arthritic type and erythrodermic type.
According to the development of the disease and lesions, there are three phases: progressive phase, stationary phase and regressive phase. The progressive phase is characterized by an expanding rash, marked inflammatory manifestations, the appearance of new rashes, and isomorphic reactions.
Depending on the severity of the disease, it is classified as mild, moderate or severe psoriasis. Body surface area involved (BSA) >10% or psoriasis area and severity index (PASI) >lO or skin disease quality of life index (DLQI) >10 are considered severe psoriasis. BSA <3% is considered mild and 3% to 10% is considered moderate.
Combining the clinical manifestations of psoriasis and the dialectical identification of Chinese medicine, it is summarized into seven Chinese medicine syndromes: 1.
1. blood-heat-wind type (ordinary progressive stage).
2. blood stasis skin type (unusual stationary phase).
3, blood deficiency and wind dryness type (unusual receding phase).
4, damp-heat type (confined or palmoplantar pustular).
5, fire and toxin type (generalized pustular).
6, wind-dampness obstruction type.
7.heat toxin injures yin type (erythrodermic psoriasis).
Third, the rash and efficacy determination.
1.Naked eye observation. Judging the efficacy according to the improvement of skin lesions (including area and scales) and clinical symptoms, before and after comparison.
2, digital camera photos, before and after comparison.
3.Based on BSA, PASI score and DLQI, before and after comparison to determine the efficacy.
IV. Laboratory tests
Blood routine, urine routine, liver and kidney function or biochemistry, ASO, CRP, RF, blood sedimentation, pharyngeal swab bacterial culture and drug sensitivity. Immunoglobulin and complement. Bone and joint x-ray radiographs.
V. Treatment.
1. topical medications: carboplatinol ointment, calcipotriol/betamethasone ointment, medium-strength glucocorticoid cream, carboplatinol application for scalp psoriasis, and our homemade compound bitter ginseng lotion.
2. our home-made herbal psoriasis agreement formula.
3. herbal qi therapy.
4.Narrow-wave UVB irradiation.
5.Internal drug treatment: retinoids, MTX, paying attention to the side effects of retinoids such as dry skin mucous membrane, teratogenic, high blood lipid, liver damage, etc., and the side effects of MTX such as affecting blood picture, liver and kidney damage, liver fibrosis, etc. Penicillins, cephalosporins and macrolide antibiotics may be given in case of punctate psoriasis or with bacterial infection.
6. intravenous closure therapy, which can be combined with compound glycopyrrolate and glycopyrrolate diamine.
7, Chinese medicine evidence-based treatment.
8.Adjunctive medicine: Chinese patent medicine anti-silver granules, moistening and anti-itching capsules, Yujin anti-silver tablets, Leigongtang polysaccharide, etc. Immunomodulators such as BCG polysaccharide nucleic acid, white peony total glucoside, transfer factor, etc. Vitamin A, β-carotene, B-vitamins, folic acid, etc.
The following points should be noted in the history taking.
1. mental and emotional conditions.
2. history of previous infections, including colds, upper respiratory tract infections, and tonsillitis. History of previous systemic diseases, including thyroid disease, ankylosing spondylitis, ulcerative colitis, skin tumors, etc.
3. history of medication use, including beta-blockers, non-steroidal antipyretic analgesics, tetracycline, hydroxychloroquine, etc.
4, history of trauma, personal physical condition and immune function, irritating diet, alcohol consumption and smoking
5, history of pregnancy and delivery in women.
6, family history of heredity.