外用糖皮质激素的合理应用

外用糖皮质激素是治疗皮肤病最有用的药物之一,目前有很多外用糖皮质激素可供选择,他们在剂型和强度上有较大差异.外用糖皮质激素成功治疗取决于正确的诊断、选择合适剂型和强度的药物、用药的频率、剂量和疗程,以及不良反应的预防.明确诊断之后,应根据外用糖皮质激素的作用机制选择药物,外用糖皮质激素可用于治疗具有增生性、炎症性和与免疫相关的皮肤病,也能缓解瘙痒和烧灼症状,但一般情况下不用于感染性疾病.虽然外用糖皮质激素在临床上普遍使用,但目前循证医学证据表明,治疗有效的疾病有银屑病、白癜风、特应性皮炎、湿疹、急性放射性皮炎、硬化性苔藓等[1-5],证据有限的疾病有黄褐斑、慢性特发性荨麻疹和斑秃[4-6].     

外用糖皮质激素效能分级的临床意义

糖皮质激素的发现和糖皮质激素类药物的开发是人类医学史上的重要里程碑,多年的临床观察发现,此类药物的应用在带来巨大临床价值的同时,还可伴随种种不良反应.正确认识糖皮质激素的效能及不良反应,对临床用药具有重要的指导意义,现就外用糖皮质激素效能分级、影响外用糖皮质激素效能的因素及效能分级的临床意义进行概述.     

规范外用糖皮质激素类药物专家共识

外用糖皮质激素类药物是重要的皮肤科外用药,具有高效、安全的特点,是许多皮肤病的一线治疗药物,但临床上也存在“滥用”和“恐惧”问题。为规范外用糖皮质激素类药物,最大限度地发挥其治疗作用,减少不良反应,中国中西医结合学会皮肤性病专业委员会环境与职业性皮肤病学组组织国内部分专家制定本共识……     

大疱性类天疱疮治疗的研究进展

系统应用糖皮质激素一直是治疗大疱性类天疱疮的主要方法 ,但大量长期使用糖皮质激素常产生较多不良反应。近年来出现了很多其他治疗方法 ,可部分替代糖皮质激素的作用 ,如免疫抑制剂、免疫调节剂、血浆置换疗法、静脉内注射免疫球蛋白等。最近 ,大规模随机多中心临床试验证实了外用强效糖皮质激素的有效性。     

钙调磷酸酶抑制剂他克莫司、吡美莫司在特应性皮炎外的皮肤科应用

大量研究表明,长期、大面积使用糖皮质激素治疗皮肤病可能产生许多不良反应。外用钙调磷酸酶抑制剂(TCIS)是皮肤科相对较新的一类药物,由于其疗效好、安全性高,可长期使用,已经被提出作为一种长期外用的糖皮质激素的替代治疗方案,在皮肤科具有广阔的应用前景。     

新适确得杯——“糖皮质激素外用原则”征文活动通知

为了推广外用糖皮质激素的合理应用,最大限度地发挥外用糖皮质激素的治疗作用,避免或减少外用糖皮质激素的不良反应,诺华制药有限公司与《临床皮肤科杂志》于2005年4月1日起共同举办“新适确得杯”糖皮质激素外用原则征文活动,具体细则如下。1.征文内容要求:凡与糖皮质激素外用原则有关的论文均可参加。征文所涉及的临床研究设计方案科学、统计分析规范、有足量的样本,并附患者治疗前后的彩色照片,提供原始资料。参加评奖的论文应未在正式杂志上发表或在会议上交流过。2.评审方法:本次有奖征文活动将聘请全国皮肤科著名专家组成评审委员会,…     

大疱性类天疱疮治疗的研究进展

系统应用糖皮质激素一直是治疗大疱性类天疱疮的主要方法，但大量长期使用糖皮质激素常产生较多不良反应。近年来出现了很多其他治疗方法，可部分替代糖皮质激素的作用，如免疫抑制剂、免疫调节剂、血浆置换疗法、静脉内注射免疫球蛋白等。最近，大规模随机多中心临床试验证实了外用强效糖皮质激素的有效性。     

氟芬那酸丁酯软膏联合糠酸莫米松乳膏治疗多形性日光疹疗效观察

目前包括多形性日光疹在内的光线性皮肤病临床常使用糖皮质激素治疗,但长期使用会出现皮肤萎缩等不良反应,且光线性皮肤病多发生在曝光部位,会加重糖皮质激素外用的不良反应。氟芬那酸丁酯是一种外用非甾体类抗炎药,研究发现,其对紫外线所致皮肤损伤有显著的治疗作用［1］。我们采用氟芬那酸丁酯软膏联合糠酸莫米松乳膏治疗多形性日光疹,取得了良好疗效,报道如下……     

卡泊三醇联合丁酸氢化可的松交替治疗外生殖器银屑病的疗效观察

外生殖器部位的银屑病皮损相对较特殊,外用较强效糖皮质激素常会出现局部不良反应,长期使用亦会产生抵抗,使药物的疗效下降.因局部环境相对封闭,外用润肤剂又常使患者有不适感.因此,我们观察了卡泊三醇(香港澳美制药厂有限公司)联合丁酸氢化可的松(天津药业集团有限公司)交替治疗外生殖器银屑病的有效性和安全性.     

