昆明医学院皮肤性病学教室《药疹》课件.pptVIP

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 inflammation. 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 American. 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 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, 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. * 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 * 一、多形性红斑型药疹 erythema multiforme drug eruption 重型药疹severe reactions * 靶形（或虹膜样）损害是该型药疹的特点 * * 药疹的临床表现（五） 二、大疱性表皮松解型药疹： drug –induced bullosa epidermolysis * 尼氏征阳性 * Nikolsky sign尼氏征阳性： ● epidermis sloughs with lateral pressure * * 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 * 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 * ● delitescence ● distribute widely symmetrily except fixed drug eruption、urticaria drug eruption ● pruritus * 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 * 预防 Allergic History Early recognize Avoid drug abuse Remember sensitive medicine * 谢 谢！ * Burn烧伤患者？ * What’s this disease? * 药 疹 Drug eruption 昆明医学院皮肤性病学教研室 付萍 教 授 *