Renfro L, Snow J S
New York University, New York.
Dermatol Clin. 1992 Jul;10(3):505-12.
Topical and systemic steroids have proven to be invaluable agents in the treatment of a wide range of disorders, but their use is not without potential complications. Before initiation of therapy with systemic steroids, a personal or family history of cataracts, glaucoma, hypertension, diabetes, hyperlipidemia, renal stones, peptic ulceration, and current infection or pregnancy should be ascertained, because these patients have an increased risk of complications. Prior to long-term therapy with systemic steroids, blood pressure measurement, tuberculin skin test, and anergy panel are recommended. Monthly follow-up may include measurements of weight, blood pressure, electrolytes, and blood sugar and guaiac testing of the stool. To prevent the ocular complications of steroid therapy, routine screening is indicated (Table 1). Screening for cataracts, which occur most commonly as a sequela of continuous systemic steroid use, may be performed by slit-lamp examinations conducted three or four times a year for patients on long-term therapy and twice a year for patients taking intermittent topical ocular or systemic steroids. Glaucoma is more often associated with topical ocular or periocular steroids than with systemic steroids; recommended screening includes a baseline intraocular pressure measurement, then routine pressure measurements taken every few weeks initially, then every few months. Ocular rebound inflammation may develop secondary to rapid tapering or abrupt discontinuation of topical ocular steroid use and is best prevented with gradual tapering. Opportunistic infections of the eye include bacterial, viral, and fungal infections and are most often associated with the use of topical ocular steroids. Ophthalmologic evaluation is indicated promptly if patients treated with ocular steroids develop ocular discharge, pain, photophobia, or redness.
局部和全身用类固醇已被证明是治疗多种疾病的宝贵药物，但其使用并非没有潜在并发症。在开始全身用类固醇治疗前，应确定患者个人或家族是否有白内障、青光眼、高血压、糖尿病、高脂血症、肾结石、消化性溃疡病史，以及目前是否有感染或妊娠情况，因为这些患者发生并发症的风险增加。在开始长期全身用类固醇治疗前，建议测量血压、进行结核菌素皮肤试验和进行无反应性检测。每月随访可能包括测量体重、血压、电解质和血糖以及粪便潜血试验。为预防类固醇治疗的眼部并发症，需进行常规筛查（表1）。白内障筛查最为常见，它通常是持续全身用类固醇的后遗症，对于长期治疗的患者，可每年进行三到四次裂隙灯检查，对于使用间歇性局部眼部或全身用类固醇的患者，每年进行两次裂隙灯检查。青光眼更多与局部眼部或眼周类固醇使用有关，而非全身用类固醇；推荐的筛查包括基线眼压测量，最初每隔几周进行常规眼压测量，之后每隔几个月进行一次。眼部类固醇快速减量或突然停药可能继发眼部反弹性炎症，通过逐渐减量可最佳地预防这种情况。眼部机会性感染包括细菌、病毒和真菌感染，最常与局部眼部类固醇的使用相关。如果接受眼部类固醇治疗的患者出现眼部分泌物、疼痛、畏光或发红，应立即进行眼科评估。
