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香港,中国 - Media OutReach - 2019年1月14日 - 皮肤发炎、红肿、灼热或瘙痒,是湿疹常见的病征,但也普遍见于银屑病患者。皮肤科专科医生何家强表示:"由于湿疹和银屑病的症状相似,患者容易将两者混淆。"银屑病患者如果误以为患上湿疹而只涂擦类固醇药膏,虽可控制皮肤症状,但长时间使用类固醇可能会出现耐药,造成病情反复和恶化。

银屑病会跟湿疹混淆而耽误治疗吗?

 

香港有不少银屑病跟湿疹混淆的临床病例,银屑病患者误诊为湿疹,后期因病情严重而转介至皮肤科时,大多已达中等至严重的程度。何家强医生表示:"虽然银屑病的病征很容易与湿疹混淆,但我们可根据患者发病年龄及位置进行鉴别诊断。"

 

2050发病高峰期

银屑病为自身免疫性疾病,与心理因素及压力有关,20岁及50岁分别为发病的两个高峰期。皮损常见于身体外侧,如手肘、膝盖、头皮及背部等。何医生指出20岁及50岁这两个年龄的人群,通常正经历着人生道路及社会角色的剧烈转变,往往因此感到压力,而易诱发银屑病。至于湿疹,则属过敏性皮肤疾病,一般常见于颈部、脸部及身体内侧的皮肤,由遗传加上外来因素诱发,发病年龄组通常为5岁或以下的儿童。

 

中度至严重程度的银屑病患者,一般可以考虑使用生物制剂治疗。生物制剂可针对性地抑制体内的炎症因子,效果显著,安全性较高,副作用相对较少及轻微。

 

白介素抑制剂治疗恢复正常生活

目前治疗银屑病的生物制剂包括甲型肿瘤坏死因子抑制剂及白细胞介素抑制剂。抗甲型肿瘤坏死因子抑制剂能控制炎症反应,但治疗两至三年后,身体有可能出现抗药抗体,使药效减弱,患者继而需加大药物剂量以维持治疗效果,治疗费用和副作用也随之增多。另外抗甲型肿瘤坏死因子抑制剂容易增加患者感染肺结核的风险。

 

至于治疗银屑病的白介素抑制剂,可分为白细胞介素17aIL-17a)抑制剂和白细胞介素23 IL-23)抑制剂,两者均针对皮肤炎症因子,而且都不易产生抗药抗体而降低疗效。

 

对于患者而言,白细胞介素23 IL-23)抑制剂可同时有效针对银屑病引起的皮肤炎症反应及失衡的T淋巴细胞,以降低复发风险,并有可能延长病情控制时间,一般治疗两星期后便能起效;而传统口服药物需要一至两个月才起效,生物制剂在快速起效方面优势明显。有研究数据显示,在治疗十六个星期后,八成患者的皮肤状况与基线相比得到90%的改善,即达到PASI 90的目标(PASI指银屑病面积和严重程度指数);四成患者甚至能达至100%的改善,即银屑病斑块完全消失。此外,研究也指出,达到PASI 90或以上的患者,生活完全恢复正常的机会会比未达到的患者多一倍以上。

 

资料来源:

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