（皮肤与性病）银屑病玫瑰疹多形红斑课件.ppt

治疗： 自限性，缩短病程，缓解减轻症状 玫瑰糠疹的治疗步骤 * * * Tumor necrosis factor [alpha] is central cytokine to both the persistence of the immune response that drives psoriasis and the aberrant keratinocyte response. 26 The anti–TNF-[alpha] agents etanercept (Enbrel; Immunex Corporation, Seattle, Wash) and infliximab (Remicade, Centocor, Malvern, Pa) bind and inhibit the activity of TNF-[alpha] through slightly different mechanisms. Etanercept is a fusion protein using the extracellular domain of the TNF-[alpha] receptor given twice a week as a subcutaneous injection. 59 Infliximab is a monoclonal antibody derived from mouse directed against human TNF-[alpha] and is given as an intravenous infusion at intervals dependent on the state of the disease. 60 Both of these molecules are FDA approved for the treatment of rheumatoid arthritis, while etanercept is approved for psoriatic arthritis and infliximab is approved for Crohn disease. 5 There is very early evidence that both these agents will have efficacy in psoriasis. In the psoriatic arthritis trials with etanercept, there was a noticeable response in several patients cutaneous psoriasis. Mean improvement in PASI was 46%, with 12 of 30 patients achieving at least a 50% improvement. Likewise, a number of case reports support a response of cutaneous psoriasis to infliximab. 61 One recent, small, randomized, controlled study demonstrated a greater than 80% response rate (more than a 75% improvement in PASI) with minimal adverse effects. 62 * frament of IgG1 fused with a fragment of lymphocyte function–associated antigen (LFA) Alefacept (LFA-3TIP) (Amevive; Biogen Pharmaceuticals, Cambridge, Mass) is a fusion protein combining the binding site of lymphocyte function–associated antigen-3 (LFA-3) with the Fc portion of human IgG. This medication binds specifically to T cells expressing CD2, the natural ligand of LFA-3. CD2 is expressed maximally in T cells that have been activated and express CD45RO, a sign of a memory