头皮银屑病发病机制和治疗的研究进展

doi:10.35541/cjd.20240001

中华皮肤科杂志 ›› 2025, e20240001.doi: 10.35541/cjd.20240001

头皮银屑病发病机制和治疗的研究进展

张亮亮¹ 张家安² 陈崑²

¹北京协和医学院中国医学科学院皮肤病医院皮肤病研究所，南京 210042；²中国医学科学院北京协和医学院皮肤病医院理疗科，南京 210042

收稿日期:2024-01-02 修回日期:2024-09-05 发布日期:2025-09-24
通讯作者: 陈崑
基金资助:
国家自然科学基金（82073445）；中国医学科学院医学与健康科技创新工程（CIFMS?2021?I2M?1?001）

Pathogenesis and treatment of scalp psoriasis

Zhang Liangliang¹, Zhang Jiaan², Chen kun²

¹Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing 210042, China; ²Department of Physiotherapy, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing 210042, China

Received:2024-01-02 Revised:2024-09-05 Published:2025-09-24
Supported by:
National Natural Science Foundation of China （82073445）; CAMS Innovation Fund for Medical Sciences （CIFMS?2021?12M?1?001）

摘要/Abstract

摘要： 【摘要】头皮是银屑病最常受累和最先发病的部位，也是最难治疗的部位之一。头皮独特的毛发生长周期和复杂的微生物群落可能导致头皮银屑病的特征性皮损。近年来头皮银屑病的治疗取得巨大进展，生物制剂和小分子抑制剂均有效，新的外用药物和光疗方法正在探索中。本文对头皮银屑病的发病机制和治疗进展进行综述。

关键词: 银屑病, 头皮皮肤病, 毛囊, 药物疗法, 生物制剂, 小分子抑制剂, 光疗法

Abstract: 【Abstract】 The scalp is not only the most frequently affected area but also the primary site of psoriasis. It is notoriously challenging to treat due to its inherent resistance. The presence of distinct hair cycles and intricate microbial communities play a role in the development of unique lesions in scalp psoriasis. In recent years, significant progress has been made in the treatment of scalp psoriasis, with both biologics and small-molecule inhibitors proving to be effective. New topical therapies and phototherapy methods are also under exploration. This review summarizes the advancements in the pathogenesis and treatment for scalp psoriasis.

Key words: Psoriasis, Scalp dermatoses, Hair follicle, Drug therapy, Biological agents, Small molecule inhibitor, Phototherapy

张亮亮张家安陈崑. 头皮银屑病发病机制和治疗的研究进展[J]. 中华皮肤科杂志, 2025,e20240001. doi:10.35541/cjd.20240001

Zhang Liangliang, Zhang Jiaan, Chen kun . Pathogenesis and treatment of scalp psoriasis[J]. Chinese Journal of Dermatology,2025,e20240001. doi:10.35541/cjd.20240001

