银屑病的治疗进展
Advances in the Treatment of Psoriasis
DOI: 10.12677/acm.2024.1461813, PDF,   
作者: 赫 群, 张晓冬*:北华大学附属医院皮肤科,吉林 吉林;王峻嵩:牡丹江医学院附属红旗医院重症科,黑龙江 牡丹江;沈佳丽:汕头市职业病防治所,广东 汕头
关键词: 银屑病局部外用药物系统治疗光疗法生物制剂中医治疗Psoriasis Topical Medications Systemic Therapies Phototherapy Biologics Traditional Chinese Medicine Treatment
摘要: 银屑病是一种慢性、复发性的免疫介导性皮肤疾病,特征是皮肤上出现红色、鳞屑状的斑块,伴或不伴有瘙痒、干燥和脱屑,常影响头皮、肘部、膝盖等部位。银屑病的发病机制涉及多基因变异和T细胞介导的免疫反应,其诱因多样,病情容易反复。目前治疗主要为对症治疗,以缓解症状、减少发作频率,并改善患者生活质量为目标。治疗方法包括局部外用药物、系统治疗、光疗和中医疗法,以及新兴的生物制剂疗法。本文概述了这些治疗手段的应用与效果。
Abstract: Psoriasis is a chronic, recurrent, immune-mediated dermatological condition characterized by the appearance of red, scaly patches on the skin, which may or may not be accompanied by itching, dryness, and flaking. Commonly affecting the scalp, elbows, and knees, the pathogenesis of psoriasis involves multigenic variations and T-cell-mediated immune responses, with diverse triggers that can lead to relapses. Current treatments primarily focus on symptomatic relief, reducing the frequency of flare-ups, and enhancing the quality of life of patients. Treatment modalities include topical medications, systemic therapies, phototherapy, traditional Chinese medicine, and emerging biologic treatments. This article provides an overview of these therapeutic approaches and their effectiveness.
文章引用:赫群, 张晓冬, 王峻嵩, 沈佳丽. 银屑病的治疗进展[J]. 临床医学进展, 2024, 14(6): 575-587. https://doi.org/10.12677/acm.2024.1461813

参考文献

[1] 孙敏. 熊果酸对咪喹莫特诱导的小鼠银屑病样皮损的影响[D]: [硕士学位论文]. 新乡: 新乡医学院, 2017.
[2] 李俊丽. 银屑病治疗现状及进展[D]: [硕士学位论文]. 重庆: 重庆医科大学, 2013.
[3] 满孝勇, 郑敏. 银屑病的治疗[J]. 中华皮肤科杂志, 2006, 39(3): 174-177.
[4] 周淑英, 许宁, 贡联兵. 寻常型银屑病临床合理用药[J]. 人民军医, 2021, 64(1): 82-84.
[5] 张培, 单葵. 银屑病外用药物治疗进展[J]. 中国药房, 2015, 26(17): 2446-2448.
[6] Nast, A., Boehncke, W.H., Mrowietz, U., Ockenfels, H.M., Philipp, S., Reich, K., et al. (2012) German S3-Guidelines on the Treatment of Psoriasis Vulgaris (Short Version). Archives of Dermatological Research, 304, 87-113. [Google Scholar] [CrossRef] [PubMed]
[7] 杨赛琳, 许爱娥. 钙调磷酸酶抑制剂他克莫司、吡美莫司在特应性皮炎外的皮肤科应用[J]. 中国中西医结合皮肤性病学杂志, 2018, 17(1): 91-94.
