Internal medicine treatment for psoriasis

  1, anti-infective drugs: bacterial, viral or fungal infection is an important trigger for the development of psoriasis, and infection can be controlled through the application of drugs. The purpose of treating psoriasis can be achieved. It is mainly applied to punctate psoriasis, common psoriasis and some erythrodermic and pustular psoriasis that are accompanied by upper respiratory tract infection, and the corresponding antibiotics or antibacterial drugs effective against Streptococcus haemolyticus can be used, such as penicillin, erythromycin and cephalosporin.  2.Methotrexate: It is an effective drug for psoriasis treatment. Methotrexate is applied according to the severity of the disease, tolerance, urgency of treatment and the patient’s compliance with medical advice. It is mainly used for erythrodermic psoriasis, arthritic psoriasis, acute generalized pustular psoriasis, psoriasis with severe functional effects, such as palmar and plantar, and extensive plaque psoriasis.  3.Vitaminic acid: Avia is effective in the treatment of plaque, pustular, palmoplantar, droplet, and erythrodermic psoriasis. 57% decrease in psoriasis rash and severity was observed at 12 weeks. Significant improvement was observed in 70% of severe patients after 1 year of treatment. It is safe for long-term use. There is no time limit, so continued treatment is effective. Although symptoms of bone changes are rare, long-term use should be limited in some patients who develop calcification of ligaments and tendons. Preferred treatment: generalized pustular psoriasis, erythrodermic psoriasis; in combination with other treatments: palmoplantar pustulosis, generalized plaque psoriasis; alone therapy or adjuvant therapy: arthritic psoriasis.  4.Cyclosporine: it has definite efficacy on psoriasis. It is relatively safe to follow strictly the dermatological application dose <5 mg?kg--?d". Nephrotoxicity is its main adverse effect. Therefore it should be carefully monitored and a nephrologist should be consulted if necessary. Severe psoriasis may recur up to 2 months after cessation of cyclosporine treatment. It is effective for all types of psoriasis, but should be used in patients with severe and failed psoriasis treated with various therapies.  5. Glucocorticoids: Application of glucocorticoids may lead to erythrodermic or generalized pustular psoriasis. Therefore, they should only be applied when deemed absolutely necessary by the dermatologist. Indications: Erythrodermic psoriasis that is difficult to control; generalized pustular psoriasis in which other drugs are ineffective or contraindicated; acute polyarticular psoriasis that can cause severe joint damage.  6.Other drugs that may be applied: salazosulfapyridine, tacrine, aminophenazone, methylsulfonamides, levamisole, transfer factor, colchicine, vitamins.  7, biological agents (etanercept): etanercept is a human source TNF a only receptor antibody fusion protein, the generic name of injectable recombinant human type II TNF-ot receptor antibody fusion protein. It was approved by FDA in 1998 for the treatment of rheumatoid arthritis, in 2002 for the treatment of psoriatic arthritis, and in 2004 for the treatment of common psoriasis. Etanercept is the only biological agent approved by the FDA for the treatment of psoriasis in China, and there are other agents currently in clinical trials. The drug must be selected for treatment of moderate or severe psoriasis with a PASI score ≥ 10 and significantly affects the patient's quality of life (DLQI > 10); the condition persists for 6 months. Treatment is ineffective and requires systemic therapy. In addition to this at least one of the following must be satisfied: ① the condition is at a high risk level and it is difficult to use standard therapy due to drug-related toxicity; ② it is not tolerant to standard systemic therapy; ③ it is not efficacious to standard therapy; ④ repeated hospitalizations are necessary to control the condition; ⑤ the use of systemic therapy drugs is hindered by the presence of comorbidities; ⑥ it has severe erythrodermic and pustular psoriasis; ⑦ it has arthritic psoriasis.