激素依赖性皮炎研究进展

随着糖皮质激素应用的日益广泛,相应的不良反应也日益明显,尤其是因糖皮质激素外用制剂的不当使用及含激素化妆品、面膜等的滥用导致的糖皮质激素依赖性皮炎(激素依赖性皮炎)的发病率逐年增高,引起医学工作者的广泛关注。其主要诱因是糖皮质激素外用制剂的长期不当使用及含激素化妆品、面膜等的滥用。其发病机制尚不完全明确,已知的主要发病机制是表皮屏障功能受损。但国内外对于激素依赖性皮炎的很多认知仍存在不小的差异,其诊断依据等仍有待研究以达成统一的标准。     

Peristomal dermatoses: a novel indication for topical steroid lotions

BACKGROUND: Dermatoses that interfere with the normal use of a stoma appliance are common. When preventable causes, such as infection or allergy, are not identified, barrier preparations or topical steroids have been used. However, topical medicaments formulated in a cream or ointment base will cause stoma bags to detach, resulting in leaks. OBJECTIVE: Our purpose was to investigate the efficacy and suitability of corticosteroids in aqueous/alcohol lotions in the management of peristomal dermatoses. METHODS: A clinic run by a dermatologist and 2 stoma nurses was created. Patients with a variety of noninfective, inflammatory dermatoses were treated with topical corticosteroid lotions up to a maximum of 4 weeks, with occasional use thereafter in some cases. RESULTS: Topical, aqueous/alcohol, corticosteroid lotions have been used in 60 patients and have proved particularly useful for the treatment of irritant dermatitis, pyoderma gangrenosum, psoriasis, and constitutional eczema. After the initial treatment course, occasional applications, approximately every 2 weeks, may be necessary to control the skin disorder. This low frequency of application minimizes the risk of side effects so that we have not identified local or systemic side effects in any of the patients treated so far. CONCLUSION: Topical corticosteroids formulated in aqueous alcohol lotion are effective and acceptable treatments for peristomal dermatoses. If used appropriately, the risk of side effects is low.     

Topical corticosteroid therapy in psoriasis vulgaris: update and new strategies

This is an update of a previous report on the use of topical steroids in the management of psoriasis vulgaris. The current focus is on new combination therapies that enhance the efficacy of corticosteroids while diminishing their potential side effects.     

Adverse effects of corticosteroids.

The introduction of corticosteroids has constitutded the most revolutionary event in dermatologic therapy in the last twenty-five years. The effectiveness of topical therapy in well diagnosed and obscure dermatoses led to wide applications by specialists and general practitioners, and resulted in the development of more potent topical steroid preparations. Their enthusiastic acceptance, and often indiscriminante use, has been followed by occasional reports of adverse effects. After the introduction of occlusive topical steroid therapy under plastic wrap, more dramatic therapeutic effects were achieved, but the adverse effects also increased. There is presently an abundance of reports elaborating on systemic and local adverse reactions resulting from topically applied or intralesionally injected steroids. This report summarizes the local side effects of these steroids.     

The hairless mouse as a model for study of local and systemic atrophogenic effects following topical application of corticosteroids.

The hairless mouse has been used as a model to distinguish between local and systemic atrophogenic effects of topical steroids. Hydrocortisone-17-butyrate, betamethasone-17-valerate, budesonide and clobetasol-17-propionate were applied topically daily for 21 days. Skinfold thickness and dermal DNA synthesis of treated and untreated skin were evaluated as parameters of local and systemic atrophogenicity. Further, body weight gain and thymus weight were assessed as markers of systemic activity. With respect to local effects, skin thickness and dermal DNA synthesis both proved to be good parameters. Of the systemic parameters, thymic involution and body weight gain paralleled quite well the skin thinning on the untreated side. The results confirmed the potency differences of the steroids. Furthermore, they emphasize the usefulness of the hairless mouse to assess the relative safety with respect to local and systemic side effects of chronically applied topical corticosteroids.     

