Yosipovitch Gil, Tang Mark B Y
Department of Dermatology, Wake Forest Medical Center, Winston Salem, North Carolina 27157, USA.
Drugs Aging. 2002;19(11):847-63. doi: 10.2165/00002512-200219110-00003.
Psoriasis in the elderly will constitute a significant challenge for the practising physician in this new millennium. Special considerations for the elderly include drug-induced or drug-aggravated psoriasis, especially for patients receiving polypharmacy or with recent worsening or poor response to conventional therapy. Other frequently encountered forms of psoriasis in the elderly include psoriatic arthritis and its complications, inverse psoriasis and potentially life-threatening complications such as erythrodermic or acute pustular psoriasis, where early recognition and systemic therapy is critical. Faced with an array of topical and systemic drug therapy options, it is of paramount importance that the physician remains focused on the holistic management of the patient, in order to achieve optimal compliance and benefit. This can be achieved through careful attention to quality-of-life issues, especially since many elderly patients may have other medical, social and economic comorbidities that can further negatively affect their overall quality of life. It is also essential that the severity of psoriasis be assessed on a more balanced, holistic scale that incorporates both physical and psychological parameters, such as the Salford Psoriasis Index. The patient and caregiver education should be multi-faceted, regularly conducted and practically orientated. Treatment goals should be kept simple and individualised for each patient, based on concomitant comorbidities, potential adverse effects, existing quality of life, self-care capability, drug history, caregiver situation, financial needs, feasibility for follow-up and patient's preferences. Topically applied medications, such as topical corticosteroids, salicylic acid, tar and dithranol preparations, calcipotriol and tazarotene, are the favoured first-line therapeutic options in the elderly. Narrowband ultraviolet B phototherapy is also well established as a standard therapy for psoriasis. Systemic therapy with agents such as methotrexate, acitretin and cyclosporin should be judiciously reserved for severe, extensive cases in view of their lower therapeutic index in the elderly. The ambulatory psoriasis treatment centre is an integral part of the overall cost-effective management of patients with psoriasis that can function as a 'one-stop' treatment and resource centre for the elderly patient.
在新千年里，老年银屑病患者将给执业医师带来重大挑战。对老年人的特殊考量包括药物诱发或药物加重的银屑病，尤其对于接受多种药物治疗或近期病情恶化或对传统治疗反应不佳的患者。老年人中其他常见的银屑病形式包括银屑病关节炎及其并发症、反向银屑病以及潜在危及生命的并发症，如红皮病型或急性脓疱型银屑病，早期识别和系统治疗至关重要。面对一系列局部和全身药物治疗选择，医生始终专注于患者的整体管理以实现最佳依从性和疗效至关重要。这可以通过仔细关注生活质量问题来实现，特别是因为许多老年患者可能有其他医疗、社会和经济合并症，这些合并症会进一步对他们的整体生活质量产生负面影响。同样重要的是，应采用更平衡、全面的量表评估银屑病的严重程度，该量表应纳入身体和心理参数，如索尔福德银屑病指数。患者和护理人员教育应是多方面的、定期进行的且注重实践。治疗目标应基于合并症、潜在不良反应、现有生活质量、自我护理能力、用药史、护理人员情况、经济需求、随访可行性和患者偏好，为每位患者保持简单且个性化。局部应用的药物，如外用糖皮质激素、水杨酸、焦油和蒽林制剂、卡泊三醇和他扎罗汀，是老年患者首选的一线治疗选择。窄谱中波紫外线光疗也已成为银屑病的标准治疗方法。鉴于甲氨蝶呤、阿维A和环孢素等药物在老年人中的治疗指数较低，应谨慎地将其全身治疗保留用于严重、广泛的病例。门诊银屑病治疗中心是银屑病患者整体成本效益管理不可或缺的一部分，它可以作为老年患者的“一站式”治疗和资源中心。
