208例儿童寻常型银屑病临床资料分析

Analysis for 208 children with psoriasis vulgaris

目的:银屑病是一种影响成人和儿童的慢性炎症性皮肤病,最常见的亚型是寻常型银屑病。本文分析儿童寻常型银屑病的发病特点及临床特征,有利于加强对儿童银屑病的认识、治疗和管理。方法:收集2012年10月到2018年12月期间,初次在中南大学湘雅医院皮肤科门诊就诊的寻常型银屑病患儿208例,对其临床资料进行回顾性分析,总结其临床特征、实验室检查结果、治疗方案及效果。结果:208例寻常型银屑病患儿发病年龄为(11.19±3.97)岁,发病高峰为12岁,病程为(27.46±31.30)个月,男女性别比为1∶0.96;初次发病部位以头皮多见(37.98%),其次为躯干(26.44%)和四肢(22.12%);疾病加重或诱发因素以感染和饮食为主;有银屑病家族史的患儿33例(15.87%),其银屑病皮损面积及严重程度指数(Psoriasis Area and Severity Index,PASI)得分和皮肤病生活质量指数(Dermatology Life Quality Index,DLQI)量表得分比无银屑病家族史者更高(均P<0.05)。所有患儿中超重29例(13.94%),肥胖19例(9.14%),超重和肥胖在寻常型银屑病患儿中的检出率高于我国正常儿童水平。47.5%的患儿血清25-羟基维生素D(25-OH-VD)水平下降,血清25-OH-VD水平与PASI得分呈负相关(P<0.05)。患儿DLQI量表得分为5.56±3.57,PASI得分为7.25±6.83,两者呈中度正相关(r=0.409,P<0.001)。72.11%的患儿病情为轻中度,治疗多以外用药及中成药为主(65.67%),维A酸类药物有较好的疗效,环孢素及氨甲蝶呤用于较严重病例时效果显著。结论:儿童寻常型银屑病诱发因素以感染和饮食为主,有家族史的患儿较无家族史患儿的病情更严重,生活质量更低,易合并代谢异常如超重和肥胖。儿童寻常型银屑病血清25-OH-VD水平与PASI得分呈负相关。

Objective:Psoriasis is a chronic inflammatory skin disease that affects adults and children.The most common subtype is psoriasis vulgaris.This article analyzes the characteristics and clinical features of children with psoriasis vulgaris to strengthen the understanding,treatment,and management for children with psoriasis.Methods:A total of 208 children with psoriasis vulgaris,who were first admitted to the Department of Dermatology,Xiangya Hospital,Central South University from October2012 to December 2018,were retrospectively analyzed.Their clinical characteristics,results of laboratory examination,treatment options and efficacy were summarized.Results:The age of the 208 children with psoriasis vulgaris was(11.19±3.97)years old,the peak incidence was 12 years old,the disease duration was(27.46±31.30)months,and the male-female ratio was 1∶0.96.The most common site of the first attack was the scalp(37.98%),followed by the trunk(26.44%)and the limbs(22.12%).The causes leading to exacerbation were more common in infections and diets.There were 33 patients(15.87%)with a family history of psoriasis,showing the higher score of Psoriasis Area and Severity Index(PASI)and the higher Dermatological Quality of Life Index(DLQI)(both P<0.05).In all patients,29 cases(13.94%)were overweight,19 cases(9.14%)were obese,and the rate of overweight and obesity in children with psoriasis vulgaris was higher than that of normal children in China.In the laboratory test,the serum levels of 25-hydroxyvitamin D(25-OH-VD)were decreased in most patients(47.5%),and the serum 25-OH-VD levels were found to be moderately negatively correlated with PASI score(P<0.05).The score of DLQI in the patient was 5.56±3.57,the score of PASI was 7.25±6.83,and they were positively correlated(r=0.409,P<0.001).In most patients(72.11%),the severity of the disease was mild to moderate.Their treatment was often dominated by topical drugs and Chinese patent medicine(65.67%).Retinoids showed a good effect on children.Cyclosporine and methotrexate were effective in more severe cases.Conclusion:Children with psoriasis vulgaris are mainly caused by infection and diet.Patients with family history have more serious illness,lower quality of life,and are more likely to have metabolic abnormalities such as overweight and obesity.The serum 25-OHVD levels in children with psoriasis vulgaris are negatively correlated with the score of PASI.