psoriasis牛皮癬銀屑病

1、1會計學(xué)psoriasis牛皮癬銀屑病牛皮癬銀屑病( Epidemiology. Chapter IV, A Psoriasis. Jacobson CC, Kimball AB )EtiologyImmunopathogenesisSevere PsoriasisPsoriasis Vulgaris (尋常型銀屑病尋常型銀屑病)Dropping Wax Candle ( Thin Membrane (薄膜現(xiàn)象) After removal of the scales, there is a glistening red membrane. Auspitzs sign (點(diǎn)狀出血) Upon

2、removal of the scales, capillary bleeding points are revealed.Psoriasis Vulgaris (尋常型銀屑病尋常型銀屑病) Most common Common UncommonRareScalp Lumbosacral AreaElbows KneesPenis and glansPsoriasis Vulgaris (尋常型銀屑病尋常型銀屑病) The lesions appear abruptly on the trunk， extremities following recent streptococcal throa

3、t infection. Treat streptococcal infection with antibiotics.Guttate Psoriasis（點(diǎn)滴狀銀屑?。㏒pecific Locations of PsoriaisisSpecific Locations of PsoriaisisSpecific Locations of Psoriaisis Kobners Phenomenon / Isomorphic Response (同形反應(yīng)同形反應(yīng))the appearance of typical lesions of psoriasis at sites of injuries

4、 or scratchBSAPASI頭面頭面 h軀干軀干 t上肢上肢 u下肢下肢 l4 4個部位個部位5 5種程度種程度3 3項(xiàng)癥狀項(xiàng)癥狀紅斑紅斑E浸潤浸潤I鱗屑鱗屑D無癥狀無癥狀0輕度輕度1中度中度2顯著顯著3非常顯著非常顯著46 6類面積類面積A A （每個（每個部位的受累面積部位的受累面積) )10%110-29%230-49%350-69%470-89%590-100%6PASI = 0.1(Eh + Ih +Dh)Ah + 0.2(Eu + Iu + Du)Au + 0.3(Et + It + Dt)At + 0.4(El +Il +Dl)Al calculated using a

5、formula including variables of plaque erythema, induration and scale, and body surface area involvement DLQI在過去一周內(nèi)在過去一周內(nèi):1. 皮膚瘙癢、疼痛或叮咬感的程度皮膚瘙癢、疼痛或叮咬感的程度 2. 因皮膚病變而感到尷尬或敏感的程度因皮膚病變而感到尷尬或敏感的程度3. 皮膚病變妨礙購物或照顧家庭皮膚病變妨礙購物或照顧家庭/苗圃的次數(shù)苗圃的次數(shù)4. 皮膚病變影響穿著的頻率皮膚病變影響穿著的頻率 5. 皮膚病變影響社交或休閑活動的次數(shù)皮膚病變影響社交或休閑活動的次數(shù)6. 不能進(jìn)行體育運(yùn)動

6、的困難程度不能進(jìn)行體育運(yùn)動的困難程度 7. 是否影響工作或?qū)W習(xí)是否影響工作或?qū)W習(xí) 如果沒有影響，則工作或?qū)W習(xí)時受皮膚的如果沒有影響，則工作或?qū)W習(xí)時受皮膚的 影響程度如何影響程度如何8. 因皮膚病變，你與配偶或親戚朋友產(chǎn)生因皮膚病變，你與配偶或親戚朋友產(chǎn)生 矛盾的程度矛盾的程度9. 對性生活的影響程度對性生活的影響程度10. 治療皮膚病給你帶來的問題有多大治療皮膚病給你帶來的問題有多大, 如給如給 家庭帶來的麻煩或占用時間的長短家庭帶來的麻煩或占用時間的長短3非非常常多多2許許多多1少少許許0無無否否0是是3BSA（體表面積） 10% (10只手掌的面積) PASI（銀屑病面積與嚴(yán)重程度指數(shù)）1

7、0 DLQI（皮膚病生活質(zhì)量指數(shù)） 10在給銀屑病患者制定合理的治療方案前，臨床醫(yī)師需要對銀屑病的嚴(yán)重程度進(jìn)行評估。定義重度銀屑病的一個簡單方法稱為10分制規(guī)則：Generalized Pustular PsoriasisGeneralized Pustular Psoriasis Nails - hyperonychia and subonychial pustules（甲下膿皰） Mucous membrane lesions are common on the tongue (geographic tongue or fissured tongue 地圖舌).Localized Pust

8、ular PsoriasisClinical Patterns of ArthritisClinical CourseHistopathology of PsoriasisSubcorneal collections of neutrophils called Munro s microabscesses Histopathology of PsoriasisKogoj microabscess: Minimal spongiform pustule in the lateral wall of a macro pustuleHistopathology of PsoriasisPsorias

9、isSeborrhoeic Dermatitisdistributionsextensor surface, elbows,knees, scalpscalp, eyebrows, nasolabial angle, ears, sternal regions.scaledry, white, shinyGreasy, oily, Auspitzs sign+ve-veTopical Therapy Anthralin (蒽林)Topical TherapyTopical TherapyCorticosteroids Topical Therapy Vitamin D analogues Topical TherapyVitamin A analoguesTopical TherapyMethotrexateSide effects of MethotrexateRetinoids CyclosporinAntimicrobial TherapyAuspitzs sign (點(diǎn)狀出血) Upon removal of the scales, capillary bleedin