exfoliative dermatitis drug eruption
Introduction
Introduction of exfoliative dermatitis drug eruption It refers to severe dermatitis caused by drugs, which is characterized by systemic skin irritation, exfoliation with severe systemic symptoms. For severe type of drug eruption, the rash is mostly measles-like or scarlet-like, and then quickly merges into a piece. The skin of the whole body is diffuse flushing and swelling, bright red to brownish red. After a lot of desquamation, desquamation has dry peeling and wet peeling. Kinds, the former hand and foot desquamation such as gloves or socks (sleeve stripping), the trunk part of the desquamation is deciduous, can last for about 1 month, hair and finger (toe) can fall off; the latter can appear blisters and Extensive erosion, especially in the folds. This disease is caused by the initial use of the drug, and more often occurs more than 20 days after taking the drug. It can also appear from the beginning, or on the basis of measles-like or scarlet-like changes. It is characterized by flushing and swelling of the whole body skin, accompanied by exudate and scarring, and then a large amount of leafy scales falling off. Mucosa can also be affected, congestion, edema, erosion. The disease has obvious systemic symptoms, including aversion to cold, fever, nausea, vomiting, severe cases can be associated with lymphadenopathy, hepatosplenomegaly, proteinuria, jaundice and so on. The course of the disease is chronic, sometimes up to one month. If the patient is not treated promptly, the patient may die due to systemic failure or a serious infection. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific people Mode of infection: non-infectious Complications: bronchial pneumonia sepsis
Cause
The cause of exfoliative dermatitis drug eruption
Most drugs have the possibility of causing drug eruption, including Chinese herbal medicines, but most of them are caused by more antigenicity, mostly luminal, sulfonamide, phenylbutazone, phenytoin, p-aminobenzoic acid, streptavidin Heavy metals such as ruthenium, gold, arsenic, others such as hydroxypyrazole, methoxythiophene cephalosporin, cimetidine, chloroquine, isoniazid, sulfurylurea, etc., in addition, for congenital allergic diseases The body and vital organs of patients with diseases, the risk of drug eruption is relatively large.
Prevention
Exfoliative dermatitis drug eruption prevention
Drug eruptions are iatrogenic diseases, so you must pay attention to:
1. Patients should be asked about the history of allergies before using the drug, avoiding the use of drugs known to be allergic or structurally similar.
2. Drugs should be targeted, try to use less sensitizing drugs, treatment should pay attention to the early symptoms of drug eruption, such as sudden itching, erythema, fever and other reactions, should immediately stop suspicious drugs, close observation and strive to determine sensitizing drugs.
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 prepared for emergency needs. It is penicillin 500u/ml, streptomycin 5mg/m1, procaine 0.25%, tetanus antitoxin 1:10, and the dosage is 0.1m1.
Complication
Exfoliative dermatitis drug eruption Complications, bronchial pneumonia
Severe cases may be associated with bronchial pneumonia, toxic hepatitis, nephritis, skin infections, and even sepsis, if not handled properly, accompanied by water and electrolyte disorders, secondary infections can also be life-threatening.
Symptom
Exfoliative dermatitis-type drug eruption symptoms Common symptoms Systemic diffuse flushing cold chills exfoliative dermatitis Skin blisters or bullae damage scarlet fever-like rash high fever
1. Most of the triggering drugs are luminal, sulfonamides, phenylbutazone, phenytoin, p-aminobenzoic acid, streptomycin, gold, arsenic and other heavy metals, others such as hydroxypyrazole, methoxythiophene cephalosporin, cimetidine Helium, chloroquine, isoniazid, sulfurylurea, etc. can also be caused.
2. The clinical manifestation of the first drug has a long incubation period, generally more than 20 days. Some of the patients have continued to take the drug on the basis of the rash-type drug eruption. This type of drug rash has chills at the onset of the disease, and high-heat and other systemic symptoms appear. The skin lesions initially appear as Measles-like or scarlet-like heat-like damage, gradually gaining weight, and finally the whole body skin is diffuse flushing, swelling, blisters in the wrinkles, erosion, exudation, scarring, itching and heavy; at the same time, lips, oral mucosa flushing, edema Or blisters smashed, crusting; eye-bound membrane edema, secretions, photophobia, superficial lymph nodes can be swollen, usually two weeks later, redness and swelling, body skin began to scale-like desquamation, hands and feet can be sleeve-like exfoliation Hair and nails can also fall off, the course of disease is 2 to 4 weeks, severe cases can be associated with bronchial pneumonia, toxic hepatitis, nephritis, skin infection, and even sepsis, if not handled properly, accompanied by water and electrolyte disorders, secondary infection can also be endangered life.
Examine
Examination of exfoliative dermatitis drug eruption
Routine inspection:
1. Blood routine.
2. Urine routine.
3. Biochemical items.
Diagnosis
Diagnostic identification of exfoliative dermatitis drug eruption
Differential diagnosis
(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) 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) 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 can still resolve after 1 to 2 weeks or more after stopping the drug.
(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.
