The money is gone and the family is gone. But after a while, the skin lesions reappeared, and each time became more serious and difficult to treat. The original local erythema and scales spread to the whole body, and there was no good skin on the whole body.

Lao Li (pseudonym) is sick.

Large areas of erythema and scale appear on his body.

It is itchy and uncomfortable, and the scales keep falling off like a snake sheds its skin.

The doctor diagnosed it as psoriasis

The money is gone and the family is broken up

Lao Liyi I started to be prescribed ointment and oral medicine at the local hospital. When I saw that the erythema and scales had improved, I stopped taking the medicine on my own. But the skin lesions reappeared after a while, and each time became more serious and more difficult to treat. Originally, the local erythema and scales spread to the whole body, and there was no good skin on the whole body.. The skin lesions all over his body not only prevented him from wearing short-sleeved shorts, but also caused severe itching every night, which affected his sleep. When he woke up the next day, his bed was covered with scales that had fallen off after scratching.

Lao Li, who was suffering from psoriasis, went to the local tertiary hospital and was prescribed more oral medicines, but if he took them, the condition would get worse if he didn't take it. Suffering from pain, Lao Li also went to the countryside to find a barefoot doctor and tried folk remedies, but the skin lesions could not be cured. Lao Li has been seeking medical advice for more than ten years, but his condition has not been cured, and his skin lesions have continued to worsen. cannot be cured for a long time. The family savings are getting smaller and smaller, but the disease has not improved. Family conflicts have continued to escalate, and finally led to the originally happy life. Family breakdown .

I’m all better now

Psoriasis caused Lao Li’s limbs to be covered with large patches of red spots and scales. Others were frightened when they saw it and dared not come near, for fear of infecting themselves. Lao Li felt uncomfortable, and he wore long, wide sleeves even on hot days. He gradually stopped socializing with relatives and friends, and his personality became extreme and withdrawn. Later, he chose to work in the southern city of Hangzhou. During his part-time job, Lao Li joined a mutual aid group for psoriasis patients. During the exchanges, he heard that more and more patients were getting better after treatment with biological agents by Dr. Man Xiaoyong, director of the dermatology department of the Second Hospital of Zhejiang University. I came to Zhejiang University Second Hospital with hope.

Before treatment

After treatment

After taking off his clothes, the large areas of skin lesions on Lao Li’s body were shocking. Professor Man Xiaoyong carefully evaluated and treated Lao Li with biological agents. After half a month, he came to the clinic. Lao Li's clothing has obviously changed during the period. He is wearing brand-new short-sleeved shirts, and the psoriasis on the exposed skin on his arms has completely subsided.. Lao Li said with emotion: "Thank you Dr. Man. I didn't know how uncomfortable it was to be treated before. My wife got divorced, I couldn't continue my job, I didn't want to go out, and my friends gradually stopped contacting me. But now, thanks to you, I am now Everything is fine!"

Psoriasis

Psoriasis, commonly known as "psoriasis" , is a polygenic genetic disease caused by the interaction of multiple factors such as genetics, immunity, infection, and endocrine. During the onset of the disease, skin lesions are spread all over the body, with obvious symptoms such as bright redness, scaling, and itching. Patients with severe conditions even dare not go out for fear of seeing other people's strange eyes, causing great financial burden and psychological pressure to the patients.

Genetic factors play an important role in the onset of psoriasis. About 40% of people with psoriasis or psoriatic arthritis have a family history of the disease. In addition to genetics, a variety of environmental factors can also induce the disease in patients, including local factors (skin injuries, scratches), systemic factors (infections, especially streptococcus and HIV), environmental factors (air pollution, climate), and psychological stress , drugs (lithium, beta-blocker , interferon and antimalarial drugs), etc.

Is psoriasis contagious?

Psoriasis is a complex hereditary, inflammatory and systemic disease. The main pathogenesis is the imbalance of the immune system rather than infection by pathogenic microorganisms such as bacteria, viruses, and fungi. Therefore Not contagious .

Why psoriasis recurs

Psoriasis is prone to relapse after treatment due to the complex etiology and pathogenesis that are not yet clear. Tobacco, alcohol, spicy food, infection, poor working and living environment including moisture and chemical pollution, mental stimulation, climate, trauma, etc. may lead to the recurrence of psoriasis.

7 Treatment methods for psoriasis

Topical drug treatment

Glucocorticoid cream or ointment has obvious curative effect, attention should be paid to its adverse reactions. Long-term application of powerful or super-potent preparations in large areas can cause systemic adverse reactions. After stopping the drug It can even induce pustular or erythrodermic psoriasis .

.05% ~ 0.01% tazarotene gel, vitamin D3 derivatives (such as calcipotriol and calcipotriol/betamethasone mixed preparations, calcitriol ointment), various keratin promoters (Such as tar preparations, anthralin ointment, 10% to 15% camptothecin ointment, salicylic acid ointment , etc.) and the aromatic hydrocarbon receptor modulator Benvimod cream are also effective in the topical treatment of psoriasis.