[8] Bissonnette, R., Stein Gold, L., Rubenstein, D.S., Tallman, A.M. and Armstrong, A. (2021) Tapinarof in the Treatment of Psoriasis: A Review of the Unique Mechanism of Action of a Novel Therapeutic Aryl Hydrocarbon Receptor-Modulating Agent. Journal of the American Academy of Dermatology, 84, 1059-1067. [Google Scholar] [CrossRef] [PubMed]
[9] Wanner, R., Panteleyev, A., Henz, B.M. and Rosenbach, T. (1996) Retinoic Acid Affects the Expression Rate of the Differentiation-Related Genes Aryl Hydrocarbon Receptor, ARNT and Keratin 4 in Proliferative Keratinocytes Only. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1317, 105-111. [Google Scholar] [CrossRef] [PubMed]
[10] Colonna, M. (2014) AHR: Making the Keratinocytes Thick Skinned. Immunity, 40, 863-864. [Google Scholar] [CrossRef] [PubMed]
[11] Furue, M., Uchi, H., Mitoma, C., Hashimoto-Hachiya, A., Chiba, T., Ito, T., et al. (2017) Antioxidants for Healthy Skin: The Emerging Role of Aryl Hydrocarbon Receptors and Nuclear Factor-Erythroid 2-Related Factor-2. Nutrients, 9, Article 223. [Google Scholar] [CrossRef] [PubMed]
[12] Kumar, S.N., Nambisan, B., Sundaresan, A., Mohandas, C. and Anto, R.J. (2013) Isolation and Identification of Antimicrobial Secondary Metabolites from Bacillus cereus Associated with a Rhabditid Entomopathogenic Nematode. Annals of Microbiology, 64, 209-218. [Google Scholar] [CrossRef
[13] Park, H.B., Goddard, T.N., Oh, J., Patel, J., Wei, Z., Perez, C.E., et al. (2020) Bacterial Autoimmune Drug Metabolism Transforms an Immunomodulator into Structurally and Functionally Divergent Antibiotics. Angewandte Chemie International Edition, 59, 7871-7880. [Google Scholar] [CrossRef] [PubMed]
[14] 葛李洋, 林世颖, 陈宏翔. 银屑病治疗中系统用药和外用药物的应用[J]. 中国医学前沿杂志(电子版), 2023, 15(5): 19-24.
[15] 陈国宁, 祁峰. 676例环孢素A血药浓度影响因素分析[J]. 黑龙江医药, 2016, 29(6): 1080-1084. [Google Scholar] [CrossRef
[16] 汪时易. 干细胞膜包裹异维A酸治疗痤疮的研究[D]: [硕士学位论文]. 长春: 吉林大学, 2021.[CrossRef
[17] Khalil, S., Bardawil, T., Stephan, C., Darwiche, N., Abbas, O., Kibbi, A.G., et al. (2017) Retinoids: A Journey from the Molecular Structures and Mechanisms of Action to Clinical Uses in Dermatology and Adverse Effects. Journal of Dermatological Treatment, 28, 684-696. [Google Scholar] [CrossRef] [PubMed]
[18] 张志祥, 李俊琴, 柴淑芳, 等. JAK抑制剂治疗银屑病性关节炎的研究进展[J]. 海南医学院学报, 2024, 30(5): 395-400. [Google Scholar] [CrossRef
[19] Schafer, P. (2012) Apremilast Mechanism of Action and Application to Psoriasis and Psoriatic Arthritis. Biochemical Pharmacology, 83, 1583-1590. [Google Scholar] [CrossRef] [PubMed]
[20] Jonak, C., Göttfried, I., Perl-Convalexius, S., Gruber, B., Schütz-Bergmayr, M., Vujic, I., et al. (2023) Characteristics and Outcomes of Patients with Psoriasis Treated with Apremilast in the Real-World in Austria—Results the Appreciate Study. Therapeutic Advances in Chronic Disease, 14. [Google Scholar] [CrossRef] [PubMed]
[21] Lin, L., Liu, W., Zhu, X., Chen, Y., Gao, Z., Gao, K., et al. (2018) Treponema pallidum Promotes Macrophage Polarization and Activates the NLRP3 Inflammasome Pathway to Induce Interleukin-1β Production. BMC Immunology, 19, Article No. 28. [Google Scholar] [CrossRef] [PubMed]
[22] Hernández-Pliego, A., Vergara-Ortega, D.N., Herrera-Ortíz, A., Toledano-Jaimes, C., Esquivel-Guadarrama, F.R. and Sánchez-Alemán, M.Á. (2022) IL-10 and IL-17 as Progression Markers of Syphilis in People Living with HIV: A Systematic Review. Biomolecules, 12, Article 1472. [Google Scholar] [CrossRef] [PubMed]
[23] Lu, D., Jia, J., Wei, S., Zhang, W., Liang, R., Liu, T., et al. (2022) Treponema pallidum (Syphilis) Antigen TpF1 Induces Activation of Macrophages and Accelerates P2X7R-Induced NLRP3-Dependent Release of IL-1β. Endocrine, Metabolic & Immune Disorders-Drug Targets, 22, 425-432. [Google Scholar] [CrossRef] [PubMed]
[24] 丁香玉. 不同NB-UVB治疗方案对寻常型银屑病患者临床疗效及IL-23/Th17细胞轴的影响[D]: [硕士学位论文]. 北京: 中国人民解放军医学院, 2017.
