▎药明康德团队
如果说“
银屑病
”您不了解的话，“
牛皮癣
”您一定听说过（牛皮癣只是银屑病常见类型的“俗称”）。
在电影《你好，我的银色恋人》中，女主角潘奕就是一名银屑病患者。她虽然怀揣演员梦想、对爱情充满憧憬，却也饱受银屑病带来的皮肤脱屑、瘙痒等症状的困扰，平时训练不敢露出皮肤，夏天也要穿很热的长裤、长袖；时常到羞愧、恐惧、自卑，不敢拥抱梦想、接受爱情。
银屑病究竟是种什么病？会不会传染？有什么症状？又该怎样治疗呢？今天，健康榨知机就带大家认识下这种疾病。
图片来源：123RF
什么是银屑病？
银屑病是一种遗传与环境因素共同作用诱发的免疫介导的慢性、复发性、炎症性、系统性疾病。银屑病不是传染病，也没有传染性。
该病典型的临床表现是鳞屑性红斑或斑块，局限或广泛分布，可发生于各年龄段人群，约2/3的患者40岁之前发病，多数患者冬季复发或加重，夏季缓解。据推算，中国约有700万银屑病患者，且患病率整体上呈逐渐上升趋势，北方高于南方。
此外，银屑病可合并心血管疾病、糖尿病、高血压、代谢综合征等多种疾病。
有哪些危险因素？
虽然银屑病的确切病因还没有完全明确，但遗传、免疫与环境因素在银屑病的发生中发挥了重要作用。
遗传是银屑病发病的主要风险因素。研究发现，31.26%的患者有家族史，一级亲属和二级亲属的遗传度分别是67.04% 和46.59%。父母一方患病时，其子女的发病率约为20%；父母双方患病时，发病率高达65%。
环境因素包括感染、精神紧张、抽烟、酗酒、某些药物反应等，在银屑病的诱发、复发或加重过程中发挥重要作用。
白细胞介素23（IL-23）和辅助性T细胞17（Th17）细胞相关的免疫通路是银屑病发病的核心机制。T细胞、树突细胞、中性粒细胞和角质形成细胞等多种细胞，通过肿瘤坏死因子α（TNF-α）、γ干扰素（IFN-γ）、IL-17和IL-22等细胞因子，刺激角质形成细胞过度增殖及产生相关的细胞因子和趋化因子，形成炎症循环。
图片来源：123RF
患病后有哪些症状？
银屑病包括寻常型银屑病、脓疱型银屑病、红皮病型银屑病、关节病型银屑病以及其他特殊类型银屑病，类型不同其症状也有区别。
寻常型银屑病
可分为斑块状银屑病和点滴状银屑病，前者多位于躯干和四肢近端，表现为暗红色斑块或浸润性红斑，上覆白色、银白色鳞屑，可有蜡滴、薄膜、点状出血等现象；后者约占所有银屑病病例的80%-90%，皮疹好发于头皮、背部和四肢伸侧，表现为粟粒至甲盖大小丘疹，上覆少许鳞屑，呈点滴状分布，严重时会遍及全身，发病前常有急性扁桃体炎，多发生于青少年。
脓疱型银屑病
包括泛发性脓疱型银屑病和局限性脓疱型银屑病。
泛发性脓疱型银屑病临床表现是红斑基础上突然泛发全身的无菌性脓疱，可伴有发热、关节肿胀疼痛、外周血白细胞增多等系统症状。
局限性脓疱型银屑病可分为掌跖脓疱病和连续性肢端皮炎，前者以红斑基础上周期性发生簇集性无菌性小脓疱并逐渐干涸、脱屑为特征；后者好发于指、趾部，常有外伤等诱因，以指趾末端开始的无菌性红斑、脓疱为特征。
红皮病型银屑病
这是一种少见的重症银屑病，多见于中老年人，大多由银屑病在急性期受某些因素刺激或治疗不当诱发。临床表现是全身弥漫性红斑、浸润肿胀并伴有大量糠状鳞屑。
关节病型银屑病
又称银屑病关节炎，甲改变是典型特征，常表现为点状凹陷、甲剥离、甲下角化过度等。患者受影响的关节可出现肿胀、疼痛、晨僵及关节活动受限等症状，严重的人可出现关节畸形，晚期甚至会出现关节强直，导致残疾。
此外，根据银屑病的严重程度，可分为轻度、中度和重度银屑病。
图片来源：123RF
患病后该怎样治疗？
患者的治疗方案可根据疾病分型和严重程度采取不同治疗方式，轻度以外用药物治疗为主；中重度可使用光疗、系统药物治疗或生物制剂治疗。
点滴状银屑病
病情较轻，可在数周或数月内自行缓解，以外用药物或光疗为主。
外用药物有维生素D3衍生物（如他卡西醇）和糖皮质激素（如氢化可的松软膏、糠酸莫米松软膏等）。
光疗方面，窄谱UVB（NB-UVB）是优先选择的疗法，而且联合保湿剂、糖皮质激素或维生素D3衍生物疗效更好。
斑块状银屑病
