measles-like erythema drug eruption
Introduction
Introduction to measles-like erythematous drug eruption Measles-like erythema-type drug eruption refers to a drug used for prevention, diagnosis, and treatment. It may cause skin and/or mucosal damage caused by any way to enter the body, and may be caused by type IV allergy. It is a measles-like erythema type drug eruption, which is a common disease in dermatology emergency department. Most drugs have the possibility of causing drug eruption, including Chinese herbal medicines, but most of them are caused by more antigenic, mostly antipyretic and analgesic drugs, barbital, penicillin, streptomycin, sulfonamide, etc. Patients with congenital allergic diseases and patients with important organs with diseases have a higher risk of drug eruption. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: drug eruption
Cause
Measles-like erythematous drug eruption
Cause:
Most drugs have the possibility of causing drug eruption, including Chinese herbal medicines, but most of them are caused by more antigenic, mostly antipyretic and analgesic drugs, barbital, penicillin, streptomycin, sulfonamide, etc. Patients with congenital allergic diseases and patients with important organs with diseases have a higher risk of drug eruption.
Prevention
Measles-like erythema type drug eruption prevention
Nursing focus
1, according to the general practice of dermatology.
2. Give high protein, high vitamin fluid or semi-liquid diet.
3. Strengthen the care of facial features and mucous membranes to prevent complications.
4. There should be a significant mark on sensitizing drugs to prevent allergies from happening again.
5, keep the clothes and clothes clean, dry and smooth.
6, strict aseptic operation, the bullous lesions can puncture drainage in the low position or use the empty needle to suck out the blister fluid, pay attention to protect the wound surface, the infected epidermis should be removed.
7. Before using the medicine, inquire about the history of allergies in detail to prevent cross-allergic reactions. For penicillin, sulfonamides, novocaine, antipyretic and analgesic, sedatives, antibiotics, etc., scratches should be strictly followed in accordance with the operating procedures before use. Or intradermal test.
8. Encourage more drinking water and promote drug discharge.
Complication
Measles-like erythema drug eruption Complications
Urticaria-like vasculitis, accompanied by vomiting, diarrhea, abdominal pain and other symptoms, can cause symptoms such as body gram, left heart failure, and pain in both upper limbs. Severe cases can cause edema of the laryngeal edema and life-threatening. For patients with decreased urine output, increased heart rate, chest tightness, palpitations, and difficulty in breathing, lung audible and wet voices, chest X-ray and cardiac B-ultrasound should be examined clearly. Heart failure has occurred, heart failure may develop at a rapid rate, and it will directly endanger the patient's life, so it should cause clinical attention.
Symptom
Measles-like erythema-type drug eruption symptoms Common symptoms Itching papules Scarlet fever-like rash Rose-like rash erythema (Boundary clear
Measles-like or scarlet-like erythematous drug eruption, also known as rash-type drug eruption, is more common and is a light drug eruption, which may be caused by type IV allergy.
1. The triggering drugs are mostly antipyretic and analgesic drugs, barbital, penicillin, streptomycin, sulfonamide and the like.
2. Clinical manifestations: sudden rash, often accompanied by mild or moderate fever, moderate or severe itching, measles-like erythematous drug eruption skin damage and measles resemble, scattered or dense red cap needle-like rash, torso is more, Generalized, the scarlet fever-like drug eruption is similar to scarlet fever. It starts with small erythema and develops downward from the face, neck, upper limbs and trunk. It can spread throughout the body in 2 to 3 days and can be swollen in the limbs. The wrinkles and the flexion of the limbs are obvious.
Examine
Examination of measles-like erythema type drug eruption
According to the repeated appearance of the skin, the rapid wheal, itching, no trace after retreat, and a clear history of medication, and the characteristics of various types of urticaria after treatment are easy to diagnose. If necessary, perform laboratory tests (including chest X-ray examination of abdominal B-ultrasound, etc.) and related tests (such as exercise, hot water, sunlight, ice), allergen testing, and blood drug concentration to further clarify the cause.
Diagnosis
Diagnosis and diagnosis of measles-like erythema type drug eruption
Need to identify with different types of drug eruptions.
(1) Fixed-type drug eruption is the most common type, often caused by sulfa preparations, antipyretic analgesics or barbiturates. The rash is a round or oval edematous purple-red spot with a diameter of about 1~ 2 or 3 ~ 4cm, often one, even several, the boundary is clear, the big ones have bullae on it, about 1 week after stopping the drug, the erythema subsides, leaving gray and black pigmentation spots, long-lasting, such as re-service The drug, often in a few minutes or hours, itchy at the original drug rash, followed by the same rash, and enlarged to the surrounding, so that the central color, edge flushing, blisters can also occur, new areas can also appear in recurrence The rash, with the increase in the number of recurrences, the number of rashes can also increase, the damage can occur in any part, but more common in the lips, mouth, glans, anus and other skin and mucous membrane junctions, the back of the hands and feet and the trunk often occur, can be When the hair or phoenix is involved, it occurs in the wrinkle mucosa and is easy to smash, causing pain. It usually disappears after 7 to 10 days. If it has ulcerated, it will heal slowly, and the severe one may be accompanied by fever.
(2) Urticaria-type drug eruption is more common, mostly caused by penicillin, serum products (such as tetanus or diphtheria antitoxin), furazolidone and salicylate. The symptoms are similar to those of acute urticaria, and may be accompanied by serum-like symptoms. Such as fever, joint pain, swollen lymph nodes, angioedema and even proteinuria, if the sensitizing drug is excreted very slowly or because of constant exposure to micro-allergens in life or work (such as medical staff allergic to penicillin, pharmaceutical factory workers Some drugs are allergic) and can be expressed as chronic measles.
