Santee Jennifer A
School of Pharmacy, Division of Pharmacy Practice, University of Missouri-Kansas City, 2411 Holmes, Kansas City, MO 64108, USA.
Am J Clin Dermatol. 2002;3(8):517-24. doi: 10.2165/00128071-200203080-00001.
For some patients, herpes zoster infections not only result in acute pain but serious consequences, including postherpetic neuralgia and damage to ocular tissues. Some authors have recommended corticosteroids for the treatment of these acute symptoms and complications. The literature concerning the use of corticosteroids for herpes zoster, however, either provides conflicting results or includes recommendations based on clinical experience rather than clinical trials. The author performed a search of the literature to address the question of whether corticosteroids are well tolerated and effective for the treatment/prevention of the acute pain of herpes zoster, postherpetic neuralgia, and/or the ocular complications resulting from herpes zoster. While smaller trials found oral corticosteroids beneficial for preventing postherpetic neuralgia, larger, better designed trials have not found oral corticosteroids to be more efficacious than placebo in preventing postherpetic neuralgia. Trials investigating the effect of oral corticosteroids for the acute pain of herpes zoster have found that corticosteroids provide a statistically significant improvement. Whether these improvements are clinically significant is uncertain. Thus, oral corticosteroids may confer a slight benefit for initial symptoms as long as the patient is not at risk for complications resulting from corticosteroid therapy. Most trials of topical and injectable corticosteroids are limited by several shortcomings. Therefore, topical and most forms of parenteral corticosteroids have yet to be proven effective for the treatment of acute pain or prevention of complications. Two controlled, blinded trials investigating the use of intrathecal corticosteroid administration for intractable postherpetic neuralgia suggest that corticosteroid administration results in a significant improvement in pain. Despite this, several authors have voiced concern over possible serious adverse events with the intrathecal administration of corticosteroids. Intrathecal corticosteroids may provide a benefit for intractable postherpetic neuralgia, but because of risks of serious complications, this is a last-line option and should only be administered by experienced personnel.
对于一些患者来说，带状疱疹感染不仅会导致急性疼痛，还会引发严重后果，包括带状疱疹后神经痛和眼部组织损伤。一些作者推荐使用皮质类固醇来治疗这些急性症状和并发症。然而，关于皮质类固醇用于带状疱疹治疗的文献，要么结果相互矛盾，要么包含基于临床经验而非临床试验的建议。作者对文献进行了检索，以探讨皮质类固醇对于治疗/预防带状疱疹急性疼痛、带状疱疹后神经痛和/或带状疱疹引起的眼部并发症是否耐受性良好且有效。虽然较小规模的试验发现口服皮质类固醇对预防带状疱疹后神经痛有益，但规模更大、设计更优的试验并未发现口服皮质类固醇在预防带状疱疹后神经痛方面比安慰剂更有效。研究口服皮质类固醇对带状疱疹急性疼痛影响的试验发现，皮质类固醇能在统计学上带来显著改善。但这些改善在临床上是否显著尚不确定。因此，只要患者没有因皮质类固醇治疗而出现并发症的风险，口服皮质类固醇可能对初始症状有轻微益处。大多数局部和注射用皮质类固醇的试验存在若干缺陷。因此，局部和大多数形式的胃肠外皮质类固醇尚未被证明对治疗急性疼痛或预防并发症有效。两项关于鞘内注射皮质类固醇治疗顽固性带状疱疹后神经痛的对照、双盲试验表明，注射皮质类固醇可使疼痛显著改善。尽管如此，几位作者对鞘内注射皮质类固醇可能出现的严重不良事件表示担忧。鞘内注射皮质类固醇可能对顽固性带状疱疹后神经痛有益，但由于存在严重并发症的风险，这是一种最后手段的选择，且应由经验丰富的人员进行操作。
