Psoriasis is a common disease that is chronic, prone to recurrence and difficult to treat, often bringing heavy mental stress to patients, and most patients are often eager to seek medical treatment. Because of this, psoriasis has become a subject of research in medical circles at home and abroad. With the continuous progress of research, in recent years, both Chinese and Western medicine have gained a deeper understanding of this disease than before, clinical treatment plans have been improved, and the treatment effect has been enhanced. Nevertheless, due to the drive of economic interests, or the limitation of professional level, some doctors deviate from the track of formal treatment, and because many patients have less basic knowledge of the disease, they are obsessed with the pursuit of “eradicating the root” and seek medical treatment, resulting in the aggravation of the patient’s condition or the emergence of adverse reactions is not uncommon.
A. What is psoriasis
Psoriasis, also known as “psoriasis”, is a common and recurring chronic inflammatory skin disease. In terms of age of onset, young adults are the most common. Most of them are winter type, but a few of them develop in other seasons. Because of its high incidence, easy recurrence and long duration, psoriasis has a great impact on patients’ physical health and mental health.
Many studies have been conducted at home and abroad on the etiology and pathogenesis of this disease, and although some achievements have been made, no definite conclusion has been reached so far. There are several theories on the main causes or triggers for the occurrence and development of the disease, such as genetic factors, infectious factors, metabolic disorders, endocrine factors, neuropsychiatric factors, immune factors, etc., but the real causes and mechanisms of the disease have not been fully elucidated so far.
According to the clinical characteristics of psoriasis, it is generally divided into four types: common, pustular, arthritic and erythrodermic psoriasis.
Psoriasis vulgaris is the most common type, accounting for more than 99%. Most of them have an acute onset. Initially, it is usually an inflammatory red papule, about the size of corn to green beans, and later it can gradually expand or fuse into brownish-red plaques with clear borders, surrounded by an inflammatory red halo, with obvious basal infiltration and covered with multiple layers of dry silvery-white scales. Gently scrape away the surface scales, then gradually reveal a layer of light red shiny translucent film, called film phenomenon. If the film is scraped away again, small bleeding spots will appear, which is called punctate bleeding phenomenon. White scales, shiny film and punctate hemorrhage are the clinical features of this disease. In the progressive stage, lesions appear at the site of trauma, which is called homomorphic reaction.
Pustular type: Dense sterile pustules of corn size appear on the basis of erythema. There are two types: generalized and limited.
Arthritic type: In addition to erythema and scaling, there are also manifestations of arthritis, with erythema and pain in distal finger, wrist and ankle joints being common. The joint symptoms appear simultaneously or successively with the skin lesions, and the two conditions have a parallel relationship.
Erythrodermic type: often due to improper treatment, the lesions expand rapidly, manifesting as diffuse redness and swelling of the skin all over the body, accompanied by a large amount of flaking, covering an area of more than 2/3 of the body surface. generalized pustular and erythrodermic psoriasis are mostly triggered by the external use of irritating drugs during the progression of common psoriasis, or the sudden discontinuation of drugs during the systematic application of glucocorticoids and immunosuppressive drugs, as well as infection and mental stress.
Scalp psoriasis has bundled hair, and the finger (toe) nails are involved with thimble-like depression of the nail plate and loss of luster. The skin lesions may have different degrees of itching.
Why is psoriasis also called “psoriasis”?
”Psoriasis” is the common name for psoriasis, also known as “psoriasis”, “pineal psoriasis”, “dry psoriasis “psoriasis” is also known as “psoriasis”, “pineal psoriasis”, “dry psoriasis”, “wind psoriasis”, “white shell sores”, etc., and is called “white scar” in Chinese medicine. The “white scar” has been recorded in Chinese medical literature for a long time, such as the Sui “Treatise on the Sources of Diseases – Sore Diseases – Dry Ringworm”, which says: “Dry ringworm, but there is Kuang Guo, the skin is withered and itchy, scratching the white flakes out is also. ” The description in the Qing “The Complete Book of Surgical Evidence and Treatment, Volume 4 – Hair without a definite place evidence” points out the characteristics of this disease, such as “white scar (a scar wind), dry and itchy skin, starting like a rash scabies but white in color, scratching the flakes up, gradually to the limbs dry chap, blood out pain.” Thus, it seems that “psoriasis” and “psoriasis”, as they are called in Western medicine, are exactly the same thing. For a long time people have been familiar with the name “psoriasis”, while the name psoriasis is relatively unfamiliar, in fact “psoriasis” is not ringworm, ringworm is a disease caused by skin infection with fungi (dermatophytes), which is somewhat infectious. The “psoriasis”, as we call it, has no fungal or bacterial presence of its own, and is therefore absolutely not contagious.
