Armstrong April W, Bukhalo Michael, Blauvelt Andrew
Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Keith Administration Building, Room 510, Los Angeles, CA, 90089, USA.
Altman Dermatology Associates, Arlington Heights, IL, USA.
Am J Clin Dermatol. 2016 Aug;17(4):329-36. doi: 10.1007/s40257-016-0206-4.
Many of the molecular pathways associated with psoriasis pathogenesis are also involved in host defense mechanisms that protect against common pathogens. Candida can stimulate the production of cytokines that trigger or exacerbate psoriasis, and many systemic psoriasis treatments may put patients at increased risk for developing oral, cutaneous, and genitourinary candidiasis. Therefore, dermatologists should regularly screen patients with psoriasis for signs of Candida infection, and take steps to effectively treat these infections to prevent worsening of psoriasis symptoms. This review provides an overview of candidiasis epidemiology in patients with psoriasis, followed by a primer on the diagnosis and treatment of superficial Candida infections, with specific guidance for patients with psoriasis. Candidiasis in patients with psoriasis typically responds to topical or oral antifungal therapy. While biologic agents used to treat moderate-to-severe psoriasis, such as tumor necrosis factor-α inhibitors and interleukin-17 inhibitors, are known to increase patients' risk of developing localized candidiasis, the overall risk of infection is low, and candidiasis can be effectively managed in most patients while receiving systemic psoriasis therapies. Thus, the development of candidiasis does not usually necessitate changes to psoriasis treatment regimens.
许多与银屑病发病机制相关的分子途径也参与了抵御常见病原体的宿主防御机制。念珠菌可刺激细胞因子的产生,从而引发或加重银屑病,许多系统性银屑病治疗可能会使患者发生口腔、皮肤和泌尿生殖系统念珠菌病的风险增加。因此,皮肤科医生应定期对银屑病患者进行念珠菌感染迹象的筛查,并采取措施有效治疗这些感染,以防止银屑病症状恶化。本综述概述了银屑病患者念珠菌病的流行病学,随后介绍了浅表念珠菌感染的诊断和治疗入门知识,并针对银屑病患者提供了具体指导。银屑病患者的念珠菌病通常对局部或口服抗真菌治疗有反应。虽然用于治疗中度至重度银屑病的生物制剂,如肿瘤坏死因子-α抑制剂和白细胞介素-17抑制剂,已知会增加患者发生局部念珠菌病的风险,但总体感染风险较低,并且在大多数接受系统性银屑病治疗的患者中,念珠菌病可以得到有效控制。因此,念珠菌病的发生通常不需要改变银屑病的治疗方案。