2 English Reference Dermatitis Drug Eruption A [2 1 Century Bilingual Dictionary of Science and Technology]
Drug eruption [Xiangya Medical Dictionary]
Drug eruption [Xiangya Medical Dictionary]
Overview of drug dermatitis (drug eruption dermatitis), also known as drug eruption. It is a variety of drugs that enter the body through various channels, causing various inflammatory reactions of skin and mucosa.
Drug eruption is a drug that is beneficial to patients and used for prevention, diagnosis and treatment. In any case, it enters the body and causes adverse reactions of skin and/or mucosal damage. It is a common disease in dermatology emergency department.
4. Etiology of drug-induced dermatitis 4. 1 Drugs enter the human body through oral administration, injection, perfusion, eye drops, nasal drops, gargling, hydration, spraying, inhalation, external use, drug fumigation, * * and bladder irrigation.
4.2 Common drugs causing drug eruption 4.2. 1 Arsenic can appear after several injections. Due to the acute poisoning symptoms of allergies, some rashes appeared after long-term use. Skin lesions are often extensive blisters, papules and pustules, which can cause exfoliative dermatitis in severe cases, and a few people can cause parapsoriasis, lichen planus, pityriasis rosea or mottled pigmentation spots.
4.2.2 Antipyretic and analgesic drugs often cause scarlet fever-like or measles-like erythema, fixed erythema and exfoliative dermatitis.
4.2.3 Sleep sedatives include measles-like erythema, vascular edema, erythema multiforme, lichenoid dermatitis, fixed drug eruption and exfoliative dermatitis.
4.2.4 Injection of antibiotics, especially penicillin, can cause anaphylactic shock reaction, and the slow reaction is itching, measles-like erythema, urticaria, angioedema and even exfoliative dermatitis.
4.2.5 Steroid hormones can cause scarlet fever-like or measles-like erythema, lupus erythematosus, and erythema fixum, and severe cases are exfoliative dermatitis, malignant bullous erythema or toxic epidermolysis. Some people died of neutropenia or congenital anemia.
4.2.6 Immunosuppressants and antineoplastics Immunosuppressants and antineoplastics often cause alopecia, exfoliative dermatitis, jaundice, neutropenia or granulocytopenia.
4.2.7 The allergic reaction caused by traditional Chinese medicine is gradually increasing. The most common are urticaria, measles-like erythema, fixed drug eruption and oral mucosal erosion.
5 Pathogenesis of drug-induced dermatitis Most drugs may cause drug eruption, including Chinese herbal medicines, but those with strong antigenicity cause the most. Common antipyretic and analgesic drugs such as antibiotics, sulfonamides, aminopyrine, analgin, phenylbutazone, salicylate, sleeping pills, antiepileptic drugs, antitoxin and other serum drugs. According to the analysis of drug structure, all drugs containing benzene ring and pyrimidine ring have strong allergenicity. In addition, patients with congenital allergic diseases and important organ diseases are at greater risk of drug eruption.
The pathogenesis of drug-induced dermatitis is very complicated, which can be immune or non-immune, but most drug eruptions are allergic reactions, because allergic drug eruptions are limited to a few people who take drugs, and many people take various drugs. After all, drug eruption is rare, and because allergic drug eruption is not pharmacological action or toxic reaction, drug eruption has nothing to do with dosage, and a very small amount of drugs can cause serious drug eruption in highly sensitive people.
5. 1 Non-allergic reaction mechanism Non-allergic reaction mechanism includes drug overdose, side effects, direct toxic reaction, hereditary allergy, JarishHexheimer reaction, ecological imbalance, biological nutrition effect and the interaction between drugs.
A few drug eruptions have nothing to do with allergic reactions. The rash caused by phototoxicity has nothing to do with allergic reaction. But it is related to drug concentration, specific wavelength and exposure. Some people have congenital defects in the activity of erythrocyte glucose-6-phosphate dehydrogenase, which is due to recessive inheritance. After taking hydralazine, sulfones and sulfonamides, hemolytic anemia can be caused. Some drugs can directly act on the release medium of mast cells, showing urticaria and vascular edema. Some drugs change the metabolic pathway of oleic acid in peanuts, that is, inhibit cyclooxygenase, so that the production of prostaglandin by oleic acid in peanuts is reduced. Drug eruption can occur when taking non-hormonal anti-inflammatory drugs. In a word, the pathogenesis of drug eruption is very complicated. At present, many theories have not been proved enough and need further study.
