Niculet Elena, Bobeica Carmen, Tatu Alin L
Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunarea de Jos" University, Galati, Romania.
Department of Dermato-Venereology, Doctoral School, University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania.
Clin Cosmet Investig Dermatol. 2020 Dec 30;13:1041-1050. doi: 10.2147/CCID.S224211. eCollection 2020.
Glucocorticoids are major therapeutic agents highly used in the medical field. Topical glucocorticoids have biologic activities which make them useful in dermatology - anti-inflammatory, vasoconstrictive, immune suppressive and antiproliferative, in treating inflammatory skin disorders (allergic contact eczema, atopic hand eczema, nummular eczema, psoriasis vulgaris or toxic-irritative eczema). Unfortunately, the beneficial effects of topical glucocorticoids are shadowed by their potential for adverse effects - muscle or skin atrophy, striae distensae, rubeosis or acne. Skin atrophy is one of the most prevalent side-effects, with changes found in all skin compartments - marked hypoplasia, elasticity loss with tearing, increased fragility, telangiectasia, bruising, cutaneous transparency, or a dysfunctional skin barrier. The structure and function of the epidermis is altered even in the short-term topical glucocorticoid treatment; it affects stratum corneum components, subsequently affecting skin barrier integrity. The dermis is altered by directly inhibiting fibroblast proliferation, reducing mast cell numbers, and loss of support; there is depletion of mucopolysaccharides, elastin fibers, matrix metalloproteases and inhibition of collagen synthesis. Atrophogenic changes can be found also in hair follicles, sebaceous glands or dermal adipose tissue. Attention should be paid to topical glucocorticoid treatment prescription, to the beneficial/adverse effects ratio of the chosen agent, and studies should be oriented on the development of newer, innovative targeted (gene or receptor) therapies.
糖皮质激素是医学领域广泛使用的主要治疗药物。外用糖皮质激素具有生物活性，使其在皮肤科具有实用性——具有抗炎、血管收缩、免疫抑制和抗增殖作用，可用于治疗炎症性皮肤病（过敏性接触性湿疹、特应性手部湿疹、钱币状湿疹、寻常型银屑病或毒性刺激性湿疹）。不幸的是，外用糖皮质激素的有益作用被其潜在的不良反应所掩盖——肌肉或皮肤萎缩、膨胀纹、皮肤发红或痤疮。皮肤萎缩是最常见的副作用之一，在所有皮肤层均有变化——明显发育不全、弹性丧失伴撕裂、脆性增加、毛细血管扩张、瘀斑、皮肤透明度增加或皮肤屏障功能障碍。即使在短期外用糖皮质激素治疗中，表皮的结构和功能也会发生改变；它会影响角质层成分，进而影响皮肤屏障的完整性。真皮会因直接抑制成纤维细胞增殖、减少肥大细胞数量和失去支撑而发生改变；粘多糖、弹性纤维、基质金属蛋白酶会减少，胶原蛋白合成也会受到抑制。毛囊、皮脂腺或真皮脂肪组织也会出现萎缩性变化。应注意外用糖皮质激素治疗的处方，关注所选药物的利弊比，并且研究应致力于开发更新的、创新的靶向（基因或受体）疗法。
