Weinberg Jeffrey M, Scheinfeld Noah S
Department of Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA.
Dermatol Ther. 2003;16(3):195-205. doi: 10.1046/j.1529-8019.2003.01629.x.
Over the past several years there have been many advances in the diagnosis and treatment of cutaneous infectious diseases. This review focuses on the three major topics of interest in the geriatric population: herpes zoster and postherpetic neuralgia (PHN), onychomycosis, and recent advances in antibacterial therapy. Herpes zoster in adults is caused by reactivation of the varicella-zoster virus (VZV) that causes chickenpox in children. For many years acyclovir was the gold standard of antiviral therapy for the treatment of patients with herpes zoster. Famciclovir and valacyclovir, newer antivirals for herpes zoster, offer less frequent dosing. PHN refers to pain lasting > or = 2 months after an acute attack of herpes zoster. The pain may be constant or intermittent and may occur spontaneously or be caused by seemingly innocuous stimuli such as a light touch. Treatment of established PHN through pharmacologic and nonpharmacologic therapy will be discussed. In addition, therapeutic strategies to prevent PHN will be reviewed. These include the use of oral corticosteroids, nerve blocks, and treatment with standard antiviral therapy. Onychomycosis, or tinea unguium, is caused by dermatophytes in the majority of cases, but can also be caused by Candida and nondermatophyte molds. Onychomycosis is found more frequently in the elderly and in more males than females. There are four types of onychomycosis: distal subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis, and candidal onychomycosis. Over the past several years, new treatments for this disorder have emerged which offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant pneumococci. While vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw an increase in vancomycin-resistant bacteria, including vancomycin-resistant enterococci (VRE). More recently, strains of vancomycin-intermediate resistant S. aureus (VISA) have been isolated. Gram-positive bacteria, such as S. aureus and Streptococcus pyogenes are often the cause of skin and skin structure infections, ranging from mild pyodermas to complicated infections including postsurgical wound infections, severe carbunculosis, and erysipelas. With limited treatment options, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin/dalfopristin.
在过去几年中，皮肤传染病的诊断和治疗取得了许多进展。本综述重点关注老年人群中三个主要感兴趣的主题：带状疱疹及带状疱疹后神经痛（PHN）、甲癣，以及抗菌治疗的最新进展。成人带状疱疹是由水痘-带状疱疹病毒（VZV）重新激活引起的，该病毒会导致儿童患水痘。多年来，阿昔洛韦一直是治疗带状疱疹患者抗病毒治疗的金标准。泛昔洛韦和伐昔洛韦是治疗带状疱疹的新型抗病毒药物，给药频率较低。PHN是指带状疱疹急性发作后持续≥2个月的疼痛。疼痛可能是持续性或间歇性的，可自发出现或由看似无害的刺激（如轻触）引起。将讨论通过药物和非药物疗法对已确诊的PHN进行治疗。此外，还将综述预防PHN的治疗策略。这些策略包括使用口服糖皮质激素、神经阻滞以及采用标准抗病毒疗法进行治疗。甲癣，即灰指甲，在大多数情况下由皮肤癣菌引起，但也可由念珠菌和非皮肤癣菌霉菌引起。甲癣在老年人中更为常见，男性多于女性。甲癣有四种类型：远端甲下型甲癣、近端甲下型甲癣、白色浅表型甲癣和念珠菌性甲癣。在过去几年中，针对这种疾病出现了新的治疗方法，这些方法比以前的疗法疗程更短、疗效更佳。老年人细菌性皮肤和皮肤结构感染的治疗是一个重要问题。革兰氏阳性菌感染的发生率惊人地增加，包括耐甲氧西林金黄色葡萄球菌（MRSA）和耐药肺炎球菌等耐药菌。虽然万古霉素一直被视为对抗革兰氏阳性多药耐药菌的最后一道防线，但在20世纪80年代后期，耐万古霉素细菌有所增加，包括耐万古霉素肠球菌（VRE）。最近，还分离出了万古霉素中度耐药金黄色葡萄球菌（VISA）菌株。革兰氏阳性菌，如金黄色葡萄球菌和化脓性链球菌，常常是皮肤和皮肤结构感染的病因，范围从轻度脓疱病到复杂感染，包括术后伤口感染、严重痈肿和丹毒。由于治疗选择有限，确定具有新作用机制的抗生素变得至关重要。已经出现了几种可能的治疗替代药物，包括利奈唑胺和奎奴普丁/达福普汀。