The incidence and season of psoriasis
Psoriasis occurs all over the world, but there are great differences between regions and ethnicities. Generally speaking, the incidence of psoriasis is higher in Caucasians, followed by yellow people, and less in black people. According to a survey conducted in 1984 in different areas of China, a total of 6,616,917 people were sampled in urban and rural areas, and 11,393 people were found to have psoriasis, with a total prevalence rate of 0.123%. The prevalence of psoriasis was higher in urban than in rural areas, and higher in the north than in the south. According to the statistics of western countries, the incidence rate of psoriasis varies according to ethnicity.
Fourth, what season is prone to develop
According to clinical research, the onset of psoriasis does have a certain relationship with the seasons. Most people develop or aggravate psoriasis in winter, and the lesions reduce or disappear in summer after the climate warms up; a few patients have aggravated or relapsed lesions in summer, and the lesions reduce or subside in winter when it is cold. Those with winter disease are called winter type, and those with summer disease are called summer type. There are also some chronic patients, due to long-term medication or improper treatment, the onset pattern of the disease has changed, and the seasonal change is not obvious.
V. Etiology and pathogenesis of psoriasis
The causes and pathogenesis of psoriasis are not yet completely clear. At present, it is internationally and domestically recognized that psoriasis is the result of the joint action of many factors such as genetic factors and environmental factors, that is, it is induced by many factors on the basis of genetic factors.
Genetic factors: In 1984, the national epidemiological survey report of psoriasis showed that 32% of people had a family history of heredity, and the mode of inheritance was autosomal dominant, with an epistatic rate of 20%.
Common predisposing factors such as the following.
1.Infection factors
It is one of the important predisposing causes of psoriasis, especially in children. Some patients (especially children) often have a history of pharyngitis, tonsillitis, colds, etc. before the onset of the disease; in some patients, the skin lesions are aggravated with the occurrence of infection, and the skin lesions improve or heal after treatment with antibiotics or antiviral drugs. It is reported that more than 90% of patients with psoriasis suffer from chronic tonsillitis, and 49.5% of patients with psoriasis occur following acute tonsillitis. Children with psoriasis are often accompanied by upper respiratory tract infections and tonsillitis. The condition of psoriasis patients can often deteriorate rapidly after being infected by streptococci, and the psoriasis can often be reduced after applying antibiotic treatment, which shows that upper respiratory tract infection and tonsillitis are related to psoriasis, and may be the body’s metamorphic reaction to bacterial toxins. All these show that the onset of psoriasis has a certain relationship with infection.
2.Spiritual factors
People have long recognized that the skin is one of the organs of expression of human internal mental activities, and excessive mental tension is a non-negligible trigger for the onset of psoriasis and its deterioration. Due to excessive mental tension, anxious temperament, emotional depression, irritability and insomnia, family disputes and other mental factors induced psoriasis accounted for the first of all other triggers, especially adults are more common. Data show that about 18.6% of the cases. Excessive mental stress produces a series of psychological or physiological reactions that promote endocrine disorders, damage the body’s immune defense system and enzyme metabolic disorders, thus promoting the occurrence of psoriasis or aggravating the disease and resistance to treatment. This situation is often encountered in clinical practice, where psoriasis patients have been cured for many years without relapse, but due to great mental stimulation, such as the death of relatives, fights and brawls, etc., the patients are overly nervous, followed by insomnia and dreaminess, distraction, and then feel hot and itchy, triggering psoriasis relapse, which is common in clinical work.
In addition, patients with psoriasis have specific personality traits (mostly type A personality) and are more prone to tension, depression and anxiety than ordinary people to certain social emergencies.
In conclusion, mental factors have an important role in the pathogenesis of psoriasis, which can induce and aggravate psoriasis. Its pathogenesis may be due to autonomic and immune dysfunction caused by psychosocial stress, coupled with psoriasis susceptibility qualities, causing the onset or aggravation. Therefore, in the treatment of psoriasis, psychotherapy is very important and can achieve twice the result with half the effort.