参考文献 47

［1］	胡煜, 顾恒, 陈崑. 中国中重度银屑病疾病负担和未满足治疗需求的系统综述［J］. 中华皮肤科杂志, 2023,56（10）:965⁃972. doi: 10.35541/cjd.20230063.
［2］	Camela E, Ocampo⁃Garza SS, Cinelli E, et al. Therapeutic update of biologics and small molecules for scalp psoriasis: a systematic review［J］. Dermatol Ther, 2021,34（2）:e14857. doi: 10.1111/dth.14857.
［3］	Honma M, Hayashi K. Psoriasis: recent progress in molecular⁃targeted therapies［J］. J Dermatol, 2021,48（6）:761⁃777. doi: 10.1111/1346⁃8138.15727.
［4］	Committee of Psoriasis, Dermatology Branch, Chinese Medical Association.Guidelines for the diagnosis and treatment of psoriasis in China: 2019 concise edition#［J］.Int J Dermatol Venerol, 2020,3（1）:14⁃26. doi: 10.1097/JD9.0000000000000074.
［5］	Mosca M, Hong J, Hadeler E, et al. Scalp psoriasis: a literature review of effective therapies and updated recommendations for practical management［J］. Dermatol Ther （Heidelb）, 2021,11（3）:769⁃797. doi: 10.1007/s13555⁃021⁃00521⁃z.
［6］	Zhang YJ, Sun YZ, Gao XH, et al. Integrated bioinformatic analysis of differentially expressed genes and signaling pathways in plaque psoriasis［J］. Mol Med Rep, 2019,20（1）:225⁃235. doi: 10.3892/mmr.2019.10241.
［7］	Brembilla NC, Senra L, Boehncke WH. The IL⁃17 family of cytokines in psoriasis: IL⁃17A and beyond［J］. Front Immunol, 2018,9:1682. doi: 10.3389/fimmu.2018.01682.
［8］	Ahn R, Yan D, Chang HW, et al. RNA⁃seq and flow⁃cytometry of conventional, scalp, and palmoplantar psoriasis reveal shared and distinct molecular pathways［J］. Sci Rep, 2018,8（1）:11368. doi: 10.1038/s41598⁃018⁃29472⁃w.
［9］	Liu S, Zhuang Z, Liu F, et al. Identification of potential biomarkers and infiltrating immune cells from scalp psoriasis［J］. Gene, 2024,893:147918. doi: 10.1016/j.gene.2023.147918.
［10］	Suzuki T, Ito T, Gilhar A, et al. The hair follicle⁃psoriasis axis: shared regulatory mechanisms and therapeutic targets［J］. Exp Dermatol, 2022,31（3）:266⁃279. doi: 10.1111/exd.14462.
［11］	Lousada MB, Lachnit T, Edelkamp J, et al. Exploring the human hair follicle microbiome［J］. Br J Dermatol, 2021,184（5）:802⁃815. doi: 10.1111/bjd.19461.
［12］	Liu X, Cai Q, Yang H, et al. Distribution of Malassezia species on the skin of patients with psoriasis［J］. J Mycol Med, 2021,31（2）:101111. doi: 10.1016/j.mycmed.2021.101111.
［13］	Tao R, Wan Z, Li RY, et al. Integrated skin microbiome⁃metabolome analysis reveals altered bacterial community composition and metabolites in psoriasis［J］. Int J Dermatol Venereol, 2023，6（4）:181⁃188. doi: 10.1097/JD9.00000000000 00350.
［14］	Kayıran MA, Sahin E, Koçoğlu E, et al. Is cutaneous microbiota a player in disease pathogenesis? Comparison of cutaneous microbiota in psoriasis and seborrheic dermatitis with scalp involvement［J］. Indian J Dermatol Venereol Leprol, 2022,88（6）:738⁃748. doi: 10.25259/IJDVL_323_21.
［15］	Schlager JG, Rosumeck S, Werner RN, et al. Topical treatments for scalp psoriasis: summary of a cochrane systematic review［J］. Br J Dermatol, 2017,176（3）:604⁃614. doi: 10.1111/bjd.14811.
［16］	Ramic L, Sator P. Topical treatment of psoriasis vulgaris［J］. J Dtsch Dermatol Ges, 2023,21（6）:631⁃642. doi: 10.1111/ddg. 15042.
［17］	Gao JC, Emmerich VK, Feldman S, et al. Evaluating calcipotriene 0.005% foam for the treatment of plaque psoriasis of the scalp and body in patients aged 12 years and older［J］. Expert Opin Pharmacother, 2021,22（5）:543⁃547. doi: 10.1080/14656566.2020.1853099.
