（优质医学）药物性皮疹.ppt

* 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) * Diagnosis 主要根据病史及体检作出诊断 * Treatment 停止一切可疑致敏药物 抗组胺药,重症应早期足量应用皮质类固醇激素 外用药以保护止痒对症治疗 * Prevention 药物过敏史 用药前皮试(青霉素,普鲁卡因,破伤风) * Case A 34-year-old woman was admitted to hospital with a 2-days history of a generalized edematous erythematous papular rash.10 days before admission,she had begun to take a medicine for folliculitis. After 8 days of treatment,she felt severe itching and erythema appeared on her back,becoming generalized in 2 days.She had low fever but no sore throat,headache or coryza.Examination showed a diffuse edematous erythematous papules rash over her trunk and the proximal extremities.What is the likely diagnosis? * Adverse reactions to most medications occur at very low rates(about 1/1000 exposures).However,certain commonly used medications(e.g.,semisynthetic penicillin and sulfamethoxazole/trimethoprim) have much higher rates of adverse reactions (30-50/1000) * * * Definition 药物不良反应是指药物在疾病预防,诊断和治疗中出现的有害的,未预料到的和不希望的作用.虽然大多数药物不良反应是轻度的,但有时是严重的,并且是大量发病甚或导致死亡的一个原因. 药疹:是药物通过各种途径进入人体后引起的皮肤黏膜急性炎症性反应,严重者可影响到机体其他系统. * Mechanism 变态反应性药疹 Ⅰ型变态反应,IgE介导:在此型反应中,与组织结合的肥大细胞释放组胺和其他化学介质可以起血管通透性增加,继而在真皮或皮下组织发生水肿.即刻反应发生在用药1小时或更短的时间,表现为荨麻疹,血管性水肿或变应性休克,而速发反应发生在用药1-72h内,常表现为荨麻疹,最常引起变应性休克的是青霉素,其他重要原因有食物,蛰伤,麻醉剂,肌肉松弛剂,乳胶,造影剂,抗生素 * Ⅱ型变态反应,细胞毒型:血小板减少性紫癜,溶血性贫血,粒细胞减少,肝损害 Ⅲ型变态反应,免疫复合物型:血清病样反应,药物热,变应性血管炎,临床表现常出现