New Year, New Psoriasis Treatment?
当您盘点2023目标时，从PSO治疗中获得最大的收益可能是首位。在这里，可能是时候进行开关的迹象了。
如果你有捕鱼大作战 ，您已经知道，降落最有效的药物或治疗结合可以耐心。适合您的最好的牛皮癣治疗方法，可以使您的皮肤完全清晰，取决于各种因素。“一个是牛皮癣的类型你有两个，你的身体表面覆盖了多少。”Mark G. Lebwohl, M.D。, the dean of clinical therapeutics at the Icahn School of Medicine at Mount Sinai Hospital in New York City and past chairman of the Psoriasis Task Force of the American Academy of Dermatology. How the psoriasis is affecting your quality of life, and whether or not you have other health issues are also considerations.
Still, even when you find the treatment that works—be it atopical,口服药物,phototherapy, orbiologic—you may feel its efficacy decrease with time. Our top dermatologists offer some of the signs to look for and when a treatment switch might be in order.
You Get New or Worsening Plaques
当您爆发时，您应该问自己的第一个问题是您是否一直在服用药物。我们明白了：如果您使用局部或口服药物，可以记住按照处方服用，通常每天一次或两次。“每天努力申请任何事情都是很难的，”Carmen Castilla, M.D., a dermatologist at New York Dermatology Group in New York City. “So the treatment might be working fine, you just may get a flare because you haven’t been consistent.” (We know you know this but still: Set up phone reminders.)
同样，如果您停止治疗，因为您对永远的感觉很清楚，那么您的牛皮癣就会回来。“这很普遍。人们会变得更好，他们认为他们已经治愈了，但目前我们无法治愈牛皮癣。”卡斯蒂利亚博士说。Whenit comes back varies from person to person, but it will. “What’s more, if you stop the medication and then restart it, it may not work. Or it may not work as well as it did the first time,” says Dr. Castilla.
如果你有been adhering, let your doctor know about the flare so you can try to figure out what may havetriggeredit. If for example, you’re on biologics, you may start to see new psoriasis plaques forming or a worsening of existing plaques right around the time of your upcoming treatment. “The newerbiologictreatments are so effective that when it’s working well you stay 100% clear. So anything less, can be a sign that the efficacy is waning,” says Dr. Castilla. Your doctor can review other treatment options with you.
关于体重增加的一句话：肥胖是well-studiedrisk factor for worsening psoriasis. “If you’ve gained weight and you get a new flare, the reason could have more to do with your weight than a waning of your treatment,” says Dr. Lebwohl. According to the American Academy of Dermatology Association, if you’re overweight, losing excess pounds can使治疗工作better.
您会出现新的或恶化的关节痛
Let’s say you have mild skin psoriasis and you’re all good with a topical treatment. And then your joints start to hurt and get swollen and you feel more stiff, particularly in the morning. This could mean you’ve developed银屑病关节炎（PSA）which affects 30% of those with psoriasis, according to the National Psoriasis Foundation. (Takethis screener quiz看看您是否可能在展示迹象。）
Psoriatic arthritis should not be ignored. “Left untreated, it can cause so much inflammation that it can damage or even destroy your joints,” says Dr. Castilla. “In these cases, we switch the treatment from topical to a biologic, which treats the psoriasis both externally and internally.”
You Notice Nail Changes
银屑病is a chronic and dynamic skin disease, meaning the extent and location of it can change over time. “指甲牛皮癣Lebwohl博士说：“是您最初可能没有的一种牛皮癣，然后再发展。”它会影响您的指甲和脚趾甲，导致油点，斑点（孔）和/或高乳变性，这是指甲床增厚的。它们还可以变成淡黄色或开始抬起指甲床。指甲中的任何这些变化都可能是您可能需要其他类型或更强类型的牛皮癣治疗的信号。
You Scrape Your Elbow
Or get an insect bite, burn, or cut yourself shaving. For some people with psoriasis, minor injuries like these can cause plaques to appear in new places, a reaction known as theKoebner phenomenon.德国皮肤科医生海因里希·科布纳（Heinrich Koebner）于1876年首次描述,it affects about 25% of people with plaque psoriasis.“This is less likely to occur if a patient is already on a biologic or other systemic therapy. But even if it does happen, it can be treated with a topical medication as a spot treatment. It doesn't necessarily mean the biologic medication needs to be changed,” says Dr. Lebwohl.
底线
不管您的治疗可能不再充分工作的原因，不要解决。让您的医生知道。“我觉得人们被困在车辙中的思维改进只是暂时的，但这不再是真的。我们在三年前还没有牛皮癣治疗，这是我们还没有的。”卡斯蒂利亚博士说。“因此，将有一些能使您100％清晰的事情。您和您的医生只需要找到它即可。”
牛皮癣和肥胖症：国际分子科学杂志。（2022.）“探索肥胖与牛皮癣之间的联系：全面的评论。”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321445/
地中海饮食和牛皮癣：JAMA Dermatology。(2018.) “Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis.”https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6143029/
减肥和药物疗效：美国皮肤科协会。（n.d.）“如果我有牛皮癣，我该吃什么？”https://www.aad.org/public/diseases/psoriasis/insider/diet/diet/psoriasis-what--what-should-eat#:~: text = weet;％20效率
Koebner现象：Bioscience Reports。（2019年。）“ Koebner现象导致新的银屑病病变的形成：证据和机制。”https://portlandpress.com/bioscirep/article/39/12/bsr20193266/221063/koebner-phenomenon-leading-to-the-formation-of-new