5.2 allergic reaction mechanism most drug eruptions are caused by this mechanism, and the mechanism is complex. Macromolecule drugs such as serum, vaccines, organ extracts, and protein products such as enzymes. , itself is an antigen and has a sensitive effect; However, most drugs themselves or their metabolites are small molecular substances with molecular weight less than 1000, which belong to haptens. When they enter the body, they will form irreversible covalent bonds with macromolecular carriers such as protein and peptides, forming binding antigens, and then have sensitization.
When the body is sensitized by drug-induced antigen and then comes into contact with similar antigen, the body can cause acute inflammatory reaction and drug eruption of skin or (and) mucosa through antibody-mediated type I, II and III allergic reaction, or sensitized lymphocyte type IV reaction, or both. Due to the differences in chemical structures and the complexity of metabolites, there are many complex drug antigenic determinants. In addition, there are different forms of individual reactions to drugs, so the same drug can cause different types of skin damage in different patients. On the contrary, the same type of skin injury may also be caused by different drugs.
Drug eruption caused by allergic reaction mechanism often has the following characteristics:
① There is no linear relationship between the occurrence of rash and dose, and it only appears in a few people;
② There is an incubation period of 4-20 days after the first drug contact, which is usually 7- 10 days. In the future, when you are exposed to drugs again, there will be no incubation period, but you will get sick within a few minutes to 24 hours.
③ The clinical manifestations have nothing to do with the pharmacological characteristics of drugs, and sometimes they may be accompanied by allergic reactions such as asthma, arthritis, lymphadenopathy, eosinophilia in peripheral blood, and even anaphylactic shock.
④ Cross-reactions can occur between drugs with similar structures.
Type 4 allergy:
Drugs such as serum and vaccine are complete antigens composed of protein, while some non-protein chemicals combine with hapten and protein in body tissues to become complete antigens. After the body is exposed to antigen, after a certain incubation period, immune cells are sensitized or produce enough antibodies, and then encounter antigenic drugs, resulting in various allergic reactions. Type I allergic reactions include urticaria and angioedema. Some eczema rashes and anaphylactic shock. Type ⅱ includes purpura caused by reduction of small steel plate. Type ⅲ includes vasculitis, serum sickness and serum sickness-like reaction. Type ⅳ may include erythema and eczema-like rash, exfoliative dermatitis, fixed drug eruption, erythema nodosum and lupus-like syndrome.
Certain types of drug eruptions can coexist. Some drugs can react with light to produce drug eruption, which is manifested as erythema, wheal and lichen planus. It may occur in frequently exposed parts or unexposed skin. Sulfonamides, chlorpromazine, birth control pills, tetracycline and other drugs often cause photosensitivity reactions. People who are allergic to some drugs may have a drug eruption on another drug with similar chemical structure.
The pathological changes of drug-induced dermatitis urticaria, erythema multiforme, erythema nodosum, eczema, erythroderma, folliculitis and vasculitis are the same as those of other idiopathic diseases, so I will not explain them here. The characteristic drug eruption will be described below.
6. 1 Most of the necrotic keratinocytes are found in the epidermis of fixed drug eruption, and the spinous cells are balloon-like degeneration, which can develop into blisters in the epidermis. Because the cell membrane of the ruptured cell remains in the blister, the blister is honeycomb-shaped. The dermis is highly edematous, with blisters under the skin, and a large number of phagocytes can be seen in the upper dermis. Lymphocyte infiltration and a small number of eosinophils and neutrophils, as well as histiocytes and mast cells can be seen in the superficial and deep dermis.
6.2 In drug-induced epidermolysis bullosa, epidermal keratinocytes fused and died in a large area, and the cell structure disappeared, resulting in nuclear dissolution, nuclear shrinkage and nuclear fragmentation. The stratum corneum is still basket-shaped, with interfacial vacuoles, subcutaneous blisters and epidermal edema. The infiltrating cells are mainly lymphocytes, with a small amount of histiocytes and eosinophils infiltrating.
