文档介绍：皮肤性病学
二
变态反应性皮肤病
第二章
药物性皮炎（药疹）
药疹的概念
亦名药物性皮炎，是药物通过内服、注射、使用栓剂或吸入等途径进入人体，在皮肤粘膜上引起的炎症反应，严重者尚可累及机体的其它系统。
药物既有治病的效用，又可能引起副作用和不良反应。由药物引起的非治疗性反应，统称为药物反应，药疹仅是其中的一种表现形式。
引起药疹的药物，随着新药不断地增加，种类也有增多。任何一种药物在一定条件下，都可能引起药疹。
临床上常见的过敏药物有：
①抗生素类，以青霉素、链霉素最多；
②磺***类；
③解热镇痛类，主要有阿司匹林,氨基比林、保泰松等；
④催眠药，镇静药与抗癫痈药，如苯巴比妥，苯妥英钠；
⑤异种血清制剂及疫苗等，如破伤风抗***，蛇毒免疫血清，狂犬病疫苗等。
⑥中药也可引起药疹。
Frequency
Drug eruptions occur in approximately 2-5% of inpatients and in greater than 1% of outpatients. Mortality rates for erythema multiforme (EM) major are significantly higher. Stevens-Johnson syndrome (SJS) has a mortality rate of less than 5%, whereas the rate for TEN approaches 20-30%; most patients die from sepsis.
Sex: Adverse cutaneous reactions to drugs are more prevalent in women than in men.
Age:Elderly patients have an increased prevalence of adverse drug reactions.
Clinical: Physical
With every drug eruption, it is important to evaluate for certain clinical features that may indicate a severe, potentially life-threatening drug reaction, such as TEN or hypersensitivity syndrome. Such features include the following:
Mucous membrane erosions
Blisters (Blisters herald a severe drug eruption.)
Pain lesion
Clinical: Physical
Nikolsky sign (epidermis sloughs with lateral pressure; indicates serious eruption that may constitute a medical emergency)
Angioedema and tongue swelling
Palpable purpura
Skin necrosis
Lymphadenopathy
High fever, dyspnea, or hypotension
Clinical: Causes
Rates of reactions to commonly used drugs
Amoxicillin - %
Sulfamethoxazole - %
Ampicillin - %
Semisynthetic penicillin - %
Blood (whole human) - %
Penicillin G - %
Cephalosporins - %
Quinidine - %
Gentamicin sulfate - 1%
Packed red blood cells - %
Mercurial diuretics - %
Heparin - %
Clinical: Causes
Drugs that commonly cause serious reactions
Allopurinol (别嘌呤醇)
Anticonvulsants
NSAIDs
Sulfa drugs
Bumetanide(布美他尼)
Captopril (卡托普利)
Furosemide (呋塞米)
Penicillamine