Nguyen Tam, Zuniga Ramiro
San Joaquin General Hospital, French Camp, CA 95231,USA.
FP Essent. 2013 Apr;407:11-6.
New drugs are available for managing several common skin disorders. For psoriasis, topical corticosteroids remain the first-line therapy, but topical vitamin D3 analogs, such as calcipotriene, now have a role. They are as effective as medium-potency topical steroids but without steroid side effects, though they can induce hypercalcemia if the dose exceeds 100 g/week. For more severe cases, methotrexate has been widely used, but other drugs now also are prescribed. They include calcineurin inhibitors, such as cyclosporine, and more recently, biologic agents, such as tumor necrosis factor inhibitors. For children and pregnant women, in whom the previously discussed drugs are not appropriate, narrowband UV-B light often is the first-line treatment. For eczema, patients requiring steroid-sparing topical drugs can be treated with calcineurin inhibitors (ie, pimecrolimus or tacrolimus); between the 2, tacrolimus is the first choice for adults and children older than 2 years. When systemic management is needed, oral calcineurin inhibitors (eg, cyclosporine) are appropriate, though oral steroids often are needed for severe cases. The need for systemic management can sometimes be delayed with use of diluted bleach baths. For acne vulgaris, standard treatments with topical benzoyl peroxide and topical or systemic antibiotics are used widely, as are oral contraceptives, but oral isotretinoin is the most effective treatment.
有多种新药可用于治疗几种常见的皮肤病。对于银屑病，外用糖皮质激素仍是一线治疗药物，但外用维生素D3类似物，如卡泊三醇，现在也发挥着作用。它们的疗效与中效外用类固醇相当，但无类固醇副作用，不过如果剂量超过100μg/周，可能会诱发高钙血症。对于更严重的病例，甲氨蝶呤已被广泛使用，但现在也会开其他药物。这些药物包括钙调神经磷酸酶抑制剂，如环孢素，以及最近的生物制剂，如肿瘤坏死因子抑制剂。对于儿童和孕妇，上述药物不合适，窄谱UV - B光通常是一线治疗方法。对于湿疹，需要使用不含类固醇外用药物的患者可用钙调神经磷酸酶抑制剂（即吡美莫司或他克莫司）治疗；两者相比，他克莫司是成人和2岁以上儿童的首选。当需要全身治疗时，口服钙调神经磷酸酶抑制剂（如环孢素）是合适的，不过严重病例通常需要口服类固醇。有时使用稀释的漂白浴可推迟全身治疗的需求。对于寻常痤疮，外用过氧化苯甲酰以及外用或口服抗生素的标准治疗方法被广泛使用，口服避孕药也常用，但口服异维A酸是最有效的治疗方法。