6.3 Lichen planus-like drug eruption is characterized by focal dyskeratosis of stratum corneum, thinning or disappearance of granular layer of dermis, vacuolation of interface and dense inflammatory infiltration. Mainly lymphocytes, histiocytes, sometimes plasma cells and eosinophils, inflammatory infiltration is not only in the shallow layer, but also in the deep layer.
Clinical manifestations of drug dermatitis The clinical manifestations of drug eruption are varied. The same drug can have different types of clinical manifestations in different individuals, and the same clinical manifestations can be caused by completely different drugs. Common drugs are summarized as follows:
7. 1 The clinical manifestations of eruptive drug eruption are measles or scarlet fever-like erythema, with sudden onset, often accompanied by chills, high fever (39 ~ 40℃), headache and general malaise. The rash begins on the face and trunk, and then spreads to the whole body, accompanied by itching and varying degrees of severity. Only a small amount of light person scattered in erythema, mild itching, self-healing after stopping taking medicine. Severe cases can be concentrated in the whole body, often accompanied by superficial lymphadenopathy. We should pay close attention to the possibility that it may develop into exfoliative dermatitis, because the latter has a poor prognosis.
7.2 Dermatitis drug eruption The main clinical manifestations of this kind of drug eruption are erythema, papules, small blisters, exudation, erosion and scab eruption. It can be divided into two types: localization and generalization; The localized type is mostly mild allergic skin rash caused by drugs, so it mainly occurs in the sun, resulting in a lichenoid rash. The generalized type may have low fever and itching, and in severe cases, there may be pustules of millet to rice grain size mixed with it. After fading, a layer of chaff scales often falls off.
7.3 Fixed erythema is mostly caused by transverse amines, barbiturates and antipyretic and analgesic drugs. However, about one-third of patients have no medication history, and allergens are not easy to find. The rash is characterized by localized round or oval erythema, bright red or purplish red, accompanied by pseudoedema, and the damage boundary is clear. There are still pigment spots after cure. After each application of sensitizing drugs, it recurs at the same site, and some of them add new harm at the same time. The number of rashes can be single or multiple, and some are distributed all over the body. The size of the rash is generally between 0.2 cm and several cm. Rash can occur in any part of the body, especially in the mouth, lips and mouth. About 80% occurs at the junction of skin and mucosa, and oral mucosa can also erupt. The regression time of fixed drug eruption is generally 1 ~ 10 days, but patients with mucosal erosion or ulcer often have a long course of disease, which can delay recovery for dozens of days. When it occurs in the foreskin, it often causes ulcers due to blister rupture or infection, which brings great pain to patients. If it is not treated properly, the patient will not be cured for weeks to months.
7.4 Urticaria-like drug eruption Urticaria-like drug eruption is one of the common drug eruptions, especially the widespread application of ritalin in recent years. Other drugs such as penicillin, streptomycin, sulfonamides and serum protein are the important reasons for this kind of drug eruption. The rash caused by serum foreign protein is called "serum sickness", which is characterized by the appearance of wind masses of different sizes. This kind of wheal rash is red in color and lasts for a long time, with a sense of self-itching. Urticaria can appear as the only symptom. It may also be accompanied by other symptoms. Such as fever and hypotension. Allergic patients usually have wheal rash and itching only a few hours after taking the medicine, but a few patients have dizziness, upset, red wind, itching and blood pressure drop within a few minutes after injecting penicillin, serum protein and other drugs. Drug eruption caused by furazolidone can only appear one week after drug withdrawal, and wheal is often very serious, with a large red rash, which is difficult to treat. After serum protein injection for 0/~ 2 weeks in serum sickness/kloc-0, fever started at 38 ~ 39℃, with wheal, itching, abdominal pain, nausea, superficial lymphadenopathy and joint pain all over the body. The course of disease was 10 ~ 14 days.
7.5 erythema multiforme erythema multiforme can be caused by drugs. Its rash is round or oval edematous erythema or papules, the size of which is like peas and broad beans. There are often blisters in the center with purple edges, which occur symmetrically in the limbs, often accompanied by fever, joint pain and abdominal pain. In severe cases, it can cause mucosal blister erosion pain. Erythema multiforme caused by other reasons, with similar symptoms, often occurs repeatedly in spring and autumn, and the course of disease is generally 2 ~ 4 weeks.