Adverse effects of topical glucocorticosteroids

Topical corticosteroids were introduced into medicine about 50 years ago. They represent a significant milestone in dermatologic therapy. Despite encouragement to report observed adverse drug reactions, the clinical practice of reporting is poor and incomplete. Likewise, adverse effects and safety of topical corticosteroids are neglected in the medical literature. The authors provide an updated review of their adverse-effect profile. Children are more prone to the development of systemic reactions to topically applied medication because of their higher ratio of total body surface area to body weight. Cutaneous adverse effects occur regularly with prolonged treatment and are dependent on the chemical nature of the drug, the vehicle, and the location of its application. The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections. Of particular interest is the rate of contact sensitization against corticosteroids, which is considerably higher than generally believed. Systemic reactions such as hyperglycemia, glaucoma, and adrenal insufficiency have also been reported to follow topical application. The authors provide an updated review of local and systemic adverse effects upon administration of topical corticosteroids, including the latest FDA report on the safety of such steroids in children. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with topical corticosteroids and their proper use.     

Ocular side–effects of topical corticosteroids: what a dermatologist needs to know

Topical corticosteroids are used frequently in dermatology and atopic dermatitis without significant adverse effects. Though ocular diseases such as glaucoma and cataracts are known complications of systemic corticosteroids, the role of topical corticosteroids is limited to case reports. This review assesses the literature regarding topical steroids and their role in ocular diseases. There is evidence of harm to vision when potent topical corticosteroids are inappropriately used for prolonged periods to periorbital sites. There is no evidence to date that weak TCS to the face or potent TCS to areas other than the eyes results in ocular complications. Further research trials are required in this area.     

Oral PUVA and topical steroids for treatment of oral manifestations of chronic graft-vs.-host disease

BACKGROUND: Oral manifestations of chronic graft-vs.-host disease (cGVHD) can significantly affect the quality of life and severity often does not correlate with systemic manifestations. We evaluated the use of topical corticosteroids and the intraoral application of psoralen-UVA (PUVA) for treatment of oral manifestations of cGVHD. METHODS: Overall, 18 patients with oral manifestations of cGVHD were treated with either intraoral PUVA (n=7) or with topical corticosteroids (n=16). Four patients received intraoral PUVA after failure of topical steroids and one patient was treated with topical corticosteroids after failing treatment with intraoral PUVA. A glass fiber extension of an UVA source was used for manual intraoral application. Treatment with topical corticosteroids consisted of 0.1 mg/ml dexamethasone mouth wash four times a day in combination with antifungal prophylaxis. RESULTS: Four patients showed complete local response (CR) due to intraoral PUVA, two improved and one did not respond. Topical corticosteroids resulted in nine patients in CR, two improved and five did not respond. CONCLUSION: Intraoral PUVA as well as topical corticosteroids are effective in treatment of oral manifestations of oral GVHD with few side-effects and improve quality of life in patients with cGVHD.     

Topical Steroid-Damaged Skin

Topical steroids, commonly used for a wide range of skin disorders, are associated with side effects both systemic and cutaneous. This article aims at bringing awareness among practitioners, about the cutaneous side effects of easily available, over the counter, topical steroids. This makes it important for us as dermatologists to weigh the usefulness of topical steroids versus their side effects, and to make an informed decision regarding their use in each individual based on other factors such as age, site involved and type of skin disorder.     

The effects of topical and systemic glucocorticosteroids on DNA synthesis in different tissues of the hairless mouse

Two topical corticosteroids, clobetasol propionate and clobetasone butyrate, have been studied in hairless mice for their effects on DNA synthesis in the epidermis, thymus and spleen. Following topical application, both clobetasol propionate and clobetasone butyrate showed significant activity at the site of application throughout the range of concentrations tested (20 μl; 0.0001–0.1%; 20 ng to 20 μg). However, whereas 20 ng clobetasol propionate also elicited significant effects in the distal (untreated) epidermis and the thymus, more than 2 μg of clobetasone butyrate were required to produce similar effects in these tissues. This finding was supported by the results obtained following intravenous administration of equivalent doses (0.01 and 0.001%; 200 μ1 dose) of the same two steroids. Only clobetasol propionate showed significant activity in the epidermis and thymus. Clobetasone butyrate showed slight, non-significant effects in the epidermis at the highest concentration (200 μl; 0.01%), but not in the thymus or spleen. An unexpected finding was that the effects following intravenous injection were generally lower than those following topical application. In conclusion, these results establish that (a) effects on DNA synthesis in the epidermis at a site distal to the application site are indicative of systemic activity from topically applied corticosteroids, (b) the thymus is especially sensitive to corticosteroids eliciting systemic effects and (c) an equivalent dose of a topical corticosteroid administered intravenously produces less inhibition of thymic and epidermal DNA synthesis than the same dose applied topically.