中国银屑病诊疗指南(2018完整版)

Guideline for the diagnosis and treatment of psoriasis in China(2018 complete edition)

银屑病是一种遗传与环境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,典型临床表现为鳞屑性红斑或斑块,局限或广泛分布,无传染性,治疗困难,常罹患终身。银屑病的病因涉及遗传、免疫、环境等多种因素,通过以T淋巴细胞介导为主、多种免疫细胞共同参与的免疫反应引起角质形成细胞过度增殖或关节滑膜细胞与软骨细胞发生炎症。中医认为多属血分热毒炽盛,营血亏耗,瘀血阻滞,化燥生风,肌肤失养。银屑病是不可治愈性疾病,目前可使用的治疗药物及方法甚多,选择适合患者的治疗药物和方法,对控制病情,维持长期疗效十分重要。指南的目的就是为了逐渐规范治疗方法,提高治疗效能,尽可能减少不良反应的发生。银屑病的治疗方案应根据患者症状确定,轻度以外用治疗为主,中重度可使用系统治疗,对传统系统性药物治疗效果欠佳的患者可适当选择靶向生物制剂治疗。银屑病的治疗目的以控制症状、改善患者生活质量为主。银屑病药物及治疗方法不断发展,新的成果不断涌现,更新指南的目的是及时将国际国内研究的新的成果及时介绍给国内医师,与全球进展保持同步发展。本指南在前两版中国银屑病诊疗指南的基础上进行补充和修订,以进一步规范中国银屑病诊断与治疗,提高诊疗效率,改善患者生活质量。

Psoriasis is an immune-mediated chronic,recurrent,inflammatory,systemic disease induced by the combination of heredity and environment.Psoriasis is a non-communicable disease,its typical clinical manifestations are limited or widely distributed scaly erythema or plaques.Its treatment is difficult,and patients usually need lifelong treatment.The etiology of psoriasis involves heredity,immunity,environment and other factors,which may induce excessive proliferation of keratinocytes or inflammation of joint synovial cells and chondrocytes via the immune response mainly mediated by T lymphocytes and various immune cells.In the theory of traditional Chinese medicine(TCM),it is believed that psoriasis is mostly caused by hot toxic blood,loss of nutritional ingredient in blood,blood perfusion stasis,dry wicked wind in the body and skin system imbalance.Psoriasis is an incurable disease,and many drugs and regimens are available for its treatment at present.Choosing appropriate drugs and regimens is very important for patients with psoriasis to control disease progression and maintain long-term efficacy.The purpose of guidelines is to gradually standardize treatment,improve treatment effectiveness,and to minimize adverse effects as far as possible.Treatment protocols of psoriasis should be determined based on patient′s symptoms.Patients with mild psoriasis can be mainly treated with externally applied agents,those with moderate to severe psoriasis can be treated with systemic medications,and targeted biological agents can be appropriately chosen for those resistant to traditional systemic treatment.The main aim of psoriasis treatment is to control symptoms and improve the quality of life.With continuing development of novel drugs and regimens for psoriasis,we update guidelines to timely introduce new international and national achievements to domestic physicians,so as to keep pace with global progress in this field.Compared with the previous two editions of guidelines for diagnosis and treatment of psoriasis in China,some contents are supplemented and revised in this edition,which will further facilitate standardization of diagnosis and treatment of psoriasis in China,increase the efficiency of diagnosis and treatment,and improve the quality of life of patients.