皮肤性病学课件：药疹（英文版）

Drugeruption

takingoralsulfamethoxazole-rimethoprim(SMZ-TMP)foraurinarytractinfection(泌尿道感染)FIXEDDRUGREACTION

（固定型药疹）leavingpersistenthyperpigmentation(遗留持久的色素沉着斑)斑疹maculaContactdermatitis？erysipelas

？Developing?Case1Causedbytherabiesantivenomandrabiesvaccine.Hislesionscharacterizedbyurticaria,andaccompaniedbyjointpain,abdominalpainandothersymptoms.Urticarial

drugeruptions（荨麻疹样型药疹）风团whealCase2

Causedbypenicillin.Onsetsuddenly,accompaniedbychills,fever,suchasdisease,skinlesionsofmeaslesrash,thereisnointernalorgansdamage.

Morbilliformdrugeruptions（麻疹样型药疹）斑疹Macula丘疹papule

measles

？eczema？case3bullousepidermalnecrolysis,BEN（大疱性表皮松解型药疹）水疱

blister糜烂erosionLargeareaburn

？pemphigus

？SSSS？causedbyantipyretics

！！case4

Difinition

Drugeruption(dermatitismedicamentosa)medicinescanleadtodrugeruptionbymanyways:oraltaking,injection,inhalation,clusis,suppository,oreventinywoundofskin;drugeruptionalwaysshowsinflammatorylesions;itcanalsoeffectonothersystemsinsomeseverecases.Mostdrugeruptionsaremild,self-limitedDrugEruption

prognosisSevereandpotentiallylife-threateningeruptionsoccurinapproximately1in1000hospitalpatientsDHShasamortalityrate10%,TENapproaches20-30%;

etiologyandpathogenesis

Etiology

Individualdifferencemedicine

medicineAntibioticsAntipyreticandanalgesicSedativesandhypnoticsAntiepilepticandantispasmodicSerumofotherspeciesandvaccine

TraditionalChinesemedicine

allergicreaction

non-allergicreactionHowdodrugsleadtodrugeruption?Featuresofallergicdrugeruption1.Itoccursonlysomeindividualswhohaveallergicconstitutions.2.Therapeuticaction,toxicreactionanddoseofdrugsdonotdeterminedegreesoftheeruption.3.Drugeruptionhasaspeciallatentperiod.4.Formsoferuptionhavenospecialties.5.Crossallergyandpolyvalentallergy6.Corticoidiseffectivetodrugeruptionafterallergicdrughavingbeenceased.NonallergicreactionDruginducesreleasingofinflammatoryfactorsOverdoseAccumulationreactionEnzymedeficiencyorsuppressionToxicreacionofsunlightClinicalmanifestations

Fixedtype

FixedtypeDrugs:non-steroidialanti-inflammatorydrugs,sulfonamids,trimethoprim,etcEruptionalwaysexistsonboundaryofcutisandmucosaelikelipid,aroundlipidandglansRoundorroundalikeEdama-maculewithpurple-redcolorDimension1-4cmItalwaysexistssolely,sometimesseveral.Grey-blackmaculeMorbilliformorscarlatiniformtypesDrugs:Penicillin,non-steroidanti-inflammatorydrugs,barbitutatesandsulfamethocazleTheyarethecommonestformofadversecutaneouseruptionandcharacterizedbyerythema,oftenwithsmallpapulesalloverthebody.

UrticariatypeurticariaDrugs:heterogeneousserum,furazolidone,penicillin,etcWhealswillkeepforlongertimeThepatientswillbeconcomitantwithotherserumsymptomslikefever,jiontache,lymphnodetumefaction,etcBulloustypewithtoxicepidermalnecrolysisTENserveredrugeruptioncausedbysulfonamides,non-steriodanti-inflammatorydrugs,antibioticsandbarbitalsimilarassuperficialsecond-degreeburn.Painsareoutstanding.NikolskysignispositiveExfoliativedermatitis–liketypeseveredrugeruptioncausedbysulfonamides,barbital,antiepileptic,non-steroidanti-inflammatorydrugsoccursafteralongtimemedicationlargeamountofscalesDeglovingandde-stockinginjurecanbeseenonhandsandfeet.Erythma,swell,vesicles,erosionswilloccuronlipandmucosaeofmouth.Erythemamultiforme–liketypeDrugs:sulfonamides,non-steriodanti-inflammatorydrug,barbitals,manifestationsaresimilartoerythmamultiformeTargetsamplespots:Skinofsoybeantohorsebeansizeroundorovaledematouserythema,edgecolorlight,centerdeeporhaveblisters,looksliketheiris.severetype:lesionsspreadtothewholebody,bulla,erosionandexudationappearontheprimaryeruption.erythmaanderosionoccuronmucosae.DiagnosisandMisdiagnosis

clearhistoryofmedication;havinganincubationperiod;symmetricaleruptionsexceptforfixeddrugeruption,lesionbeingbright–colored;salientitch;eliminationofotherdiseases.Treatment⑴theallergicandsuspiciousorsimilardrugmustbestopped.⑵Treatmentofmilddrugeruption