7.6 Malignant bullous erythema Malignant bullous erythema is also called StevensJonnson syndrome. It is a serious drug eruption and erythema bulla, which spreads widely, and the oral cavity, eyes and pharynx mucosa are eroded, and the red edge of the lips is ulcerated and scabbed. At the same time, the patient has systemic symptoms such as high fever, headache and joint pain. The course of disease is about 4 weeks, and the mortality rate before hormone use reaches 30%. Although it is a skin lesion in drug eruption, there is no medication history in many cases, indicating that only part of this type is related to drug reaction. Some patients can also be caused by "septicemia", which deserves attention.
7.7 Drug-induced epidermolysis bullosa Drug-induced epidermolysis bullosa is the most serious kind of drug eruption, which is characterized by a rapid increase in the patient's body temperature after taking the drug, which can exceed 39 ~ 40℃. The skin first has erythema, which expands rapidly and changes from red to brownish red. A day or two later, loose blisters appeared on a large area of erythema, and the blisters were irregular, and the blister membrane was easy to tear and peel off, revealing a painful large area of rotten face, much like burns. Mucosa is also eroded and peeled off. The patient has severe symptoms of systemic poisoning, accompanied by high fever and visceral damage. Jaundice, hematuria, renal failure, pneumonia, coma, convulsion and even death may occur. Otherwise, after 10 ~ 14 days, the condition improved rapidly, the body temperature dropped rapidly, and the rash dried off and recovered naturally.
7.8 Exfoliative dermatitis Exfoliative dermatitis can be caused by different reasons, and drugs are one of the important reasons. Often, due to the failure of general drug eruption patients to stop using sensitizing drugs in time and treat them correctly, the disease develops, and the rash merges into exfoliative dermatitis, or the disease suddenly develops at the beginning, with high fever of 40 ~ 465438 0℃, itchy measles-like erythema merges into large or diffuse flushing, with obvious swelling, superficial lymph node enlargement, hepatomegaly, tenderness and even jaundice, and splenomegaly. It should be differentiated from erythroderma caused by psoriasis, dermatitis, red scab of hair, red scab of skin and mycosis fungoides.
7.8. 1 Lupus-like syndrome Lupus-like syndrome can be caused by drugs, and its clinical manifestations and histological changes are the same as those of real systemic lupus erythematosus. The patient has various symptoms of lupus erythematosus, such as fever, rash, joint pain, pleurisy, pericarditis, granulocytopenia and lupus erythematosus cell positive. Therefore, systemic lupus erythematosus syndrome is considered as drug-induced systemic lupus erythematosus. Patients with mild illness will recover within a few months after stopping taking the drug, and those with severe illness may die of lupus nephritis or other lupus erythematosus damage. The course of disease is 2 ~ 3 weeks to 3 months, and drugs such as hydralazine and griseofulvin are easy to cause this syndrome.
7.8.2 After taking the medicine for two weeks to several months, the patient developed fever, general malaise, joint pain, superficial lymph nodes, hepatosplenomegaly, and the rash was diffuse erythema, edema, bullae or mushroom-like granulomatous damage. The touch is quite firm, mainly seen in the trunk emptying distribution, irregular, with clear edges and a diameter of about 3 ~ 4 cm. After treatment, the symptoms gradually disappear for about 3 weeks.
7.8.3 Other drug eruption The drug eruption of allergic vasculitis caused by some drugs or serum and other foreign proteins can cause punctate keratosis of palms and soles or keratosis of skin pores due to long-term use of a small amount of arsenic. Mercury is toxic to acrodynia, rash and stomatitis. Long-term use of iodine and steroid hormones can produce acne-like rashes. Taking antimalarial drugs can produce a lichenoid rash. Some drugs can also produce purple scars and eczema-like rashes.
The diagnosis of drug-induced dermatitis can only be made by inquiring about the medical history in detail, being familiar with all kinds of drug eruption types, observing the clinical manifestations and development process, and comprehensive analysis, but it is still impossible to make a clear diagnosis. Because, until today, there is still a lack of reliable experimental diagnosis methods for drug eruption. People with positive skin test will not have drug eruption after taking the medicine, while those with negative skin test will have drug eruption. Moreover, intradermal test can cause serious drug eruption or other drug reactions in highly sensitive people, and even cause anaphylactic shock and death. It is not safe and reliable to carry out drug testing again, and it can only be used with caution for patients with fixed drug eruption or no serious reaction. The history of drug eruption, disappearance after drug withdrawal and recurrence after drug use is of great diagnostic significance.
