| Psoriasis is a kind of skin disease related to genetic,immune and environmental factors.Its recurrent and protracted characteristics have a great impact on the life of patients.At the same time,the treatment of Psoriasis is also a huge challenge to clinicians.Dermoscopy is a kind of noninvasive physical examination,which can observe the various micro structures of the epidermis and dermis,such as blood vessels and pigment changes,which are not visible to the naked eye.It is often used in the clinical diagnosis and differential diagnosis of skin diseases.At home and abroad,there are few studies on the effect evaluation of vascular changes,distribution pattern,density and other characteristics under dermoscopy.Objective 1.To evaluate the clinical efficacy and safety of fluticasone propionate ointment combined with imimolus ointment in the treatment of psoriasis vulgaris;2.Use dermoscope to dynamically observe the changes of skin lesions and blood vessels after fluticasone propionate ointment combined with imimolus ointment in the treatment of psoriasis vulgaris to judge the efficacy.3.To investigate the correlation between PASI score,itch score,quality of life score and vascular structure in psoriasis lesions.Methods A total of 90 patients with psoriasis vulgaris were selected from the outpatient department of Tangshan Workers Hospital were randomly divided into three groups: pimetolimus group(n=30),fluticasone propionate group(n=30),and pimetolimus combined with fluticasone propionate group(n=30).Immeolimus group was treated with immeolimus,2/day,topical use.Fluticasone propionate group was treated with fluticasone propionate,2/day,for external use.The remaining group was treated with pimetolimus combined with fluticasone propionate,for external use 2/day,and pimetolimus ointment was applied evenly and then fluticasone propionate was applied.The three groups were given Xiaoyin Capsule 1.5g/time,3/day and Compound Aminopeptidin 5 tablets/time,3/day.The course of treatment was 4 weeks.For patients in the first time to see a doctor,2 weeks,4 weeks,6 weeks follow-up,each time followed by the same researchers according to psoriasis area and severity index score method(PASI score method),quality of life score and itching degree evaluation method to evaluate the patient,at the same time,application of skin mirror fixed detected collection selected at each patient skin mirror images,statistical skin microscopic image characteristics(blood vessel diameter,blood vessels,area,the density of blood vessels),and observe and record in the process of the three groups of patients in the treatment of adverse reactions,8 weeks telephone follow-up recurrence.Results 1 Age,duration of three groups of patients with psoriasis vulgaris with no statistically significant difference were observed in the one-way ANOVA(P>0.05).Chisquare test showed that there was no significant difference in sex composition ratio and skin lesion composition ratio among the three groups(P>0.05).2 Before treatment,there were no statistical differences(P>0.05)among the three groups,including PASI,QIDL,pruritus score,vessel diameter,vessel area and vessel density,which were comparable.3 Clinical observation indicators after treatment: PASI,QIDL and pruritus scores of the three groups all decreased,and PASI score of the pimecrolimus/fluticasone propionate group was significantly lower than that of the pimecrolimus and fluticasone propionate group alone(F=17.23;P<0.05);DLQI was significantly lower than the other two groups(F=21.13;P<0.05);The itching score was significantly lower than that of the other two groups(F=14.65;P<0.05).4 Changes of vascular structure under dermoscopic microscope after treatment: vascular diameter,vascular area and vascular density all decreased,and the vascular diameter in the pimecrolimus/fluticasone propionate group was significantly smaller than that in the other two groups(F=10.42;P<0.05);Vascular area was also significantly lower than that of the other two groups(F=10.07;P<0.05);However,there was no significant difference in vascular density between the three groups after treatment(F = 2.72,P>0.05).5 The PASI score of psoriasis lesions during treatment was consistent with the changes of vessel diameter and vessel area over time,but the decrease rate of PASI score was significantly faster than that of vessel diameter.PASI score of psoriatic lesions showed the same trend with time as itching score and quality of life score,and itching score and quality of life score mostly decreased faster than PASI score of psoriatic lesions.6.PASI score of psoriasis lesions was positively correlated with pruritus score(R=0.533),quality of life score(R=0.544),vascular diameter(R=0.658),vascular area(R=0.652)and vascular density(R=0.528).Conclusion 1 This study found that fluticasone propionate ointment combined with pimecrolimus ointment is effective in treating psoriasis vulgaris with high safety and low recurrence rate.2 The changes of vascular structure in psoriasis lesions under dermoscopy can be used as an evaluation index of the condition improvement and drug efficacy.3 The PASI score of psoriasis was positively correlated with pruritus score,quality of life score,vessel diameter,vessel area and vessel density.4 Dermatoscopy can dynamically observe the changes of psoriatic lesions after treatment,and judge the curative effect more accurately from the microscopic point of view.Figure15;Table12;Reference 223... |
