Today, we will talk about the “medication” of systematic hormone therapy. First, a brief introduction to hormones. Hormone is a word that translates to hormone. Hormone is a Greek word that means “arousing activity”, and it plays an important role in regulating the metabolism, growth, development, reproduction, sex, sexual desire and sexual activity of the body. There are several major types of hormones. However, the ones we use in dermatology are generally glucocorticoids (hormones for short). It has five major effects: excellent anti-inflammatory, immunosuppressive, anti-cytotoxic, anti-shock and anti-proliferative. It is mainly used in clinical treatment for serious infections, anti-shock (toxic and anaphylactic shock), allergic diseases (anaphylaxis), hematological diseases, etc. Hormones used topically are mainly used for skin disorders, and their effects and side effects, etc. are not included in today’s content. However, the long-term use of hormones in large quantities systematically can cause many side effects. The main ones are pathogenic microbial infections, mucous membrane damage of digestive system, osteoporosis, ischemic necrosis, neurological symptoms, induction of diabetes, hypertension, cataract, etc. In addition, inappropriate discontinuation or too rapid reduction of dosage can lead to recurrence or aggravation of the original disease (rebound phenomenon). Therefore, when hormone therapy is mentioned, we can often see 2 different reactions: one is “It’s terrible! Never use it!” and the other reaction is to treat hormones as a “miracle cure” and ask for their use. In fact, these reactions are both wrong. Therefore, I hope that in the process of treating diseases, we must correctly understand the effects and side effects of hormones and cooperate with doctors’ treatment, instead of misunderstanding hormone therapy. The following are several common misunderstandings: 1. Fear of medication: Because of the side effects caused by improper use of hormones, people are afraid of hormones and refuse to use them or do not insist on using them. This kind of patients are frightened to refuse to use hormones due to hearsay about various side effects of hormones, and specifically look for some partial, secret and so-called good medicine to treat them, which not only cost a lot of money, delay the disease and lose the chance of eradication, but also may have the non-scientific hazards of partial prescriptions …… There are many such examples. Therefore, I hope that you will not refuse to use glucocorticoids for fear of side effects. 2, unauthorized discontinuation: In the process of hormone therapy, some patients, for various reasons of their own, easily stop using hormones when their symptoms are not yet fully controlled. This is because if hormones are stopped easily, the disease will “rebound” or “relapse”. For patients who have been taking hormones for a long time, the reduction or withdrawal plan of hormones must be considered by the doctor according to the condition and laboratory results. Usually, after the disease is under control, the hormone dose can be gradually reduced, and the dose can be reduced every other day to maintain the control of the disease. 3.Dependence on medication: Some people are reluctant to reduce or withdraw hormones because they are worried about the relapse of the disease, especially because they think that hormones can “reduce fever as soon as they are taken”. I hope you will remember that no disease can be treated by hormones alone. It should be reminded that the improvement or disappearance of certain symptoms is not the same as the “cure” of the disease, and the aggravation of certain symptoms is not necessarily the relapse of the disease, so do not easily increase the dosage of hormones when the symptoms worsen. Patients should follow the doctor’s instructions and go to the hospital regularly to review the immune indexes, and the doctor will adjust the hormone dosage according to the patient’s symptoms, physical signs and laboratory results. Principles of hormone reduction: Principle 1: Hormone reduction should be considered only after the condition has been stable (usually more than 2 weeks) and the factors of relapse and rebound have been removed. Stable disease must be maintained even after hormone reduction, otherwise it means failure. Indeed, sustained stability of the disease refers to the disappearance of clinical symptoms, normal laboratory tests or a longer period of stability, and normalization of blood picture. The main laboratory indicators of hormone reduction are usually blood routine, urine protein amount, and if necessary, complement, dsDNA, nucleosome antibodies can be checked as well. Principle 2: Only after the elimination of various factors that may cause relapse. Such as infection, overexertion, during pregnancy, etc. should be regarded as relapse factors. Hormone reduction should also not be considered if the patient’s life or work environment has recently changed significantly. Principle 3: The process of hormone reduction should be slow rather than fast. On the basis of maintaining the basic stability of the disease, the dosage should be reduced gradually (2-3 weeks, 10% reduction) in a conditional and step-by-step manner, and at the same time, each time the hormone dosage takes a step, the dosage of other drugs with anti-inflammatory properties of hormone replacement should be increased appropriately. The amount of hormone reduction should be reduced by no more than 1/4 of the total amount each time. If the reduction does not continue to stabilize, the issue of continued reduction should never be considered. In the process of reducing or stopping the hormone, if the situation such as infection occurs at any time, you can consider increasing the amount of hormone again. The above is for reference only, and specific patients need to analyze the dosage reduction. Be sure to follow the doctor’s instructions. In addition, except for a very small number of patients, dermatology patients generally do not need to use hormones systematically for a long time. Therefore, the vast majority of patients, even if they use hormones, are on a short-term moderate amount or less. Therefore, there is no need to worry excessively. Also. Patients using hormones should pay attention to the use of low salt and low fat and high quality low protein diet, to reduce the stimulation of alcohol, coffee and spicy food, especially in the hot season, to pay attention to blood sugar level, as well as to ensure emotional stability.