Psoriasis, also known as psoriasis, is a common and multifaceted disease in dermatology, and its etiology is more complex. For many years, the debate about hormone therapy for psoriasis has been going on, and in some primary units, the indications for hormone therapy are poorly grasped and abuse occurs. When hormones are discontinued and the disease rebound, most patients appear to panic. Can hormones be applied or not, and under what circumstances? First of all, hormone application should be based on clinical typing. According to the characteristics of skin lesions, psoriasis can be divided into four types: common type, pustular type, erythrodermic type and joint type. 1.Unusual psoriasis: it is the most common type and can be divided into drip type, plaque type and map type according to the shape of skin lesions. The basic damage is a well-defined erythematous plaque covered with white scales. Small bleeding spots can be seen when the scales are scraped away, which is called Auspitz sign. The lesions can be distributed all over the body, but the extremities and head are the most common. Generally speaking, oral hormones are prohibited for psoriasis vulgaris, and topical hormones should be used in moderation. If the scales are thin, use weak hormones such as hydrocortisone; if the scales are thicker, use medium to strong hormones such as mometasone furoate and lumetasone. Secondly, avoid long-term application of hormones, and generally change to other non-hormonal drugs after the condition is controlled. When topical hormone is used, it can be used together with other drugs, using sequential therapy, such as calcipotriol ointment, twice a day for 5 days, and change to medium-acting hormone application for 2 days. You can also use compound preparations containing hormones, such as calcipotriol betamethasone ointment, which is generally used for hypertrophic lesions, and then switch to calcipotriol or tacalcitol when the lesions improve. 2, pustular psoriasis: relatively rare, but the disease is more serious. It is clinically divided into limited type and generalized type. The localized type is mostly seen in the palmoplantar area, manifesting as limited erythema and rice grain-sized pustules scattered on the basis of erythema, divided into two types of palmoplantar pustulosis and continuous limb dermatitis. Pan-pustular psoriasis is often accompanied by systemic symptoms, such as high fever, chills, fatigue, depression and lethargy. The typical lesion is a generalized rice-grain sized superficial pustule, scattered or densely distributed. The disease is easily transformed into erythrodermic disease after treatment. 3.Erythrodermic psoriasis: it is mostly transformed from common psoriasis or pustular psoriasis, and is related to the sudden reduction or discontinuation of glucocorticosteroids applied externally with strong stimulating drugs and systematically. Clinical manifestations are redness and peeling of the whole body, mostly accompanied by systemic symptoms such as fever, fatigue, malaise, generalized muscle aches and pains and other systemic symptoms. The first choice of treatment for pustular psoriasis and erythrodermic psoriasis is Avelox, and hormones are not used as the first-line treatment. Because of the slow onset of action of Avia, which usually takes about 2 weeks, and the unsatisfactory efficacy of some patients. When the disease is severe, with high fever, pustular eruption, severe generalized peeling and poor effect of conventional treatment, hormones can be used as appropriate, but the application time should be as short as possible, and the dose should not be too high, with 0.5mg/kg/d as the best starting dose. However, the biggest difficulty in hormone therapy for these two types of psoriasis comes from hormone dose reduction, and once the hormone dose is reduced, the disease will easily relapse. At the same time, in order to prevent the difficulty of hormone dose reduction, oral Avelox, 0.5mg/kg/d, can be taken at the same time, which can avoid the problem of slow onset of Avelox and win time for treatment. When the disease is under control, hormone reduction can be carried out first. If the starting dose is larger (above 0.5mg/kg/d), the dose can be reduced slightly faster, by 2 tablets per week, and 1 tablet per week if it is below 0.5mg/kg/d. When the hormone is reduced to 3 tablets, Avia can be considered to be reduced to 20mg/d, and the hormone reduction cycle can be extended to 3-4 weeks, by 1 tablet each time, until the drug is stopped. If the disease recurs, the hormone dose can be increased to one times the original dose, while Avia resumes the original treatment dose. 4.Arthritic psoriasis, also known as psoriatic arthritis: it can occur in patients with common psoriasis, erythrodermic psoriasis and pustular psoriasis, and psoriatic lesions can also appear at a later stage. The main manifestations are redness, swelling, pain, and dysfunction of large and small joints throughout the body, with interphalangeal joint lesions at the end of the fingers (toes) being the most characteristic. It is clinically similar to rheumatoid arthritis, which is positive for rheumatoid factor and does not have skin damage. Treatment of arthritic psoriasis is tricky, and the first choice of treatment is immunosuppressive agents such as methotrexate, which can treat both the arthritis and the skin lesions. However, the effect of methotrexate is slower, about 1-2 months. For some patients with more acute disease, especially those who have used hormones and have relapsed after hormone reduction or discontinuation, hormones should be applied early to control the disease to avoid irreversible joint damage. Hormone therapy for arthritic psoriasis also faces difficulties in drug reduction, so when applying hormone, other drugs for arthritis should be taken at the same time, such as methotrexate, leflunomide, leptospermidine, lorazepam, etc. The efficacy of Avia in the treatment of arthritic psoriasis is poor and it is not recommended. When the disease is controlled and immunosuppressive drugs are effective, the hormone can be reduced. In addition, for more severe cases, two immunosuppressive agents, such as salazosulfapyridine and methotrexate, can be taken simultaneously, or methotrexate combined with leflunomide. In recent years, the introduction of biologics has been a boon for patients with arthritic psoriasis. These drugs are effective in the treatment of arthritic psoriasis and have the tendency to replace immunosuppressive drugs. Second, special treatment plans are used for psoriasis in special areas. In addition to the four common types of psoriasis mentioned above, there are also some special parts of psoriasis in clinical practice. Scalp psoriasis with lesions occurring only on the scalp is more difficult to treat, and can be treated with topical carbotriol scalp rubs for mild cases, or with medium to severe cases with medium to strong hormone ointment combined with carbotriol scalp rubs. Hormones are not recommended for psoriasis occurring on the face, with tacalcitol and calcium-modulated neurophosphatase inhibitors such as tacrolimus or pimecrolimus preferred. Treatment of paradoxical psoriasis is based on emollients and less irritating agents such as tacalcitol, and topical hormones are generally not advocated. Treatment of vulvar psoriasis is based on tacrolimus or pimecrolimus. Application of hormones can lead to local irritation, atrophy and folliculitis and is not recommended. Nail psoriasis has a greater psychological impact on young female patients and is tricky to treat. Strong hormones or calcium-regulated neurophosphatase inhibitors can be used to seal the package and combine with systemic therapy.