1 斑块状银屑病的概念、诊断及病情评估方法
斑块状银屑病是银屑病的最常见类型,约占所有类型的80%~90%,点滴型一般多发于年龄<20岁的年轻人。临床诊断主要依据皮损特点和查体:皮疹基本特点为境界清楚的暗红色斑块或浸润性红斑,上附白色、银白色鳞屑;查体见“蜡滴现象”“薄膜现象”“点状出血现象”(Auspitz征)和“束状发”等。皮疹好发于头皮、背部和四肢伸侧;伴或不伴瘙痒;进行期可有同形反应;皮损反复发作,多数冬重夏轻。疾病严重程度的评估方法主要依据人体体表面积(body surface area, BSA)、医生整体评估(physician′s global assessment, PGA)、银屑病面积和严重程度指数(psoriasis area and severity index, PASI)和<!--IIYITAG:8:pifubing-->皮肤病<!--IIYITAG:/8:pifubing-->生活质量指数(dermatology life quality index,DLQI)。各国指南大同小异,但是对疾病严重程度的分级,各国有所不同。中国、其他亚洲国家和美国分为轻、中、重度,而欧洲及法国指南只分为轻度和中重度。国际银屑病理事会(IPC)通过改进的德尔菲分类法,此分类法重新定义了系统治疗的准入标准。并非按轻度、中度和重度的分类,而是采取二分法:将银屑病患者分为适合局部治疗或全身治疗两种。后者是至少符合以下标准之一的患者:①体表面积10%;②疾病涉及特殊部位;③局部治疗失败。详见表1[1,4-5,7-8]。
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