Psoriasis of the face and flexures
Psoriasis of the face and flexures
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面部和屈曲处的牛皮癣
DOI：
10.1080/09546630701341949
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Laetitia Bouérat Duvold
中科院分区：
文献类型：
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作者：
P. C. van de Kerkhof;G. Murphy;J. Austad;A. Ljungberg;F. Cambazard;Laetitia Bouérat Duvold
面部和屈曲型银屑病可能会严重损害银屑病患者的生活质量。对于银屑病的适当治疗，重要的是要注意这些敏感部位的皮损，这需要在几个方面不同于其他部位皮损的处理方法。进行了广泛的文献检索，以收集面部和屈曲银屑病的流行病学、临床特征、致病因素和各种治疗方法的循证数据。随后，哥本哈根牛皮癣工作组(CPWG)这一专家小组讨论了这些方面，并根据循证数据提出了几项建议。17%-46%的牛皮癣患者患有面部牛皮癣，6.8-36%的牛皮癣患者患有挠曲型牛皮癣。因此，这些部位的牛皮癣不能被视为罕见的表现。面部银屑病是预示银屑病预后不良的预后指标。面部和屈曲型银屑病不能被视为不同的疾病实体，而是部位变异。根据面部银屑病的临床特征，银屑病分为三种亚型：发际型银屑病、色波型银屑病和真性面部银屑病。不能忽视外耳炎和眼部表现。微生物学因素可能与面部和屈曲牛皮癣相关的证据几乎没有。对于面部牛皮癣来说，对紫外线辐射的反应是不同的。至少有5%的牛皮癣患者患有光敏性牛皮癣。在这些患者中，必须排除红斑狼疮和多形性光疹等光敏性疾病。根据文献评估和工作组讨论，CPWG得出以下结论。(1)低效力的局部皮质类固醇、维生素D3类似物和钙调神经磷酸酶抑制剂是面部和屈曲牛皮癣的首选治疗方法。前两种模式的有效性证据为3级，而第三种模式的有效性证据为1级。建议采用个体化治疗方法；例如，在过去有皮质类固醇副作用的情况下，应选择其他两种方法，而对于易受刺激的不稳定银屑病，应避免使用维生素D3类似物的单一治疗。(2)面部和屈曲型银屑病不适用抗菌药物治疗。(3)地塞诺尔和焦油治疗不会被列为一线治疗，但只有在一线治疗方案失败的情况下才能使用。(4)局部治疗无效时，可采用光疗和全身治疗。(5)对于未来的药物开发，建议将维生素D3类似物与低强度的皮质类固醇相结合。
Facial and flexural psoriasis may impair the quality of life of psoriatic patients considerably. For the adequate management of psoriasis it is important to pay attention to lesions at these sensitive sites, which require an approach different to that for lesions on other sites in several respects. An extensive literature search was carried out to collect evidence‐based data on facial and flexural psoriasis with respect to epidemiology, clinical aspects, pathogenetic factors and various treatments. Subsequently, a panel of experts, the Copenhagen Psoriasis Working Group (CPWG), discussed these aspects and several recommendations were formulated reconciling the evidence‐based data. Facial psoriasis occurs in 17–46% of psoriatics and flexural psoriasis is experienced by 6.8–36% of patients with psoriasis. Therefore, psoriasis at these sites cannot be regarded as a rare manifestation. Facial psoriasis is a prognostic marker indicating a poor prognosis of psoriasis. Facial and flexural psoriasis cannot be regarded as distinct disease entities but rather as site variations. The clinical features of facial psoriasis suggest that there are three subtypes: hairline psoriasis, sebo‐psoriasis and true facial psoriasis. Otitis externa and ocular manifestations should not be neglected. Evidence that microbiological factors may be relevant to facial and flexural psoriasis is virtually absent. For facial psoriasis the response to UV radiation is variable. At least 5% of psoriatics have photosensitive psoriasis. In these patients photosensitive diseases such as lupus erythematodes and polymorphic light eruption have to be excluded. Based on the literature assessment and working group discussions the CPWG concluded the following. (1) Low‐potency topical corticosteroids, vitamin D3 analogues and calcineurin inhibitors are first choice treatments in facial and flexural psoriasis. Evidence for the efficacy of the first two modalities is at level 3 while it is at level 1 for the third one. An individualized approach is indicated; for example, in case of corticosteroid side effects in the past the other two modalities should be selected and in unstable psoriasis prone to irritation, monotherapy with vitamin D3 analogues should be avoided. (2) Antimicrobial treatments are not indicated for facial and flexural psoriasis. (3) Dithranol and tar treatment are not indicated as first‐line treatment but only if the first‐line options fail. (4) In case topical therapies are not effective, phototherapy and systemic treatments are indicated. (5) For future drug development the combination of vitamin D3 analogues with low strength corticosteroids is recommended.