Miller J A, Munro D D
Drugs. 1980 Feb;19(2):119-34. doi: 10.2165/00003495-198019020-00004.
The development of topical corticosteroids has enabled many dermatoses to be more effectively treated than previously, but there is also no doubt that misuse of these preparations can lead to troublesome local effects and potentially serious systemic problems. The most effective assay for comparing different compounds has been their vasoconstrictive activity, and this on the whole correlates well with clinical effect. To be effective, corticosteroid must be absorbed and the importance of concentration, occlusion, the type of vehicle, added penetrants such as urea and the anatomical site, on the amount of absorption and therefore on clinical activity has been demonstrated. Ointments have been shown to be more effective than creams but because of the considerable choice of potencies now available most dermatologists tend to prescribe the different formulations according to the wishes of the patient. For the same reason, dilution of the commercially marketed preparations is now not generally recommended. The main therapeutic activity of topical corticosteroids is their nonspecific anti-inflammatory effect, thought to be primarily a result of their action on the chemical mediators of inflammation. They have also been shown to be antimitotic which may well be relevant not only to the treatment of scaling dermatoses but also to their dermal thinning effect resulting from inhibition of fibroblasts. Combinations of corticosteroids with antibacterial and antifungal agents have been shown to be very effective in flexural eruptions and secondarily infected dermatoses. As a general rule, the use of topical corticosteroids in outpatients, unless badly misused, is not associated with any significant risk of adrenal axis suppression, but care must be exercised as to the amount prescribed, especially if large areas of the body are to be treated with highly potent preparations. Certain groups such as young children and patients with liver failure, and certain anatomical sites such as the flexures and face appear much more prone to side effects, and in these cases mild or moderate compounds should be used in preference to the stronger preparations.
局部用皮质类固醇的发展使许多皮肤病比以前得到更有效的治疗，但毫无疑问，这些制剂的滥用会导致令人烦恼的局部效应以及潜在的严重全身问题。比较不同化合物最有效的测定方法是它们的血管收缩活性，总体而言，这与临床效果密切相关。为了发挥作用，皮质类固醇必须被吸收，并且已经证明浓度、封包、载体类型、添加的渗透剂如尿素以及解剖部位对吸收量进而对临床活性的重要性。软膏已被证明比乳膏更有效，但由于现在有相当多的效价可供选择，大多数皮肤科医生倾向于根据患者的意愿开不同的制剂。出于同样的原因，现在一般不建议稀释市售制剂。局部用皮质类固醇的主要治疗活性是其非特异性抗炎作用，据认为这主要是它们对炎症化学介质作用的结果。它们还被证明具有抗有丝分裂作用，这不仅可能与鳞屑性皮肤病的治疗有关，而且可能与抑制成纤维细胞导致的皮肤变薄效应有关。皮质类固醇与抗菌和抗真菌剂的组合已被证明在屈侧皮疹和继发感染的皮肤病中非常有效。一般来说，门诊患者使用局部用皮质类固醇，除非严重滥用，不会有肾上腺轴抑制的任何重大风险，但必须注意所开的剂量，特别是如果要用高效制剂治疗身体大面积部位时。某些群体如幼儿和肝功能衰竭患者，以及某些解剖部位如屈侧和面部似乎更容易出现副作用，在这些情况下，应优先使用轻度或中度的化合物而不是更强效的制剂。
