您能给我们介绍一下您在EADV会议上演讲的主题吗？
此次EADV大会，我围绕“老年人银屑病”做了一场报告。以前，我们看到过许多年龄超过70岁的患者。对于他们而言，是否还存在少量银屑病斑块已经不再那么重要了。但现在，我们从生活质量调查中得知：在老年患者中，银屑病确实会极大地影响他们的生活质量。
我的演讲内容还涉及到合并症，尤其是心血管疾病和代谢性疾病。在70岁以上的人群中，超过50%患有高血压，接近50%的人有血液学异常，诸如此类。因此，在我们的确需要排查老年患者的合并症，并对银屑病的治疗保持怀疑。我在演讲中提到，所有疗法都可以在老年患者中使用。实际上，所有的治疗方法都可以使用，但外用疗法和光疗对于老年患者来说，有时会有困难。外用疗法和光疗每天要重复操作的次数较多，这需要花费很多精力来进行论证。或者说让患者每周去治疗中心接受3次光疗，这个方案是可行的，但对患者有些要求。维A酸可能会引起低钾血症，这已属于银屑病的合并症。因此，可以在老年患者中使用上述疗法，但必须额外关注血脂。至于环孢素，我们应该意识到老年人的肾功能较差，而环孢素甚至有可能会进一步损害肾功能。所以我不太建议在老年患者中使用环孢素。可以给予甲氨蝶呤，但我们应该严密监测肾功能。也就是说，当患者的肾功能下降时，我们应该知道监测的必要性。甲氨蝶呤的血药浓度将会更高，被代谢掉的部分就更少。现在有了生物制剂，我们可以看到：在生物制剂治疗期间发生的感染可能略多。我也注意到了一些其他的不良反应，但这种情况很少发生，只是略多一些。当我们研究这些不良反应时，实际上只是因为这些人年龄较大，他们伴有更多的合并症和更多的疾病。总体而言，不能只说是药物引起了这些不良反应，老年患者伴有某些合并症的可能性更大。所以在银屑病患者的后续治疗中需要特别关注合并症，在使用生物制剂进行治疗时要意识到这是一个安全的方案。有几种生物制剂，包括抗TNF药物，可能会有一定的影响。事实上，当结核病流行或患者有感染倾向时我不会使用阿达木单抗。实际上，乌司奴单抗对老年患者的治疗十分有利。它和抗IL-17以及抗IL-23药物一样，安全性良好。因此，治疗老年银屑病患者也应抱以积极的态度。
Could you introduce to us the topic of your speech at the EADV Conference?
At this EADV congress, I have myself given a presentation on psoriasis in the elderly. And in earlier days, we saw many people are older than seventy years, it is not so important any more whether there a few psoriasis plaques. But we now know, also from quality of life investigations, that in older patients, psoriasis really can impact quality of life tremendously.
The other aspects in my presentation was the following. That is comorbidities, especially cardiovascular disease, metabolic disease. More than 50% of people older than 70 years have hypertension and nearly 50% of abnormal limits in their blood. And that is a lot. Therefore, in elderly patients, we have indeed to look for comorbidities, and then we suspect to the treatment of psoriasis. I have given in my talk in overview all treatments can be used in elderly. Well, actually, all treatments can be used, but with topicals and with photo therapy, sometimes it can be too much for elderly people to do the application. It can be too much every day, and it takes a lot of effort to put on the arguments, or three times a week to go to a treatment center for phototherapy There was it can be given, but it may ask something from the patient. Then treatment of retinoic acid may cause hyperlipidemia, and that is already a comorbidity and psoriasis. But therefore, you can give it, but you'll have to look extra serum lipids, Cyclosporin, We should be aware that elderly people have less functioning of the kidneys, and that cyclosporin may decrease even this function of the kidney. So I'm not so happy with cyclosporin in the elderly people. MethotrexateIt can be given, But it's need to tracks it, we should look carefully at kidney function. l mean, kidney function is somewhat less than we should know that actually need to tracks it. Does methotrexate blood levels will be higher, as me to track. It will be less eliminated. And now with biologics, actually, we see that maybe there are slightly more infections during biologics. I've also noticed slightly more other side effects. but these were very seldom. It was only slightly more. And when we study these side effects, it is actually just for reason that these people are older, and the older people have more comorbidities, have more diseases. And then it is at the end of day, it's not adequate to say, well that the drug has done it. It is elderly people have a highest chance for some comorbidities, So in the follow up of the treatment of psoriasis patients. Be ambitious, take attention to the comorbidities. Realize that this is a safe approach. There are several biologics along the anti-TNF may have some impact. Indeed, when there are tuberculosis endemic or patients are inclined for infections. I would not give adalimumab. Actually, the treatment with ustekinumab is very favorable in elderly people can be given with high safety as well as anti-IL-17 and anti-IL-23. So, treatment of elderly in psoriasis be ambitious.