［18］	Kircik LH, Alonso⁃Llamazares J, Bhatia N, et al. Once⁃daily roflumilast foam 0.3% for scalp and body psoriasis: a randomized, double⁃blind, vehicle⁃controlled phaseⅡb study［J］. Br J Dermatol, 2023,189（4）:392⁃399. doi: 10.1093/bjd/ljad182.
［19］	周玲慧. 抗人白介素⁃8单克隆抗体乳膏治疗头皮银屑病的疗效观察［D］.宁夏医科大学, 2022. doi: 10.27258/d.cnki.gnxyc. 2022.000096.
［20］	Heidemeyer K, Kulac M, Sechi A, et al. Lasers for the treatment of psoriasis: a systematic review［J］. Expert Rev Clin Immunol, 2023,19（7）:717⁃744. doi: 10.1080/1744666X.2023.2205640.
［21］	中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南（2023版）［J］. 中华皮肤科杂志, 2023,56（7）:573⁃625. doi: 10.35541/cjd.20220839.
［22］	Schlager JG, Rosumeck S, Werner RN, et al. Topical treatments for scalp psoriasis［J］. Cochrane Database Syst Rev, 2016,2（2）:CD009687. doi: 10.1002/14651858.CD009687.pub2.
［23］	Bagel J, Lynde C, Tyring S, et al. Moderate to severe plaque psoriasis with scalp involvement: a randomized, double⁃blind, placebo⁃controlled study of etanercept［J］. J Am Acad Dermatol, 2012,67（1）:86⁃92. doi: 10.1016/j.jaad.2011.07.034.
［24］	Fotiadou C, Lazaridou E, Sotiriou E, et al. Scalp psoriasis and biologic agents: a retrospective, comparative study from a tertiary psoriasis referral centre［J］. J Eur Acad Dermatol Venereol, 2016,30（12）:2091⁃2096. doi: 10.1111/jdv.13780.
［25］	Noda S, Mizuno K, Adachi M. Treatment effect of adalimumab and infliximab in Japanese psoriasis patients: results in a single community⁃based hospital［J］. J Dermatol, 2012,39（3）:265⁃268. doi: 10.1111/j.1346⁃8138.2011.01312.x.
［26］	Thaçi D, Unnebrink K, Sundaram M, et al. Adalimumab for the treatment of moderate to severe psoriasis: subanalysis of effects on scalp and nails in the BELIEVE study［J］. J Eur Acad Dermatol Venereol, 2015,29（2）:353⁃360. doi: 10.1111/jdv.12553.
［27］	Khobzey K, Liskova I, Szegedi A, et al. Effectiveness of adalimumab in the treatment of scalp and nail affection in patients with moderate to severe plaque psoriasis in routine clinical practice［J］. Acta Dermatovenerol Alp Pannonica Adriat, 2017,26（1）:11⁃14. doi: 10.15570/actaapa.2017.3.
［28］	Bagel J, Duffin KC, Moore A, et al. The effect of secukinumab on moderate⁃to⁃severe scalp psoriasis: results of a 24⁃week, randomized, double⁃blind, placebo⁃controlled phase 3b study［J］. J Am Acad Dermatol, 2017,77（4）:667⁃674. doi: 10.1016/j.jaad.2017.05.033.
［29］	Rompoti N, Katsimbri P, Kokkalis G, et al. Real world data from the use of secukinumab in the treatment of moderate⁃to⁃severe psoriasis, including scalp and palmoplantar psoriasis: a 104⁃week clinical study［J］. Dermatol Ther, 2019,32（5）:e13006. doi: 10.1111/dth.13006.
［30］	Reich K, Leonardi C, Lebwohl M, et al. Sustained response with ixekizumab treatment of moderate⁃to⁃severe psoriasis with scalp involvement: results from three phase 3 trials （UNCOVER⁃1, UNCOVER⁃2, UNCOVER⁃3）［J］. J Dermatolog Treat, 2017,28（4）:282⁃287. doi: 10.1080/09546634.2016.1249820.
［31］	Langley RG, Papp K, Gooderham M, et al. Efficacy and safety of continuous every⁃2⁃week dosing of ixekizumab over 52 weeks in patients with moderate⁃to⁃severe plaque psoriasis in a randomized phaseⅢ trial （IXORA⁃P）［J］. Br J Dermatol, 2018,178（6）:1315⁃1323. doi: 10.1111/bjd.16426.
