6。Drug eruption药物疹.ppt

* * * * * * * * * * * * * * * * * * * Delayed-type hypersensitivity reactions (DTH) Occur 1 – 3 days following antigen contact Large amount of antigen required Mechanism of action Presentation of antigen to memory T cells CD4 TH1, CD4 TH2 and CD8 Effector T cells secrete cytokines Macrophage activation, inflammation, tissue destruction Examples Tuberculin skin test Contact with poison ivy * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Presentation: spread rapidly (within 4 days) to their maximum extent Initial lesions: macular, iris lesions and bullae followed by desquamation, then slough. mucosal surfaces: difficult swallowing(GI), painful urination, photophobia, respiratory and alimentary tract involvement. Workup: Skin bx DDX: Paraneoplastic pemphigus (excluded with DIF). Graft-versus host disease (hx) and SSSS ( superficial blister). Management Similar to an extensive burn Fluid and electrolyte imbalances, bacteremia from loss of protective skin barrier, hypercatabolism, and sometimes ARDS IVIG in 10 pts in doses up to 0.75 g/kg/day for 4 days led to response in 48 hrs and skin healing within 1 week No adverse rxn’s where observed Previous general experience with the drugs Latent periods: The rash begins 5 to 10 days (range, 1 day to 4 weeks) after beginning the drug and may occur after the drug is terminated. Clinical manifestation Skin testing (penicillin, vaccine et al.) Diagnosis Management Discontinue the offending agent Administer appropriate treatment Glucocorticoids: as early as possible, full dose, Antibiotics: Provide supportive or palliative care e.g., hydration, warm / cold compresses, analgesics or antipruritics Topical treatment Prevention Avoid inappropriate drugs in the context of clinical condition Use right dose, route, frequency based on patient variables Elicit medication history; consider untoward incidents Elicit history of allergies [in patients with allergic diseases] Rule out drug interactions Adopt r