Psoriasis, commonly known as “psoriasis”, is a common, chronic and recurring skin disease. It typically appears as scaly red patches or plaques on the skin. Patients usually have redness and flaking of varying sizes. Most exacerbations occur in the fall and winter and decrease in the spring and summer. Although psoriasis can occur at any age, it is generally more prevalent in young adults. The disease has no major impact on physical health and is not contagious, but the recurring attacks of skin lesions cause considerable distress to the patient’s psychological condition and daily interactions. Why does psoriasis happen to me? Although a lot of research has been conducted at home and abroad on the etiology and pathogenesis of psoriasis, and great progress has been made, it is not yet completely clear. More research now supports the possibility that the disease may be related to an immune response against one’s own skin cells resulting from a dysregulated immune response. Many factors may be associated with the development or exacerbation of psoriasis. In fact, with the exception of genetic factors, all of them can be considered as triggers or aggravating factors of psoriasis. (1) Heredity: The disease often has a family history of development. Studies have found that 1/3 of the relatives of psoriasis patients also have psoriasis; at the same time, the incidence of psoriasis among relatives of psoriasis patients is three times higher than that of normal people. When one parent had psoriasis, the chance of the child developing the disease was 8.1 percent. When both parents have psoriasis, the prevalence of children increases to 41%. This is because psoriasis is a polygenic genetic disease in which genetic and environmental factors interact, and environmental factors also play a very important role in its pathogenesis, and the lack of acquired environmental factors does not necessarily lead to clinical symptoms even if one carries certain relevant genes. (2) Infections: Some infections, especially upper whistle infections (including the common so-called “cold”), may be important factors in the onset and progression of psoriasis. Clinically, there are patients who do not have a family history of psoriasis, but gradually and suddenly develop psoriasis after a cold. There are also some types of psoriasis, for example, acute drip psoriasis often appears 1 to 2 weeks after an acute bacterial (streptococcal) infection. (3) Thought stress: long-term mental tension, depression, anxiety and stress are also important factors leading to the triggering and aggravation of psoriasis. The current fast-paced living condition and continuous high-intensity work may be related to the onset of some young and middle-aged patients. Therefore, relieving emotional tension and avoiding overexertion are helpful to the overall efficacy and recovery of psoriasis. (4) Endocrine: Some studies have found that the incidence of psoriasis is higher in women during puberty and menopause, and the condition often improves when they are pregnant, so it is presumed that endocrine, especially sex hormone levels, may have some influence on psoriasis. (5) Food and medication: Spicy food and alcohol are often thought to worsen the disease, but there is a lack of sufficient medical evidence. Therefore, food avoidance needs to be individualized. Some drugs can also cause psoriasis to develop or worsen, such as antimalarials and lithium salts, which should be avoided. (6) Others: Moderate sun exposure is beneficial to psoriasis, but excessive exposure may also worsen psoriasis. Obesity, smoking and environmental pollution may be related to the onset and aggravation of some psoriasis. Can psoriasis be cured? Many psoriasis patients are anxious, and various information media say that this disease cannot be cured and is an “undead cancer”. The various ways and methods of treatment make people dizzy and they don’t know which one to listen to. It is true that there are many ways to treat psoriasis, but there is no cure at the moment, and those who claim to be able to “cure psoriasis” are deceptive advertisements. The current variety of treatment can only achieve the recent effect, can not prevent recurrence. After standard treatment, psoriasis can be controlled and relieved for a long time. Slow diseases should be treated slowly. How do doctors generally treat psoriasis? Since the disease is a chronic and recurrent disease, treatment should focus on long-term treatment. The standard treatment includes topical topical medication and systemic medication (oral medication or injections) as well as physical therapy. Systemic treatment is mainly used for patients with large lesions, while local treatment should be considered first for patients with small and stable lesions. Due to the recurrent nature of the disease, single treatment is prone to dependence, drug resistance or poor therapeutic effect. Therefore, alternating therapy and combination therapy are generally used in clinical practice. Rotational therapy refers to the alternating use of different classes of drugs and treatment modalities in order to reduce the risk of single treatment and improve treatment responsiveness, while combination therapy involves the simultaneous use of different treatment modalities or drugs with the aim of shortening the course of treatment or reducing side effects in treatment. Both doctors and patients should be patient in treatment and should communicate fully in treatment, which must take into account long-term safety, efficacy and convenience at the same time, and avoid unregulated treatment concepts and methods. What are the commonly used topical medications? (1) Topical hormone ointment: topical hormones have anti-inflammatory and anti-proliferative pharmacological effects, and are the first-line drugs for the treatment of psoriasis, with fast onset of action. However, it is easy to relapse after stopping the drug when used alone, so at present, it is mostly combined with other non-hormone ointments, such as topical vitamin D3 derivatives and vitamin A acid ointment. There are many kinds of topical hormone ointments, and doctors usually choose the type of ointment, dosage form, treatment method and course of treatment according to the site and type of skin lesion. The use of topical hormones is safe, but it should be noted that long-term use of strong hormone ointments can produce side effects such as skin atrophy, capillary dilation, pigment loss and treatment resistance, especially in areas with thin and tender skin, such as the face, groin and scrotum. Therefore, medical advice should be followed in the process of use, and care should be taken to avoid long-term and continuous use of strong hormones. (2) Topical vitamin D3 derivatives: This drug mainly inhibits the proliferation of keratinocytes and promotes their differentiation, and has an anti-inflammatory effect. The main ones currently used in clinical practice are carbotriol ointment and tacalcitol ointment. This drug may cause mild local irritation, especially at the beginning of treatment. To reduce irritation and increase efficacy, there are also some compounded preparations containing hormones, such as Depo-Provera ointment containing betamethasone and calcipotriol. Compounded preparations are generally recommended for use at the beginning of treatment and can often achieve results that can quickly control symptoms. (3) Topical retinoic acid ointment, a derivative of vitamin A, such as tazarotene gel, can regulate epidermal cell proliferation and differentiation. It can be used clinically in combination with hormone ointment, which can better reduce the thickness of psoriasis lesions and decrease flaking, but has limited effect on erythema. (4) Moisturizers: The use of moisturizers can avoid skin dryness and reduce the frequency and duration of disease recurrence. After control with the above medications, the usual routine use can be considered. When do I need systemic treatment? Commonly used medications include methotrexate (MTX), cyclosporine, retinoic acid and some biological agents (e.g. Ixepro) for patients with large areas and heavy lesions, preferably under the guidance of a doctor. Oral hormones are generally not advocated for psoriasis patients and can lead to rebound and aggravation of the lesions. In addition, medium-wave ultraviolet light therapy (UVB) can inhibit the function of immune cells in the skin and reduce skin inflammation. Combining with drugs can shorten the course of the disease and reduce the amount of drugs used, which is also a very effective treatment. What should I pay attention to in my daily life to reduce recurrence? Although psoriasis is not easy to be cured, the following aspects can be paid attention to in daily life to avoid or reduce the aggravation and recurrence of psoriasis: (1) Reasonable arrangement of work and rest, looking down on the gains and losses in work and life; (2) Regular exercise, weight control, improve immunity, avoid colds, and some studies have confirmed that moderate daily exercise can alleviate the disease and reduce recurrence; (3) Appropriate attention during the onset of the disease Avoid spicy food, drinking alcohol, scratching and other triggering factors; (4) Do not seek medical advice and use drugs indiscriminately for a long time, and do not believe in Chinese medicine that can cure the disease, as some oral drugs may cause the deterioration of psoriasis; (5) Please maintain communication with your doctor at all times.