Woman with 3 months of Flexural (Inverse) Psoriasis 皮褶型牛皮癣
A 45-year-old otherwise healthy female was presented with 3 months of flexural psoriasis. Initially, she reported rashes appearing on areas on the groin and submammary folds. GP prescribed Fobancort (Fusidic acid and Betamethasone dipropionate) cream and referred her to a dermatologist for final diagnosis and a treatment plan to help improve her condition. However, rashes developed on areas of her popliteal and chelidon. A diagnosis of flexural psoriasis was then made by a dermatologist and Triamcinolone acetonide cream (potent steroid) was further administrated. Her rash resolved intermittently but successively appeared on both retroauricular folds. She came to seek a third opinion.
Upon examination, there were glossy and sharp demarcated erythema presented on areas of the groin, submammary folds, preauricular area, retroauricular fold, popliteal and chelidon. The scaling on shiny erythematous plaques of the skin folds is minimal (Fig.1,2,3). She was prescribed with herbal medicinal powder and was told to take it twice daily. She was then reviewed every 4 weeks with her progress tracked by photographs. The lesions improved considerably with herbal medicine within 8 weeks of starting the treatment. When there was complete resolution at month 5, prescription of herbal medication was ceased. We continued to follow-up the patient for an additional 12 months with no recurrence of lesions observed till date.
Fig. 1-3 Inverse (flexural) Psoriasis. Shiny erythematous plaques of the skin-to-skin folds that lack scaling. There is much less scaling than in untreated chronic plaque psoriasis. Flexural lesions are characterized by shiny, pink to red, sharply demarcated thin plaques.
Due to the moist nature of the skin folds, the appearance of the psoriasis is slightly different from untreated chronic plaque psorisis. Many clinicians would make the diagnois of Candida infection, intertrigo or seborrhoeic dermatitis. The inverse psoriasis tends not to have silvery scale, but is shiny and smooth. There may be a crack (fissure) in the depth of the skin crease. The deep red colour and well-defined borders characteristic of psoriasis may still be obvious. The most common sites of involvements are the retroauricular fold, intergluteal cleft, inguinal crease, axilla, and inframammary region, skin-to-skin contact area. Sweating is impaired in affected areas.
When flexural areas are the only sites of involvement, the term “inverse” psoriasis is sometimes used. Localized dermatophyte, candidal or bacterial infections can be a trigger for flexural psoriasis.
My Thoughts and Self-Reflection
With an autoimmune skin disease, like psoriasis, the immune system attacks the body’s own tissue, skin. Immunosuppressant drugs, a class of drugs that suppress or weaken the body’s immune system, are administrated conventionally to reduce the impact of the autoimmune disease on the body.
However we take the initiative NOT to use conventional or herbal steroids or immunosuppressants to treat non-life-threatening skin diseases. Tangs herbal medication helps the body balance and revitalize its immune system to treat skin disorders in a natural and safe way.
Such unorthodox methods are the polar opposite of what modern medical treatments preaches.
This then begs the question of whether the example mentioned above an anecdotal evidence, a single person’s story being used to support a claim? Indeed we do need a large sample size of prospective cohort studies to further test the hypothesis. We have been continually presented with a series of cases reporting of disconfirming evidence for the conventional immunosuppressant treatment theories of autoimmune skin diseases, that our treatment results are in direct opposition to the guidelines of the conventional skin disease treatments.
However, certain beliefs about conventional treatment that we hold – beliefs that seem obvious to us, to be empirical facts – have turned out, in light of numerous disconfirming evidence, to be mistaken philosophical “beliefs”. We are then, in a sense, in a similar situation to that of our predecessors, Aristotle, Newton and Einstein on the 2000, 400 and 100 years ago respectively. Maybe our entire way of looking at the world might turn out to be the wrong way of looking at the world? Just as new discoveries forced them to rethink core beliefs they had long taken as apparent facts, the recent scientific discoveries force us to rethink some of our most fundamental beliefs about the sort of medical treatments we accept to be the panacea.
一名 45 岁其他方面健康的女性罹患皮褶型银屑病 3 个月。她称最初在腹股沟和双乳下褶皱区域出现皮疹。全科医生开了Fobancort（夫西地酸和二丙酸倍他米松）乳膏，并将她转介给皮肤专科医生进行最终确诊和治疗。随后皮疹出现在她的腘窝和肘窝区域，皮肤专科医生诊断为皮褶型牛皮癣，并处方曲安奈德乳膏（强效类固醇）涂药皮疹间歇性消退，但随即又在两耳后褶皱处出现皮疹。她前来我处寻求第三方意见。
我们多年以来所持有的某些常规治疗信念 – 在我们看来是显而易见的、经验性的事实 – 会慢慢地在越来越多的证据下，被证明是错误的哲学”信念”。因此，从某种意义上就我们的当前医学理念而言，我们所处的情况与我们的前辈亚里士多德，牛顿和爱因斯坦分别在2000年前，400年前和100年前所遇到的境况极其相似：也许我们曾经自以为看待世界的正确观念是否后来会被证明是看待世界的错误观念？正如新的发现迫使过去的前辈们重新思考他们长期以来一直认为是明显事实的核心信念一样，最新的医疗发现也迫使当前的我们重新思考关于我们所传承下来的一些疾病治疗信念是否是一场错误的哲学”信念”。