药物性皮疹概要课件.ppt

是第二常见的药疹,特点是红斑和水肿性风团,瘙痒 可伴有发热,关节痛,淋巴结肿大,蛋白尿 常见药物:阿司匹林,青霉素,血清制品,疫苗 是一种严重的药物反应 发病急骤,用药数分钟内即可发作 临床可见皮肤水肿性红斑及风团,呼吸道阻塞症,周围循环衰竭症,神经系统症状 常见青霉素,桃,坚果 表现为单发或多发局限性类圆形或椭圆形水肿性紫红色斑块,重者可发生水疱,多见于四肢和外阴 有瘙痒或烧灼感 一般在用药后30分到8小时内出现 再次摄入同样药物可在同一部位再次出现皮疹 为重症药疹之一,死亡率高, 起病急,全身中毒症状重 皮损为弥漫性紫红或暗红色斑片,触疼明显,有大小不等松弛性水疱,尼氏征阳性,大片表皮坏死松解及糜烂,类似烧伤,黏膜常受累 重者可合并感染,肝肾功能紊乱,电解质紊乱,内脏出血 磺胺类,解热镇痛药,巴比妥类 多形红斑性药疹(Erythema multiforme-like reaction) 剥脱性皮炎型药疹(Exfoliative dermatitis-like reaction) 紫癜或血管炎性药疹(Purpuric drug eruption or vasculitic eruption) 湿疹型药疹(eczema-like eruption) 痤疮型药疹(Acneiform eruption) 光感性药疹(Drug induced photosensitivity) SLE样反应(Systemic lupus erythematosus-like eruption) 扁平苔藓样药疹(Lichen planus-like eruption) 大疱型药疹(Bullous eruption) 银屑病样药疹(Psoriasiform eruption) 发现皮疹时应仔细观察和记录其出现与消失的时间、发展顺序、分布部位、形态大小、颜色及压之是否褪色、平坦或隆起、有无瘙痒及脱屑等。 very young and very old age concomitant diseases : asthma, cardiovascular diseases concurrent medications : β-blockers and ACEI Exercise Ethanol NSAID Specific food (wheat, celery, or shellfish) Acute intercurrent infections Fever Emotional stress Disruption of routine Premenstrual status in females Antimicrobial, antiviral, and antifungal agents NSAIDs Chemotherapeutic agents : carboplatin and doxorubicin Biologic agents : the monoclonal antibodies cetuximab, rituximab, infliximab, and rarely, omalizumab Contaminants in medications Radiocontrast media Medical dyes Peri-operative interventions Hypnotics Opioids … Skin tests (especially intradermal tests) Challenge/provocation tests with food or medication Allergen-specific immunotherapy Medication desensitization Natural rubber latex First line (priority medication) Epinephrine (adrenaline) 1:1,000 (1 mg/mL)for intramuscular injection 0.01 mg/kg, to a maximum of 0.5 mg (adult), 0.3 mg (child) H1-antihistamine for intravenous infusion eg. chlorpheniramine 10 mg (adult), 2.5-5 mg (child) or diphenhydramine 25-50 mg (adult) (1 mg/kg, maximum 50 mg [child]) Decrease itch, flush, urticaria, sneezing, and rhinorrhea, but are not lif