3.Immune function disorder
Immunological research confirms that the humoral immunity of psoriasis patients is disordered, the T suppressor cells in the blood of patients are significantly decreased, the T helper cells are elevated, the cellular immune function is low, the transformation rate of lymphocytes and the natural petal formation rate are reduced, the skin delayed hypersensitivity test is weakened, and it is also reported that the infiltrating cells at the site of psoriasis lesions are mainly T cells, and the expression of HLA-DR and LL-2 receptors on the surface of these cells It is also reported that the infiltrating cells at the site of psoriasis lesions are mainly T cells, and the surface of these cells express HLA-DR and LL-2 receptors, which can secrete some cytokines.
4.Trauma
It is common for psoriasis lesions to occur after trauma, such as bruises, injection needles, insect bites, burns, scalds and scratches.
5.Metabolic disorders
The important pathophysiological change of psoriasis is the acceleration of epidermal cell proliferation, which shortens the epidermal cell turnover time. The normal epidermal cell turnover time is 26-28 days, while the turnover time of psoriasis lesions is 3-4 days, thus the maturation of epidermal cells is disturbed, resulting in the disorder of epidermal histology, serialization and keratinization, producing a series of pathological phenomena such as silvery white scales. Such rapid growth of epidermal cells in psoriasis may be directly related to the action of a substance called “polyamine”, which is an important regulatory substance in cell biology, especially related to the biometabolism of DNA and RNA proteins. Proteins combined together, through accelerated enzyme reaction and direct action, causing accelerated cell division and shortened cell turnover time, resulting in some pathological changes of psoriasis.
6.Endocrine dysfunction
Clinical data show that female patients are related to menstruation and pregnancy, most patients are better during menstruation and pregnancy, and the improvement of skin lesions mostly occurs within 3-6 months after pregnancy, while most patients’ condition is aggravated after delivery, which may be related to the increase of corticosteroid secretion during pregnancy.
etc. All these stimuli can cause skin damage and then induce the occurrence of psoriasis.
7.Other
Such as allergy, cold, humidity, dry climate and high temperature are also common triggering causes of psoriasis.
Sixth, psoriasis Chinese medicine etiology pathogenesis
The onset of the disease is caused by the lack of endowment, the couples are loose, the wind evil outside the bundle, the loss of harmony between qi and blood, blocking the muscle surface, the Yang Qi closed and depressed, containing and turning into heat, and the heat Sheng Sheng wind and dryness, blocking the muscle surface and birth; the disease is prolonged qi and blood depletion, blood deficiency and wind, skin loss of nourishment; or by the loss of harmony between Ying and Wei, the flow of qi and blood is blocked, resulting in stasis blocking the muscle surface and the onset of the disease.
Seven, common psoriasis is often identified as three types of treatment
1. Blood-heat and wind-dry evidence Most often seen in the progressive stage of the disease, with increasing skin lesions, reddish color, obvious punctate bleeding, thickened scales and itching. It is accompanied by fear of heat, dry stool, yellow urine, red tongue with yellow coating and slippery pulse. Treatment is to disperse wind and clear heat, cool blood and moisten dryness. Commonly used drugs: honeysuckle, forsythia, fu ling, samphire root, panacea, dacquoise leaf, raw earth, dandruff, red peony, comfrey, white fresh peel, scutellaria, fried acacia rice, raw licorice, etc.
2.Blood deficiency and wind dryness are mostly seen in the quiescent and receding phases of the disease, where the lesions are no longer expanding, or there are only a few new rashes. The skin is dry, the lesions are light red, itchy or painful with cracking. It may be accompanied by dizziness and blurred eyes, white face, light tongue with thin coating and moist and thin pulse. Treatment is to nourish blood and moisten dryness, dispel wind and clear heat.
3.Blood stasis and obstruction evidence Long duration of the disease, recurrent attacks, many years without healing, purple lesions or pigmentation, thick scales, or with unfavorable joint movement, dark tongue with petechiae, thin and astringent pulse. Treatment is to invigorate blood circulation and eliminate blood stasis, dispel wind and moisten dryness. Commonly used drugs: peach kernel, safflower, raw earth, red peony, angelica, Chuanxiong, salvia, trigonella, curcuma longa, Chuanxiu knee, comfrey, raw licorice, etc.
