《昆明医学院皮肤性病学教研室《药疹》课件》由会员分享，可在线阅读，更多相关《昆明医学院皮肤性病学教研室《药疹》课件（41页珍藏版）》请在金锄头文库上搜索。
1、1 1Burn烧伤患者 ？2 2vWhats this disease?3 3药 疹Drug eruption昆明医学院皮肤性病学教研室昆明医学院皮肤性病学教研室付萍付萍 教教 授授contentsvDefinition vEtiology and pathogenesis vClinical feature vDaignoses and Differential Diagnoses vManagement一、Definition定义drug eruption:Drug was gotten into human body by all kinds of ways, causing skin、
2、mucosal inflammation. Severly, Viscera may be involved. v 药疹(drug eruption)又称药物性皮炎(dermatitis medicamentosa),是药物通过各种不同的途径（内服、注 射、吸入、灌注、栓剂等）进入人体后，在皮肤黏膜上引 起炎症反应，严重者可累及机体的其他系统。 v 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。FrequencyvDrug eruptions occur in approximately 2-5% of inpatients and in greater than 1
3、% of outpatients in American. vIn China ?病 因etiologyvindividual factor:机体对药物的敏感性各不相同，同一个体在不同的时期，敏感性也可不同。concurrent infections, metabolic disorders, or immunocompromise vDrug 药物因素vVirus activating 病毒的活化8 8antibiotic 解热镇痛药 Analgesics antipyretics镇静催眠 sedative, hypnotics抗癫痫癫痫 anticonvulsants血清制品 Serum
4、product 其他中药 chinese medicine病 因9 9发病机制可分为变态反应性可分为变态反应性Immunologically Immunologically mediated reactionsmediated reactions或非变态反应性或非变态反应性NonimmunologicallyNonimmunologically mediated reactions mediated reactions ，多数药疹为变态反应性多数药疹为变态反应性发病机制pathogenesis1010semiantigen（大多数药物）+ 载体（蛋白、多肽、多糖）血清制品、疫苗antigena
5、llergy4 type allergy一、一、变态变态反应性反应性mmunologicallymmunologically mediated mediated reactionsreactions 具体某一种药物通过那一型变态反应引起药疹大多不清 一种药疹可能几种变态反应共同参与1111 manority people who take medicine occur Drug Eruption the severity of rash was not related with drugs pharmacological properties、dose；the minimum drug can
6、 cause severe drug eruption； delitescence cross allergy and multi-allergy thethe rash is lacking of specificity corticosteroid was effective；变态反应引起的药疹，有以下共同特点1212交叉过敏cross allergy ：机体被某种药物致敏后，可能同时对与 该种药物化学结构相似或存在共同化学基团的药物产生过敏。 drug eruption recur if drugs chemically related to the causative agent ar
7、e administered. 磺胺类普鲁卡因类苯环1313多价过敏multi-allergy ：机体处于高敏状态下，可能对平常不过敏、与致敏药物化学结构不同的药物也产生过敏。1414药疹的发病机制（ 三） direct release of mast cell mediators ： overdosage ：中毒性药疹 accumulation adverse effectsaccumulation adverse effects photosensitivity二、非免疫性反应二、非免疫性反应 nonimmunologicallynonimmunologically mediated re
8、actions mediated reactions 1515药疹临床表现复杂多变，被称为“万能的模拟者”，Drug eruptions can mimic a wide range of dermatoses可模拟各种皮肤病表现，如麻疹、猩红热、湿疹等临床表现Clinical feature1616轻型药疹一、一、固定型药疹fixed drug eruption17171818同一部位,皮损 反复多次发作 edematous plaques 1919hyperpigmentation2020药疹的临床表现（ 二）二、荨麻疹型药疹urticarial drug eruption2121全身风团
9、可伴有关节 痛等血清病样反应2222药疹的临床表现（ 三）三、麻疹样或猩红热样型药疹morbilliform drug eruption and scarlatiniform drug eruption232324242525这两型药疹，与相应的 传染病麻疹、猩红热 鉴别很重要，麻疹粘膜 斑、杨梅状舌是重要的 鉴别诊断依据2626一、多形性红斑型药疹erythema multiforme drug eruption重型药疹severe reactions 2727靶形（或虹膜 样）损害是该 型药疹的特点28282929药疹的临床表现（ 五）二、大疱性表皮松解型药疹：drug induced b
10、ullosa epidermolysis3030尼氏征阳性3131Nikolsky sign尼氏征阳性： epidermis sloughs with lateral pressure3232v三、剥脱性皮炎型药疹drug-induced exfolalive dermatitisv三、药物超敏反应综合症(drug-induce hypersensitivity syndrome)也称伴发嗜酸性粒 细胞增多及系统症状的药疹（drug eruption with eosinophilia and systemic symptoms,drees）:This is a potentially lif
11、e-threatening complex of symptoms. Patients have fever, sore throat, rash, lymphadenopathy, hepatitis, nephritis, and leukocytosis with eosinophilia. It usually begins within 1-3 weeks after a new drug is started, but it may develop 3 months or later into therapy. 3636重型药疹除皮损外 ，往往伴有高热、 肝肾等内脏功能损 害，不及
12、时处理往 往引起死亡3737诊断和鉴别诊断 diagnosis and deferential diagnosis隐蔽途径诊诊断依据： using drug historyusing drug history用药药史3838 delitescence distribute widely symmetrily except fixed drug eruption、urticaria drug eruption pruritus3939治疗treatment加速药物排泄轻型重型对症治疗对症治疗加强护理防治感染糖皮质激素 早期使用糖皮质激素 中小量4040预防Allergic HistoryEarly recognizeAvoid drug abuseRemember sensitive medicine4141谢谢 谢！谢！