(3) Photosensitive drug eruptions are often caused by taking hibernation, sulfonamide, promethazine (phenazone), tetracycline, griseofulvin, hydrochlorothiazide (hydrochlorothiazide), psoralen and methoxypsoralen. Caused by sunlight or ultraviolet radiation, can be divided into two categories: 1 phototoxie erythema: rash is similar to sunburn, mostly occurs 7 to 8 hours after exposure, limited to the exposure site, anyone can occur; 2 ph0to al-lergic eruption: only a few people occur, need a certain incubation period, the skin lesions are mostly eczema-like, visible in the exposed parts and cover, in addition, a small number of patients can develop urticaria or Mossy-like rash can still resolve after 1 to 2 weeks or more after stopping the drug.
(4) Eczema-type drug eruptions are mostly caused by topical sulfa or antibiotic ointment causing contact dermatitis, which increases skin sensitivity. Later, taking the same or similar chemical structure, it can cause this type of drug eruption. Its form is miliary size papules. And herpes herpes, often fused into a piece, generalized body, may have erosive exudate, but few systemic symptoms such as chills, fever, gradually improved after stopping the drug, to penicillin, streptomycin, sulfonamides, amalgam and quinine Ning et al. caused more people.
(5) Polymorphic erythema type drug eruption is often caused by sulfonamides, barbiturates and antipyretic analgesics. The clinical manifestations are similar to polymorphic erythema. The lesions are round or oval edematous erythema of pea to broad bean, papules. The center is purple-red, or has blisters. The boundary is clear. It is symmetrically distributed on the extremities of the extremities. The trunk, mouth and lips have itching sensation. In severe cases, it can be in the mouth, nostrils, eyes, anus, external genitalia and general body. Bullae and erosion, severe pain, may be associated with high fever, liver and kidney dysfunction and pneumonia, etc., the disease is sinister, known as severe polymorphic erythematous drug eruption.
(6) Astragalus-type drug eruption This type of drug eruption can be caused by barbiturate, methyl propylamine (metholamine), oral diuretics, neomycin, quinine, etc., thrombocytopenic purpura or III by type II allergy Type allergic reaction causes inflammation of the capillaries and produces purpura. In the light, the lower legs have red spots or ecchymoses, scattered or densely distributed, and some may slightly bulge. The severe limbs may be involved, even mucosal hemorrhage, anemia, etc. Sometimes small blisters can occur with the wheal or center.
(7) Bullous epidermolysis drug eruption is a serious drug eruption, often caused by sulfonamides, antipyretic analgesics (salicylic acid, phenylbutazone, aminopyrine, etc.), antibiotics, barbiturates, etc. Rapid onset, severe symptoms of systemic poisoning, high fever, fatigue, sore throat, vomiting, diarrhea and other symptoms, skin lesions are diffuse purplish red or dark red patches, often starting in the sputum and groin, quickly spread throughout the body, touch Significant pain, immediately in the erythema, the size of the blistering blister, a little smashed into a smashed surface, or the formation of a large area of epidermal necrolysis, Nie's sign positive, necrotic epidermis gray-red over the erosion surface Leaves painful peeling surface, like superficial second degree burns, mouth, buccal mucosa, conjunctiva, respiratory tract, gastrointestinal mucosa can also be eroded, ulcers, some cases start with polymorphous erythema or fixed drug eruption, very It is necessary to stop the drug and rescue immediately. In severe cases, it is often caused by secondary infection, liver and kidney dysfunction, electrolyte imbalance or visceral hemorrhage, proteinuria or even azotemia.
(8) Exfoliative dermatitis drug eruption is a serious drug eruption, mostly caused by barbiturates, sulfonamides, phenytoin, phenylbutazone, sodium salicylate, penicillin, streptomycin, etc. Most cases are after long-term use. Occurred, the first onset of the incubation period of about 20 days, some cases are based on the drug eruption, continue to use drugs, acute onset, often accompanied by high fever, chills, skin lesions initially measles-like or scarlet fever, in development In the process, it gradually intensifies and merges into diffuse redness and swelling of the whole body, especially on the face and hands and feet. It can have erosion, herpes or blister, and the effusion and sputum after rupture, until about 2 weeks, the body skin desquamation is scaly or Deciduous, hands and feet are peeled off in gloves or socks, after the hair, finger (toe) can fall off (healing can be regenerated), lips and oral mucosa flushing, swelling or blisters and erosion, affecting eating, conjunctival congestion, Edema, photophobia, increased secretion, corneal ulcer can occur when heavy, superficial lymph nodes often swollen, may be associated with bronchial pneumonia, toxic hepatitis, white blood cell count significantly increased or decreased, even fine Lack, if not promptly disabled sensitizing drugs, corticosteroids hormone therapy, skin exfoliation sustainable 2 to 3 months or longer, severe due to systemic failure or secondary infection and death.
(9) Acne-like drug eruption (acniform eruption) is caused by long-term use of iodine, bromine, corticosteroid preparation, contraceptive and isoniazid. The incubation period is longer, which is characterized by acne-like rash, which is more common in the face and chest and back. Slow development, generally no systemic symptoms, long-term use of bromine agents can develop into granulomatous lesions.
