Guillot B
Département de dermatologie, CHU de Montpellier, 80, rue Augustin-Fliche, 34295 Montpellier cedex 5, France.
Rev Med Interne. 2013 May;34(5):310-4. doi: 10.1016/j.revmed.2012.12.004. Epub 2013 Jan 9.
Glucocorticoids are largely used in therapy for many diseases with a noteworthy efficacy. However, the use of glucocorticoids by a systemic or local way (topical or inhaled) is associated with numerous cutaneous side effects. Long duration of treatment and high dosage are associated with more severe side effects. Complications are related to the pharmacological properties of the molecules, especially metabolic and immunosuppressive. Metabolic side effects are mainly skin atrophy: the skin is thin, with easy bleeding and superficial erosions. Other metabolic complications are striae, acne of papulo-pustular type, hypertrichosis, and delayed wound healing. Immunosuppressive side effects are mainly infections: mycoses (dermatophytosis), parasites (Norwegian scabies), bacterial or viral (especially with herpes virus) infections. Glucocorticoids promote opportunistic infections of the skin. Allergy to glucocorticoids is frequent but its diagnosis is uneasy. Clinical aspect is an eczematous eruption related to delayed hypersensitivity and etiological diagnosis is obtained by epicutaneous tests. A better knowledge of glucocorticoid-induced cutaneous side effects can allow to propose preventive measures and especially educational program for patients receiving long-term glucocorticoids for chronic diseases.
糖皮质激素在许多疾病的治疗中广泛应用，疗效显著。然而，全身或局部（外用或吸入）使用糖皮质激素会引发众多皮肤副作用。治疗时间长和剂量大会导致更严重的副作用。并发症与这些分子的药理特性有关，尤其是代谢和免疫抑制特性。代谢性副作用主要是皮肤萎缩：皮肤变薄，易出血且有浅表糜烂。其他代谢并发症有萎缩纹、丘疹脓疱型痤疮、多毛症以及伤口愈合延迟。免疫抑制性副作用主要是感染：真菌感染（皮肤癣菌病）、寄生虫感染（挪威疥疮）、细菌或病毒感染（尤其是疱疹病毒感染）。糖皮质激素会引发皮肤的机会性感染。对糖皮质激素过敏很常见，但诊断并不容易。临床表现为与迟发型超敏反应相关的湿疹样皮疹，通过皮肤试验可进行病因诊断。更好地了解糖皮质激素引起的皮肤副作用有助于提出预防措施，特别是为因慢性病长期接受糖皮质激素治疗的患者制定教育计划。
