5.psoriasis牛皮癣，银屑病.ppt

☆方法简单，好学易用 ? 受累体表面积易被高估 该方法假定单只手掌面积为体表面积的1％； 实际上单只手掌面积为体表面积的 male :0.8% female:0.7% children:0.94% Generalized Pustular Psoriasis Goeckerman regimen - tar bath, coal tar, UVB Ingram regimen - tar bath, anthralin, UVB Narrowband (308nm, 311nm) is more effective than broadband UVB with lower risk of burning, photoaging （光老化）and skin cancer. 2-3 x/wk narrowband UVB Ultraviolet Radiations Photochemotherapy (PUVA) oral 8-methoxypsoralen(甲氧基补骨脂素） or 5-methoxypsoralen followed by UVA (320-400nm) radiation highly effective for chronic, thicker plaque disease better for treating nail or palmar/plantar（掌跖） disease 2-3 x/week for severe psoriasis risk of basal cell and squamous cell carcinoma potential for eye and lymphocyte damage Systemic Therapy Should be considered in the case of an extensive psoriasis (＞20% of the body surface ) The potential side effects are great The most commonly used systemic treatments are Methotrexate （甲氨蝶呤） Retinoids （维甲酸类） Cyclosporin （环孢素） Antimicrobial （抗微生物） folic acid antagonist inhibiting DNA synthesis first effective systemic drug in 1950 and is the standard for systemic therapy indications: arthropathic Psoriasis erythrodermic psoriasis pustular psoriasis psoriasis vulgaris 20% BSA doses 10-25 mg/wk, oral or IV Methotrexate Minor nausea and malaise are common. The most serious drawback is hepatic fibrosis. A liver biopsy is advised after every cumulative dose 1.0-1.5g. blood tests to exclude marrow suppression Renal and liver function tests The drug should not be given to females and males in reproductive years due to teratogenic effects. Side effects of Methotrexate Acitretin (阿维A) is an analogues of vitamin A. Highly effective for pustular psoriasis dose of 20-50mg/day combine with ultraviolet radiation for plaque psoriasis Retinoids Side Effects of Retinoids Minor side effects include dry lips, mouth,