Urticaria drug eruption
Introduction
Introduction to urticaria drug rash Drugs used for prevention, diagnosis, and treatment, regardless of the skin and/or mucosal damage caused by any route into the body, are mostly caused by type I and type III, and even by type II allergic reaction. A similar feature to acute urticaria is the urticaria-type drug eruption, which is a common disease in dermatological emergency. Urticaria-type drug eruptions are more common. Mostly caused by Type I and Type III, and even by Type II allergy. Similar to acute urticaria. Patients may have high-grade fever, joint pain, lymphadenopathy, angioedema, proteinuria and other serum-like syndrome-like manifestations, and may involve internal organs and even anaphylactic shock. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific population Mode of infection: non-infectious Complications: urticaria
Cause
Cause of urticaria drug eruption
Most drugs have the possibility of causing drug eruption, including Chinese herbal medicines, but most of them are caused by more antigenicity. Commonly used antibiotics are penicillin, serum products, trifluralin, salicylate, sulfonamide. In addition, for patients with congenital allergic diseases and patients with diseases of vital organs, the risk of drug eruption is relatively high.
Prevention
Urticaria drug eruption prevention
Drug eruptions are iatrogenic diseases, so you must pay attention to:
1. Before the medication, ask the patient what kind of allergy history, avoid using known allergic or structurally similar drugs.
2. The medication should be targeted, try to use less sensitizing drugs, the early symptoms of drug rash should be paid attention to during treatment, such as sudden itching, erythema, fever, etc., suspicious drugs should be stopped immediately, and close observation and determination of sensitizing drugs should be made. .
3. When applying penicillin, serum, procaine and other drugs, skin test should be carried out according to the prescribed method. Positive patients should not be treated with this drug. Before the skin test, emergency medicine should be provided for emergency needs. The concentration of the solution was penicillin 500 u/ml, streptomycin 5 mg/ml, procaine 0.25%, and tetanus antitoxin 1:10, and the dosage was 0.1 ml.
4. If the drug has been diagnosed as a drug eruption, the sensitizing drug should be recorded in the medical record and the patient should be kept in mind. Tell the doctor not to use the drug every time you see a doctor.
Complication
Urticaria drug eruption Complications urticaria
Can involve the internal organs, and even anaphylactic shock, and secondary infection may be.
Symptom
Urticaria-type drug eruption symptoms Common symptoms Edema, rash-like rash, lymph node enlargement, hyperthermia, itch, body congestion, proteinuria, shock
Urticaria-type drug eruption is more common, mostly caused by type I and type III, and even by type II allergic reaction.
1. Most of the triggering drugs are penicillin, serum products, trifluralin, salicylate, sulfonamide, procaine and the like.
2. The clinical manifestations are similar to those of acute urticaria. It can also have high fever, joint pain, swollen lymph nodes, angioedema, proteinuria and other serum-like syndrome-like manifestations, and may involve internal organs and even anaphylactic shock.
Examine
Examination of urticaria type drug eruption
Routine inspection:
1. Blood routine.
2. Urine routine.
3. Biochemical items.
Diagnosis
Diagnosis and identification of urticaria drug eruption
And identification of 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) 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, it can be divided into two categories:
1 Phototoxie erythema: rash is similar to sunburn, mostly occurs 7-8 hours after exposure, limited to the exposed part, anyone can happen;
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, which can last for 1-2 weeks or more after stopping the drug,
(3) Measles-like or scarlet-like fever-like drug eruption is more common, mostly caused by antipyretic and analgesic drugs, barbiturates, penicillin, streptomycin and sulfonamides. The incidence is sudden, often accompanied by systemic symptoms such as chills and fever. Measles-like drug eruption is scattered or dense, red, cap needle to large grain rash or maculopapular rash, symmetric distribution, can spread the whole body, with a trunk more, similar to measles, severe cases may be associated with small bleeding points, scarlet fever From the beginning of the drug rash, it is a small piece of erythema. It develops from the face, neck, upper limbs and trunk. It can spread throughout the body within 2 to 3 days and fuse with each other. When it reaches the climax, the whole body is covered with erythema, the limbs are swollen, and it resembles a scarlet hot rash. The wrinkles and the flexion of the extremities are more obvious. The rash of this type of drug eruption is distinct, but the systemic symptoms are milder than measles and scarlet fever. There are no other symptoms of measles or scarlet fever. The number of white blood cells can be increased. Over-the-normal, 1 to 2 weeks after stopping the drug, the condition gradually decreased, the body temperature gradually decreased, followed by sputum or large piece of desquamation, the course of the disease is generally shorter, but if not found in time The cause and withdrawal of the drug can be developed to a severe drug rash.
(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.