轻度以外用药物治疗为主，包括维生素D3衍生物、维A酸类药物、中效或强效糖皮质激素、钙调磷酸酶抑制剂、本维莫德、抗人IL-8单克隆抗体乳膏（一种外用生物制剂）等。对单一外用药物不良反应明显或效果不好的患者，可选择两种或多种药物交替或联合治疗，以提高疗效，降低不良反应。
光疗也是治疗顽固性病变的有效方法之一，可选用NB-UVB或308 nm准分子激光。
中重度可选用系统药物治疗，包括维A酸类药物（如阿维A）、甲氨蝶呤、环孢素、生物制剂、PDE4抑制剂（如阿普米司特片）和其他免疫抑制剂（如羟基脲、6-硫鸟嘌呤、硫唑嘌呤和他克莫司）。病情顽固患者可采用联合疗法，即系统药物联合光疗及外用药。此外，患者也可以参与到临床试验中。
临床试验
一项评价D-2570治疗中、重度斑块状银屑病有效性和安全性的Ⅱ期临床研究正在中国约30家医院进行，计划招募160名中、重度斑块状银屑病患者。
D-2570是一款靶向TYK2的新型口服选择性抑制剂。值得一提的是，同靶点药物氘可来昔替尼片已于2023年10月获得国家药品监督管理局（NMPA）批准，用于适合系统治疗或光疗的成年中重度斑块状银屑病患者。
如您或您身边的家属、朋友有意愿参与该临床研究，您可点击后方蓝字了解详情：临床试验信息
脓疱型银屑病
《中国银屑病诊疗指南（2023版）》建议，阿维A、甲氨蝶呤、环孢素和TNF-α抑制剂是成人泛发性脓疱型银屑病的一线治疗药物。
超强效外用糖皮质激素可作为连续性肢端皮炎的初始治疗，也可外用维生素D3衍生物或他克莫司联合治疗；光疗通常联合外用药物。
掌跖脓疱病可选用维生素D3衍生物、维A酸类药物或糖皮质激素复方制剂。《中国银屑病诊疗指南（2023版）》推荐，系统治疗首选环孢素，阿维A或阿维A联合局部光疗作为一线治疗。
红皮病型银屑病
《中国银屑病诊疗指南（2023版）》推荐，系统治疗一线方案为环孢素、阿维A或甲氨蝶呤；二线方案为TNF-α 抑制剂、IL-12/23 抑制剂、IL-17抑制剂，儿童首选环孢素和阿维A。
关节病型银屑病
治疗包括护理和药物干预。治疗药物包括传统非甾体抗炎药、抗风湿药、生物制剂以及小分子靶向药物。锻炼、理疗和技能训练等康复治疗也可适当选择，如活动关节的柔韧运动。
图片来源：123RF
小结
尽管
银屑病还无法根治
，但通过治疗可以控制、稳定病情，避免疾病复发及加重，减轻红斑、鳞屑、斑块厚度及瘙痒程度，控制相关并发症。
患者在治疗时应听取医务人员建议，坚持治疗方案，按医嘱用药，以尽可能实现症状和皮损的完全清除或几乎完全清除，改善生理、心理、社会功能，提高生活质量。
延缓皮肤衰老的10个小诀窍
护肤养颜抗衰老，哪些说法是对的？
……
参考资料
[1] 中华医学会皮肤性病学分会银屑病专业委员会,(2023).中国银屑病诊疗指南（2023版）. 中华皮肤科杂志,DOI:10.35541/cjd.20220839.
[2] 中华医学会,等,(2022). 银屑病基层诊疗指南（2022年）. 中华全科医师杂志,DOI: 10.3760/cma.j.cn114798-20220214-00098.
[3] Psoriasis.Retrieved Mar 20,2024,from https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
[4] 7 Types of Psoriasis.Retrieved Mar 20,2024,from https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-types
[5]国家药监局批准氘可来昔替尼片上市.Retrieved Mar 20,2024,from https://www.nmpa.gov.cn/yaopin/ypjgdt/20231019160913165.html
[6] 张学军，郑捷. 皮肤性病学[M].第9版.北京：人民卫生出版社，2018.
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