[25] Rajpara, A.N., O’Neill, J.L., Nolan, B.V., Yentzer, B.A. and Feldman, S.R. (2010) Review of Home Phototherapy. Dermatology Online Journal, 16, 12. [Google Scholar] [CrossRef
[26] Larko, O. and Swanbeck, G. (1979) Home Solarium Treatment of Psoriasis. British Journal of Dermatology, 101, 13-16. [Google Scholar] [CrossRef] [PubMed]
[27] Koek, M.B.G., Buskens, E., van Weelden, H., Steegmans, P.H.A., Bruijnzeel-Koomen, C.A.F.M. and Sigurdsson, V. (2009) Home versus Outpatient Ultraviolet B Phototherapy for Mild to Severe Psoriasis: Pragmatic Multicentre Randomised Controlled Non-Inferiority Trial (PLUTO Study). BMJ, 338, b1542. [Google Scholar] [CrossRef] [PubMed]
[28] Saurat, J.-H., Stingl, G., Dubertret, L., Papp, K., Langley, R.G., Ortonne, J.-P., et al. (2007) Efficacy and Safety Results from the Randomized Controlled Comparative Study of Adalimumab vs. Methotrexate vs. Placebo in Patients with Psoriasis (CHAMPION). British Journal of Dermatology, 158, 558-566. [Google Scholar] [CrossRef] [PubMed]
[29] 王珏. 白疕三黄软膏联合阿达木单抗治疗中重度斑块型银屑病的临床研究[D]: [硕士学位论文]. 成都: 成都中医药大学, 2023.[CrossRef
[30] 蔡祯, 陶娟. 生物制剂在银屑病治疗中的临床实践[J]. 中国医学前沿杂志(电子版), 2023, 15(11): 1-8.
[31] Brodmerkel, C., Li, K., Garcet, S., Hayden, K., Chiricozzi, A., Novitskaya, I., et al. (2019) Modulation of Inflammatory Gene Transcripts in Psoriasis Vulgaris: Differences between Ustekinumab and Etanercept. Journal of Allergy and Clinical Immunology, 143, 1965-1969. [Google Scholar] [CrossRef] [PubMed]
[32] 李晨丹, 李领娥, 孟娇玉, 等. 中医治疗寻常型银屑病血热证研究进展[J]. 辽宁中医药大学学报, 2021, 23(4): 117-121.
[33] 杨勤军, 周超. 从性味配伍探讨清营汤的组方特点[J]. 浙江中医药大学学报, 2016, 40(3): 221-222.
[34] 杨素清, 赵媛媛, 安月鹏. 疏风凉血汤治疗血热内蕴型银屑病临床疗效观察及安全性分析[J]. 辽宁中医药大学学报, 2019, 21(11): 8-11.
[35] 李美红, 孙丹, 闫隽, 等. 消银胶囊治疗血热证寻常型银屑病的临床研究[J]. 现代中医药, 2017, 37(6): 66-68. [Google Scholar] [CrossRef
[36] 王学军, 许庆瑞, 张洪娟. 丹槐银屑浓缩丸治疗寻常型银屑病药效学实验研究[C]//中华中医药学会外科分会, 山东中医药学会外科专业委员会. 2008年中医外科学术年会论文集. 哈尔滨: 黑龙江省中医研究院, 2008: 3.
[37] 焦磊, 龚丽萍. 局部封包机制探讨及其在皮肤科中的运用[J]. 中医药临床杂志, 2019, 31(4): 616-619.
[38] 蒋睦圆, 郑益志, 周东来, 等. 中医情志疗法对银屑病患者神经-内分泌-免疫网络调节临床研究[J]. 浙江中西医结合杂志, 2020, 30(8): 623-626.
[39] 戴想荣, 彭芳芳, 苗雅琇, 等. 五行角调音乐对气郁质银屑病患者干预效果的护理观察[J]. 湖南中医药大学学报, 2018, 38(6): 715-718.