Physical therapy

Photochemotherapy (PUVA), UVB phototherapy, especially narrow-wave UVB (NB-UVB), 308nm excimer laser, bath therapy, etc. can be used in the treatment of psoriasis.

Systemic oral therapeutic drugs

Traditional disease-modifying anti-rheumatic drugs can be used to treat psoriasis. Among them, oral retinoic acid drugs are suitable for various types of psoriasis, such as acitretinate 0.75~1.0mg/(kg·d) orally.

Immunosuppressants are mainly suitable for moderate to severe plaque, erythrodermic, generalized pustular, and arthropathic psoriasis. Methotrexate is commonly used, and cyclosporine or tripterygium wilfordii can also be used. glycosides.

Glucocorticoids are generally not recommended for use in psoriasis vulgaris. Considering the effectiveness and price of current biological agents, they can be used with caution in erythrodermic psoriasis, acute arthropathy psoriasis and generalized psoriasis. For pustular psoriasis, etc., the dosage can be reduced when combined with immunosuppressants and retinoic acid. It should be used for a short period of time and the dosage should be gradually reduced to prevent the disease from rebounding.

Biological agents

Since 2004, the TNF-α antagonist Etanercept has been approved by the US FDA for the treatment of psoriatic arthritis and moderate to severe psoriasis.

Currently, commonly used biological agents in China include the TNF-α antagonist Etanercept, Infliximab, Adalimumab, and the IL-12/23p40 antagonist ustekinumab. (Ustekinumab), IL-17A antagonists Secukinumab and Ixekizumab, brodalumab (IL-RA monoclonal antibody), IL-23p19 monoclonal antibody Gusekin Guskizumab, Risankizumab (Table 11). Biologics are indicated for patients with moderate to severe psoriasis and/or psoriatic arthritis. Biological agents are very effective, but their indications and contraindications need to be strictly controlled.

Psychotherapy

Psychological stress is a trigger and aggravating factor of psoriasis, but psoriasis often aggravates the patient's psychological stress, causing tension, anxiety and even depression mental state. Through good doctor-patient communication , the humanistic care of medical workers, and necessary psychological consultation and treatment, the psychological state of patients can be improved to a certain extent, the symptoms of the disease can be improved, and the recurrence can be slowed down.

6 Things to pay attention to during the treatment of psoriasis

Medication management

Patients with psoriasis usually need to take long-term combination medication. Following the doctor's instructions and not reducing, increasing or stopping the medication on their own is crucial to the efficacy of psoriasis.

Skin management

Psoriasis is related to the skin barrier function, so patients need to keep their skin clean and strengthen skin protection in winter and spring. If necessary, they can use skin protectants after consulting a doctor.

Lifestyle management

Factors such as smoking, drinking, and obesity may lead to the recurrence and aggravation of psoriasis. Therefore, we recommend that patients quit smoking, drinking, and lose weight during treatment.

Prevent infection

Infection is a risk factor for inducing or exacerbating psoriasis. Paying attention to personal hygiene and avoiding public places where people gather can reduce the risk of infection inducing psoriasis.

Emotional management

Finding a suitable outlet for your emotions and maintaining a positive and optimistic attitude will help shorten the course of the disease and reduce recurrence.

7 Psoriasis Subspecialty

The Dermatology Department of the Second Hospital of Zhejiang University is a national key clinical specialty, the Psoriasis Research Center of the Dermatology and Venereology Branch of the Chinese Medical Association, and the presiding unit of the Dermatology Branch of the Zhejiang Provincial Medical Association. It ranks among the specialty rankings of Chinese hospitals. Forefront.

Psoriasis subspecialty is a key direction in the development of dermatology. The specialized group is thriving under the leadership of the honorary director of the department, Professor Zheng Min, and the subject leader, Professor Man Xiaoyong. It diagnoses and treats more than 20,000 psoriasis patients every year. He has conducted more than 30 research projects related to chip diseases, and published a large number of basic and clinical results in the core journal at home and abroad.

8

Discipline leader

Man Xiaoyong

Director of the Department of Dermatology, doctoral supervisor, and deputy director of the Youth Committee of the Dermatology and Venereology Branch of the Chinese Medical Association. He has presided over 5 National Natural Science Foundation projects, including 1 National Natural Science Foundation key project, 3 National Natural Science Foundation general projects, and 1 National Natural Science Foundation major research plan cultivation project, with a total of more than 5 million scientific research funds.

is good at the pathogenesis and treatment of psoriasis, scleroderma, and is good at skin surgery. He has good clinical experience in the cosmetic treatment of common skin tumors and the treatment of underarm odor.

Outpatient clinic hours: All day on Wednesday and Friday (Jiefang Road Campus) Tuesday and Sunday morning (Binjiang Campus)

Text | Dermatology Wang Yuntong Yan Bingxi Fu Ni Chang

Picture | Partly from the Internet

Review | Dermatology Full Xiaoyong

editor | Zhu Junjun