［32］	Langley RG, Rich P, Menter A, et al. Improvement of scalp and nail lesions with ixekizumab in a phase 2 trial in patients with chronic plaque psoriasis［J］. J Eur Acad Dermatol Venereol, 2015,29（9）:1763⁃1770. doi: 10.1111/jdv.12996.
［33］	Elewski B, Rich P, Lain E, et al. Efficacy of brodalumab in the treatment of scalp and nail psoriasis: results from three phase 3 trials［J］. J Dermatolog Treat, 2022,33（1）:261⁃265. doi: 10. 1080/09546634.2020.1749546.
［34］	Nakagawa H, Niiro H, Ootaki K. Brodalumab, a human anti⁃interleukin⁃17⁃receptor antibody in the treatment of Japanese patients with moderate⁃to⁃severe plaque psoriasis: efficacy and safety results from a phaseⅡ randomized controlled study［J］. J Dermatol Sci, 2016,81（1）:44⁃52. doi: 10.1016/j.jdermsci.2015. 10.009.
［35］	Kokolakis G, Ghoreschi K. The clinical significance of simultaneous IL⁃17A and IL⁃17F blockade in psoriasis non⁃responding to anti⁃IL17A therapy［J］. J Clin Med, 2022,12（1）:35. doi: 10.3390/jcm12010035.
［36］	Megna M, Picone V, Ventura V, et al. A case of scalp psoriasis resistant to ixekizumab treated with bimekizumab［J］. JAAD Case Rep, 2023,38:123⁃126. doi: 10.1016/j.jdcr.2023.05.043.
［37］	Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti⁃interleukin⁃23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phaseⅢ, double⁃blinded, placebo⁃ and active comparator⁃controlled VOYAGE 1 trial［J］. J Am Acad Dermatol, 2017,76（3）:405⁃417. doi: 10.1016/j.jaad.2016.11.041.
［38］	Reich K, Armstrong AW, Foley P, et al. Efficacy and safety of guselkumab, an anti⁃interleukin⁃23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: results from the phaseⅢ, double⁃blind, placebo⁃ and active comparator⁃controlled VOYAGE 2 trial［J］. J Am Acad Dermatol, 2017,76（3）:418⁃431. doi: 10.1016/j.jaad.2016. 11.042.
［39］	Galluzzo M, Talamonti M, Cioni A, et al. Efficacy of tildrakizumab for the treatment of difficult⁃to⁃treat areas: scalp, nail, palmoplantar and genital psoriasis［J］. J Clin Med, 2022,11（9）:2631. doi: 10.3390/jcm11092631.
［40］	Papp KA, Blauvelt A, Bukhalo M, et al. Risankizumab versus ustekinumab for moderate⁃to⁃severe plaque psoriasis［J］. N Engl J Med, 2017,376（16）:1551⁃1560. doi: 10.1056/NEJMoa1607017.
［41］	Reich K, Rich P, Maari C, et al. Efficacy and safety of mirikizumab （LY3074828） in the treatment of moderate⁃to⁃severe plaque psoriasis: results from a randomized phaseⅡ study［J］. Br J Dermatol, 2019,181（1）:88⁃95. doi: 10.1111/bjd.17628.
［42］	Orsini D, Gargiulo L, Ibba L, et al. Effectiveness of risankizumab in plaque psoriasis with involvement of difficult⁃to⁃treat areas: a real⁃world experience from two referral centers［J］. J Dermatolog Treat, 2023,34（1）:2220849. doi: 10.1080/09546634.2023.2220849.
［43］	王玲艳, 潘靖, 苗钢, 等. 对生物制剂治疗抵抗的银屑病患者皮损部位分析［J］. 中华皮肤科杂志, 2022,55（7）:583⁃587. doi: 10.35541/cjd.20220133.
［44］	Keating GM. Apremilast: a review in psoriasis and psoriatic arthritis［J］. Drugs, 2017,77（4）:459⁃472. doi: 10.1007/s40265⁃017⁃0709⁃1.
［45］	Blauvelt A, Rich P, Sofen H, et al. Deucravacitinib, a selective, allosteric tyrosine kinase 2 inhibitor, in scalp psoriasis: a subset analysis of two phase 3 randomized trials in plaque psoriasis［J］. J Am Acad Dermatol, 2024,90（4）:775⁃782. doi: 10.1016/j.jaad.2023.11.060.
［46］	王茜, 孙雪淞, 张丽宏, 等. 中药外治法治疗头皮型银屑病的Meta分析［J］. 云南中医中药杂志, 2023,44（1）:31⁃37. doi: 10.3969/j.issn.1007⁃2349.2023.01.010.
［47］	黄强, 龚丽萍. 头皮银屑病的中西医结合治疗进展［J］. 江西中医药, 2021,52（1）:75⁃77.

