1、1,Burn烧伤患者？,2,Whats this disease?,3,药 疹 Drug eruption,昆明医学院皮肤性病学教研室付萍 教 授,contents,Definition Etiology and pathogenesis Clinical feature Daignoses and Differential Diagnoses Management,一、Definition定义,drug eruption:Drug was gotten into human body by all kinds of ways, causing skin、mucosal inflammatio
2、n. Severly, Viscera may be involved. 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。 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。,Frequency,Drug eruptions occur in approximately 2-5% of inpatients and in greater than 1% of outpatients in Ameri
3、can. In China ?,病 因etiology,individual 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 Drug 药物因素 Virus activating 病毒的活化,8,antibiotic,解热镇痛药 Analgesics antipyretics,镇静催眠 sedative, hypnotics,抗癫痫 anticonvulsants,血清制品 Serum product,其他,中药chinese medi
4、cine,病 因,9,发病机制,可分为变态反应性Immunologically mediated reactions或非变态反应性Nonimmunologically mediated reactions ，多数药疹为变态反应性,发病机制pathogenesis,10,一、变态反应性mmunologically mediated reactions,11, manority people who take medicine occur Drug Eruption the severity of rash was not related with drugs pharmacological pr
5、operties、dose；the minimum drug can cause severe drug eruption； delitescence cross allergy and multi-allergy the rash is lacking of specificity corticosteroid was effective；,变态反应引起的药疹，有以下共同特点,12,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 rel
6、ated to the causative agent are administered.,13,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。,所以药疹治疗用药一定简单、单一。,14,药疹的发病机制（三）, direct release of mast cell mediators ： overdosage ：中毒性药疹 accumulation adverse effects photosensitivity,二、非免疫性反应 nonimmunologically mediated reactions,15,药疹临床表现
7、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 feature,16,轻型药疹,一、固定型药疹 fixed drug eruption,17,18,同一部位,皮损反复多次发作edematous plaques,19,hyperpigmentation,20,药疹的临床表现（二）,二、荨麻疹型药疹 urticarial drug eruption,21,全身风团可伴有关节痛等血清病样反应,22,药疹的临床表现（三）,三、麻疹样或猩红热样型
8、药疹 morbilliform drug eruption and scarlatiniform drug eruption,23,24,25,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,26,一、多形性红斑型药疹 erythema multiforme drug eruption,重型药疹severe reactions,27,靶形（或虹膜样）损害是该型药疹的特点,28,29,药疹的临床表现（五）,二、大疱性表皮松解型药疹： drug induced bullosa epidermolysis,30,31,Nikolsky sign尼氏征阳性：
9、 epidermis sloughs with lateral pressure,32,三、剥脱性皮炎型药疹drug-induced exfolalive dermatitis,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 life-threatening complex of symptoms. Patients have fever
10、, 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.,36,重型药疹除皮损外，往往伴有高热、肝肾等内脏功能损害，不及时处理往往引起死亡,37,诊断和鉴别诊断 diagnosis and deferential diagnosis,隐蔽途径,诊断依据： using drug history用药史,38, delitescence distribute widely symmetrily except fixed drug eruption、urticaria drug eruption pruritus,39,40,41,谢 谢！,