Modern immune tests, such as lymphocyte transformation test, radioactive allergen adsorption test (RAST), basophil degranulation test, macrophage migration inhibition test and leukocyte histamine test, can help us understand the immune relationship between drugs and the body, and have no practical diagnostic value. In a word, drug eruption is a common disease. When diagnosing drug eruption, it is necessary to objectively analyze and exclude the possibility of the disease.
Diseases that need to be differentiated from drug dermatitis should be differentiated from measles, scarlet fever, rubella, infectious mononucleosis, Kawasaki disease, lichen planus, solar dermatitis urticaria, toxic epidermal necrolysis and so on.
10 treatment plan for drug-induced dermatitis 10. 1 treatment principle (1) Stop using all drugs suspected of allergy and drugs with similar structures.
(2) promoting the excretion of drugs in the body.
(3) Application of antiallergic drugs or antidotes.
(4) Prevention and control of secondary infection.
(5) Support therapy, etc.
10.2 application principle of antiallergic drugs or antidotes (1) antihistamines are important chemical transmitters in allergic reactions, and they have effects by exciting H 1 receptors, H2 receptors and H3 receptors. H 1 receptor makes bronchial and gastrointestinal smooth muscle contract, vascular smooth muscle relax, atrial muscle contract strengthen, atrioventricular conduction slow down, and gastric acid secretion increases in gastric parietal cells. H2 receptor increases gastric acid secretion, vascular smooth muscle contraction, ventricular contraction and sinus heart rate. Antihistamines are mainly drugs that competitively antagonize histamine at the receptor site. It should be noted that the release medium of mast cells is mainly histamine (Grade I medium), but at the same time it needs to be synthesized and released (Grade II medium), so it can stabilize mast cells and is also an important part of anti-allergy. Commonly used drugs: Naoyizine, Sibelium, Doxepin, Cisplatin, Terfenadine.
(2) Media blockers, drugs for stabilizing mast cell membrane, piperazine and haijunsheng can block the release of SPS, but cannot block the release of histamine (combined with other drugs).
Sodium cromoglycate inhibits the release of histamine, but has no effect on the release of SPS, and thiophenol can stabilize mast cell membrane.
(3) Calcium is used to increase capillary density, reduce permeability and reduce exudation.
1) blocks the adhesion of neutrophils on the blood vessel wall, stabilizes the lysosomal membrane and prevents the release of lysozyme.
2) Inhibit the bactericidal power of monocytes, reduce the reaction of monocytes to MIF released by T cells, reduce the release of mediator (lymphatic factor), and reduce the migration of cells to inflammation.
3) Circulating T cells are redistributed and T cells are reduced.
4) It has a stabilizing effect on neutrophils and mast cells.
The choice of drugs should be decided according to the condition, especially for severe drug eruption, corticosteroids should be used in time. When the body temperature drops to normal, the blisters and erosion of the rash can be gradually reduced. Pay attention to the disorder of water and dielectric, control infection, pay attention to the functions of heart, liver, kidney and hematopoietic system, and pay attention to blood sugar to prevent cerebral hemorrhage. If abnormal reaction is found, handle it in time.
For mild drug eruption, adequate antihistamines, corticosteroids, vitamin C and calcium should be given to prevent the re-release of class II mediators, especially for patients treated in outpatient observation room, who can't go home until their condition is very stable.
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10.3 strengthen nursing. Those with mucosal damage should actively protect the mucosa, especially the conjunctiva, to prevent corneal opacity and mucosal adhesion. Children should pay attention to * * * and foreskin erosion, leading to foreskin stenosis. 3% boric acid water can be used to clean eyes or corticosteroid eye drops every day. Pay attention to clean your mouth and rinse your mouth frequently. You can choose 2% sodium bicarbonate solution to gargle.
