Liu Melinda, Huang Yuan Yu M, Hsu Sylvia, Kass Joseph S
Baylor College of Medicine, Houston, TX, USA.
Department of Dermatology, Baylor College of Medicine, Houston, TX, USA.
CNS Drugs. 2016 Dec;30(12):1149-1168. doi: 10.1007/s40263-016-0392-x.
Severe, recalcitrant dermatologic conditions often require systemic treatment. Although efficacious, these medications have been associated with wide-ranging adverse reactions. Some are reversible, predictable, and either dose-dependent or treatment length-dependent, while others are unpredictable, irreversible, and potentially fatal. This review examines the neuropsychiatric adverse effects associated with US FDA-approved medications for treatment of the following dermatologic pathologies that typically require systemic therapy: autoimmune dermatoses, acne, psoriasis, and melanoma. A search of the literature was performed, with adverse effects ranging from mild headaches and neuropathy to severe encephalopathies. The medications associated with the most serious reactions were those used to treat psoriasis, especially the older non-biologic medications such as cyclosporine A and methotrexate. Given the importance of these systemic dermatologic therapies in treating severe, recalcitrant conditions, and the wide variety of potentially serious neuropsychiatric adverse effects of these medications, neurologists, psychiatrists, dermatologists, oncologists, and primary care providers must be aware of the potential for these neuropsychiatric adverse reactions to allow for appropriate counseling, management, and medication withdrawal.
严重的、难治性皮肤病往往需要全身治疗。尽管这些药物有效，但它们与广泛的不良反应相关。有些不良反应是可逆的、可预测的，且与剂量或治疗时长有关，而其他不良反应则是不可预测的、不可逆的，甚至可能是致命的。本综述探讨了美国食品药品监督管理局（US FDA）批准的用于治疗以下通常需要全身治疗的皮肤病的药物所相关的神经精神不良反应：自身免疫性皮肤病、痤疮、银屑病和黑色素瘤。我们对文献进行了检索，不良反应范围从轻度头痛和神经病变到严重脑病。与最严重反应相关联的药物是用于治疗银屑病的药物，尤其是较老的非生物制剂，如环孢素A和甲氨蝶呤。鉴于这些全身皮肤病治疗方法在治疗严重难治性疾病方面的重要性，以及这些药物具有的各种各样潜在严重神经精神不良反应，神经科医生、精神科医生、皮肤科医生、肿瘤学家和初级保健提供者必须意识到这些神经精神不良反应的可能性，以便进行适当的咨询、管理和停药处理。
