银屑病患者长期外用糖皮质激素导致肾上腺抑制

Adrenal Suppression With Chronic Topical Corticosteroid Use in Psoriasis Patients.

作者信息

Lam Lisa H, Sugarman Jeffrey L

出版信息

J Drugs Dermatol. 2016 Aug 1;15(8):945-8.

Abstract

BACKGROUND

Topical corticosteroids (TCS) are typically used for extended periods of time for chronic skin conditions, including psoriasis. Chronic TCS use may result in side effects similar to those of systemic corticosteroids. Patients may have subclinical adrenal suppression and be unaware of their risk in the case of serious trauma.

OBJECTIVE

The objective of this study was to investigate the real world effects of chronic TCS use and its effects on adrenal suppression in a chronic disease such as psoriasis.

MATERIALS

This retrospective study utilized data from screening visits of a psoriasis clinical trial in which subjects had been on chronic TCS.

RESULTS

In this study, subjects with moderate to severe psoriasis affecting 16-20% of total body surface area (BSA) and using high-potency TCS at screening had a lower post-cosyntropin cortisol level (18.83 mcg/dL) compared to those with moderate psoriasis involving 10-15% of total BSA and using lower potency TCS at screening (23.22 mcg/dL; P=0.03). Both subject groups had lower post-cosyntropin cortisol levels compared to normal, healthy adults (P<0.001 for both).

CONCLUSION

This suggests that real world chronic use of high potency TCS over a larger BSA may result in silent adrenal suppression.

J Drugs Dermatol. 2016;15(8):945-948.

摘要

背景

外用糖皮质激素（TCS）通常长期用于治疗慢性皮肤病，包括银屑病。长期使用TCS可能会导致与系统性糖皮质激素类似的副作用。患者可能存在亚临床肾上腺抑制，在发生严重创伤时未意识到自身风险。

目的

本研究旨在调查长期使用TCS的实际影响及其对银屑病等慢性疾病肾上腺抑制的作用。

材料

本回顾性研究利用了一项银屑病临床试验筛查访视的数据，其中受试者长期使用TCS。

结果

在本研究中，中度至重度银屑病累及全身表面积（BSA）16 - 20%且在筛查时使用高效TCS的受试者，其促肾上腺皮质激素刺激试验后皮质醇水平（18.83 mcg/dL）低于中度银屑病累及总BSA 10 - 15%且在筛查时使用低效TCS的受试者（23.22 mcg/dL；P = 0.03）。与正常健康成年人相比，两组受试者的促肾上腺皮质激素刺激试验后皮质醇水平均较低（两组P均<0.001）。