10.4 local treatment can relieve itching, absorb rotten surface, keep clean and heal quickly for mild drug eruption. For severe drug eruption, it is best to use dry exposure therapy (under infrared lampshade) or local Revneur wet compress or external PC cream, air disinfection, and use sterile sheets and bedding.
10.5 Chinese medicine is used to treat general drug eruption, urticaria, erythema multiforme and exfoliative dermatitis. Liang Xue Xiaofeng Decoction, Qi-blood Liangshao Formula, Qingwen Baidu Drink, and Liangxue Jiedu Quban Formula are effective.
1 1 prevention of drug-induced dermatitis (1) When treating diseases, ask about the history of drug allergy first, or don't abuse drugs that are easy to cause drug eruption.
(2) The drugs that cause allergies should be clearly written on the medical records to attract the attention of doctors who rely on these drugs. It is suggested that patients should avoid using this drug or some drugs containing this drug, which are related to chemical structure and easy to cause cross-reactions.
(3) Before using penicillin, tetanus antitoxin and procaine, skin test must be done, and all medicines and measures needed for first aid must be prepared.
Acupoints for treating drug-induced dermatitis are deficiency of both yin and yang, cold belongs to yin, and exterior, excess and heat belong to yang; In treatment, both acupoints and drugs have yin and yang properties, which can be used to correct the excess of yin and yang in the body. ...
Physiological functions such as adrenal blood pressure. A variety of adrenal hormones and their analogues have been used as drugs in clinic. Name of Auricular Point Adrenal Gland: Adrenal Gland (shènsh ...
Changes in acupoints can also be treated with various * * * (such as acupuncture, * * *, electroacupuncture, drug injection, etc.). ) to regulate the functions of various viscera and achieve therapeutic effects. Division of acupoints and meridians ...
Listen to Yin Jiao, Qi Hai, etc. Shenshu point, Guanyuan point and Taixi point. Added to those with kidney deficiency; Drug poisoning, Jiabaihui, dumb door, satellite, foreign official, etc. Listen, open your mouth slightly. ...
Listen to rivers, seas, etc. ; Shenshu point, Guanyuan point and Taixi point. Added to those with kidney deficiency; Drug poisoning, Jiabaihui, dumb door, satellite, foreign official, etc. Listen, open your mouth slightly. ...
Treating Drug Dermatitis by Selecting More Points
A Chinese patent medicine syrup for cooling blood and expelling wind for treating drug dermatitis is mainly used for clearing away heat and toxic materials, cooling blood and expelling wind. Can be used for urticaria, eczema, drug dermatitis, psoriasis, etc. Administration and dosage: oral. ...
Treatment of Sanjiu Weitai. Sanjiu Weitai Poisoning: Adverse reactions: measles-like drug eruption, fixed drug eruption, urticaria drug eruption, epidermolysis bullosa drug eruption, etc. ...
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Urticaria pill's urticaria caused by taking or injecting certain drugs belongs to drug allergy (drug eruption), so he should go to the hospital in time. 5. During taking the medicine, if suddenly accompanied by chest tightness. ...
Compound Danshen injection. Therefore, it is very important for clinicians to be familiar with the interaction between compound Danshen injection and various drugs, so as to avoid possible adverse reactions in the combination of drugs. ...
More Chinese patent medicines for treating drug dermatitis.
Diphenhydramine hydrochloride tablets related to drug dermatitis are also effective for neuroedema, allergic rhinitis, skin itching and drug eruption, as well as insect bites and contact dermatitis. Prevention and treatment of motion sickness has a strong antiemetic effect. ...
Nitroglycerin solution vomiting, weakness, sweating, pallor and collapse. ⑷ Syncope, flushing, drug eruption and exfoliative dermatitis were all reported. Contraindications are forbidden in the early stage of myocardial infarction (with ...
Nitroglycerin tablets vomit, feel weak, sweat, pale and collapse. ⑷ Syncope, flushing, drug eruption and exfoliative dermatitis were all reported. Contraindications are forbidden in the early stage of myocardial infarction (with ...
Sulfamethazine sodium injection. Allergic reactions are common, which can be manifested as drug eruption, and in severe cases, exudative erythema multiforme, exfoliative dermatitis and epidermolysis bullosa atrophic dermatitis can occur. ...
Sulfamethoxazole tablets