[1]	戴叶芹宋秀祖. 毛囊及毛囊细胞移植在白癜风治疗中的应用进展[J]. 中华皮肤科杂志, 2025, 58(9): 882-885.
[2]	薛珂陈佳李斌. 系统性红斑狼疮靶向治疗研究进展[J]. 中华皮肤科杂志, 2025, 58(8): 781-784.
[3]	杨凯林尽染, 祝飞冯苏云李政张悦胡瑞铭程含皛周圳滔吴亚桐杨顶权张菊芳吴文育, . 某国产毛囊提取系统提取雄激素性秃发患者毛囊的有效性和安全性：多中心、前瞻性、随机、自身对照临床试验[J]. 中华皮肤科杂志, 2025, 58(7): 603-607.
[4]	丁炜蕴林尽染刘庆梅张悦杨凯倪春雅吴文育. 干细胞在头皮衰老中的作用及相关治疗策略[J]. 中华皮肤科杂志, 2025, 58(7): 671-675.
[5]	李昱王紫薇叶容嘉李容朱艳张小华黄丹鞠梅. 白癜风患者家庭光疗实施及管理需求调查分析[J]. 中华皮肤科杂志, 2025, 58(7): 608-612.
[6]	陈钰虹吕中法. 毛囊生长周期调控的机制进展[J]. 中华皮肤科杂志, 2025, 58(7): 686-690.
[7]	杨洁刘莉萍. 单细胞测序在毛发相关研究中的应用[J]. 中华皮肤科杂志, 2025, 58(7): 690-694.
[8]	孙佳怡宋秀祖. 自噬在毛发生理病理中的研究进展[J]. 中华皮肤科杂志, 2025, 58(7): 679-682.
[9]	李翔倩张建中周城. 系统小分子药物和生物制剂治疗斑秃的临床研究进展[J]. 中华皮肤科杂志, 2025, 58(7): 646-649.
[10]	魏然李钦峰. 儿童斑秃新型靶向药物治疗研究进展[J]. 中华皮肤科杂志, 2025, 58(7): 650-653.
[11]	丁雨欣, 苗宇杰毛美淇陈锦阳林志伟吕中法. 脐带间充质干细胞衍生的纳米囊泡诱导毛发再生的作用研究[J]. 中华皮肤科杂志, 2025, 58(5): 431-439.
[12]	中华医学会皮肤性病学分会银屑病学组. [开放获取] 阿普米司特治疗银屑病专家指导意见（2025版）[J]. 中华皮肤科杂志, 2025, 58(5): 416-424.
[13]	中国医师协会皮肤科医师分会中华医学会皮肤病学分会治疗学组中国医疗保健国际交流促进会皮肤医学分会国家皮肤与免疫疾病临床医学研究中心中国罕见病联盟皮肤罕见病专业委员会. 大疱性类天疱疮诊疗专家共识（2025版）[J]. 中华皮肤科杂志, 2025, 58(5): 405-415.
[14]	于金蕾吴桥芳孙悦鑫包军周映. 佩索利单抗治疗6例泛发性脓疱型银屑病临床观察[J]. 中华皮肤科杂志, 2025, 0(5): 20240440-e20240440.
[15]	李紫钰鲁严. 关注新型冠状病毒感染后重症皮肤病[J]. 中华皮肤科杂志, 2025, 58(4): 378-383.

头皮银屑病发病机制和治疗的研究进展

Pathogenesis and treatment of scalp psoriasis

PDF

PDF (Mobile)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 47

相关文章 15

Metrics

本文评价

推荐阅读 0