Anti-histaminedrug,vitaminecSometimes-moderatedoseofprednisone(30-60mg)Topicaltreatment:calaminelotion,oil,solution

⑶treatmentofseveredrugeruption

Immediateuseofenoughglucocorticoidisapremisetodecreasethedeathrate.Preventionandtreatmentofcomplicationsarethekeypointstodecreasedeathrate.Supportingtherapyisneeded

Correctingdisorderofelectrolures

Payattentiontoeye–care

Meticulouscareandtopicaltreatmentwillbeanassurancetoshortencourseofdiseaseaandacquiresuccessfulresults.

Inconclusion

DefinitionPathogenPathogenesisClinicalmanifestationsDiagnosisandtreatment

药疹亦称药物性皮炎，是药物通过内服、注射、吸入、灌肠、栓剂使用，甚至通过破损皮肤等途径进入人体后，在皮肤粘膜上引起的炎症反应，严重者尚可累及机体的其他系统。

病因个体因素：过敏体质或生理状态的影响。药物因素：①抗生素类：以青、链霉素最多；磺胺类

②解热镇痛类

③催眠类、镇静类与抗癫痫类

④异种血清及疫苗

⑤中药免疫性反应：即变态反应，多数药疹属于此类反应。与药疹发生有关的变态反应包括：①IgE依赖型变态反应（Ⅰ型），②细胞毒型变态反应（Ⅱ型）,③免疫复合物性反应（Ⅲ型）,④迟发型变态反应（Ⅳ型）。变态反应型药疹的特点:

①少数人发病；

②皮疹与药理作用无关，与服药量无一定的相关性；

③一定的潜伏期，4～20天；

④形态各异；

⑤交叉过敏，多价过敏；

⑥抗过敏药治疗有效（H）。非免疫性反应：

①药物直接诱导炎症介质的释放：组胺释放剂：阿斯匹林、鸦片类药物、多粘菌素B、放射造影剂。抑制环氧化酶、↑脂氧化酶功能→白三烯↑→炎症增强②过量反应；③蓄积作用④酶缺陷或抑制⑤光变态反应、光毒性反应。临床表现遗留灰黑色色素沉着斑，不易消退常由解热镇痛类、磺胺类或巴比妥类引起多见于唇、口周、龟头等皮肤粘膜交界处，手、足背、躯干亦可发生圆形或类圆形水肿性暗紫红色斑疹，1～4cm，1至数个，边清、绕红晕、稍痒，重者可出现水疱、大疱、糜烂、浅溃疡。一般不伴周身症状再次用药，原有皮损处发痒，出现同样皮疹停药一周可消退

固定型药疹

麻疹样或猩红热样药疹青霉素类、解热镇痛类、巴比妥类、磺胺类，尤其半合成青霉素。散在或密集的红色针头大小至米粒大小斑疹或斑丘疹，对称，泛发，以躯干为多，可伴有小出血点，初起为小红斑点，面、颈、上肢、躯干向下发展，2-3日遍布全身并相互融合，伴面部、四肢肿胀，皱折处及屈侧更明显。大疱性表皮松解型药疹常由磺胺类、解热镇痛类、抗生素类、巴比妥类引起起病急骤：皮损为弥漫性紫红或暗红色斑，迅速遍及全身，出现松驰性水疱或大疱，尼氏征阳性→大面积表皮松解坏死→暗灰色坏死的表皮覆于糜烂面上，大量渗出，似浅二度烫伤，触痛明显，全身中毒症状，粘膜受累。常因继发感染，肝肾功能衰竭，电解质紊乱、内脏出血、蛋白尿、氮质血症死亡。剥脱性皮炎型药疹多为磺胺类、巴比妥类、抗癫痫药（如苯妥英钠、卡马西平等）、解热镇痛类、抗生素引起长期用药后发生，潜伏期20日左右初呈麻疹样或猩红热样→融合成全身弥漫性潮红、肿胀→2至3周后红肿消退，全身出现大量鳞片状或落叶状脱屑，手足呈手套、袜套状剥脱、头发、指趾甲可脱落、粘膜受累，病程较长，如未及时停用致敏药物积极治疗，严重着常因全身衰竭或继发感染而死亡。

多形红斑型

Erethemamultiforme

drugeruptions

即药物引起的多形红斑。多由磺胺药、解热镇痛药或巴比妥类等引起。皮损多分布于四肢伸侧、躯干，对称发生，伴有瘙痒。皮疹泛发全身，出现大疱、糜烂，累及口、眼、外阴等处粘膜，甚至肝、肾受累，称为重症多形红斑，为重型药疹之一，病情凶险，可致死亡。

重症多形红斑

黏膜受累