VIII. Treatment principles of psoriasis and selection of treatment methods
Psoriasis is a very common chronic skin disease, clinically divided into the common type, pustular type, arthritic type and erythrodermic type, among which the common type is the most common. Although common psoriasis does not have much impact on physical health, most patients often have a heavy burden on their minds due to factors such as affecting aesthetics. Therefore, many patients are eager to seek treatment, hoping to be completely cured and never relapse. However, so far, the cause of the disease is still unknown, so there is a lack of special treatment to cure it. At present, the status quo of psoriasis treatment is rather confusing, and many patients suffer from adverse consequences due to blind medical consultation and improper medication. Therefore, regular treatment should be adopted after the disease. Various treatments should be based on the principle of safety and effectiveness.
The treatment principles of psoriasis are as follows.
1.The ratio of benefit/disadvantage and efficacy/risk should be considered when choosing treatment options.
2, the near-term efficacy and long-term efficacy are given equal importance, if the near-term efficacy is good, but the long-term efficacy is unsatisfactory or aggravates the disease (such as glucocorticoids, immunosuppressants, etc.) should be selected with caution.
3, health economics principle: choose inexpensive and has been proven effective methods.
4, individualization: a treatment method can not be effective for all patients, different patients use different treatment plans.
5.Determine the goals of treatment: (1) the first-episode patients strive for long-term remission; (2) chronic relapsing psoriasis treatment aims to improve the patient’s quality of life and strengthen psychotherapy; (3) patients with long-term attacks are prompted to remit and prolong the remission period, or maintain the disease in a milder state.
Choice of treatment plan.
1, all patients should pay attention to psychological treatment.
2. Those with lesions less than 10% of the total body surface area should be treated with psychotherapy + topical medication. Tar, anthralin, retinoids, glucocorticoids and herbal medicines can be chosen. After the lesions are controlled, the number of medications can be reduced and the medications can be gradually stopped after maintaining the efficacy for a period of time in order to prolong the remission period or reduce recurrence.
3.In the case of the first episode or sudden recurrence of long-term remission, possible triggering factors such as infection and mental stimulation should be actively searched for, so that the corresponding treatment can be taken. Antibiotics, vitamins, heavy metal-free herbal preparations, etc. can be applied, and glucocorticoids and immunosuppressants are prohibited or used with caution to avoid affecting the prognosis. Each recurrence is closely related to tonsillitis, tonsillectomy can be performed.
4. For those with long duration of disease, frequent recurrence but not much rash, strengthen psychological treatment, accept reality, do not blindly ask for a cure, adjust your mental state, and try to apply a treatment plan with little adverse reactions, such as herbal medicines and topical drugs that do not contain heavy metals.
5, for long-term recurrent and heavy rash, rash area greater than 30% of the body surface area, should be a detailed analysis of the condition, with the general treatment methods are ineffective, can be carefully selected methotrexate, retinoic acid drugs, phototherapy, hot spring bath therapy, etc.. The narrow-wave UV B phototherapy developed in recent years has achieved better efficacy in the treatment of psoriasis, and the side effects are small.
6.Joint therapy: In order to strengthen the therapeutic effect and shorten the course of the disease, joint medication is often used. Such as internal medicine + external medicine, external medicine + mineral bath + phototherapy, etc.
In the process of psoriasis treatment, most of them adopt ladder therapy, that is, treatment is like going up a staircase, starting from the most simple life and skin care, and giving skin topical drugs, topical drugs + phototherapy, topical drugs + internal Chinese medicine, etc. according to the development of the disease.
Traditional Chinese medicine has a long history of treating this disease, which is safe and effective with a low recurrence rate. Therefore, more and more patients are happy to accept this treatment. Chinese medicine treatment often adopts the method of diagnosis and treatment, generally according to the blood heat, blood stasis, blood dry three types of medicine. With correct treatment, satisfactory results are often received. In order to obtain good results, it is best to let the professional technicians consult and treat the patient, and not to listen to the advertising propaganda that is overstated. In addition, treatment should be patient, because psoriasis is a chronic disease, no matter what kind of treatment is needed for a sufficient course of treatment. After proper treatment and mind-body conditioning, it is possible to make psoriasis remit. Although the remission can’t be cured, the patient can live with the disease for years, and the patient can “live in peace” with psoriasis and live and work normally.