Rebora A
Department of Endocrinological and Medical Science, Section of Dermatology, University of Genoa, Italy.
Reumatismo. 2007;59 Suppl 1:77-80. doi: 10.4081/reumatismo.2007.1s.77.
Conventional treatments of psoriasis include topical and systemic drugs. For sake of brevity, the presentation will deal only with systemic therapy. Three drugs are presently available in Italy: methotrexate, acitretin and cyclosporin A. Their efficacy is almost identical, all of them achieving PASI 75 in about 60% of cases in 12 weeks The indications (which, in Italy, do not include psoriasis for methotrexate), the contraindications, the interactions, the adverse effects and the precautions in their use will be discussed. Methotrexate side effects account for more than 10% of cases and include nausea and vomiting and chiefly increase of blood levels of liver enzymes. Acitretin side effects are numerous and varied, the most severe being increase of liver enzymes and blood lipids, renal impairment, and teratogenicity. Cyclosporin side effects are chiefly hypertension and renal failure. The Author concludes that cyclosporin is the drug with the best efficacy/side effect ratio, though it should be used in selected cases.
银屑病的传统治疗方法包括局部用药和全身用药。为简洁起见，本文仅讨论全身治疗。目前在意大利有三种药物可用：甲氨蝶呤、阿维A和环孢素A。它们的疗效几乎相同，在12周内约60%的病例中，所有药物都能使银屑病面积和严重程度指数（PASI）改善75%。将讨论它们的适应症（在意大利，甲氨蝶呤的适应症不包括银屑病）、禁忌症、相互作用、不良反应以及使用时的注意事项。甲氨蝶呤的副作用占病例的10%以上，包括恶心和呕吐，主要是肝酶水平升高。阿维A的副作用众多且多样，最严重的是肝酶和血脂升高、肾功能损害以及致畸性。环孢素的副作用主要是高血压和肾衰竭。作者得出结论，环孢素是疗效/副作用比最佳的药物，尽管应在特定病例中使用。
