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首页> 外文期刊>Clinics in dermatology >Psoriasis treatment in difficult locations: scalp, nails, and intertriginous areas.
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Psoriasis treatment in difficult locations: scalp, nails, and intertriginous areas.

机译：牛皮癣的治疗在困难的地方：头皮，指甲和三尖瓣部位。

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Psoriasis comprises a broad spectrum of different clinical courses among which the chronic stable psoriasis by far occurs most frequently. The clinical presentation ranges from mild disease to more serious forms involving large areas of skin and/or joint disease. A number of modifying factors may impact on treatment choice in individual cases (eg, location of the lesions, disease phase, treatment history, response to previous treatments, comorbidity). Aside from this consideration, there are special localizations that remain some of the most difficult regions to control. Such entities are the scalp, nails, and intertriginous areas. Topical treatment of such different-to-treat areas has to be considered as a first-line intervention strategy, at least in those patients who are presenting an exclusively isolated involvement. In some situations (eg, in severe psoriasis or in patients who are refractory to topical treatment), however, a systemic treatment is indicated. Most obvious difficulties in treating these locations are due to unrealistic expectations from the patients' perspectives, time-consuming applications, side effects, cosmetic injuries, and restricted bioavailability of active compounds. Aside from hair care, initial use of keratolytics for scalp psoriasis, corticosteroids, and vitamin D3 and analogues are currently standard treatments. Recently developed new formulations of both active ingredients such as foam or gel appear to be more acceptable to patients than traditional creams or ointments. Current treatment options for nail psoriasis are very often poorly efficacious, associated with undesirable effects, or time consuming. Success has to be measured in terms of months. Topical treatments (eg, corticosteroids, vitamin D analogues, tazarotene) are mainly used, but impressive improvement rates mostly will be achieved by systemic treatment of conventional and biologic agents. Finally, the usefulness of corticosteroids, vitamin D and analogues, and calcineurin inhibitors in treating intertriginous psoriasis clearly is demonstrated. Especially the use of calcineurin inhibitors exhibits efficacy in intertriginous regions and therefore may be seen as a promising treatment option in the future. Besides the important innovations in the last years, there is a need for new effective and well-tolerated treatment modalities, especially for long-term use in the 3 difficult-to-treat locations, which encompass cosmetic acceptability.
机译：牛皮癣包括广泛的不同临床病程，其中，慢性稳定型牛皮癣到目前为止最常见。临床表现从轻度疾病到更严重的形式，涉及大面积的皮肤和/或关节疾病。许多修改因素可能会影响个别病例的治疗选择（例如，病变位置，疾病阶段，治疗史，对既往治疗的反应，合并症）。除了这种考虑之外，还有一些特殊的地区仍然是最难控制的区域。这样的实体是头皮，指甲和三叉区域。至少在那些表现为完全孤立的患者中，这样的不同治疗区域的局部治疗必须被视为一线干预策略。但是，在某些情况下（例如，严重的牛皮癣或局部治疗难以治疗的患者），需要进行全身治疗。治疗这些部位最明显的困难是由于从患者的角度出发不切实际的期望，耗时的应用，副作用，美容损伤以及活性化合物的生物利用度受到限制。除了护发外，最初用于角质病牛皮癣，皮质类固醇和维生素D3及其类似物的角质层溶解剂目前是标准治疗方法。最近开发的两种活性成分（如泡沫或凝胶）的新配方似乎比传统的乳膏或软膏更易为患者接受。当前用于指甲牛皮癣的治疗选择常常是无效的，伴有不良影响或耗时。成功必须用几个月来衡量。主要使用局部治疗（例如皮质类固醇，维生素D类似物，他扎罗汀），但通过常规治疗和生物制剂的全身治疗，大部分改善率将显着提高。最后，明确证明了皮质类固醇，维生素D和类似物以及钙调神经磷酸酶抑制剂在治疗间质性牛皮癣中的有用性。尤其是钙调神经磷酸酶抑制剂的使用在三叉神经区域表现出功效，因此可能被视为未来的有前途的治疗选择。除了过去几年中的重要创新外，还需要一种新的有效且耐受良好的治疗方式，尤其是在3个难以治疗的地点长期使用，其中包括化妆品可接受性。

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