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老年人皮肤疾病的口服皮质类固醇治疗:尽量减少潜在的不良反应。

Oral Corticosteroids for Skin Disease in the Older Population: Minimizing Potential Adverse Effects.

机构信息

University of Arizona, College of Medicine - Phoenix, 475 N 5th St, Phoenix, AZ, 85004, USA.

University of Arizona, College of Medicine - Tucson, Tucson, AZ, USA.

出版信息

Drugs Aging. 2024 Oct;41(10):795-808. doi: 10.1007/s40266-024-01143-8. Epub 2024 Sep 16.

Abstract

Corticosteroids play a crucial role as anti-inflammatory and immunomodulatory agents in dermatology and other medical specialties; however, their therapeutic benefits are accompanied by significant risks, especially in older adults. This review examines the broad spectrum of adverse effects (AEs) associated with oral corticosteroid therapy and offers strategies to prevent, monitor, and manage these issues effectively in older adults. AEs associated with systemic corticosteroids include immune suppression, gastrointestinal problems, hyperglycemia, insulin resistance, weight gain, cardiovascular complications, ocular issues, osteoporosis, osteonecrosis, muscle weakness, collagen impairment, psychiatric symptoms, and adrenal suppression. To minimize these AEs, tailored dosing and duration, frequent monitoring, and additional preventative measures can be employed to optimize corticosteroid treatment. By customizing management plans to the specific needs and risk factors associated with each patient, clinicians can promote the safe and effective use of oral corticosteroids, ultimately improving outcomes and quality of life in patients with inflammatory dermatologic disorders.

摘要

皮质类固醇在皮肤科和其他医学专业中作为抗炎和免疫调节剂发挥着关键作用;然而,它们的治疗益处伴随着重大风险,尤其是在老年人中。本综述探讨了与口服皮质类固醇治疗相关的广泛不良反应(AE),并提供了在老年人中有效预防、监测和管理这些问题的策略。与全身皮质类固醇相关的 AE 包括免疫抑制、胃肠道问题、高血糖、胰岛素抵抗、体重增加、心血管并发症、眼部问题、骨质疏松症、骨坏死、肌肉无力、胶原蛋白损伤、精神症状和肾上腺抑制。为了最大限度地减少这些 AE,可以采用量身定制的剂量和疗程、频繁监测和额外的预防措施来优化皮质类固醇治疗。通过根据每位患者的具体需求和相关风险因素定制管理计划,临床医生可以促进口服皮质类固醇的安全有效使用,最终改善炎症性皮肤病患者的结局和生活质量。

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