"The plaques on my neck itch unbearably; the more I scratch the thicker they get, and wearing turtlenecks has become a luxury." This is a common complaint among many psoriasis patients. Psoriasis (the medical standard name "silver dermatitis") is far from a simple skin issue — it embodies the pathological essence of immune dysregulation, a clinical pattern of recurrent flares, and is often accompanied by comorbid risks such as joint damage and depression or anxiety. Today's diagnosis and treatment have entered a new era of "precision targeting + integrated mind‑body therapy."

1. Decoding Etiology: The Dual Symphony of Genetics and Environment

The onset of psoriasis is like the malfunction of a precision instrument; it results from the combined action of genetic susceptibility and environmental triggers:

Core mechanism: the immune system "cannot distinguish friend from foe," with abnormal activation of inflammatory factors such as TNF-α and IL-17, causing skin cells to proliferate at about 10 times the normal rate and forming characteristic scaly plaques.

Genetic code: first-degree relatives of affected individuals have a threefold higher risk than the general population, but only 20%–30% of carriers actually develop the disease; environmental factors are the critical "switch."

Triggering factors: infections such as the common cold and tonsillitis can directly trigger the disease (for example, guttate psoriasis is often associated with streptococcal infection); psychological stress raises levels of inflammatory factors— a survey in Shanghai found that 62% of relapses were related to emotional fluctuation; additionally, skin trauma, sleep deprivation, high-sugar diets, and alcohol abuse can all potentially provoke the condition.

Traditional Chinese medicine perspective: External invasion of wind-evil, emotional injury, and depletion from chronic illness are the main etiologies; for example, long-term anxiety can lead to disharmony of qi and blood, precipitating lichenification of the skin.

II. Pattern identification: diagnostic codes for different lesions

Psoriasis is not "the same in a thousand people"; precise identification of the type is a prerequisite for treatment:

Plaque psoriasis (accounts for 80%): the most common form, characterized by well-demarcated red plaques covered with silvery-white scales; after scraping, a "membrane phenomenon" and "pinpoint bleeding" can be seen. It commonly affects the scalp and extensor surfaces of the limbs. When the scalp is involved, scales often adhere to the hair roots and must be differentiated from seborrheic dermatitis.

Psoriatic arthritis: About 30% of patients have joint involvement, presenting with swelling and pain of the fingers and toes; in severe cases this leads to joint deformity and requires combined treatment with rheumatology and immunology.

Pustular and erythrodermic types: These are severe forms; the former presents with dense sterile pustules, the latter with generalized skin erythema and desquamation. They are often triggered by misuse of corticosteroids or folk remedies and require urgent hospitalization.

Special-site types: When occurring on the vulva or in skin folds, scaling is minimal and it is easily misdiagnosed as eczema; nail psoriasis presents with pitting and discoloration of the nails and must be differentiated from onychomycosis.

3. Treatment escalation: The 2025 precision “deployment”

The 2025 diagnosis and treatment consensus clarifies the principle of "tiered treatment" and, combined with the latest drug advances, therapy has achieved "precision on-demand dosing":

Mild patients (lesions < 3% body surface area): first-line therapy is vitamin D3 derivatives (such as calcipotriol); for sensitive sites like the face and vulva use calcineurin inhibitors instead, avoiding long-term use of high-potency corticosteroids. Scalp involvement may be treated with foams or lotions, and shortening the hair can improve efficacy.

Moderate patients: narrowband UVB (NB-UVB) combined with topical agents is the classic regimen; a newly available anti–human IL-8 monoclonal antibody cream can improve lesions within an 8–12 week course.

Severe patients: biologics provide a revolutionary breakthrough. The domestically produced IL-23 inhibitor pikangqiba monoclonal antibody, launched in December 2025, achieves "one injection every 12 weeks"; Phase III data show a 90% lesion clearance rate (PASI 90) in 80.3% of patients at 16 weeks, particularly suitable for difficult-to-treat sites such as the scalp and palms/soles, and breaking the import drug monopoly. Patients with psoriatic arthritis may be treated with TNF inhibitors or JAK inhibitors for rapid relief of joint pain.

Integration of Traditional Chinese and Western Medicine: Liu Wali, Chief Physician at the China Academy of Chinese Medical Sciences, recommends using heat-clearing and blood-cooling Chinese herbs during the acute phase and blood-nourishing, dryness-moisturizing formulas during the stabilization phase to reduce recurrence frequency.

4. Mind–Body Protection: Key Details of Daily Management

Scientific care can reduce recurrence rates by 40%, focusing on "protecting the skin barrier + modulating immunity + emotional management":

Skin care: Keep bath water temperature between 37°C and 40°C; avoid scrub towels that cause friction; choose fragrance-free emollient ointments for moisturizing, and apply urea ointment to fissured areas. During itch flares, use the fingertips to tap gently instead of scratching to prevent Koebner phenomenon from worsening lesions.

Dietary management: Emphasize a light diet, eat plenty of fresh fruits and vegetables rich in vitamins, and avoid highly astringent tea, coffee, seafood, spicy and other allergenic foods. Studies have shown that supplementing with omega-3 fatty acids can help reduce inflammation.

Emotional management: 13.9% of patients have moderate to severe depression; anxiety can be alleviated through diaphragmatic breathing (inhale 3 seconds, exhale 7 seconds) and music meditation. Joining patient support groups to obtain social support can significantly improve treatment adherence.

Routine and exercise: Ensure 7–8 hours of sleep per night and avoid staying up late; 30 minutes of brisk walking, yoga, or similar exercise daily can help regulate immune balance, but avoid heavy sweating after exercise that may irritate the skin.

5. Prevention first: Protective guidelines for high-risk populations

For those with a family history or immunosuppression, prevention should specifically avoid triggers:

Strict infection control: wear masks during flu season; evaluate surgical removal for those with recurrent tonsillitis, as such infections are a major trigger for guttate psoriasis.

Avoid irritants: prevent skin trauma and sunburn; protect the scalp when dyeing hair; ventilate thoroughly after renovations to reduce exposure to formaldehyde and other chemicals.

Regular screening: perform a self-examination of the skin every quarter; if pale red papules with slight scaling are found, promptly consult dermatology—early intervention can prevent disease progression.

Chronic disease management: Patients with hypertension and diabetes need strict control of their underlying conditions, because metabolic abnormalities can raise inflammation levels and increase the risk of disease onset.

Mr. Wang, 71, has battled psoriasis for 30 years and frequently sought medical care due to recurrent relapses. After starting a domestically developed innovative biologic in December 2025, he achieved long-lasting control with a "one dose per quarter" regimen and regained a normal life. This case demonstrates that although psoriasis cannot be cured, long-term disease stability can be fully achieved through "precision therapy + scientific care + emotional regulation." Abandon folk remedies and trust standard diagnosis and treatment; every patient can live in peace with the disease.